EFFECT OF N-ACETYLCYSTEINE(NAC) TREATMENT ON HIV-1 INFECTION - A DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL

Objective: In a double-blind placebo-controlled trial, human immunodef iciency virus (HIV)seropositive patients with a CD4 lymphocyte cell co unt of more than 200 x 10(6) . l(-1) were randomised to receive either 800 mg N-acetylcysteine (NAG) or placebo for 4 months. Before treatme nt low plasma cysteine levels, high free radical activity in neutrophi ls in the presence of autologous plasma - measured by the nitroblue te trazolium (NET) test - and increased tumor necrosis factor (TNF)-alpha levels were found in the HIV positive patients. Results: After treatm ent the low plasma cysteine level in the NAC group increased to normal , and the decline of the CD4+ lymphocyte count before the study start, was less steep in the NAC group than in the placebo group after treat ment, There was also a reduction in TNF-alpha level. However NAC had n o effect on the radical production by neutrophils, and although it did not increase the CD4+ cell count, it may have decreased the decline i n CD4+ cells. Conclusion: Further controlled trials with NAC are neede d to devermine whether it has a beneficial effect in the treatment of asymptomatic HIV-infected individuals.