Aktuelle Aspekte zur Epidemiologie, Diagnose und Therapie der Tuberkulose bei HIV-infizierten Patienten^[*]

Zusammenfassung

Die Diagnostik und Behandlung der Tuberkulose (TB) bei HIV-infizierten Patienten hat sich in den letzten 10 Jahren weltweit stark verbessert. Dennoch bleibt die Mortalität koinfizierter Patienten erhöht. Der Anteil von HIV-infizierten Patienten an allen TB-Fällen variiert in den europäischen Ländern stark; in Deutschland liegt er bei 4 – 5 %. Die HIV-Infektion beeinflusst die Epidemiologie der TB und die Antibiotikaresistenz. In Ländern mit hoher TB-Inzidenz werden HIV-infizierte Patienten nach Abschluss einer TB-Behandlung oft neu infiziert. Die HIV-Infektion beeinträchtigt viele Immunzellen, die an der TB-Immunabwehr beteiligt sind, und auch eine antiretrovirale Therapie (ART) kann nicht alle Immunfunktionen wiederherstellen. Das klinische Erscheinungsbild der TB bei Patienten mit fortgeschrittener HIV-Infektion ist oft untypisch, und eine disseminierte Erkrankung ist häufig. Neue „Point-of-Care“ Testmethoden versprechen eine Verbesserung der Diagnostik, bedürfen allerdings weiterer Studien. Die Therapie der Koinfektion wird kompliziert durch vielfältige Arzneimittel-Interaktionen und dem Immunrekonstitutionsyndrom (IRIS). Neue Konzepte und Behandlungsstrategien zur Chemoprävention der TB sind insbesondere für HIV-infizierte Patienten erforderlich.

Abstract

Globally, the diagnosis and treatment of tuberculosis (TB) in HIV-co-infection has improved dramatically over the last 10 years. Nonetheless, the mortality of co-infected patients remains elevated. In European countries, the proportion of HIV-infected patients amongst all TB cases varies greatly; in Germany it is about 4 – 5 %. HIV-infection changes the molecular epidemiology of TB and the drug resistance situation. In endemic areas, HIV-infected patients are often re-infected after completion of treatment for active TB. HIV has a profound influence on the anti-TB-immune response and antiretroviral therapy (ART) cannot completely restore normal immune function. The clinical presentation in advanced HIV-infection is atypical and disseminated disease is common. New “Point-of-Care” test methods are poised to improve the diagnoses of TB in HIV-infection; however, further research is required. The treatment of co-infection is complicated by drug interactions and the immune reconstitution syndrome (IRIS). New concepts and treatment regimens for chemoprevention of TB are necessary, especially for HIV-infected persons.

^* Professor Hartmut Lode zum 75. Geburtstag gewidmet.

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