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
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1 Herrn Prof. Dr. Balder Gloor gewidmet.
2 Die Rekonstitution des Immunsystems unter HAART schafft völlig neue Perspektiven,
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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.
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