Die HIV-assoziierte Demenz und ihre Vorstufen

G. Arendt; T. Nolting

doi:10.1055/s-0038-1627335

Nervenheilkunde, Inhaltsverzeichnis

Nervenheilkunde 2008; 27(10): 875-882
DOI: 10.1055/s-0038-1627335

Originaler Artikel

Schattauer GmbH

Die HIV-assoziierte Demenz und ihre Vorstufen

HIV-associated dementia and its precursor stages

G. Arendt

¹Neurologische Klinik des Universitätsklinikums Düsseldorf (UKD)

,

T. Nolting

²Psychiatrische Klinik des Universitätsklinikums Düsseldorf (UKD)

› Institutsangaben

Abstract

Zusammenfassung

Als 1996 die modernen antiretroviralen Kombinationstherapien (hochaktive antiretrovirale Therapie, HAART) in die Behandlung der HIV-Infektion eingeführt wurden, herrschte die Vorstellung, es werde gelingen, alle Komplikationen dieser Infektionskrankheit erfolgreich zu therapieren. Zunächst nahmen die neurologischen Komplikationen auch deutlich ab. Zu Beginn dieses Jahrtausends zeigte sich dann aber eine Prävalenzzunahme der HIV-assoziierten Gehirnerkrankungen, was als Folge der längeren Überlebenszeiten HIV-positiver Menschen interpretiert wurde. Von 2003 an erschienen jedoch Publikationen, die auch auf eine Inzidenzzunahme hinwiesen. Für den praktisch tätigen Mediziner sind daher Wissen über die klinische Präsentation dieser Erkrankungen und die sorgfältige differenzialdiagnostische Abgrenzung von sogenannten opportunistischen Infektionen (Cytomegalie-Virus-Encephalitis, zerebrale Toxoplasmose oder zerebrales Lymphom mit diffuser Ausbreitung und progressive, multifokale Leukencephalopathie) wesentlich. Die folgende Arbeit soll neue diagnostische Kriterien vorstellen und differenzialdiagnostische Überlegungen erleichtern.

Summary

When modern antiretroviral combination therapy (highly active antiretroviral therapy, HAART) was established as standard treatment of HIV-1-positive patients in 1996, the hope was to successfully cure all complications of this infectious disease. During the late nineties, especially neurological HIV-1-associated diseases declined in incidence. But during the first years of this century, there was a rise in prevalence of HIV-induced central and peripheral nervous system diseases what has been interpreted as a consequence of longer survival times of HIV-1-positive patients. From 2003 on, publications pointed to a parallel rise in incidence especially of HIV-1-associated neuro-cognitive disorders. Thus, the generalist should have knowledge on clinical presentation of HIV-1-associated brain disease and differential diagnosis with respect to opportunistic brain disease (esp. cytomegalovirus encephalitis, cerebral toxoplasmosis or diffusely spreading cerebral lymphoma as well as progressive multifocal leukoencephalopathy, PML). This paper presents new diagnostic criteria and should facilitate differential diagnosis.

Schlüsselwörter

HIV-Infektion - Demenz - asymptomatische neuro-kognitive Einschränkung (ANE) - mildes neuro-kognitives Defizit (MND)

Keywords

HIV-infection - dementia - asymptomatic neuro cognitive impairment (ANI) - mild neuro-cognitive disorder (MND)

Volltext

Referenzen

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