SODIUM SELENITE AND N-ACETYLCYSTEINE IN ANTIRETROVIRAL-NAIVE HIV-I-INFECTED PATIENTS - A RANDOMIZED, CONTROLLED PILOT-STUDY

Background The aim of this work was to study the effects of combined o ral administration of N-acetylcysteine (NAC) and sodium selenite (Se) on plasma glutathione (GSH), lymphocyte subpopulations and viral load in asymptomatic human immunodeficiency virus (HIV)-infected patients. Methods We used a prospective, randomized and controlled therapy trial with partial crossover. Twenty-four antiretroviral-naive HIV-infected outpatients at Centers for Disease Control (CDC) '93 stages I and II were randomized to receive the antioxidant combination NAC 600 mgt.i.d . and Se 500 mu g per day for either 24 weeks (group A, n = 13) or fro m the end of week 12 (group B, n = 11) until the end of week 24. Thus, group B served as untreated control during the first 12 weeks. Result s There was (a) a trend towards an increase in the percentage of CD4() lymphocytes after 6 weeks (P=0.08); (b) an increase in the CD4/CD8 r atio after 6 and 12 weeks (P = 0.02 and P = 0.04 respectively); and (c ) a decrease in the absolute CD8/CD38 count and percentage of lymphocy tes after 6 weeks (P = 0.002 and P = 0.033 respectively) and 12 weeks (P = 0.033, P = 0.1 respectively) in group A compared with the control period of group B. The effects observed in group A were, however, not paralleled to the same extent by group B after crossing-over to treat ment after 2 weeks. In addition, erythrocyte glutathione peroxidase (G SH-Px) activity and GSH, glutathionedisulphide (GSSG) concentrations a nd the reduced/total GSH ratio were not affected by the treatment. Ser um selenium levels increased significantly (P<0.001) upon treatment. V iral load was not altered. Conclusions The changes in lymphocyte subse ts after NAC/Se treatment were not comparable to those after standard antiretroviral drug therapy. This, however, does not preclude per se p ossible benefits of antioxidant supplementation in HIV disease.