Immunrekonstitutionssyndrom

Der natürliche Verlauf der HIV-Infektion ist charakterisiert durch eine fortschreitende Destruktion des zellulären Immunsystems, der durch Surrogatmarker (CD4+ T-Lymphozytenzahl im peripheren Blut) abgeschätzt werden kann. Hochaktive antiretrovirale Kombinationstherapien (HAART) bewirken einen raschen Abfall der HI-Plasmavirämie und in der Folge eine Rekonstitution des Immunsystems, meßbar auch in einem signifikanten Anstieg der CD4+ T-Zellen im Blut.

Die unter HAART auftretende Immunrekonstitution hat wesentlichen Einfluß auf die Inzidenz opportunistischer Erkrankungen, aber auch auf den Verlauf prävalenter opportunistischer Infektionen und Autoimmunopathien.

Mit inflammatorischen Reaktionen einhergehende atypische Krankheitsbilder im Rahmen einer HAART bei HIV-Infizierten werden unter dem Begriff des »Immunrekonstitutionssyndroms« zusammengefaßt. Die Kenntnis dieser Krankheitsbilder ist von praktischer Bedeutung für den Kliniker. Diese Übersicht charakterisiert anhand des bisherigen publizierten Wissenstandes und an einer Reihe von eigenen Fällen die Vielfältigkeit und Besonderheiten von inflammatorischen Immunrekonstitutionssyndromen und gibt einen Überblick über den Stellenwert möglicher diagnostischer und therapeutischer Strategien.

The natural history of HIV infection is characterized by progressive destruction of the cellular immune system, which is reflected by decrease of CD4+ T-lymphocytes in peripheral blood. Inhibition of replicative HIV infection by use of highly active antiretroviral therapy (HAART) leads to reconstitution of the impaired immune system. In Western countries morbidity and mortality caused by HIV-infection could be decreased remarkably by whitespread use of HAART.

By improving the potency of the immune system HAART increases inflammatory responses and is able to change the individual course of prevalent subclinical opportunistic infections or autoimmune diseases.

Such atypical inflammatory disorders, which predominantly developed a short time after initiating HAART have been summarized as »immune reconstitution disorders«. The awareness for these diseases is clinically important for physicians treating HIV infected persons.

This review describes the pattern of immunoreconstitution disorders by summarizing the literature and presenting typical cases and will give an overview about possible diagnostical pitfalls and therapeutical options.

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