Erworbenes Immundefektsyndrom

Das erworbene Immundefektsyndrom, auch als AIDS für "Acquired Immune Deficiency Syndrome" bezeichnet, ist das Ergebnis einer chronischen Infektion mit dem Humanen Immundefizienz-Virus (HI-Virus, HIV).

Diese Krankheit betrifft den folgenden Prozess: infektiös.

Symptome

AIDS manifestiert sich als rezidivierende, schwere und gelegentlich lebensbedrohliche Infektionen und/oder opportunistische Malignome. Die Symptome sind die der bestehenden Krankheit, was bedeutet, dass die HIV-Infektion als eine zugrunde liegende Ursache vermutet werden sollte, wenn ungewöhnliche Infektionen bei scheinbar gesunden Individuen auftreten.
AIDS-definierende Bedingungen sind opportunistische Erkrankungen, die aufgrund der Immunsuppression häufiger oder stärker auftreten. Dazu gehören vor allem opportunistische Infektionen, aber auch bestimmte maligne Erkrankungen. Sie wurden von den Centers for Disease Control and Prevention (CDC) und der Weltgesundheitsorganisation (WHO) definiert, wobei die Kriterien leicht variieren. Zu ihnen zählen unter anderem: Kaposi-Sarkom, disseminierte oder extrapulmonale Kokzidioidomykose, Burkitt-Lymphom, Pneumocystis-Pneumonie, progressive multifokale Leukenzephalopathie, Tuberkulose und zerebrale Toxoplasmose.

Zudem tritt eine Vielzahl von anderen Befunden durch die schwere Immunsuppression auf, darunter mukokutane Candidiasis, orale Haarleukoplakie, Herpes-Infektionen, eosinophile Follikulitis, Xerose und Prurigo nodularis. Hämatologische Aberrationen sind auch sehr häufig und Anämie, Leukopenie, Lymphopenie oder Thrombozytopenie finden sich bei über 40 Prozent der Patienten mit einer CD4+-Zellzahl <200 Zellen pro µl [9].

Diagnostik

Eine umfassende Anamnese des HIV-infizierten Patienten sollte erhoben werden. Diese umfasst eine Bewertung der Dauer und des Stadiums der HIV-Infektion, die Anwesenheit von Komorbiditäten, die die Prognose beeinflussen könnten, die Wahl der antiretroviralen Therapie und das Vorhandensein epidemiologischer Faktoren, die das Risiko der HIV-Übertragung und anderer Infektionen erhöhen. Eine umfassende körperliche Untersuchung, einschließlich Gewicht und Größe, sollte als Teil der Erstuntersuchung durchgeführt werden. Initiale Labortests sollten die Beurteilung von HIV-Staging-Parametern (CD4+-Zellzahl, HIV-RNA, HIV-Genotyp), Tests der Organfunktion und Untersuchungen auf mögliche Co-Infektionen wie Virushepatitis, Tuberkulose oder Toxoplasmose umfassen.

Therapie

Die Behandlung der HIV-Infektion hängt von dem Stadium der Erkrankung und von begleitenden opportunistischen Infektionen ab. Ab einer gewissen Zellzahl ist eine antiretrovirale Therapie, deren Ziel die Verlängerung des Lebens und die Verbesserung der Lebensqualität durch Wiederherstellung und Erhaltung der immunologischen Funktion (gemessen an CD4+-Zahlen) ist, nötig. Die Viruslast maximal und dauerhaft zu unterdrücken und die Übertragung zu verhindern sind dabei ebenfalls von großer Bedeutung [10]. Es stehen folgende Substanzgruppen zur Verfügung: Nukleosid- und Nukleotidanaloga (NRTI), Nichtnukleosidische Reverse-Transkriptase-Inhibitoren (NNRTI), HIV-Proteaseinhibitoren (PI), Entry- und Fusionsinhibitoren, sowie Integraseinhibitoren. Die Behandlung von opportunistischen Infektionen ist von größter Bedeutung und sollte auf den spezifischen Erreger gerichtet sein.

Prognose

Die Prognose bei Patienten mit unbehandelter HIV-Infektion ist schlecht, mit einer Gesamtmortalität von mehr als 90%. Sobald die Infektion zu AIDS fortgeschritten ist, ist die Überlebenszeit bei unbehandelten Patienten in der Regel weniger als 2 Jahre. Das mediane Überleben von Patienten mit fortgeschrittener HIV-Infektion (CD4-Zellzahl <50 Zellen pro µl) beträgt 12 bis 18 Monate in Abwesenheit einer antiretroviralen Therapie [6] [7] [8]. Die meisten Patienten, die an AIDS-bedingten Komplikationen versterben, haben CD4-Zellzahlen in diesem Bereich.

