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Epidemiologie und Therapie von Schmerzen und Depression bei HIV und Aids

Epidemiology and therapy of pain and depression during HIV and AIDS

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Zusammenfassung

Schmerzen bilden den häufigsten Grund für die stationäre Einweisung von Patienten mit Aids. Oft verbergen sich hinter körperlichen Symptomen depressive Episoden. Therapiebedingte Schmerzen stellen ein zunehmendes Problem in der HIV-Behandlung dar, was als Konsequenz eine Alteration der hochaktiven antiretroviralen Therapie (HAART) bedeutet. Kopfschmerzen treten bei bis zu 90% aller Patienten mit einer HIV-Infektion auf. Zu differenzieren sind idiopathische Kopfschmerzen, die schon vor der HIV-Infektion bestanden, Kopfschmerzen durch opportunistische Infektionen, als Nebenwirkung von HAART sowie ein eigenständiger HIV-assoziierter Kopfschmerz. Bis zu 20% aller Neuropathien entstehen bei HIV-Infizierten iatrogen durch HAART. Je nach individuellem Resistenzprofil ist eine Umstellung von HAART indiziert. Interaktionen der HAART mit den Medikamenten, die zur Schmerztherapie über die Cytochrom-P450-Systeme eingesetzt werden, stellen einen speziellen therapeutischen Aspekt dar, der besonders berücksichtigt werden muss, um nicht die Resistenzentwicklung des HI-Virus zu fördern.

Abstract

Pain is one of the most common reasons for admission to hospital for patients suffering from AIDS. Pain and other symptoms very often cover depressive episodes. Pain induced by AIDS therapy represents a progressive problem and induces the necessity to alter the highly active antiretroviral therapy (HAART). Of HIV-infected people 90% complain of headaches. Headache may result from opportunistic infections, from side-effects of HAART or from the HIV in the CNS itself but also the high burden of idiopathic headaches must be considered. Up to 20% of all neuropathies in HIV-infected people are caused by HAART. In most cases changing of HAART is necessary. Problems of interactions between HAART and the substances used for pain therapy via the cytochrome P450 system represents a special therapeutic problem during HAART in order to avoid development of resistance by the HIV.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Husstedt: Advisory Board der Fa. Boehringer, BMS; Referentenhonorare von Astra, Boehringer, BMS, GSK, Gilead, Pfizer, Grünenthal, MSD, Behring, Forschungsförderung von Gilead für Investigator initiated study. Reichelt: Referentenhonorare von Boehringer, GSK, Gilead, Roche. Hahn: Referentenhonorare von Glaxo, Pfizer, Novartis, Serono. Arendt: Referentenhonorare von GSK, Gilead Roche; Forschungsförderung von Gilead für Investigator initiated study. Evers: Grants und Referentenhonorare Allergan, Berlin Chemie, Boehringer, Desitin, Dysport, Eisai, GSK, MSD, Novartis, Pfizer, UCB, Weber & Webwer.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Str 33, 48129, Münster, Deutschland

    I.W. Husstedt & S. Evers

  2. Medizinische Poliklinik D, Universitätsklinikum Münster, Münster, Deutschland

    D. Reichelt

  3. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Münster, Deutschland

    F. Kästner

  4. Klinik für Neurologie, Universitätsklinikum Charité Campus Mitte, Berlin, Deutschland

    K. Hahn

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  1. I.W. Husstedt
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  5. K. Hahn
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Correspondence to I.W. Husstedt.

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Husstedt, I., Reichelt, D., Kästner, F. et al. Epidemiologie und Therapie von Schmerzen und Depression bei HIV und Aids. Schmerz 23, 628–639 (2009). https://doi.org/10.1007/s00482-009-0846-x

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