NAC INFO SHEET

What Is It Really?
NAC (N- acetylcysteine) is a derivative of the naturally occurring amino acid cysteine. In the United States, NAC is available by prescription as an aerosol drug (similar to aerosolized pentamidine) to treat bronchitis. NAC is also used in liquid form in very high doses to treat Tylenol overdoses. In Europe, oral NAC is very commonly used for bronchitis.

The Theory Behind NAC
One reason PWAs take NAC is to try to pump up levels of glutathione (GSH). GSH is a vital protein that cells need to function. Many studies have documented low GSH in people with HIV. Dr. Luc Montagnier's work with CD4 cells from PWAs suggests that even cells without HIV can grow weak and die, but with added GSH can regain their vigor. This is where NAC comes in. NAC is broken down by the body into cysteine. Researchers have also noted that low levels of cysteine in PWAs. The body uses cysteine to replace glutathione. Taking NAC may be a way to add cysteine, so that your body can replenish depleted GSH levels. This was demonstrated in the 1996 Standford study.

More Theory Behind Taking NAC
Whether or not NAC is converted to GSH, it might help protect the body from the effects of excess TNF-alpha (tumor necrosis factor). TNF is a naturally occurring protein in your body. It's often elevated in people with HIV and may be a part of HIV disease. It can turn on latent HIV, and increase HIV reproduction. It can cause a generalized inflammatory response that may be critical to AIDS-related weight loss. Both GSH and NAC interfere with TNF in the test tube.

NAC and GSH are also anti-oxidants -substances that mop up free radicals, volatile particles produced naturally in the body, especially when you have an infection. Too many free radicals can cause inflammation and damage organs; and like TNF, may turn on and speed the spread of HIV. How much these free radicals contribute to HIV disease is unclear.

There are reports that taking NAC with dapsone reduces some of that drug's toxicity without reducing its effectiveness. A study in Canada found that taking NAC did not decrease PWAs' allergic reactions to Bactrim/Septra.

NAC Studies in PWAs
Studies of NAC seem to have raised more questions than they've answered. An old NIH study was disappointing: after 12 weeks of taking up to 9600 mg a day, NAC had no effect on CD4 cell counts or p24 (a sloppy marker of HIV activity). However, PWAs in the study had regular GSH levels, so NAC shouldn't have done much anyway.

This NIH study created a storm of controversy. The researchers reported that NAC was very poorly absorbed - it did not get into the blood, and that people in the study had no change in their intracellular GSH levels. Other researchers protested that the NIH didn't follow the proper procedures for measuring NAC or GSH levels.

A later study in HIV positive people with low GSH reported increaalso lacks the buffer.

We carry two kinds of NAC:

Effervescent NAC is cheaper per mg, and comes as fizzy tablets which you dissolve in a small glass of water, like Alka Seltzer. Wht capsules can be more convenient at times. Both forms are absorbed equally well. NAC is approved for bronchitis in Europe.

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last modified: 7/15/97