Skip to main content
Erschienen in: Current Infectious Disease Reports 6/2015

01.06.2015 | Central Nervous System Infections (J Lyons, Section Editor)

HIV-associated Neurocognitive Disorders and Antiretroviral Therapy: Current Concepts and Controversies

verfasst von: Mark R. Etherton, Jennifer L. Lyons, Kevin L. Ard

Erschienen in: Current Infectious Disease Reports | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Abstract

Antiretroviral drugs may help prevent neurological decline in individuals with HIV infection by suppressing viral replication and associated chronic immune activation in the central nervous system. However, HIV control in the brain may come at the price of drug-induced neurotoxicity. Herein, we review recent advances in the balance between adequate viral suppression in the nervous system and adverse effects of the medications used in HIV treatment.
Literatur
2.
Zurück zum Zitat Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17:3–16.CrossRefPubMedCentralPubMed Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17:3–16.CrossRefPubMedCentralPubMed
3.
Zurück zum Zitat Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.CrossRefPubMed Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.CrossRefPubMed
4.
Zurück zum Zitat Chiao S, Rosen HJ, Nicolas K, Wendelken LA, Alcantar O, Rankin KP, et al. Deficits in self-awareness impact the diagnosis of asymptomatic neurocognitive impairment in HIV. AIDS Res Hum Retrovir. 2013;29:949–56.CrossRefPubMedCentralPubMed Chiao S, Rosen HJ, Nicolas K, Wendelken LA, Alcantar O, Rankin KP, et al. Deficits in self-awareness impact the diagnosis of asymptomatic neurocognitive impairment in HIV. AIDS Res Hum Retrovir. 2013;29:949–56.CrossRefPubMedCentralPubMed
5.
Zurück zum Zitat Portegies P, Enting RH, de Gans J, Algra PR, Derix MM, Lange JM, et al. Presentation and course of AIDS dementia complex: 10 years of follow-up in Amsterdam, The Netherlands. AIDS. 1993;7:669–75.CrossRefPubMed Portegies P, Enting RH, de Gans J, Algra PR, Derix MM, Lange JM, et al. Presentation and course of AIDS dementia complex: 10 years of follow-up in Amsterdam, The Netherlands. AIDS. 1993;7:669–75.CrossRefPubMed
6.
Zurück zum Zitat Sacktor N, Lyles RH, Skolasky R, Kleeberger C, Selnes OA, Miller EN, et al. HIV-associated neurologic disease incidence changes: multicenter AIDS Cohort Study, 1990–1998. Neurology. 2001;56:257–60.CrossRefPubMed Sacktor N, Lyles RH, Skolasky R, Kleeberger C, Selnes OA, Miller EN, et al. HIV-associated neurologic disease incidence changes: multicenter AIDS Cohort Study, 1990–1998. Neurology. 2001;56:257–60.CrossRefPubMed
7.
Zurück zum Zitat Mocroft A, Katlama C, Johnson AM, Pradier C, Antunes F, Mulcahy F, et al. AIDS across Europe, 1994-98: the EuroSIDA study. Lancet. 2000;356:291–6.CrossRefPubMed Mocroft A, Katlama C, Johnson AM, Pradier C, Antunes F, Mulcahy F, et al. AIDS across Europe, 1994-98: the EuroSIDA study. Lancet. 2000;356:291–6.CrossRefPubMed
8.
Zurück zum Zitat Simioni S, Cavassini M, Annoni JM, Rimbault Abraham A, Bourquin I, Schiffer V, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010;24:1243–50.PubMed Simioni S, Cavassini M, Annoni JM, Rimbault Abraham A, Bourquin I, Schiffer V, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010;24:1243–50.PubMed
9.
