N-Acetyl-Cysteine (Montiff). Each bottle, 90 capsules. Each tablet contains 500 mg of USP-grade NAC. USP means United States Pharmacopoeia and is a standardized, pharmaceutical grade of product. Most people with HIV, and many of us with Hepatitis C, use 500 mg to 2000 mg per day.

In a Pasteur Institute study of people with HIV, NAC stopped premature apoptosis, one of the leading models for immune cell loss. NIH laboratory studies have also demonstrated that NAC is effective as an antioxidant and reduces apoptosis. Early test tube studies showed that NAC elevates glutathione inside cells and also inhibited HIV production. Clinical studies have had mixed 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 some evidence exists that suggests a longer period is necessary. Apoptosis reductions seen in the French study did not occur before six months. Further, that 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 assays are suspect as are the conclusions they drew which sound more like bias than science.

At Stanford University, the NIH results were soundly refuted. First, they showed that the 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 went up to 8,000 mg!) have been suggested by Wulf Droge (perhaps 1,800 mg every other day) and the doses used in the apoptosis study suggest a physiologically relevant role for NAC supplementation. The study that showed reductions in the degree of apoptosis used 600 to 1200 mg/day.

Subsequent data indicate that the dose may depend on your 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 to patients 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. Finally, if you (must) use acetaminophen (Tylenol), you should probably use NAC (which some European brands add in to the formula; they are so far ahead of America.)

CATIE News See NAC entries on http://nybc.wordpress.com/

Store in a cool, dry place. Do not refrigerate. Once open, keep sealed and in a dark, cool, dry area.