HIV und Lunge

Zusammenfassung

Der Verlauf der HIV-Infektion ist durch eine progrediente Immundefizienz und ein gesteigertes Risiko für die Entwicklung opportunistischer Infektionen und Neoplasien gekennzeichnet. Infektionen der Lunge spielen dabei eine besondere Rolle, da die Atemwege ständigem Kontakt mit Mikroorganismen aus der Atemluft ausgesetzt sind. Neben dem Spektrum der Erreger ambulant erworbener Pneumonien treten mit zunehmender Immunschwäche auch Infektionen durch Mikroorganismen auf, die von Defekten der zellulären Immunabwehr profitieren. Hierzu gehören u.a. Infektionen mit Pneumocystis jirovecii, nicht-tuberkulösen Mykobakterien und viralen Erregern. Im Gegensatz dazu tritt die Tuberkulose auch schon in frühen Stadien der HIV-Infektion gehäuft auf. Als Folge der HIV-Pandemie ist die Inzidenz der Tuberkulose daher in vielen Ländern wieder stark angestiegen. In den vergangenen Jahren ist es aber durch den Einsatz einer kombinierten antiretroviralen Therapie (ART) in den industrialisierten Ländern gelungen, die HIV-assoziierte Morbidität und Mortalität drastisch zu senken. Als Folge der Immunrekonstitution unter ART ist damit auch die Inzidenz pulmonaler Koinfektionen in Ländern, in denen diese Therapien verfügbar sind, deutlich zurückgegangen.

Abstract

HIV-infection is characterized by a progressive immunodeficiency that predisposes affected persons to opportunistic infections and neoplasias. Pulmonary co-infections play a key role in HIV-infection as the airways are constantly exposed to aerosolized microorganisms during ventilation. In addition to the spectrum of microorganisms that are responsible for the development of community acquired pneumonia in immunocompetent hosts, persons with HIV-infection are vulnerable to infections with organisms that profit from the progressive cellular immune defects. Examples are infections with Pneumocystis jirovecii, non-tuberculous mycobacteria and viral pathogens. In contrast, tuberculosis can occur in all stages of HIV-infection. Following the HIV-pandemic, the incidence of tuberculosis has increased again in many areas of the world. The advent of antiretroviral therapies (ART) in recent years had resulted in a dramatic decrease of HIV-related morbidity and mortality in industrialized countries. As a result of the reconstitution of the immune-system under ARTs the incidence of pulmonary co-infections has also declined substantially in persons living with HIV in countries where these therapies are available.

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