Background
Untreated HIV infection is associated with changes in blood lipids, inflammation, thrombotic activity, and increased risk for CVD.
Methods
We studied high-density lipoprotein particle (HDLp) concentrations and inflammatory (hsCRP, IL-6), endothelial activation (E-selectin, sICAM-1) and thrombotic (fibrinogen and D-dimer) biomarkers in 32 untreated HIV-infected and 29 uninfected persons. Differences in blood lipids and biomarkers by HIV status were examined before and after adjustment for: age, gender, race/ethnicity, smoking status, BMI, and hepatitis C.
Results
HIV-infected, versus uninfected, participants had lower HDLc (−26%) and total (−21%), large (−50%)and small HDLp (−20%; p≤0.01 for all), but not medium HDLp. A trend was present for higher total cholesterol (p=0.15) and triglycerides (p=0.11) with HIV infection. Levels of IL-6, sICAM-1 and D-dimer were 65–70% higher in HIV-infected participants (p≤0.02 for all). Covariate adjustment did not diminish these associations. For HIV-infected participants, total and small HDLp (respectively) tended to correlate inversely with levels of IL-6 (p=0.08 and p=0.02), sICAM-1 (p<0.01 for both) and D-dimer (p=0.03 and p<0.01).
Conclusions
Persons with untreated HIV infection have lower HDLp, primarily large and small HDLp, and higher IL-6, sICAM-1, and D-dimer levels, and the relationship of these markers with risk for HIV-mediated atherosclerotic risk requires further study.
Membrane diffusion potentials induced by amphotericin B (AmB), amphotericin B methyl ester (AmE), N-fructosyl AmB (N FruAmB) and vacidin, an aromatic polyene antibiotic, in ergosterol- or cholesterol-containing egg yolk phosphatidylcholine large unilamellar vesicles (LUV), were measured in various media, in order to determine the relative selectivity of Na+, K+, Cl- and other ions in these environments. Changes in the membrane potential were followed by fluorescence changes of 3,3'-dipropylthiadicarbocyanine (diS-C3-(5)). Subtle changes in intercationic selectivity were monitored by measuring biionic potentials, using the fluorescent pH sensitive probe pyranine. In all the cases studied, the intercationic selectivity of the permeability pathways induced by the four antibiotics was weak compared to that of specific biological channels, though distinct differences were noted. With AmB the selectivity appeared to be concentration dependent. Above 5 x 10(-7) M, the sequence determined for sterol-free small unilamellar vesicles (SUV) and cholesterol-containing SUV and LUV, Na+ > K+ > Rb+ > or = Cs+ > Li+ (sulfate salts), corresponded closely to Eisenman selectivity sequence number VII. At 5 x 10(-7) M and below the selectivity switched from Na+ > K+ to K+ > Na+. In contrast, Li+ was the most permeant ion for AmB channels in the presence of ergosterol. The selectivity between Na+ or K+ vs. Cl- varied with the antibiotic. It was very strong with vacidin at concentrations below 5 x 10(-7) M, smaller with AmB, nil with AmE and N FruAmB. The selectivities observed were antibiotic, concentration and time dependent, which confirms the existence of different types of channels.
We describe a case of Staphylococcus lugdunensis pulmonary valve endocarditis in a 65-year-old woman on chronic hemodialysis and provide a review of previously reported cases. The patient presented with fever and altered mental status, but had no other localizing symptoms or signs; coagulase-negative staphylococcus (subsequently identified as S. lugdunensis) was isolated from two sets of blood cultures. Transthoracic and transesophageal echocardiograms showed a large (2.3 × 3.1 cm) vegetation on the pulmonary valve with moderate valvular insufficiency. The patient was treated with 6 weeks of antibiotic therapy and is stable 4 months following the completion of therapy; no surgical intervention was performed. Of the 28 previously reported cases of S. lugdunensis endocarditis, only 1 had previously survived with medical therapy alone. This is the 3rd case report of S. lugdunensis endocarditis in a patient on hemodialysis; the presumed portal of entry in this and previously reported cases was the vascular access device. Endocarditis due to this organism is characterized by a high mortality, rapid tissue destruction, and a predilection for native valves. Because the clinical outcome is much more favorable with valvular replacement, speciation of the organism assumes great importance in defining the therapeutic approach.
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