Zurück zum Zitat Peluso MJ, Ferretti F, Peterson J, Lee E, Fuchs D, Boschini A, et al. Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load. AIDS. 2012;26:1765–74.CrossRefPubMed Peluso MJ, Ferretti F, Peterson J, Lee E, Fuchs D, Boschini A, et al. Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load. AIDS. 2012;26:1765–74.CrossRefPubMed
10.•
Zurück zum Zitat Eden A, Fuchs D, Hagberg L, Nilsson S, Spudich S, Svennerholm B, et al. HIV-1 viral escape in cerebrospinal fluid of subjects on suppressive antiretroviral treatment. J Infect Dis. 2010;202:1819–25. This study showed detectable CSF HIV RNA in 10 % of HIV-positive individuals with suppressed plasma viral loads.CrossRefPubMedCentralPubMed Eden A, Fuchs D, Hagberg L, Nilsson S, Spudich S, Svennerholm B, et al. HIV-1 viral escape in cerebrospinal fluid of subjects on suppressive antiretroviral treatment. J Infect Dis. 2010;202:1819–25. This study showed detectable CSF HIV RNA in 10 % of HIV-positive individuals with suppressed plasma viral loads.CrossRefPubMedCentralPubMed
11.
Zurück zum Zitat Canestri A, Lescure FX, Jaureguiberry S, Moulignier A, Amiel C, Marcelin AG, et al. Discordance between cerebral spinal fluid and plasma HIV replication in patients with neurological symptoms who are receiving suppressive antiretroviral therapy. Clin infect Dis Off Publ Infect Dis Soc Am. 2010;50:773–8.CrossRef Canestri A, Lescure FX, Jaureguiberry S, Moulignier A, Amiel C, Marcelin AG, et al. Discordance between cerebral spinal fluid and plasma HIV replication in patients with neurological symptoms who are receiving suppressive antiretroviral therapy. Clin infect Dis Off Publ Infect Dis Soc Am. 2010;50:773–8.CrossRef
12.
Zurück zum Zitat Aquaro S, Calio R, Balzarini J, Bellocchi MC, Garaci E, Perno CF. Macrophages and HIV infection: therapeutical approaches toward this strategic virus reservoir. Antivir Res. 2002;55:209–25.CrossRefPubMed Aquaro S, Calio R, Balzarini J, Bellocchi MC, Garaci E, Perno CF. Macrophages and HIV infection: therapeutical approaches toward this strategic virus reservoir. Antivir Res. 2002;55:209–25.CrossRefPubMed
13.
Zurück zum Zitat Eisfeld C, Reichelt D, Evers S, Husstedt I. CSF penetration by antiretroviral drugs. CNS Drugs. 2013;27:31–55.CrossRefPubMed Eisfeld C, Reichelt D, Evers S, Husstedt I. CSF penetration by antiretroviral drugs. CNS Drugs. 2013;27:31–55.CrossRefPubMed
14.
Zurück zum Zitat Best BM, Letendre SL, Koopmans P, Rossi SS, Clifford DB, Collier AC, et al. Low cerebrospinal fluid concentrations of the nucleotide HIV reverse transcriptase inhibitor, tenofovir. J Acquir Immune Defic Syndr. 2012;59:376–81.CrossRefPubMedCentralPubMed Best BM, Letendre SL, Koopmans P, Rossi SS, Clifford DB, Collier AC, et al. Low cerebrospinal fluid concentrations of the nucleotide HIV reverse transcriptase inhibitor, tenofovir. J Acquir Immune Defic Syndr. 2012;59:376–81.CrossRefPubMedCentralPubMed
15.
Zurück zum Zitat Avery LB, Sacktor N, McArthur JC, Hendrix CW. Protein-free efavirenz concentrations in cerebrospinal fluid and blood plasma are equivalent: applying the law of mass action to predict protein-free drug concentration. Antimicrob Agents Chemother. 2013;57:1409–14.CrossRefPubMedCentralPubMed Avery LB, Sacktor N, McArthur JC, Hendrix CW. Protein-free efavirenz concentrations in cerebrospinal fluid and blood plasma are equivalent: applying the law of mass action to predict protein-free drug concentration. Antimicrob Agents Chemother. 2013;57:1409–14.CrossRefPubMedCentralPubMed
16.
