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Clinical evaluation of NAC in HIV–tuberculosis co-infection was advanced by Safe and colleagues, who conducted an open-label randomized phase II trial assessing oral NAC in hospitalized patients with HIV-associated tuberculosis [22]

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In addition, Akkermansia muciniphila , a mucolytic commensal, is generally reduced in the gut of these patients, with a consequent increase of the overall mucosal bacteria population ( Faecalibacterium prausnitzii (199) that is well-known to have anti-inflammatory properties through its ability to produce butyrate, allowing for T regulatory cell and T helper 17 regulation (200)