Nervenheilkunde 2020; 39(09): 536-541
DOI: 10.1055/a-1182-3723
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Opportunistische Infektionen des Nervensystems bei AIDS

Opportunistic infections in patients with HIV
Matthias Maschke
1   Klinik für Neurologie und Neurophysiologie, Brüderkrankenhaus Trier
› Author Affiliations
Further Information

Publication History

Publication Date:
24 August 2020 (online)

ZUSAMMENFASSUNG

Opportunistische Infektionen des ZNS sind bei Menschen mit HIV-Infektion mit einer substanziellen Morbidität und Mortalität verknüpft. Die häufigsten Infektionen sind die progressive multifokale Leukenzephalopathie (PML), die Toxoplasma-Enzephalitis und die Kryptokokken-Meningitis. Die Inzidenz liegt unter der antiretroviralen Kombinationstherapie (cART) unter 1,0/1000 Patientenjahre. Andere Infektionen wie die Cytomegalievirus-Enzephalitis, das EBV-assoziierte primäre ZNS-Lymphom, Infektionen mit Mykobakterien, anderen Herpesviren und anderen Pilzen wie Aspergillus und Candida sind mittlerweile noch seltener. Komplizierend ist das inflammatorische Immunrekonstitutionssyndrom (IRIS), welches nach Initiierung einer cART in Anwesenheit einer gleichzeitigen opportunistischen Infektion auftreten kann. Durch die moderne cART, aber auch durch andere Behandlungsmöglichkeiten ist die Prognose der opportunistischen Infektionen entscheidend verbessert worden.

ABSTRACT

Opportunistic CNS infections of HIV patients are accompanied by a substantial morbidity and mortality. Most frequent infections are progressive multifocal leukoencephalopathy (PML), Toxoplasma encephalitis and Cryptococcus meningitis. The incidence decreased under antiretroviral combination treatment (cART) below 1.0/1,000 patient years. Other infections such as Cytomegalie virus encephalitis, EBV associated primary CNS lymphoma, infections with Mykobacteria, other herpesviruses and fungi such as Aspergillus and Candida are very infrequent today. The inflammatory immune reconstitution syndrome (IRIS) complicates the disease course especially if cART has to be initiated during opportunistic CNS infections. However, modern cART dramatically improved prognosis of opportunistic CNS infections.

 
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