Virological and immunological effects of antioxidant treatment in patientswith HIV infection

Background Intracellular oxidative stress in CD4+ lymphocytes due to distur bed glutathione homeostasis may lead to impaired lymphocyte functions and e nhanced HIV replication in patients with HIV infection, especially in those with advanced immunodeficiency. The aim of the present study was to assess whether short-term, high-dose antioxidant treatment might have effects on immunological and virological parameters in patients with HIV infection. Materials and methods In this pilot study, we examined virological and immu nological effects of antioxidant combination treatment for 6 days with high doses of N-acetylcysteine (NAC) and vitamin C in 8 patients with HIV infec tion. The following were assayed before, during and after antioxidant treat ment: HIV RNA plasma levels; numbers of CD4+, CD8+, and CD14+ leukocytes in blood; plasma thiols; intracellular glutathione redox status in CD4+ lymph ocytes and CD14+ monocytes; lymphocyte proliferation; lymphocyte apoptosis and plasma levels of tumour necrosis factor (TNF)alpha; soluble TNF recepto rs and neopterin in plasma. Results No significant changes in HIV RNA plasma levels or CD4+ lymphocyte counts in blood were noted during antioxidant treatment in the patient grou p. However, in the 5 patients with the most advanced immunodeficiency (CD4 lymphocyte counts < 200 x 10(6) L-1), a significant rise in CD4+ lymphocyt e count, a reduction in HIV RNA plasma level of 0.8 log, an enhanced lympho cyte proliferation and an increased level of intracellular glutathione in C D4+ lymphocytes were found. No change in lymphocyte apoptosis was noted. Conclusions Short-term, high-dose combination treatment with NAC and vitami n C in patients with HIV infection and advanced immunodeficiency lead to im munological and virological effects that might be of therapeutic value.