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Bedrohung durch die HIV/Tuberkulose-Koinfektion

Threat posed by coinfection with HIV and TB

Der Pneumologe volume 8, pages 32–39 (2011)Cite this article

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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Literatur

  1. WHO global tuberculosis control report (2009)

  2. 09 AIDS Epidemic report. Available at http:// data.unaids.org/pub/Report/2009

  3. Ahmed AB, Abubakar I, Delpech V et al (2007) The growing impact of HIV infection on the epidemiology of tuberculosis in England and Wales. Thorax 62:672–676

    Article  PubMed  Google Scholar 

  4. Kliiman K, Altraja F (2009) Predictors of poor outcome in multi- and extensively drug-resistant pulmonary TB. Eur Respir J 33:1085–1094

    CAS  Article  PubMed  Google Scholar 

  5. Andrews JR, Gandhi NR, Moodley P et al (2008) Exogenous reinfection as a cause of multidrug-resistant and extensively drug-resistant tuberculosis in rural South Africa. J Infect Dis 198:1–8

    Article  Google Scholar 

  6. Sonneberg P, Glynn JR, Fielding K (2005) How soon after infection with HIV does the risk tuberculosis start to increase? J Infect Dis 191:150–158

    Article  Google Scholar 

  7. Lange C, Schaaf B, Dalhoff K (2004) HIV und die Lunge. Pneumologie 58:416–427

    CAS  Article  PubMed  Google Scholar 

  8. Kalsdorf B, Scriba TJ, Wood K (2009) HIV-1 infection impairs the bronchoalveolar T-cell response to mycobacteria. Am J Respir Crit Care Med 180:1262–1270

    CAS  Article  PubMed  Google Scholar 

  9. Harris TG, Li J, Hanna DB et al (2010) Changing sociodemographic and clinical characteristics of tuberculosis among HIV-infected patients. Clin Infect Dis 50:1524–1531

    Article  PubMed  Google Scholar 

  10. Getahun H, Gunneberg C, Granich R et al (2010) HIV infection associated tuberculosis: the epidemiology and the response. CID 50(S3):201–207

    Article  Google Scholar 

  11. Chaisson RE, Schechter GF, Theuer CP et al (1987) Tuberculosis in patients with the acquired immunodeficiency syndrome. Am Rev Respir Dis 136:570–574

    CAS  PubMed  Google Scholar 

  12. Lawn SD, Bangani N, Vogt M et al (2007) Utility of interferon-gamma ELISPOT assay responses in highly tuberculosis exposed patients with advanced HIV infection in South Africa. BMC Infect Dis 7:99

    Article  PubMed  Google Scholar 

  13. Karam F, Mbow F, Fletcher H et al (2008) Sensitivity of IFN gamma release assay to detect latent tuberculosis infection is retained in HIV infected patients but dependent on HIV/AIDS progression. PLoS One 1:e1441

    Article  Google Scholar 

  14. Brindle RJ, Nunn PP, Batchelor BI et al (1993) Infection and morbidity in patients with tuberculosis in Nairobi, Kenya. AIDS 7:1467–1474

    Article  Google Scholar 

  15. Moore DA, Evans CA, Gilman RH (2006) Microscopic-observation drug-susceptibility assay fort he diagnosis of TB. N Engl J Med 355:1539–1550

    CAS  Article  PubMed  Google Scholar 

  16. Boehme CC, Nabeta P, Hilleman D (2010) Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 363:1005–1015

    CAS  Article  PubMed  Google Scholar 

  17. Conde MB, Soares SL, Mello FC et al (2000) Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis. Am J Respir Crit Care Med 162:2238–2240

    CAS  PubMed  Google Scholar 

  18. Dean GL, Edwards SG, Yves NJ (2002) Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. AIDS 16:75–83

    CAS  Article  PubMed  Google Scholar 

  19. Khan FA, Minion J, Pai M et al (2010) Treatment of active tuberculosis in HIV-coinfected patients: a systematic review and metaanalysis. CID 50:1288–1299

    Article  Google Scholar 

  20. Abdool Karim SS, Naidoo K, Grobler A et al (2010) Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 362:697–706

    Article  Google Scholar 

  21. Torok ME, Yen NT, Chau TT et al (2009) Randomised controlled trial of immediate versus deferred antiretroviral therapy in HIV associated tuberculous meningitis. 49th ICAAC, San Francisco, Abstract H-1224

  22. Breen RA, Smith CJ, Bettinson H et al (2004) Paradoxical reactions during tuberculosis treatment in patients with and without HIV coinfection. Thorax 59:704–707

    CAS  Article  PubMed  Google Scholar 

  23. Meintjes G, Wilkinson RJ, Morroni C et al (2009) Randomised placebo controlled trial of prednisone for the TB immune reconstitution inflammatory syndrome. 16th Conference on Retroviruses and opportunistic infections, Montreal. Abstract 34

  24. Reddy KP, Brady MF, Bilman RH et al (2010) Microscopic observation drug susceptibility assay for tuberculosis screening before isoniazid preventive therapy in HIV-infected persons. Clin Infect Dis 50:988–996

    CAS  Article  PubMed  Google Scholar 

  25. Golub JE, Saraceni V, Cavalcante SC (2007) The impact of antiretroviral therapy and isoniazid preventive ttherapyon tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS 21:1441–1448

    Article  PubMed  Google Scholar 

  26. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents (2009) MMWR 58, 1th April 2009, RR-4

  27. Guidelines for the use of antiretroviral agents in HIV1-infected adults and adolescents. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf (accessed 20.10.2010)

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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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  • DOI: https://doi.org/10.1007/s10405-010-0402-5

Zusammenfassung

  • Tuberkulose
  • HIV-Infektion
  • Tuberkulose/HIV-Koinfektion
  • Antituberkulöse Therapie
  • Immunrekonstitutionssyndrom

Keywords

  • Tuberculosis
  • HIV Infection
  • TB/HIV coinfection
  • TB treatment
  • Immune reconstitution syndrome