Neuro-AIDS in der cART-Ära

 

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Zusammenfassung

Nach der Einführung der antiretroviralen Mehrfachkombinations-Therapien in die Behandlung der HIV-Infektion im Jahr 1996 (HAART-/cART-Ära = hochaktive antiretrovirale Therapie, combination antiretroviral therapy) erwartete man eine stetige Abnahme der Krankheitskomplikationen, insbesondere auch der Manifestationen am zentralen und peripheren Nervensystem. Bis Anfang des neuen Jahrtausends erfüllte sich diese Hoffnung; dann kam es zu einem erneuten Anstieg zunächst nur der Prävalenz, dann aber auch der Inzidenz der direkt virusassoziierten neurologischen Komplikationen bei HIV-infizierten Patienten. Die Erkrankungen, die heutzutage Neurologen im Alltag begegnen können, sind: die HIV-assoziierte Demenz (HAD) und ihre Vorstufen, die HIV-assoziierte Myelopathie, HIV-assoziierte Polyneuro- und Myopathien sowie opportunistische Infektionen und sog. Immunrekonstitutionsphänomene (IRIS). Dieser Artikel stellt praxisorientiert diagnostische Vorgehensweisen in Anlehnung an die aktuellen Leitlinien der Deutschen Gesellschaft für Neurologie und therapeutische Optionen dar.

Abstract

After the introduction of antiretroviral combination therapy for the treatment of HIV infection in 1996 (highly active antiretroviral therapy = HAART, nowadays called combination antiretroviral therapy = cART), a steady decline in infection associated complications had been expected, especially with respect to central and peripheral nervous system manifestations. Until the beginning of the new millenium this hope came in fact true, but since then there has been a slow, but constant rise in the prevalence, and later on also in the incidence of directly virus-associated neurological complications in HIV infected patients. HIV-associated diseases that neurologists might see in their routine work include HIV-associated dementia (HAD) and its precursor stages, HIV-associated myelopathy, HIV-associated polyneuropathies and myopathies as well as the opportunistic brain infections and immune reconstitution phenomena (IRIS). This article describes practical diagnostic procedures according to the guidelines of the German Neurological Society and the respective therapeutic options.

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