Zusammenfassung
Die neurologischen System-Manifestationen der HIV-Infektion haben sich nach Einführung der antiretroviralen Therapie 1996 nicht wie die extranervalen Komplikationen zurückgebildet, sondern nehmen in den letzten Jahren - wie internationale Studien ausweisen - relativ gesehen - wieder zu. Der klinisch und in der ambulanten Versorgung tätige Arzt sollte daher diese Krankheitsbilder - auch in ihren Frühstadien - erkennen können. Der vorliegende Artikel beschreibt Symptome sowie bildgebungs- und liquortechnische Diagnostik und die Therapie primär HIV-1-assoziierter Erkrankungen wie der Enzephalo- und Myelopathie und der Polyneuropathien. Ferner werden diejenigen opportunistischen Erkrankungen, Infektionen durch Bakterien, Viren und Parasiten, die bei manifester Immunschwäche auftreten und heutzutage noch von zahlenmäßiger Relevanz sind, nach diagnostischen, differenzialdiagnostischen und therapeutischen Gesichtspunkten dargestellt. Ein gesonderter Abschnitt ist der hochaktiven, antiretroviralen Therapie (HAART) und ihren Interaktionen mit neurologisch/psychiatrischen Standardtherapien gewidmet.
Abstract
After the introduction of highly active antiretroviral therapy (HAART) in 1996 the neurological manifestations of human immunodeficiency virus (HIV-1)-infection did not decline in incidence and prevalence like the other complications of immunodeficiency; in contrast, due to the longer survival times of HAART treated HIV-1-positive individuals, prevalence of virus associated neurological disease increased during the last years, as international studies underline. Therefore, clinicians and HIV-therapists should be able to diagnose HIV-1-associated neurological disease even in early stages. This article describes symptoms and signs, neuro-imaging and cerebrospinal fluid findings as well as therapy options in primary HIV-1-associated neurological disease like encephalo- and myelopathy and polyneuropathy. Furthermore, those opportunistic infections, caused by bacteria, viruses other than HIV and parasites emerging with manifest immunodeficiency and remaining to be relevant in the HAART era are presented from diagnostic, differential-diagnostic and therapeutic points of view. An extra paragraph describes the interaction of HAART with neurological/psychiatric standard therapies.
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eMail: Gabriele.Arendt@uni-duesseldorf.de