Zurück zum Zitat Letendre S, Marquie-Beck J, Capparelli E, Best B, Clifford D, Collier AC, et al. Validation of the CNS penetration-effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch Neurol. 2008;65:65–70.CrossRefPubMedCentralPubMed Letendre S, Marquie-Beck J, Capparelli E, Best B, Clifford D, Collier AC, et al. Validation of the CNS penetration-effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch Neurol. 2008;65:65–70.CrossRefPubMedCentralPubMed
17.
Zurück zum Zitat Letendre S. Central nervous system complications in HIV disease: HIV-associated neurocognitive disorder. Top Antivir Med. 2011;19:137–42.PubMed Letendre S. Central nervous system complications in HIV disease: HIV-associated neurocognitive disorder. Top Antivir Med. 2011;19:137–42.PubMed
18.
Zurück zum Zitat Allavena C, Le Moal G, Michau C, Chiffoleau A, Raffi F. Neuropsychiatric adverse events after switching from an antiretroviral regimen containing efavirenz without tenofovir to an efavirenz regimen containing tenofovir: a report of nine cases. Antivir Ther. 2006;11:263–5.PubMed Allavena C, Le Moal G, Michau C, Chiffoleau A, Raffi F. Neuropsychiatric adverse events after switching from an antiretroviral regimen containing efavirenz without tenofovir to an efavirenz regimen containing tenofovir: a report of nine cases. Antivir Ther. 2006;11:263–5.PubMed
19.
Zurück zum Zitat Song X, Hu Z, Zhang H. Acute dystonia induced by lamivudine. Clin Neuropharmacol. 2005;28:193–4.CrossRefPubMed Song X, Hu Z, Zhang H. Acute dystonia induced by lamivudine. Clin Neuropharmacol. 2005;28:193–4.CrossRefPubMed
20.
Zurück zum Zitat Pollock K, Stebbing J, Bower M, Gazzard B, Nelson M. Emtricitabine intolerance in treatment-experienced patients switched from lamivudine: a method of assessing toxicity. J Antimicrob Chemother. 2006;58:227–8.CrossRefPubMed Pollock K, Stebbing J, Bower M, Gazzard B, Nelson M. Emtricitabine intolerance in treatment-experienced patients switched from lamivudine: a method of assessing toxicity. J Antimicrob Chemother. 2006;58:227–8.CrossRefPubMed
21.
Zurück zum Zitat Colebunders R, Hilbrands R, De Roo A, Pelgrom J. Neuropsychiatric reaction induced by abacavir. Am J Med. 2002;113:616.CrossRefPubMed Colebunders R, Hilbrands R, De Roo A, Pelgrom J. Neuropsychiatric reaction induced by abacavir. Am J Med. 2002;113:616.CrossRefPubMed
22.
Zurück zum Zitat Foster R, Taylor C, Everall IP. More on abacavir-induced neuropsychiatric reactions. AIDS. 2004;18:2449.PubMed Foster R, Taylor C, Everall IP. More on abacavir-induced neuropsychiatric reactions. AIDS. 2004;18:2449.PubMed
23.
Zurück zum Zitat Mollan KR, Smurzynski M, Eron JJ, Daar ES, Campbell TB, Sax PE, et al. Association between efavirenz as initial therapy for HIV-1 infection and increased risk for suicidal ideation or attempted or completed suicide: an analysis of trial data. Ann Intern Med. 2014;161:1–10.CrossRefPubMedCentralPubMed Mollan KR, Smurzynski M, Eron JJ, Daar ES, Campbell TB, Sax PE, et al. Association between efavirenz as initial therapy for HIV-1 infection and increased risk for suicidal ideation or attempted or completed suicide: an analysis of trial data. Ann Intern Med. 2014;161:1–10.CrossRefPubMedCentralPubMed
24.