Ätiologie

Eine HIV-Infektion wird durch HIV (Humanes Immundefizienz-Virus)-1 oder HIV-2 verursacht, die beide sehr ähnliche Krankheitsbilder verursachen. HIV-1 und HIV-2 gehören zu den Retroviren aus der Gattung der Lentiviren, behüllte Einzel(+)-Strang-RNA-Viren (ss(+)RNA). Die Infektion erfolgt in der Regel durch Geschlechtsverkehr, Exposition gegenüber infiziertem Blut oder durch perinatale Übertragung.

Die Anamnese sollte Risikofaktoren für die mögliche HIV-Exposition umfassen, einschließlich der folgenden:

  • Ungeschützter Geschlechtsverkehr, besonders rezeptiver Analverkehr
  • Große Anzahl an Sexualpartnern
  • Vergangene oder bestehende sexuell übertragbare Krankheiten (STDs)
  • Benutzung nicht steriler Spritzen, z.B. bei Drogenkonsum
  • Empfang von Blutprodukten (heute kaum noch von Bedeutung)
  • Schleimhautkontakt mit infiziertem Blut oder Nadelstichverletzungen
  • Mütterliche HIV-Infektion

Epidemiologie

Laut UNAIDS waren 2008 weltweit rund 33,4 Millionen Menschen (1% der erwachsenen Bevölkerung im Alter von 15-49 Jahren) mit HIV infiziert [1]. Die überwiegende Mehrheit der Infektionen wird in Afrika südlich der Sahara verzeichnet, wo geschätzt 5,2% der Bevölkerung infiziert sind. Die Anzahl der Neuinfektionen in Österreich beträgt seit 2003 etwa 450 pro Jahr [2] in Deutschland werden etwa 3000 Neuinfektionen pro Jahr berichtet.

Geschlechtsverteilung
Altersverteilung

Pathophysiologie

Die HIV-Infektion kann in folgende Stadien unterteilt werden:

  • Ansteckung und Inkubationszeit
  • Akute HIV-Infektion (auch als primäre HIV-Infektion bezeichnet)
  • Chronische HIV-Infektion: Asymptomatisch/Frühzeitige symptomatische HIV-Infektion (früher als AIDS-assoziierter Komplex bezeichnet)/AIDS, gekennzeichnet durch eine CD4-Zellzahl <200 Zellen pro µl oder die Anwesenheit von AIDS-definierenden Erkrankungen/Fortgeschrittene HIV-Infektion, charakterisiert durch eine CD4-Zellzahl <50 Zellen pro µl

Die spezifischen Details des Krankheitsprozesses, der zu AIDS führt, sind trotz umfangreicher Fortschritte in der Virologie von HIV und der Immunologie des menschlichen Wirtes nicht vollständig geklärt [3] [4]. Es kommt zu einem spezifischen Rückgang der CD4+ Helfer-T-Zellen, was zu einer Inversion des normalen CD4/CD8-T-Zell-Verhältnisses und einer Dysregulation der B-Zell-Antikörperproduktion führt [5]. Die Immunantwort auf bestimmte Antigene nimmt ab und der Wirt reagiert nicht ausreichend auf opportunistische Infektionen und normalerweise harmlose Erreger. Da hauptsächlich die zelluläre Immunität beeinflusst wird, sind die Infektionen meist fungal oder viral.

Prävention

Die wirksamsten Methoden zur Prävention der HIV-Infektion umfassen die Vermeidung von sexuellem Kontakt außerhalb einer monogamen Beziehung, sichere Sexualpraktiken für alle anderen sexuellen Begegnungen und Abstinenz von intravenösem Drogengebrauch.

Zusammenfassung

Das erworbene Immundefektsyndrom, auch als AIDS für "Acquired Immune Deficiency Syndrome" bezeichnet, ist das Ergebnis einer chronischen HIV-Infektion und konsequenter Reduktion von CD4+-Zellen. Es wird durch eine CD4+-Zellzahl <200 Zellen pro µl oder die Anwesenheit jeglicher AIDS-definierende Erkrankung unabhängig von der CD4+-Zellzahl definiert. Zu den AIDS-definierenden Erkrankungen zählen unter anderem: Kaposi-Sarkom, disseminierte oder extrapulmonale Kokzidioidomykose, Burkitt-Lymphom, Pneumocystis-Pneumonie, progressive multifokale Leukenzephalopathie, Tuberkulose und zerebrale Toxoplasmose.

