Z Gastroenterol 2007; 45(11): 1185-1190
DOI: 10.1055/s-2007-963529
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie der HIV-assoziierten Ösophagitis

HIV und ÖsophagitisDiagnosis and Therapy of HIV Associated EsophagitisHIV and EsophagitisH. Neumann1 , K. Mönkemüller1
  • 1Zentrum für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität Magdeburg
Further Information

Publication History

Manuskript eingetroffen: 13.7.2007

Manuskript akzeptiert: 15.8.2007

Publication Date:
19 November 2007 (online)

Zusammenfassung

Die Erkrankungen des gastrointestinalen Traktes zählen gegenwärtig zu den häufigsten, mit dem acquired immunodeficiency syndrome (AIDS) assoziierten Komplikationen. Obwohl die Erfahrungen in der Diagnostik und Therapie dieser opportunistischen Infektionen seit den frühen 90er-Jahren deutlich zugenommen haben und sich auch das therapeutische Spektrum sehr entwickelt hat, so sind wir gegenwärtig noch immer nicht in der Lage, für alle opportunistischen Infektionen eine effektive Diagnostik und Therapie anzubieten. Der folgende Artikel soll einen Überblick über die aktuellen Möglichkeiten in der Differenzialdiagnostik und Therapie von mit dem HI-Virus assoziierten Infektionen des oberen Gastrointestinaltraktes geben.

Abstract

Diseases of the gastrointestinal tract are one of the most common complication of the acquired immunodeficiency syndrome (AIDS). Although there have been advances in the diagnosis and therapy of GI diseases in AIDS, currently, the diagnosis of and therapy for such opportunistic diseases still represent a challenge. The following article focuses on the diagnostic approach, differential diagnosis of and therapy for opportunistic esophageal diseases in AIDS.

