HIV-assoziierte Neuropathien

Zusammenfassung

Weltweit gesehen ist die HIV-Infektion neben Diabetes mellitus und Lepra eine der führenden Ursachen von Polyneuropathien und die häufigste neurologische Manifestation der HIV-Infektion. Der Subtyp der Neuropathie ist abhängig vom Immunstatus des Patienten. Inflammatorische Neuropathien wie das Guillain-Barré-Syndrom oder die chronisch inflammatorisch demyelinisierende Polyneuropathie werden typischerweise im Frühstadium der HIV-Infektion diagnostiziert, während beispielsweise die erregerbedingte Polyradikulitis eine Komplikation im AIDS-Stadium darstellt. Die distal-symmetrische Polyneuropathie als Prototyp aller Neuropathien stellt die häufigste Neuromanifestation bei Patienten mit HIV-Infektion dar. Die Wahrscheinlichkeit, eine Polyneuropathie zu entwickeln, ist durch die verlängerte Überlebenszeit unter hochaktiver antiretroviraler Therapie (HAART), den Einsatz neurotoxischer antiretroviraler Substanzen und deren längere Anwendungsdauer gestiegen. Oft bestehen komplexe Interaktionen dieser Risikofaktoren.

Summary

Human immunodeficiency virus (HIV) associated polyneuropathy has become the most common neurological complication of HIV infection and is one of the main risk factors for development of a neuropathy worldwide. Many types of peripheral neuropathies are seen in HIV infection depending on the stage of infection. The inflammatory demyelinating neuropathies both acute (i. e. Guillain Barré syndrome) and chronic (i. e. chronical inflammatory demyelinating neuropathy) occur mainly at the time of seroconversion or early in the course of the disease while syndromes associated with opportunistic infections like CMV (i.e. polyradiculoneuropathy) occur in the late phase of HIV infection and are related to the loss of immune function. Distal symmetrical polyneuropathy (DSP) is the most common neuropathy in HIV infected patients. The main risk factors for development of a neuropathy are age and use of certain NRTIs. With the increasing age of the HIV population other factors such as comorbidities have to be taken into account.

Schlüsselwörter

HIV-Infektion - Polyneuropathie - Polyradikulitis - Therapie

Keywords

HIV infection - polyneuropathy - polyradiculitis - therapy

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