Laut dem gemeinsamen Programm der Vereinten Nationen zu HIV/AIDS (UNAIDS) waren 2008 weltweit rund 33,4 Millionen Menschen (1% der erwachsenen Bevölkerung im Alter von 15-49 Jahren) mit HIV infiziert [1]. Eine HIV-Infektion wird in der Regel durch Geschlechtsverkehr, Exposition gegenüber infiziertem Blut oder durch perinatale Übertragung erworben.

Patientenhinweise

Das erworbene Immundefektsyndrom, auch als AIDS für "Acquired Immune Deficiency Syndrome" bekannt, ist das Ergebnis einer chronischen Infektion mit dem Humanen Immundefizienz-Virus (HI-Virus, HIV). Bei den Erkrankten kommt es zu lebensbedrohlichen (sogenannten opportunistischen) Infektionen und Tumoren, die sich die geschwächte Verfassung des Immunsystems zunutze machen. AIDS ist definiert als entweder eine CD4+-Zellzahl unter 200 Zellen pro μL oder das Auftreten spezifischer Erkrankungen in Verbindung mit einer HIV-Infektion. In Abwesenheit einer spezifischen Behandlung, entwickeln etwa die Hälfte der Menschen mit HIV-Infektion innerhalb von zehn Jahren AIDS. Durch die effektivere Therapie mit antiretroviralen Wirkstoffen ist AIDS in Industriestaaten seltener geworden.