Zurück zum Zitat Clifford DB, Evans S, Yang Y, Acosta EP, Ribaudo H, Gulick RM, et al. Long-term impact of efavirenz on neuropsychological performance and symptoms in HIV-infected individuals (ACTG 5097s). HIV Clin Trials. 2009;10:343–55.CrossRefPubMedCentralPubMed Clifford DB, Evans S, Yang Y, Acosta EP, Ribaudo H, Gulick RM, et al. Long-term impact of efavirenz on neuropsychological performance and symptoms in HIV-infected individuals (ACTG 5097s). HIV Clin Trials. 2009;10:343–55.CrossRefPubMedCentralPubMed
25.
Zurück zum Zitat Ciccarelli N, Fabbiani M, Di Giambenedetto S, Fanti I, Baldonero E, Bracciale L, et al. Efavirenz associated with cognitive disorders in otherwise asymptomatic HIV-infected patients. Neurology. 2011;76:1403–9.CrossRefPubMed Ciccarelli N, Fabbiani M, Di Giambenedetto S, Fanti I, Baldonero E, Bracciale L, et al. Efavirenz associated with cognitive disorders in otherwise asymptomatic HIV-infected patients. Neurology. 2011;76:1403–9.CrossRefPubMed
27.
Zurück zum Zitat Morlese JF, Qazi NA, Gazzard BG, Nelson MR. Nevirapine-induced neuropsychiatric complications, a class effect of non-nucleoside reverse transcriptase inhibitors? AIDS. 2002;16:1840–1.CrossRefPubMed Morlese JF, Qazi NA, Gazzard BG, Nelson MR. Nevirapine-induced neuropsychiatric complications, a class effect of non-nucleoside reverse transcriptase inhibitors? AIDS. 2002;16:1840–1.CrossRefPubMed
28.
Zurück zum Zitat Harris M, Larsen G, Montaner JS. Exacerbation of depression associated with starting raltegravir: a report of four cases. AIDS. 2008;22:1890–2.CrossRefPubMed Harris M, Larsen G, Montaner JS. Exacerbation of depression associated with starting raltegravir: a report of four cases. AIDS. 2008;22:1890–2.CrossRefPubMed
29.
Zurück zum Zitat Eiden C, Peyriere H, Peytavin G, Reynes J. Severe insomnia related to high concentrations of raltegravir. AIDS. 2011;25:725–7.CrossRefPubMed Eiden C, Peyriere H, Peytavin G, Reynes J. Severe insomnia related to high concentrations of raltegravir. AIDS. 2011;25:725–7.CrossRefPubMed
30.
Zurück zum Zitat Gray J, Young B. Acute onset insomnia associated with the initiation of raltegravir: a report of two cases and literature review. AIDS Patient Care STDs. 2009;23:689–90.CrossRefPubMed Gray J, Young B. Acute onset insomnia associated with the initiation of raltegravir: a report of two cases and literature review. AIDS Patient Care STDs. 2009;23:689–90.CrossRefPubMed
31.
Zurück zum Zitat Walmsley SL, Antela A, Clumeck N, Duiculescu D, Eberhard A, Gutierrez F, et al. Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection. N Engl J Med. 2013;369:1807–18.CrossRefPubMed Walmsley SL, Antela A, Clumeck N, Duiculescu D, Eberhard A, Gutierrez F, et al. Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection. N Engl J Med. 2013;369:1807–18.CrossRefPubMed
32.
Zurück zum Zitat Berger JR, Clifford DB. The relationship of CPE to HIV dementia: slain by an ugly fact? Neurology. 2014;83:109–10.CrossRefPubMed Berger JR, Clifford DB. The relationship of CPE to HIV dementia: slain by an ugly fact? Neurology. 2014;83:109–10.CrossRefPubMed
33.
Zurück zum Zitat Ellis RJ, Letendre S, Vaida F, Haubrich R, Heaton RK, Sacktor N, et al. Randomized trial of central nervous system-targeted antiretrovirals for HIV-associated neurocognitive disorder. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014;58:1015–22.CrossRef Ellis RJ, Letendre S, Vaida F, Haubrich R, Heaton RK, Sacktor N, et al. Randomized trial of central nervous system-targeted antiretrovirals for HIV-associated neurocognitive disorder. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014;58:1015–22.CrossRef
