Objectives To assess the association of inflammatory and endothelial activation biomarkers with the presence of lipoatrophy in HIV-infected subjects and to examine the role of HIV, antiretroviral therapy (ART), and metabolic parameters in endothelial activation and inflammation. Design Prospective, cross-sectional study including 4 groups: HIV+ on ART with HIV-1 RNA <1000 copies/mL with and without clinical lipoatrophy, HIV+ ART naive, and healthy controls. Methods We measured plasma levels of inflammatory cytokines (tumor necrosis factor-α, soluble tumor necrosis factor receptors I and II, interleukin-6, C-reactive protein, and myeloperoxidase) and endothelial activation markers (soluble intercellular and vascular cell adhesion molecules and von Willebrand factor). Results We enrolled 182 subjects. Limb fat and lipoatrophy status were not correlated with endothelial markers. Endothelial markers were higher in HIV+ ART naive when compared with healthy controls and with HIV+ on ART but were similar between HIV+ on ART and healthy controls. Neither endothelial nor inflammatory markers were correlated with HIV duration, CD4 count, lipids, glucose, or specific ART. Strong correlations were found between some inflammatory cytokines and endothelial markers. Conclusions There is enhanced endothelial activation in ART naive, whereas HIV+ on ART has similar values to healthy controls. Lipoatrophy did not seem to affect endothelial activation. Results highlight a potential association between heightened inflammation and endothelial activation.

Lactococcus garvieae is a Gram-positive coccus that has morphological and biochemical similarities to enterococci. L. garvieae strains rare human pathogens, with only a few cases reported in the literature, mainly as a cause of infective endocarditis. L. garvieae is well known as a fish pathogen, and in some of the reported cases, the patients had a history of contact with raw fish. Some of the reported endocarditis patients had valvular damage as a predisposing condition. We report a case of L. garvieae endocarditis in a patient with no history of contact with raw fish and with history of valvular repair in an unaffected heart valve. CASE REPORT We present the case of a 64-year-old male with an extensive cardiac history, including mitral valve repair and coronary artery bypass grafting (CABG) 3 years prior to presentation and an intracardiac defibrillator (ICD) placed 2 years prior to presentation. His past medical history was also significant for hypertension, diabetes mellitus type II, and chronic obstructive pulmonary disease. The patient was referred to our institution from an outside hospital with the diagnosis of aortic valve endocarditis complicated by hypotension.The patient had presented to the outside facility with a history of progressive fatigue, weight loss, and anorexia over several weeks. The symptoms worsened gradually, and he ultimately developed a significant decline in physical abilities and lost the ability to ambulate. After admission, an echocardiogram showed 4ϩ aortic insufficiency with vegetations on the aortic valve. One of two blood cultures drawn grew Gram-positive cocci in chains. The patient was started on vancomycin and transferred to our institution for further management.The patient recalled having had a dental procedure 6 months prior. He had received 3 weeks of prophylactic antibiotics at that time. No other relevant history was found.At our institution, the surgical management included a median sternotomy with open heart and aortic valve replacement with a Carpentier-Edwards valve, as well as ascending aorta repair with bovine pericardial patch and ICD lead and pacemaker removal. The heart valve obtained during surgery was positive in culture for the same organism that was later detected in the same tissue by universal PCR followed by sequencing. However, multiple blood cultures drawn at our institution were negative. The positive blood culture at the outside laboratory reported a gamma-hemolytic streptococcus; the Microscan Walk Away system (Dade Behring, Inc., West Sacramento, CA), was used for identification without success in this case. Susceptibility testing, also performed with the Microscan system, reported full resistance to clindamycin and intermediate resistance to penicillin and ampicillin using Streptococcus sp. breakpoints.At our laboratory, small to medium-sized, white transparent colonies with a smooth and shiny surface and alpha-hemolysis were seen on the blood agar plate after 48 h of incubation of the valvular tissue. At 24 h, growth was incipient. A Gram sta...

Objective-Thymidine reverse transcriptase inhibitors (tNRTI) are strong inhibitors of PPAR-γ and clearly implicated as a cause of lipoatrophy. Thiazolidenediaones (TZD), potent PPAR-γ agonists, would be expected to be beneficial in HIV lipoatrophy, but prior studies have been conflicting. None specifically excluded the use of tNRTIs. We report the first study in individuals treated with tNRTI-sparing regimens using a TZD for treatment of HIV lipoatrophy.Design: This double-blind, placebo-controlled study evaluated limb fat in HIV-infected subjects with lipoatrophy who discontinued tNRTI at least 24 weeks prior to enrollment.Methods-Subjects were randomized to rosiglitazone vs. placebo for 48 weeks. Dual energy Xray absorptiometry (DEXA)-scans and fasting metabolic assessments were serially performed.Results-We enrolled 71 subjects: 17% were female and 51% white. Baseline characteristics were similar between groups except for higher total cholesterol in the placebo group (p=0.04). At 48 weeks, limb fat (grams) increased significantly (p=0.02) more in the rosiglitazone than in the placebo group: median (IQR) 448 (138, 1670) vs. 153 (−100, 682), respectively. Of lipids parameters, only total cholesterol increased significantly more in rosiglitazone group (p=0.008). Prevalence of metabolic syndrome and total bone mineral density did not change between or within groups.Conclusion-In the absence of tNTRIs, rosiglitazone significantly improves lipoatrophy without deleterious effect on bone mineral density. Total cholesterol, but not triglycerides, significantly increased in the rosiglitazone arm. The glitazones may be a promising addition for accelerating fat recovery in subjects who had switched off tNRTI and remain with significant lipoatrophy.