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Klin Monbl Augenheilkd 2000; 216(2): 61-67
DOI: 10.1055/s-2000-10519
ÜBERSICHT

Georg Thieme Verlag Stuttgart · New York

Affektionen der vorderen Augenabschnitte bei HIV-Infektion nach Einführung der hochaktiven antiretroviralen Therapie (HAART)[1] [2] [3]

Anterior segment involvement in HIV-associated eye disease after the commencement of highly active antiretroviral therapy (HAART)Justus  G. Garweg
  • Univ.-Augenklinik, Inselspital, CH-3010 Bern (Dir.: Prof. Dr. med. F. Körner)
  • E-mail: justus.garweg@insel.ch
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung

Das klinische Bild der opportunistischen Infektionen bei der HIV-Infektion stellt sich heute anders als bis noch vor wenigen Jahren dar. Eine erhebliche Verbesserung der antiretroviralen Therapie ermöglicht eine - zumindest partielle - Rekonstitution des Immunsystems. Diese führt nicht nur zu einer Modifikation des klinschen Bildes HIV-assoziierter Veränderungen, sondern verursacht darüber hinaus nicht selten eine Uveitis als Zeichen der wiedererlangten Immunität (die sog. Immunrekonvaleszenz-Uveitis).

Infolge eines längeren Überlebens der HIV-Infektion sehen wir aber auch immer mehr therapieinduzierte Probleme wie die schmerzhafte, aber morphologisch wenig eindrückliche Cidofovir®- und die wenig symptomatische Rifabutin®-assoziierte Uveitis mit einer nicht selten ausgeprägten intraokularen Reizung.

Der vorliegende Artikel stellt, nach einer kurzen Darstellung der geläufigen HIV-assoziierten Veränderungen der vorderen Augenabschnitte, die Beschreibung dieser neuen Krankheitsbilder und ihres Hintergrundes sowie neuerer Therapien in den Vordergrund, die dem praktisch tätigen Arzt eine Hilfe für die Einschätzung der von ihm erhobenen Befunde und die Bewertung der interdisziplinären Informationen und Therapievorschläge bieten soll.

The clinical picture of HIV-associated eye disease has changed dramatically since the introduction of highly active antiretroviral chemotherapy (HAART). As a consequence of the marked reconstitution of immune function and the control of retroviral replication, thereby effected, the clinical manifestations of infectious eye disease are not so patent. Although direct infectious destruction of tissue is less severe, inflammatory infiltration is augmented, and this gives rise to a situation that is open to misinterpretation. Furthermore, several completely new disease entities have been described. One of these is the so-called immune-recovery uveitis, which involves mainly the anterior uvea and vitreous, and is not uncommonly associated with a marked disturbance of visual function. Another group of new diseases has been attributed to the toxic effects of drugs, i.e. of Cidofovir® and Rifabutin®. In both instances, a principally anterior form of uveitis develops, which is characterized by a discrepancy between clinical symptoms and morphological changes; the former condition is distinguished by severe pain, and the latter by marked inflammation.

This article describes the clinical pictures characterizing these new affections of the anterior segment, postulates on the possible causes of the seemingliy paradoxical clinical, morphological and immunological situations sometimes presented by them, and comments on recommended treatment strategies. The information furnished is designed to help the clinical practitioner in making his/her diagnostic and therapeutic decisions.

Schlüsselwörter

HIV-1 - HIV-Infektion - HAART - Augenbeteiligung - VZV - Zoster ophthalmicus - Medikamenten-Toxizität - Medikamenten-induzierte Uveitis - Immunrekonvaleszenz-Uveitis - Vitreitis - Cidofovir® - Rifabutin® - CMV-Retinitis - AIDS

Key words

HIV-1 - HIV infection - HAART - eye disease - VZV - Zoster dermatitis - drug toxicity - drug- induced disease - Cidofovir® - Rifabutin® - immune-recovery uveitis - vitreitis - CMV-retinitis - AIDS

1 Herrn Prof. Dr. Balder Gloor gewidmet.

2 Die Rekonstitution des Immunsystems unter HAART schafft völlig neue Perspektiven, aber auch diagnostische und therapeutische Probleme in der Betreuung HIV-Infizierter, die hier, soweit sie die vorderen Augenabschnitte betreffen, diskutiert werden.

3 Manuskript eingereicht am 20. 7. 99 und in der vorliegenden Form angenommen am 24. 10. 99.

Literatur

1 Herrn Prof. Dr. Balder Gloor gewidmet.

2 Die Rekonstitution des Immunsystems unter HAART schafft völlig neue Perspektiven, aber auch diagnostische und therapeutische Probleme in der Betreuung HIV-Infizierter, die hier, soweit sie die vorderen Augenabschnitte betreffen, diskutiert werden.

3 Manuskript eingereicht am 20. 7. 99 und in der vorliegenden Form angenommen am 24. 10. 99.

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