Covid-19 is a novel coronavirus disease that has been (SARS-CoV-2) responsible for a worldwide pandemic of infectious pneumonia associated with severe acute respiratory syndrome. Although in most cases the disease can be resolved on its own, in severe or critical cases, patients can ultimately pass away, mainly due to the diffuse and massive alveolar damage associated with disease progression. One in four patients will be admitted to the Intensive Care Unit (ICU). A constant characteristic in severely affected patients is the exacerbated systemic inflammatory response. This is attributed to the excessive immune response mediated by cytokine secretion, which therefore causes acute lung injury, acute respiratory distress syndrome, multiple organ failure and even death. Currently, there are no effective antiviral agents and there are no fully elucidated or validated therapeutic options that can halt disease progression in some patients. Therefore, there is an urgent need for new treatments to delay the excessive inflammatory response and accelerate the repair of functional lung tissue in these patients. Glutathione may fit these criteria because it has some properties which can be associated with antiviral effects and it also participates in immune responses with the ability to balance oxidative stress.

Introduction: The incidence of hepatotoxicity is life-threatening and can result to an end-stage liver disease in long-term patients on combined antiretroviral therapy (cART). Our study sought to evaluate the incidence and predictors of cART-induced hepatotoxicity (CIH) among long term users on cART in a rural District hospital. Methods: This was a hospital-based cross-sectional study in the Bali District Hospital. Spectrophotometric method was use for the quantitative measurement of alanine-aminotransferase (ALT) and aspartate-aminotransferase (AST) levels. Patients with elevations of both ALT and AST were considered CIH. The Chi (χ2) square test, ANOVA and Kaplan Meier log-ranked/ survival analyses were used to analyses the data. Results: Of the 350 participants enrolled [156 (44.6%) males and 194 (55.4%) females], aged 43.87 ± 0.79 years (range 20 – 84 years) included in this analysis, 26 (4.4%) experienced moderate CIH. We observed 57 (16.3%), 62 (17.7%) and 238 (68%) elevated levels ALT + AST, ALT and AST respectively. Two independent predictive factors of CIH were the male sex and alcoholism during the study period. Conclusion: The prevalence of CIH in HIV-infected patients in Bali was lower than that observed in previous studies. The duration of therapy had no influence on the frequency of CIH. Alcoholism and smoking showed significant differences in the development of CIH.