Nabipur Leena, Mouawad Michael, Venketaraman Vishwanath
College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA.
Viruses. 2025 Jan 17;17(1):127. doi: 10.3390/v17010127.
HIV and tuberculosis (TB) co-infection poses a significant health challenge, particularly when involving the central nervous system (CNS), where it leads to severe morbidity and mortality. Current treatments face challenges such as drug resistance, immune reconstitution inflammatory syndrome (IRIS), and persistent inflammation. Glutathione (GSH) has the therapeutic potential to enhance treatment outcomes by improving antibiotic efficacy, reducing inflammation, and mitigating immune dysfunction.
Relevant studies were identified through systematic searches of PubMed, Elsevier, WHO, and related databases. Inclusion criteria focused on preclinical and clinical research examining GSH or its precursors in HIV, TB, or co-infection, with emphasis on microbial control, immune modulation, and CNS-related outcomes.
Preclinical studies showed that GSH improves macrophage antimicrobial function, reduces oxidative stress, and limits () growth. Animal models demonstrated reduced bacterial burden in the lungs, liver, and spleen with GSH supplementation, along with enhanced granuloma stability. Clinical studies highlighted increased TH1 cytokine production, reduced inflammatory markers, and improved CD4+ T cell counts in HIV- co-infected patients. N-acetylcysteine (NAC), a GSH precursor, was shown to significantly enhance the efficacy of first-line TB antibiotics and mitigate treatment-associated toxicity.
GSH shows promise as an adjunct therapy for HIV- co-infection, particularly for cases involving the CNS, where it may improve immune recovery and reduce inflammation. However, evidence is limited by small sample sizes and a lack of randomized trials. Future research should focus on developing CNS-directed GSH formulations and evaluating its integration into current treatment protocols to address the dual burden of HIV and TB, ultimately improving patient outcomes.
人类免疫缺陷病毒（HIV）与结核病（TB）合并感染对健康构成重大挑战，尤其是当累及中枢神经系统（CNS）时，会导致严重的发病率和死亡率。目前的治疗面临耐药性、免疫重建炎症综合征（IRIS）和持续性炎症等挑战。谷胱甘肽（GSH）具有通过提高抗生素疗效、减轻炎症和缓解免疫功能障碍来改善治疗效果的治疗潜力。
通过对PubMed、爱思唯尔、世界卫生组织及相关数据库进行系统检索来确定相关研究。纳入标准侧重于临床前和临床研究，这些研究考察了HIV、结核病或合并感染中GSH或其前体，重点是微生物控制、免疫调节和中枢神经系统相关结果。
临床前研究表明，GSH可改善巨噬细胞抗菌功能、降低氧化应激并限制（）生长。动物模型显示，补充GSH可降低肺部、肝脏和脾脏中的细菌负荷，同时增强肉芽肿稳定性。临床研究强调，HIV合并感染患者的TH1细胞因子产生增加、炎症标志物减少且CD4 + T细胞计数改善。GSH前体N - 乙酰半胱氨酸（NAC）被证明可显著提高一线结核病抗生素的疗效并减轻治疗相关毒性。
GSH作为HIV合并感染的辅助治疗显示出前景，特别是对于涉及中枢神经系统的病例，它可能改善免疫恢复并减轻炎症。然而，证据受样本量小和缺乏随机试验的限制。未来的研究应专注于开发针对中枢神经系统的GSH制剂，并评估其纳入当前治疗方案以应对HIV和结核病双重负担的情况，最终改善患者预后。