Literatur

  • 1 Mönkemüller K E, Call S A, Lazenby A J. et al . Declining prevalence of opportunistic gastrointestinal disease in the era of combination antiretroviral therapy.  Am J Gastroenterol. 2000;  95 457-462
  • 2 Mönkemüller K E, Lazenby A J, Lee D H. et al . Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy.  Dig Dis Sci. 2005;  50 230-234
  • 3 Weinert M, Grimes R M, Lynch D P. Oral manifestations of HIV infection.  Ann Intern Med. 1996;  125 485-496
  • 4 Wilcox C M, Straub R F, Clark W S. Prospective evaluation of oropharyngeal findings in human immunodeficiency virus-infected patients with esophageal ulcer.  Am ] Gastroenterol. 1995;  90 1938-1941
  • 5 Bonacini M, Young T, Laine L. The causes of esophageal symptoms in human immunodeficiency virus infection: a prospective study of 110 patients.  Arch Intern Med. 1991;  151 1567-1572
  • 6 Wilcox C M. Evaluation of a technique to examine the underlying mucosa in patients with AIDS and severe Candida esophagitis.  Gastrointest Endosc. 1995;  42 360-363
  • 7 Coleman D C, Bennett D E, Sullivan D J. et al . Oral Candida in HIV infection and AIDS: new perspectives/new approaches.  Crit Rev Microbiol. 1993;  19 61-82
  • 8 Sullivan D J, Henman M C, Moran G P. et al . Molecular genetic approaches to identification, epidemiology and taxonomy of non-albicans Candida species.  J Med Microbiol. 1996;  44 399-408
  • 9 Fichtenbaum C J, Koletar S, Yiannotsos C. et al . Refractory mucosal candidiasis in advanced human immunodeficiency virus infection.  Clin Infect Dis. 1998;  26 556-565
  • 10 Gallant J E, Moore R D, Richman D D. et al . Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine.  J Infect Dis. 1992;  166 1223-1227
  • 11 Mönkemüller K E, Wilcox C M. Diagnosis and treatment of colonic disease in AIDS.  Gastrointest Endosc Clin N Am. 1998;  8 889-911
  • 12 Wilcox C M, Schwartz D A, Clark W S. Esophageal ulceration in human immunodeficiency virus infection. Causes, response to therapy, and long-term outcome.  Ann Intern Med. 1995;  123 143-149
  • 13 Bagdades E K, Pillay D, Squire S B. et al . Relationship between herpes simplex virus u1ceration and CD 4 + cell counts in patients with HIV infection.  AIDS. 1992;  6 1317-1320
  • 14 Mönkemüller K E, Wilcox C M. Diagnosis and treatment of esophageal ulcers in AIDS.  Compr Ther. 2000;  26 163-168
  • 15 Kotler D P, Reka S, Orenstein I M. et al . Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome.  Mod Pathol. 1995;  8 568-572
  • 16 Wilcox C M, Zaki S R, Coffield L M. et al . Evaluation of idiopathic esophageal ulcer for human immunodeficiency virus.  Mod Pathol. 1995;  8 568-572
  • 17 Raufman J P. Odynophagia/dysphagia in AIDS.  Gastroenterol Clin North Am. 1988;  17 599-614
  • 18 Genereau T, Lortholary O, Bouchaud O. et al . Herpes simplex esophagitis in patients with AIDS: report of 34 cases.  Clin Infect Dis. 1996;  22 926-931
  • 19 Wilcox C M, Straub R A, Schwartz D A. Prospective endoscopic characterization of cytomegalovirus esophagitis in patients with AIDS.  Gastrointest Endosc. 1994;  40 481-484
  • 20 Mönkemüller K E, Bussian A H, Lazenby A J. et al . Special histologic stains are rarely beneficial for the evaluation of HIV-related gastrointestinal infections.  Am J Clin Pathol. 2000;  114 387-389
  • 21 Wilcox C M, Alexander L N, Clark W S. et al . Fluconazole compared with endoscopy for human immunodeficiency virus-infected patients with esophageal symptoms.  Gastroenterology. 1996;  110 1803-1809
  • 22 Koletar S L, Russell J A, Fass R J. et al . Comparison of oral f1uconazole and c1otrimazole troches as treatment of oral candidiasis in patients infected with human immunodeficiency virus.  Antimicrob Agents Chemother. 1990;  34 2267-2268
  • 23 Pons V, Greenspan D, Derbruin M. et al . Therapy for oropharyngeal candidiasis in HIV-infected patients: a randomized, prospective multicenter study of oral fluconazole versus clotrimazole troches.  J Acquir Immune Defic Syndr. 1993;  6 1311-1316
  • 24 Pons V, Greenspan D, Lozada-Nur F. et al . Oropharyngeal candidiasis in patients with AIDS: randomized comparison of fluconazole versus nystatin oral suspensions.  Clin Infect Dis. 1997;  24 1204-1207
  • 25 DeWit S, Goosens H, Clumeck N. Single-dose versus 7 days of fluconazole treatment for oral candidiasis in human immunodeficiency virus-infected patients: a prospective, randomized pilot study.  J Infect Dis. 1993;  168 1332-1333
  • 26 Hoffmann C. Opportunisctische Infektionen. Hoffman C, Rockstroh J, Kamps BS HIV.NET Wuppertal-Weyenburg; Steinhäuser Verlag 2005 6: 243-307
