Antiretrovirale Therapie der
HIV-Infektion

Gemeinsame Erklärung der Deutschen AIDS-Gesellschaft
(DAIG) und der Österreichischen AIDS-Gesellschaft (ÖAG)

doi:10.1055/s-0028-1123965

DMW - Deutsche Medizinische Wochenschrift, Table of Contents

Dtsch Med Wochenschr 2009; 134: S4-S15
DOI: 10.1055/s-0028-1123965

Konsensus | Review article

Antiretrovirale Therapie der HIV-Infektion

Deutsch-Österreichische Leitlinien (Stand September 2008)Antiretroviral therapy of HIV infectionGerman-Austrian recommendationsGemeinsame Erklärung der Deutschen AIDS-Gesellschaft (DAIG) und der Österreichischen AIDS-Gesellschaft (ÖAG)

Abstract

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References

Literatur

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1 In einer knapp 500 Teilnehmer umfassenden Untergruppe der SMART Studie wurde ein ca. 5-fach erhöhtes Risiko schwerwiegender klinischer Ereignisse bei verzögertem Therapiebeginn und intermittierender Therapiegabe (CD4 < 250/µl) im Vergleich zu einer kontinuierlich behandelten Gruppe mit einer mittleren Ausgangs-CD4-Zellzahl von 447 CD4+ Zellen/µl beobachtet. Dies betraf sowohl HIV- als auch nicht-HIV assoziierte Ereignisse.

2 Ein um 10 Jahre höheres Alter ist mit einem 1,3-fach höheren Risiko einer AIDS-Erkrankung und einem 1,5-fach höheren Sterberisiko assoziiert (Referenzgruppe 15 – 24 Jahre).

3 Bei CD4+ T-Lymphozytenzahlen <50 Zellen/µl haben Frauen in der Regel eine höhere, bei Zellzahlen > 350/µl eine niedrigere Viruslast als Männer, ohne dass sich diese Unterschiede in einer unterschiedlichen Krankheitsprogession niederschlagen.

4 In einer Untersuchung des Robert Koch-Instituts im Jahr 2006 wurde bei HIV-positiven Männern mit gleichgeschlechtlichen Sexualkontakten, die keine antiretrovirale Therapie erhielten, weil noch keine Therapieindikation gestellt worden war, eine nahezu doppelt so hohe Inzidenz bakterieller sexuell übertragbarer Infektionen (Chlamydien-Infektionen, Gonorrhö, Syphilis) festgestellt wie bei Männern, die eine antiretrovirale Kombinationstherapie erhielten (Ulrich M, Schmidt AJ, Hamouda O. Erste Ergebnisse der KABaSTI-Studie des RKI. HIV and MORE 2006; 04: 35-37). Nach diesen Daten führt die HAART in dieser Betroffenengruppe nicht zur Zunahme, sondern eher zur Abnahme von Risikoverhalten.

5 In der D:A:D Studie und der SMART-Studie hatten Patienten mit einer kardiovaskulären Risikokonstellation (Framingham-Score > 20 %) signifikant häufiger Myokardinfarkte, wenn sie mit Abacavir behandelt wurden. Bei solchen Patienten sollte Abacavir am ehesten als alternative Therapie eingesetzt werden.

Deutsche AIDS-Gesellschaft

Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik I

Sigmund-Freud-Str. 1

53127 Bonn

Phone: +49/228/287-11208

Fax: +49/228/287-15034

Email: DAIG@ukb.uni-bonn.de