Moderne Diagnostik und Therapie opportunistischer Infektionen bei AIDS

Zusammenfassung

Mit Einführung der hochaktiven antiretroviralen Therapie (HAART) ist die Inzidenz der opportunistischen Infektionen (OI) stark gesunken. Heute erkranken meist nur noch Patienten, denen ihre HIV-Infektion unbekannt ist, die sie nicht haben behandeln lassen oder die trotz HAART einen schlechten Immunstatus haben. Dadurch nimmt das allgemeine Wissen um Diagnostik und Therapie dieser Erkrankungen ab und es wird immer weniger an die Möglichkeit einer zerebralen OI gedacht. Dabei sind OI noch immer lebensbedrohliche Erkrankungen und die Mortalität in den ersten Wochen ist seit der prä-HAART-Ära unverändert geblieben. Daher sollte jeder, der neurologische Notfälle behandelt, mit den wichtigsten diagnostischen Schritten und den aktuellen Therapien der zerebralen OI vertraut bleiben. Es wird ein Überblick über den aktuellen Stand der Diagnostik und Behandlung der wichtigsten OI gegeben: zerebrale Toxoplasmose, progressive multifokale Leukenzephalopathie, Cytomegalievirus-Enzephalitis, Kryptokokken- Meningitis und primär zerebrales Lymphom als HIV-assoziiertes Malignom.

Summary

The incidence of opportunistic infections (OI) in the western world has declined with the introduction of highly active antiretroviral therapy (HAART). Today, OI are only seen in patients with unknown HIV-status, patients without HAART and patients with a severe immunodeficiency despite HAART. Thus, the knowledge of diagnosis and treatment of OI and the awareness of these particular cerebral diseases are more and more reduced. But OI are still life-threatening diseases and the mortality during the first weeks has not changed since the pre-HAART era. The outcome during the first weeks is mainly depending on an early treatment start. Thus, also nowadays, every physician treating neurological emergencies must be familiar with the main diagnostic steps and treatment of central nervous system OI. This review provides an overview on recent developments in diagnosis and treatment of the most important OI: cerebral toxoplasmosis, progressive multifocal leukoencephalopathy, cytomegalovirus encephalitis, cryptococcus meningitis and primary central nervous system lymphoma as HIV-associated malignoma.

Schlüsselwörter

Opportunistische Infektion - AIDS - HIV

Keywords

Opportunistic infections - AIDS - HIV

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