Objectives: Antioxidant defense status was investigated in HIV-infected patients by measuring serum selenium, erythrocyte glutathione peroxidase (GSH-Px) activity, plasma thiol (-SH) and glutathione (GSH) concentrations along with the assessment of the clinical stage and surrogate markers of HIV-disease. Design, setting and subjects: Serum selenium levels were determined cross-sectionally in 104 sequentially selected HIV-infected patients (83 outpatients and 21 patients with ongoing AIDS de®ning events). The patients were classi®ed into three stages of the disease, I, II and III according to the 1993 Centers For Disease Control (CDC) classi®cation system for HIV-infection. GSH-Px activities, plasma SH and plasma GSH concentrations were determined in a subset of 24 patients at stage I and 12 patients at stage III with an active AIDS-de®ning disease. Results: Mean serum selenium levels were lower in CDC stage II (68.7 AE 20.9 mg/l; P`0.01; n 34) and stage III (51.4 AE 14.7 mg/l; P`0.01; n 37) HIV-infected patients than in healthy subjects (89.2 AE 20.9 mg/l; n 72) and stage I patients (82.3 AE 20.5; mg/l; n 33). Serum selenium levels were positively correlated with CD4-count (r 0.42; P`0.001; n 104) and inversely with levels of soluble tumor necrosis factor receptors type II (r 7 0.58; P`0.01; n 35), neopterin (r 70.5; P`0.001; n 80) and b2-microglobulin (r 70.4; P`0.001; n 94). Hepatitis C virus (HCV) and HIV-coinfected patients at CDC stages I and II showed markedly lower selenium concentrations compared to HIV-infected patients without concomitant HCVinfection. Serum selenium and GSH-Px activity in hospitalized AIDS patients was signi®cantly lower as compared to asymptomatic patients and healthy subjects, whereas plasma SH and GSH concentrations were lower in both, asymptomatic -and AIDS-patients, than in the controls. Conclusion:The results show that stages I±III of HIV-disease are characterized by signi®cant impairments of antioxidative defenses provided by selenium, GSH-Px, SH-groups and GSH. Sponsorship:

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.

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