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Bedrohung durch die HIV/Tuberkulose-Koinfektion

Threat posed by coinfection with HIV and TB

  • Leitthema
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Zusammenfassung

Die HIV/Tuberkulose-Koinfektion betrifft weltweit 15% der Tuberkulosepatienten. Die höchsten Koinfektionsraten werden in der Dritten Welt sowie in Ländern der ehemaligen Sowjetunion gefunden. Die Tuberkulose kann in allen Stadien der HIV-Infektion auftreten; die klinische Präsentation hängt von der Schwere des Immundefekts ab. Die Diagnose der latenten Infektion (LTBI) ist bei zellulärer Immunschwäche erschwert. Bei negativer Sputumdiagnostik ist eine bronchoskopische Abklärung indiziert. Differenzialdiagnostisch sind nichttuberkulöse Mykobakteriosen abzugrenzen. Bei der Therapie ist die Interaktion mit antiretroviralen Substanzen zu berücksichtigen, wenn die HIV-Infektion gleichzeitig behandelt wird. Auch eine verlängerte Therapiedauer ist häufig zu empfehlen, um Rückfälle zu vermeiden. Mit Immunrekonstitutionssyndromen ist besonders bei simultanem Therapiebeginn beider Infektionen zu rechnen. Die Inzidenz der aktiven Tuberkulose kann bei HIV-positiven Personen durch präventive Therapie der LTBI deutlich gesenkt werden. Umgekehrt senkt die rechtzeitige Einleitung einer antiretroviralen Therapie das Risiko einer Tuberkulose beträchtlich.

Abstract

Globally 15% of TB patients are also infected with HIV. The highest rates of coinfection are found in the developing world and in the countries of the former Soviet Union. Active TB can occur in all stages of HIV infection; the clinical presentation depends on the grade of immunodeficiency. The diagnosis of latent TB infection (LTBI) is difficult if cellular immunity is severely impaired. In cases with negative sputum smears bronchoscopy should be performed. Nontuberculous mycobacterioses should be ruled out. During the treatment of TB, interactions with concomitantly given antiretrovirals should be taken into consideration. The duration of TB treatment may be frequently prolonged to prevent relapse. The risk of the immune reconstitution syndrome is increased when treatment of both infections is started simultaneously. The incidence of active tuberculosis in HIV-positive persons can be reduced by preventive treatment of LTBI. Vice versa timely initiation of antiretroviral therapy considerably decreases the risk of TB.

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Authors and Affiliations

  1. Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    K. Dalhoff & J. Rupp

  2. Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    J. Rupp

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  1. K. Dalhoff
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  2. J. Rupp
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Correspondence to K. Dalhoff.

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Dalhoff, K., Rupp, J. Bedrohung durch die HIV/Tuberkulose-Koinfektion. Pneumologe 8, 32–39 (2011). https://doi.org/10.1007/s10405-010-0402-5

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