Nicht-tuberkulöse Mykobakteriosen bei der HIV-Infektion

Zusammenfassung

Infektionen mit nicht-tuberkulösen Mykobakterien (NTM) gehören zu den AIDS-definierenden Erkrankungen der HIV-Infektion. Immunsupprimierte Patienten mit weniger als 50 CD4+ T-Lymphozyten/µl im peripheren Blut sind besonders gefährdet, daran zu erkranken. Über 90 % der NTM-Infektionen bei HIV-seropositiven Patienten werden durch Bakterien des M.-avium-Komplex verursacht. Die Krankheitsbilder der NTM-Infektionen sind in der Regel nicht erregerspezifisch. Für die klinisch oft schwierige Abgrenzung einer Infektion von einer Kolonisation, z. B. beim Nachweis von NTM-Spezies aus bronchopulmonalen Sekreten, sind die Kriterien der American Thoracic Society und der Infectious Diseases Society of America (ATS/IDSA) hilfreich. Die Behandlung von Infektionen mit NTM erfolgt in Abhängigkeit von der Spezies mit einer Kombinationstherapie aus 2 – 4 Medikamenten. Im Gegensatz zur Therapie der Tuberkulose sind die Ergebnisse der in vitro Resistenztestungen von antimykobakteriellen Antibiotika bei NTM oft nicht aussagekräftig. Wechselwirkungen mit antiretroviralen Medikamenten werden häufig beobachtet. Diese komplexen Zusammenhänge werden aus epidemiologischer, mikrobiologischer und klinischer Perspektive erörtert

Abstract

Infections with non-tuberculous mycobacteria (NTM) belong to the AIDS-defining illnesses of HIV infection. Severe immunosuppression with CD4+ lymphocyte counts lower than 50 cells/µl is a risk factor for the acquaintance of NTM infections. More than 90 % of NTM infections in HIV-seropositive individuals are caused by bacteria of the M. avium complex. The manifestations of the disease are heterogeneous and not specific for the causative mycobacterial species. Furthermore, the differentiation between infection and colonisation can be challenging, especially when NTM are isolated from respiratory specimen. Diagnosis and therapy are recommended according to the guidelines of the American Thoracic Society and the Infectious Diseases Society of America (ATS/IDSA). The treatment success relies on the effects of antiretroviral therapy and a combination of 2 – 4 antimycobacterial antibiotics tailored to the NTM species. In vitro resistance testing often does not predict the clinical response. Interactions with antiretroviral medications are common. The complexity of HIV/NTM co-infection is discussed from an epidemiological, microbiological and clinical perspective.

Schlüsselwörter

AIDS - HIV-Infektion - Immunrekonstitutionssyndrom (IRIS) - nichttuberkulöse Mykobakterien - Mycobacterium-avium-Komplex

Keywords

AIDS - HIV infection - immune reconstitution inflammatory syndrome (IRIS) - non-tuberculous mycobacteria (NTM) - Mycobacterium avium complex

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