34.
Zurück zum Zitat Garvey L, Winston A, Walsh J, Post F, Porter K, Gazzard B, et al. Antiretroviral therapy CNS penetration and HIV-1-associated CNS disease. Neurology. 2011;76:693–700.CrossRefPubMedCentralPubMed Garvey L, Winston A, Walsh J, Post F, Porter K, Gazzard B, et al. Antiretroviral therapy CNS penetration and HIV-1-associated CNS disease. Neurology. 2011;76:693–700.CrossRefPubMedCentralPubMed
35.•
Zurück zum Zitat Caniglia EC, Cain LE, Justice A, Tate J, Logan R, Sabin C, et al. Antiretroviral penetration into the CNS and incidence of AIDS-defining neurologic conditions. Neurology. 2014;83:134–41. This large-scale, prospective study showed a negative association of high CPE regimens with risk of HIV dementia but not of other neuroAIDS conditions.CrossRefPubMedCentralPubMed Caniglia EC, Cain LE, Justice A, Tate J, Logan R, Sabin C, et al. Antiretroviral penetration into the CNS and incidence of AIDS-defining neurologic conditions. Neurology. 2014;83:134–41. This large-scale, prospective study showed a negative association of high CPE regimens with risk of HIV dementia but not of other neuroAIDS conditions.CrossRefPubMedCentralPubMed
36.
Zurück zum Zitat Robertson K, Jiang H, Kumwenda J, Supparatpinyo K, Evans S, Campbell TB, et al. Improved neuropsychological and neurological functioning across three antiretroviral regimens in diverse resource-limited settings: AIDS Clinical Trials Group study a5199, the International Neurological Study. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;55:868–76.CrossRef Robertson K, Jiang H, Kumwenda J, Supparatpinyo K, Evans S, Campbell TB, et al. Improved neuropsychological and neurological functioning across three antiretroviral regimens in diverse resource-limited settings: AIDS Clinical Trials Group study a5199, the International Neurological Study. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;55:868–76.CrossRef
37.
Zurück zum Zitat Tozzi V, Balestra P, Salvatori MF, Vlassi C, Liuzzi G, Giancola ML, et al. Changes in cognition during antiretroviral therapy: comparison of 2 different ranking systems to measure antiretroviral drug efficacy on HIV-associated neurocognitive disorders. J Acquir Immune Defic Syndr. 2009;52:56–63.CrossRefPubMed Tozzi V, Balestra P, Salvatori MF, Vlassi C, Liuzzi G, Giancola ML, et al. Changes in cognition during antiretroviral therapy: comparison of 2 different ranking systems to measure antiretroviral drug efficacy on HIV-associated neurocognitive disorders. J Acquir Immune Defic Syndr. 2009;52:56–63.CrossRefPubMed
38.
Zurück zum Zitat Marra CM, Zhao Y, Clifford DB, Letendre S, Evans S, Henry K, et al. Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance. AIDS. 2009;23:1359–66.CrossRefPubMedCentralPubMed Marra CM, Zhao Y, Clifford DB, Letendre S, Evans S, Henry K, et al. Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance. AIDS. 2009;23:1359–66.CrossRefPubMedCentralPubMed
40.
Zurück zum Zitat Gardner K, Hall PA, Chinnery PF, Payne BA. HIV treatment and associated mitochondrial pathology: review of 25 years of in vitro, animal, and human studies. Toxicol Pathol. 2013;42:811–22.CrossRefPubMed Gardner K, Hall PA, Chinnery PF, Payne BA. HIV treatment and associated mitochondrial pathology: review of 25 years of in vitro, animal, and human studies. Toxicol Pathol. 2013;42:811–22.CrossRefPubMed
41.