Selbsttest

Quellen

  1. UNAIDS report on the global AIDS epidemic 2009, Available from: http://files.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2009/jc1700_epi_update_2009_en.pdf
  2. Virusepimiologische Information Nr. 03/16, Medizinische Universität Wien, Available from: http://www.virologie.meduniwien.ac.at/fileadmin/virologie/files/Epidemiologie/2016/0316.pdf
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  5. Easterbrook PJ, Emami J, Moyle G, Gazzard BG. Progressive CD4 cell depletion and death in zidovudine-treated patients. J Acquir Immune Defic Syndr 1993; 6:927.
  6. Pantaleo G, Fauci AS. New concepts in the immunopathogenesis of HIV infection. Annu Rev Immunol. 1995;13:487-512.
  7. Pantaleo G, Graziosi C, Fauci AS. New concepts in the immunopathogenesis of human immunodeficiency virus infection. N Engl J Med. 1993 Feb 4;328(5):327-35.
  8. Schechter MT, Boyko WJ, Craib KJ, et al. Effects of long-term seropositivity to human immunodeficiency virus in a cohort of homosexual men. AIDS. 1987 Jul;1(2):77-82.
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  • Association of Pityrosporum orbiculare (Malassezia furfur) with seborrheic dermatitis in patients with acquired immunodeficiency syndrome (AIDS) - D Groisser, EJ Bottone, M Lebwohl - Journal of the American Academy of , 1989 - Elsevier
  • 2′, 3′-dideoxyinosine (ddI) in patients with the acquired immunodeficiency syndrome or AIDS-related complex - JS Lambert, M Seidlin, RC Reichman - England Journal of , 1990 - Mass Medical Soc
  • And ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome - DM See, N Broumand, L Sahl, JG Tilles - Immunopharmacology, 1997 - Elsevier
  • , delayed-type hypersensitivity skin testing, and CD4+ T cell subset phenotyping independently predict survival time in patients infected with human immunodeficiency - MJ Dolan, M Clerici, SP Blatt - Journal of Infectious , 1995 - jid.oxfordjournals.org
  • An outbreak of community-acquired Pneumocystis carinii pneumonia - H Masur, MA Michelis, JB Greene - England Journal of , 1981 - Mass Medical Soc
  • Microsporidian previously undescribed in humans, infecting enterocytes and macrophages, and associated with diarrhea in an acquired immunodeficiency syndrome - JM Orenstein, M Tenner, A Cali, DP Kotler - Human pathology, 1992 - Elsevier
  • Acquired immunodeficiency syndrome in infants - GB Scott, BE Buck, JG Leterman - New England Journal , 1984 - Mass Medical Soc
  • Acquired immunodeficiency syndrome and the kidney. - FD Seney Jr, DK Burns, FG Silva - diseases: the official journal of the , 1990 - ukpmc.ac.uk
  • Trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome - M Pierce, S Crampton, D Henry, L Heifets - England Journal of , 1996 - Mass Medical Soc
  • Acquired immunodeficiency syndrome in African patients - N Clumeck, J Sonnet, H Taelman - England Journal of , 1984 - Mass Medical Soc
  • Or Aerosolized Pentamidine for Secondary Prophylaxis of Pneumocystis carinii Pneumonia in Patients with the Acquired Immunodeficiency Syndrome - WD Hardy, J Feinberg, DM Finkelstein - England Journal of , 1992 - Mass Medical Soc
  • Acquired immunodeficiency syndrome-associated arthritis - RI Rynes, DL Goldenberg, R Digiacomo - The American journal of , 1988 - Elsevier
  • Disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1- - SA Madhi, K Petersen, A Madhi - Clinical Infectious , 2000 - cid.oxfordjournals.org
  • Immunodeficiency virus type 1 (HIV-1) variants detectable in all stages of HIV-1 infection lack T-cell line tropism and syncytium-inducing ability in primary T-cell culture - H Schuitemaker, NA Kootstra, RE De Goede - Journal of , 1991 - Am Soc Microbiol
  • Cerebral white matter changes in acquired immunodeficiency syndrome dementia: Alterations of the blood‐brain barrier - C Power, PA Kong, TO Crawford - Annals of , 2004 - Wiley Online Library
  • Pneumonitis in 50 adult patients infected with the human immunodeficiency virus: lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis - WD Travis, CH Fox, KO Devaney, LM Weiss - Human pathology, 1992 - Elsevier
  • Acute infectious diarrhea - NM Thielman, RL Guerrant - New England Journal of Medicine, 2004 - Mass Medical Soc
  • (Lf) O. Hoffm. and Gasteria bicolor Haw. against opportunistic fungi associated with human immunodeficiency virus/acquired immunodeficiency syndrome - WM Otang, DS Grierson, RN Ndip - Pharmacognosy Magazine, 2012 - ncbi.nlm.nih.gov
  • Or Aerosolized Pentamidine for Secondary Prophylaxis of Pneumocystis carinii Pneumonia in Patients with the Acquired Immunodeficiency Syndrome - WD Hardy, J Feinberg, DM Finkelstein - England Journal of , 1992 - Mass Medical Soc
  • -2 enhances the depressed natural killer and cytomegalovirus-specific cytotoxic activities of lymphocytes from patients with the acquired immune deficiency syndrome. - AH Rook, H Masur, HC Lane, W Frederick - Journal of Clinical , 1983 - ncbi.nlm.nih.gov
  • Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome - HC Lane, H Masur, LC Edgar, G Whalen - England Journal of , 1983 - Mass Medical Soc
  • For early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Studies - I Grant, JH Atkinson, JR Hesselink - Annals of Internal , 1987 - ukpmc.ac.uk
  • Acquired immunodeficiency syndrome in infants - GB Scott, BE Buck, JG Leterman - New England Journal , 1984 - Mass Medical Soc
  • Correlation of in situ hybridization with histology and viral culture in patients with acquired immunodeficiency syndrome with cytomegalovirus colitis. - F Clayton, EB Klein, DP Kotler - Archives of pathology & laboratory , 1989 - ukpmc.ac.uk
  • Acquired immunodeficiency syndrome cholangiopathy: spectrum of disease - JP Cello - The American journal of medicine, 1989 - Elsevier
