Sodium selenite and N-acetylcysteine in antiretroviral-naive HIV-1-infected patients: a randomized, controlled pilot study.
BACKGROUND
The aim of this work was to study the effects of combined oral 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 mg t.i.d. and Se 500 micrograms per day for either 24 weeks (group A, n = 13) or from 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.


RESULTS
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 ratio 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 lymphocytes 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 treatment after 12 weeks. In addition, erythrocyte glutathione peroxidase (GSH-Px) activity and GSH, glutathionedisulphide (GSSG) concentrations and the reduced/total GSH ratio were not affected by the treatment. Serum selenium levels increased significantly (P < 0.001) upon treatment. Viral load was not altered.


CONCLUSIONS
The changes in lymphocyte subsets after NAC/Se treatment were not comparable to those after standard antiretroviral drug therapy. This, however, does not preclude per se possible benefits of antioxidant supplementation in HIV disease.
Look
M P
MP
Department of General Internal Medicine, University of Bonn, Germany. Look@Uni-Bonn.de
Rockstroh
J K
JK
Rao
G S
GS
Barton
S
S
Lemoch
H
H
Kaiser
R
R
Kupfer
B
B
Sudhop
T
T
Spengler
U
U
Sauerbruch
T
T
D000111:Acetylcysteine / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D004912:Erythrocytes / Q000201:enzymology; D005260:Female; D005978:Glutathione / Q000097:blood; D019803:Glutathione Disulfide / Q000097:blood; D005979:Glutathione Peroxidase / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012016:Reference Values; D012643:Selenium / Q000097:blood; D018038:Sodium Selenite / Q000627:therapeutic use*; D016176:T-Lymphocyte Subsets / Q000187:drug effects; D019562:Viral Load
D005979:Glutathione Peroxidase; D005978:Glutathione; D012643:Selenium; D018038:Sodium Selenite; D019803:Glutathione Disulfide; D000111:Acetylcysteine