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 immunodeficiency virus (HIV)seropositive patients with a CD4 lymphocyte cell count 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 treatment low plasma cysteine levels, high free radical activity in neutrophils in the presence of autologous plasma - measured by the nitroblue tetrazolium (NET) test - and increased tumor necrosis factor (TNF)-alpha levels were found in the HIV positive patients. Results: After treatment 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 treatment, There was also a reduction in TNF-alpha level. However NAC had no effect on the radical production by neutrophils, and although it did not increase the CD4+ cell count, it may have decreased the decline in CD4+ cells. Conclusion: Further controlled trials with NAC are needed to devermine whether it has a beneficial effect in the treatment of asymptomatic HIV-infected individuals.