Diagnostik der Resistenz bei der AIDS-Therapie

Monitoring der antiretroviralen Therapie

Neueste Daten nationaler und lokaler Zentren deuten darauf hin, dass die Zahl der HIV-1-infizierten Patienten, die an AIDS versterben, in Deutschland drastisch zurückgegangen ist, während dies bei der Zahl der HIV-Neuinfektionen nicht der Fall ist [35]. Der Erfolg der verlangsamten Krankheitsprogression bei HIV-infizierten Patienten ist auf die Einführung und Anwendung der »highly active antiretroviral therapy« (HAART) zurückzuführen [6] [16]. Diese Therapieform umfasst die gleichzeitige Gabe von Medikamenten, die unterschiedliche Zielpunkte im Replikationszyklus des HI-Virus angreifen. Es werden nukleosidale Reverse Transkriptase-Inhibitoren (NRTI), kombiniert mit Protease-Inhibitoren (PI) oder nichtnukleosidalen RT (NNRTI), eingesetzt [11] [Tab. 1]. Diese Medikamentenkombination führt bei vielen HIV-infizierten Patienten zu einer drastischen Reduktion der Zahl an freien Virionen im Blut (Viruslast), z. T. bis unter die Nachweisgrenze der zur Zeit gängigen Testsysteme [32] [Tab. 2] . HIV-Patienten, die mit einer HAART behandelt werden, sind weniger anfällig für opportunistische Infektionen und zeigen eine verlangsamte Krankheitsprogression zum Stadium AIDS [33]. Die Viruslast (Anzahl der aus Plasmaproben extrahierbaren HIV-1-RNA-Kopien) und die Zahl der CD₄-positiven Zellen (Hauptzielzellen des HI-Virus) im Blut HIV-infizierter Patienten gelten als wichtigste Laborparameter und sollten in regelmäßigen Abständen zur Bewertung des Krankheitsstatus bestimmt werden [4] [16] [30].

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