  • , and dexamethasone with zalcitabine in patients with acquired immunodeficiency syndrome‐related lymphoma: Effect on human immunodeficiency virus and serum - AM Levine, A Tulpule, B Espina, W Boswell, J Buckley - Cancer, 1998 - Wiley Online Library
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  • Acquired immunodeficiency syndrome (AIDS) associated with transfusions - JW Curran, DN Lawrence, H Jaffe - New England journal , 1984 - Mass Medical Soc
  • An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome - BR Edlin, JI Tokars, MH Grieco - England Journal of , 1992 - Mass Medical Soc
  • Acquired ichthyosis in a patient with acquired immunodeficiency syndrome and Kaposi's sarcoma. - L Young, HK Steinman - Journal of the American Academy of , 1987 - ncbi.nlm.nih.gov
  • Acquired immunodeficiency syndrome in infants - GB Scott, BE Buck, JG Leterman - New England Journal , 1984 - Mass Medical Soc
  • A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome - WG Powderly, MS Saag, GA Cloud - England Journal of , 1992 - Mass Medical Soc
  • Of cytomegalovirus retinitis and human immunodeficiency virus-related noninfectious retinal vasculopathy in patients with acquired immunodeficiency syndrome. - BD Kuppermann, JG Petty, DD Richman - American journal of , 1993 - ukpmc.ac.uk
  • Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia. - H Saito, EJ Anaissie, RC Morice - CHEST , 1988 - journal.publications.chestnet.org
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  • Acquired immunodeficiency syndrome in infants - GB Scott, BE Buck, JG Leterman - New England Journal , 1984 - Mass Medical Soc
  • Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus - DR Johns, M Tierney - New England Journal of , 1987 - Mass Medical Soc
  • AIDS and the oral cavity: Epidemiology and clinical oral manifestations of human immune deficiency virus infection: A review - M Schiødt, JJ Pindborg - International journal of oral and maxillofacial , 1987 - Elsevier
  • An insight into Dupuytren's contracture. - GA Murrell - Annals of the Royal College of Surgeons of England, 1992 - ncbi.nlm.nih.gov
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  • Antibodies to human T-lymphotropic virus type-I in patients with tropical spastic paraparesis - A Gessain, JC Vernant, L Maurs, F Barin, O Gout - The Lancet, 1985 - Elsevier
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  • Central nervous system dysfunction in acquired immunodeficiency syndrome. - RM Levy, DE Bredesen - Journal of acquired immune deficiency , 1988 - ukpmc.ac.uk
  • The resurgence of tuberculosis among AIDS-patients has become a disturbing prob-lem underlining that the breakdown of immune mech-anisms due to AIDS - A Virus - 1988 - lib.itg.be
  • And tuberculosis treatment failure rate among human immunodeficiency virus (HIV) seropositive compared with HIV seronegative patients with pulmonary tuberculosis - JH Perriëns, RL Colebunders - American Journal of , 1991 - Am Thoracic Soc
  • Activity of clarithromycin against Mycobacterium avium infection in patients with the acquired immune deficiency syndrome: a controlled clinical trial - B Dautzenberg, C Truffot, S Legris - American Journal of , 1991 - Am Thoracic Soc
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  • Adverse events associated with itraconazole in 189 patients on chronic therapy - RM Tucker, Y Haq, DW Denning - Journal of , 1990 - Br Soc Antimicrob Chemo
  • A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome - WG Powderly, MS Saag, GA Cloud - England Journal of , 1992 - Mass Medical Soc
  • Of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome: efficacy of long- - C Leport, F Raffi, S Matheron, C Katlama - The American journal of , 1988 - Elsevier
  • A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome - WG Powderly, MS Saag, GA Cloud - England Journal of , 1992 - Mass Medical Soc
  • Acquired immunodeficiency without evidence of infection with human immunodeficiency virus types 1 and 2 - J Laurence, E Schattner, FP Siegal, I Gelman, S Morse - The Lancet, 1992 - Elsevier
  • Acquired syphilis in adults - EW Hook III, CM Marra - New England Journal of Medicine, 1992 - Mass Medical Soc
  • , risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS - DA MacKellar, LA Valleroy, GM Secura - Immune Deficiency , 2005 - journals.lww.com
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  • Discontinuation of antifungal therapy for disseminated cryptococcal disease in patients with acquired immunodeficiency syndrome, following immunologic response to - JA Aberg, RW Price, DM Heeren - Journal of Infectious , 2002 - jid.oxfordjournals.org
  • The resurgence of tuberculosis among AIDS-patients has become a disturbing prob-lem underlining that the breakdown of immune mech-anisms due to AIDS - A Virus - 1988 - lib.itg.be
  • Acanthamoeba meningoencephalitis in a patient with acquired immunodeficiency syndrome. - C Di Gregorio, F Rivasi, N Mongiardo - Archives of pathology , 1992 - ukpmc.ac.uk
  • Acquired immunodeficiency syndrome-related lymphoma [see comments] - AM Levine - Blood, 1992 - bloodjournal.hematologylibrary.org
  • Acquired immunodeficiency syndrome. Clinicopathologic study of 56 autopsies. - GW Niedt, RA Schinella - of pathology & laboratory medicine, 1985 - ukpmc.ac.uk
  • An Erythema Infectiosum—like Illness Caused by Human Parvovirus Infection - FA Plummer, GW Hammond, K Forward - England Journal of , 1985 - Mass Medical Soc
  • Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS - DA Nyberg, MP Federle, RB Jeffrey - American journal of , 1985 - Am Roentgen Ray Soc
  • Acquired immunodeficiency syndrome in infants - GB Scott, BE Buck, JG Leterman - New England Journal , 1984 - Mass Medical Soc
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