Zinc alpha-2 glycoprotein is implicated in dyslipidaemia in HIV-1-infected patients treated with antiretroviral drugs.

OBJECTIVES: Treated HIV-1-infected patients with lipodystrophy often develop insulin resistance and proatherogenic dyslipidaemia. Zinc alpha-2 glycoprotein (ZAG) is a recently characterized adipokine which has been shown to be involved in the development of obesity and metabolic syndrome in uninfected subjects. We assessed the relationship between circulating ZAG levels and metabolic derangements in HIV-1-infected patients receiving antiretroviral drugs. METHODS: Plasma ZAG levels were assessed in 222 individuals: 166 HIV-1-infected patients treated with antiretroviral drugs (77 with lipodystrophy and 89 without lipodystrophy) and 56 uninfected controls. Plasma ZAG levels were assessed by enzyme-linked immunosorbent assay (ELISA) and were correlated with fat distribution abnormalities and metabolic parameters. RESULTS: HIV-1-infected patients had lower plasma ZAG levels compared with uninfected controls (P < 0.001). No differences were found in ZAG plasma levels according to the presence of lipodystrophy, components of the metabolic syndrome or type of antiretroviral treatment regimen. Circulating ZAG levels were strongly determined by high-density lipoprotein cholesterol (HDLc) in men (B = 0.644; P < 0.001) and showed a positive correlation with total cholesterol (r = 0.312; P < 0.001) and HDLc (r = 0.216; P = 0.005). CONCLUSIONS: HIV-1-infected patients have lower plasma ZAG levels than uninfected controls. In infected patients, plasma ZAG levels are in close relationship with total cholesterol and HDLc.

The IL-6 system in HIV-1-infection and in HAART-related fat redistribution syndromes.

We determined the IL-6 -174 G>C single nucleotide polymorphism, IL-6 mRNA expression in subcutaneous adipose tissue (SAT) and IL-6 plasma levels in HIV-1-infected patients with and without lipodystrophy and uninfected controls. HIV-1-infected patients had a greater prevalence of the IL-6 -174 C/C genotype and the C allele, higher SAT IL-6 mRNA expression and plasma IL-6 levels than controls. The IL-6 -174 G>C genotype distribution and allele frequencies, SAT IL-6 mRNA expression and IL-6 plasma levels were non-significantly different between HIV-1-infected patients with and without lipodystrophy.

Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features.

To evaluate and compare the diagnostic utility of multiple quantitative parameters as measured on knee magnetic resonance (MR) examinations of patients suffering objective patellar instability (OPI). We performed a retrospective evaluation of knee MR examinations in a group of 46 patients (59 knees) with clinically proven OPI, and in a control group of 69 patients (71 knees). Multiple quantitative parameters in both groups were statistically evaluated and compared for their association with OPI. OPI patients tend to present shallower trochlear groove (<5 mm), larger Insall-Salvati index (>1.2), shorter patellar nose (<9 mm), smaller morphology ratio (<1.2), and larger patellar tilt (>11 degrees ) than control patients. The best sensitivities were those of the lateral patellar tilt (92.7%), the trochlear groove depth at the roman arch level (85.7%) and the Insall-Salvati index (78%). The best specificities were those of the morphology ratio (86.9%), the patellar nose (84.5%) and the patellar tendon length (84.5%). Shallow trochlear groove may be confidently identified at the roman arch view in OPI patients. Patella alta may be more reliably detected by the Insall-Salvati index in OPI patients. Patellar nose and morphology ratio are very specific indicators of OPI. A short patellar nose (that is to say, a patellar nose ratio of <0.25) has a high association with OPI. Lateral patellar tilt remains the single feature with the highest sensitivity and specificity for identifying OPI patients.

Painful os sustentaculi: imaging findings of another symptomatic skeletal variant.

The os sustentaculi is a rare accessory bone of the ankle and foot region. We describe the imaging findings of a symptomatic os sustentaculi in a 49-year-old man. Its clinical significance and associated conditions are also briefly discussed.