Early clinical studies produced confusing results: One NIH study of 23 people with HIV using various doses found no effect on elevating glutathione nor any effect on p24 antigen or CD4 counts. However, this trial lasted only six weeks and evidence suggests a longer period is necessary. Further, the NIH study looked for NAC in the blood, but it is converted in the tissues (particularly the liver) to glutathione, so it is not surprising that NAC was not found in the blood. It is clear that NAC does work for acetaminophen overdose and other disorders, so the NIH study came to seem suspect.

A Stanford University study of NAC subsequently refuted the NIH results. First, the Stanford study’s 27 people using NAC did obtain increases in glutathione inside cells. They also showed a very strong correlation between increased progression rate and low glutathione levels.

Lower doses of NAC than those used in the Stanford study (which were as high as 8,000 mg) have been suggested by Wulf Droge (perhaps 1,800 mg every other day) and by René Olivier’s apoptosis study (600 mg per day) suggest a physiologically relevant role for NAC supplementation. Apoptosis reductions seen in Olivier’s study did not occur before six months. The dose that produced reductions in the degree of apoptosis was 600 to 1,200 mg/day. Subsequent data indicate that the useful dose may depend on one’s current condition and level of intracellular glutathione.

Another rationale for using NAC is to offset an increase in glutamate levels: PWHIV have moderately elevated levels of glutamate which prevents cysteine from getting inside cells where it is needed to make more glutathione. As Drs. Droge, Breitkreutz and colleagues reported in a 2000 J. of Molecular Medicine article that compared NAC recipients to those receiving a placebo, those who received NAC had significantly improved immune function, perhaps through offsetting the massive loss of sulfur that they had previously reported upon.

Some PWHIV with chronic sinusitis find they can keep it under control with between 3–5 grams of NAC per day. It has been suggested that taking highly acidic NAC on an empty stomach chronically for years may not be sensible. Take NAC (and vitamin C as ascorbic acid) with food where their combined acidity may also counteract the recognized low stomach acidity common in HIV infection to increase food and supplement absorption.

Finally, if you must use acetaminophen (Tylenol), you should probably also use NAC (which some European brands even add to acetaminophen). In Europe, NAC is used as an IV treatment for acute acetaminophen poisoning.

A long list of NAC-related scientific abstracts can be found on the Life Extension Foundation's site.

NAC Effervescent (Hexall/ACC Akut) Each box, 20 wafers. Each wafer, 600 mg NAC. Imported from Germany.