  • 27 Hernandez-Sampelayo T. Multicenter Study Group . Fluconazole versus ketaconazole in the treatment of oropharyngeal candidiasis in HIV-infected children.  Eur J Clin Microbiol Infect Dis. 1994;  13 340-344
  • 28 Laine L, Dretler R H, Conteas C N. et al . Fluconazole compared with ketoconazole for the treatment of candida esophagitis in AIDS: a randomized trial.  Ann Intern Med. 1992;  117 655-660
  • 29 Barbaro G, Barbarini G, Caladeron W. et al . Fluconazole versus itraconazole for Candida esophagitis in acquired immunodeficiency syndrome.  Gastroenterology. 1996;  111 1169-1177
  • 30 Gallant J E, Moore R D, Chaisson R E. Prophylaxis for opportunistic infections in patients with HIV infection.  Ann Intern Med. 1994;  120 932-944
  • 31 Marriott D JE. Fluconazole once a week as secondary prophylaxis against oropharyngeal candidiasis in HIV-infected patients: a doubleblind placebo-controlled study.  Med J Aust. 1993;  158 312-316
  • 32 Leen C LS, Dunbar E M, Ellis M E. et al . Once-weekly f1uconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS and AIDS-related complex: a double-blind placebo-controlled study.  J Infect. 1990;  21 55-60
  • 33 Martin D F, Sierra-Madero J, Walmsley S. et al . A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis.  N Engl J Med 2002. 2002;  346 1119-1126
  • 34 Dieterich D T, Chachoua A, Lafleur F. et al . Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS.  Rev Infect Dis. 1988;  10 532-537
  • 35 Wilcox C M, Straub R F, Schwartz D A. Cytomegalovirus esophagitis in AIDS: a prospective study of clinical response to ganciclovir therapy, relapse rate, and long-term outcome.  Am J Med. 1995;  98 169-176
  • 36 Blanshard C. Treatment of HIV-related cytomegalovirus disease of the gastrointestinal tract with foscarnet.  J Acquir Immune Defic Syndr. 1992;  1 25-28
  • 37 Dieterich D T, Kotler D P, Busch D F. et al . Ganciclovir treatment of cytomegalovirus colitis in AIDS: a randomized, double-blind, placebocontrolled multicenter study.  J Infect Dis. 1993;  167 278-282
  • 38 Parente F, Bianchi Porro G. Treatment of cytomegalovirus esophagitis in patients with acquired immunodeficiency syndrome: a randomized controlled study of foscarnet versus ganciclovir; the Italian Cytomegalovirus Study Group.  Am J Gastroenterol. 1998;  93 317-322
  • 39 Blanshard C, Benhamou Y, Dohin E. et al . Treatment of AIDS-associated gastrointestinal cytomegalovirus infection with foscarnet and ganciclovir: a randomized comparison.  J Infect Dis. 1995;  172 622-628
  • 40 Mönkemüller K E, Wilcox C M. Esophageal ulcer caused by cytomegalovirus: resolution during combination antiretroviral therapy for acquired immunodeficiency syndrome.  South Med J. 2000;  93 818-820
  • 41 Murdoch D M, Venter W D, Van Rie A. et al . Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options.  AIDS Res Ther. 2007;  4 9
  • 42 Laskin O L. Clinical pharmacokinetics of acyclovir.  Clin Pharmacokinet. 1983;  8 187-201
  • 43 Safrin S. Treatment of acyclovir-resistant herpes simplex virus in patients with AIDS.  J Acquir Immune Defic Syndr. 1992;  1 29-32
  • 44 Hardy W. Foscarnet treatment of acyclovir-resistant herpes simplex virus in patients with acquired immunodeficiency syndrome: preliminary results a controlled, randomized, regimen-comparative trial.  Am J Med. 1992;  92 30-35
  • 45 Wilcox C M, Schwartz D A. Comparison of two corticosteroid regimens for the treatment of HIV-associated idiopathic esophageal ulcer.  Am J Gastroenterol. 1994;  89 2163-2167
  • 46 Nelson M R, Erskine D, Hawkins D A. et al . Treatment with corticosteroids: a risk factor for the development of clinical cytomegalovirus disease in AIDS.  AIDS. 1993;  7 375-378
  • 47 Paterson D L, Georghiou P R, Allworth A M. et al . Thalidomide as treatment of refractory aphthous ulceration related to human immunodeficiency virus infection.  Clin Infect Dis. 1995;  20 250-254
  • 48 Alexander L N, Wilcox C M. A prospective trial of thalidomide for the treatment of HIV-associated idiopathic esophageal ulcers.  AIDS Res Hum Retroviruses. 1997;  13 301-304
  • 49 Mönkemüller K, Wilcox C M. Diseases of the esophagus, stomach and bowel. Dolin R, Masur H, Saag MS AIDS Therapy 2nd Ed New York; Churchill Livingstone 2003 64: 885-901
  • 50 Fichtenbaum C J. Candidiasis. Dolin R, Masur H, Saag MS AIDS Therapy, 2nd Ed New York; Churchill Livingstone 2003 39: 85-901

Dr. Klaus Mönkemüller

Gastroenterologie, Hepatologie und Infektiologie, Uniklinikum Magdeburg

Leipzigerstr. 44

39120 Magdeburg

Phone: ++ 49/3 91/6 71 31 00

Fax: ++ 49/3 91/6 71 31 05

Email: klaus.moenkemueller@medizin.uni-magdeburg.de

    >