title: Anti-retroviral therapy is associated with decreased alveolar glutathione levels even in healthy HIV-infected individuals.
abstract: OBJECTIVE
  Lung infections are a leading cause of death in HIV-infected individuals. Measuring redox in HIV-infected individuals may identify those with chronic oxidative stress who are at increased risk for lung infection. We sought to estimate the association between HIV infection and oxidative stress in the lung, as reflected by decreased levels of glutathione and cysteine in the epithelial lining fluid.
  
  
  METHODS
  Bronchoalveolar lavage (BAL) fluid was collected from healthy HIV-infected subjects and controls. Individuals were excluded if they had evidence of major medical co-morbidities, were malnourished or smoked cigarettes.
  
  
  RESULTS
  We enrolled 22 otherwise healthy HIV and 21 non-HIV subjects. Among the HIV-infected subjects, 72.7% were on anti-retroviral therapy (ART) with a median CD4 count of 438 (279.8-599) and viral load of 0 (0-1.0) log copies/mL. There were no significant differences in median BAL fluid glutathione and cysteine levels between HIV and HIV-uninfected subjects. However, BAL glutathione was significantly higher in HIV-infected subjects on anti-retroviral therapy (ART) compared to those not on ART [367.4 (102-965.3) nM vs. 30.8 (1.0-112.1) nM, p = 0.008]. Further, HIV infection with ART was associated with an OR of 2.02 for increased BAL glutathione when adjusted for age and body mass index, whereas HIV infection without ART was associated with an OR of 2.17 for decreased BAL glutathione.
  
  
  CONCLUSIONS
  HIV infection without ART was associated with increased oxidative stress, as reflected by decreased alveolar glutathione levels, in otherwise healthy HIV-infected individuals. Further study needs to be done identify predictors of lung health in HIV and to address the role of ART in improving lung immunity.
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Sushma K
authors.initials: SK
authors.lastname: Cribbs
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia, United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Guidot
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lennox
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Lou Ann
authors.initials: LA
authors.lastname: Brown
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D018893:Bronchoalveolar Lavage; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003545:Cysteine / Q000378:metabolism; D004848:Epithelium / Q000378:metabolism*; D005260:Female; D005978:Glutathione / Q000378:metabolism*; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D008171:Lung Diseases / Q000150:complications / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010084:Oxidation-Reduction; D018384:Oxidative Stress; D011650:Pulmonary Alveoli / Q000378:metabolism*
chemical_list: D044966:Anti-Retroviral Agents; D005978:Glutathione; D003545:Cysteine