Zurück zum Zitat Schweinsburg BC, Taylor MJ, Alhassoon OM, Gonzalez R, Brown GG, Ellis RJ, et al. Brain mitochondrial injury in human immunodeficiency virus-seropositive (HIV+) individuals taking nucleoside reverse transcriptase inhibitors. J Neurovirol. 2005;11:356–64.CrossRefPubMed Schweinsburg BC, Taylor MJ, Alhassoon OM, Gonzalez R, Brown GG, Ellis RJ, et al. Brain mitochondrial injury in human immunodeficiency virus-seropositive (HIV+) individuals taking nucleoside reverse transcriptase inhibitors. J Neurovirol. 2005;11:356–64.CrossRefPubMed
42.
Zurück zum Zitat Akay C, Cooper M, Odeleye A, Jensen BK, White MG, Vassoler F, et al. Antiretroviral drugs induce oxidative stress and neuronal damage in the central nervous system. J Neurovirol. 2014;20:39–53.CrossRefPubMedCentralPubMed Akay C, Cooper M, Odeleye A, Jensen BK, White MG, Vassoler F, et al. Antiretroviral drugs induce oxidative stress and neuronal damage in the central nervous system. J Neurovirol. 2014;20:39–53.CrossRefPubMedCentralPubMed
43.
Zurück zum Zitat Tovar-y-Romo LB, Bumpus NN, Pomerantz D, Avery LB, Sacktor N, McArthur JC, et al. Dendritic spine injury induced by the 8-hydroxy metabolite of efavirenz. J Pharmacol Exp Ther. 2012;343:696–703.CrossRefPubMedCentralPubMed Tovar-y-Romo LB, Bumpus NN, Pomerantz D, Avery LB, Sacktor N, McArthur JC, et al. Dendritic spine injury induced by the 8-hydroxy metabolite of efavirenz. J Pharmacol Exp Ther. 2012;343:696–703.CrossRefPubMedCentralPubMed
44.
Zurück zum Zitat Robertson KR, Su Z, Margolis DM, Krambrink A, Havlir DV, Evans S, et al. Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort. Neurology. 2010;74:1260–6.CrossRefPubMedCentralPubMed Robertson KR, Su Z, Margolis DM, Krambrink A, Havlir DV, Evans S, et al. Neurocognitive effects of treatment interruption in stable HIV-positive patients in an observational cohort. Neurology. 2010;74:1260–6.CrossRefPubMedCentralPubMed
45.
Zurück zum Zitat Strategies for Management of Antiretroviral Therapy Study G, El-Sadr WM, Lundgren J, Neaton JD, Gordin F, Abrams D, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283–96.CrossRef Strategies for Management of Antiretroviral Therapy Study G, El-Sadr WM, Lundgren J, Neaton JD, Gordin F, Abrams D, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283–96.CrossRef
Metadaten
Titel
HIV-associated Neurocognitive Disorders and Antiretroviral Therapy: Current Concepts and Controversies
verfasst von
Mark R. Etherton
Jennifer L. Lyons
Kevin L. Ard
Publikationsdatum
01.06.2015
Verlag
Springer US
Erschienen in
Current Infectious Disease Reports / Ausgabe 6/2015
Print ISSN: 1523-3847
Elektronische ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-015-0485-6

Weitere Artikel der Ausgabe 6/2015

Current Infectious Disease Reports 6/2015 Zur Ausgabe

Intra-abdominal Infections, Hepatitis, and Gastroenteritis (T Steiner, Section Editor)

Epidemiology and Treatment of Trichomoniasis

Genitourinary Infections (J Sobel, Section Editor)

Vulvovaginal Candidiasis in Pregnancy

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

Sepsis in the Severely Immunocompromised Patient

Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)

The Pros, Cons, and Unknowns of Search and Destroy for Carbapenem-Resistant Enterobacteriaceae

Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)

The Swiss Transplant Cohort Study: Lessons from the First 6 Years

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.