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Behandlung von Neuro-Aids auf der neurologischen Intensivstation

Epidemiologie, Outcome und Prädiktoren des Verlaufs

Treatment of neuro-AIDS on a neurological intensive care unit

Epidemiology and predictors of outcome

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Zusammenfassung

Hintergrund

Analysen des Verlaufs von Neuro-Aids auf der neurologischen Intensivstation sind selten. Ziel war es, Prädiktoren für „Versterben“ zu analysien.

Materialien und Methoden

Es wurden 56 Patienten, die im Mittel 39±0,7 Jahre alt waren, im Mittel 130±166 CD4+-Zellen/µl und eine Viruslast im Plasma von 146,520±198,059 Kopien/ml aufwiesen, wegen Neuro-Aids auf der neurolgischen Intensivstation behandelt.

Ergebnisse

Es waren 34% der Patienten Immigranten, von denen 74% aus Regionen der Sahara stammen. Bei 57% wurde die Diagnose einer „Human-immunodeficiency-virus“- (HIV-)Infektion erst auf der Intensivstation gestellt. Der Median für den Zeitraum zwischen der Diagnose der HIV-Infektion und der Aufnahme auf die Intensivstation betrug für Immigranten 8 Tage, für die einheimischen HIV-Infizierten 10 Jahre. Die häufigsten Neuromanifestationen der HIV-Infektion stellten die zerebrale Toxoplasmose, Kryptokokkose und die progressive multifokale Leukoenzephalopathie (PML) dar. Während des Aufenthalts verstarben 28 der Patienten (50%). Als negative Prädiktoren für „Versterben auf der Intensivstation an Neuro-Aids“ stellten sich die Faktoren a) Beatmungspflichtigkeit, b) antiretroviral naiver Immigrant, c) primär zerebrales Lymphom und d) fehlende hochaktive antiretrovirale Therapie (HAART) bei der Aufnahme auf die Intensivstation heraus.

Schlussfolgerung

Die Versterbensrate bei Neuro-Aids ist deutlich höher als bei internistischen Erkrankungen, die zur Behandlung auf einer Intensivstation führen. Antiretroviral naive Immigranten weisen eine besonders hohe Versterbensrate im Vergleich zur einheimischen Bevölkerung auf. Es sind noch erhebliche Anstrengungen notwendig, um weltweit HAART zur Verfügung zu stellen, sodass auch die Prognose von Neuro-Aids bei Behandlung auf der neurologischen Intensivstation verbessert wird.

Summary

Background

Investigations concerning the outcome for patients suffering from neuro-AIDS treated on a neurological intensive care unit and specific predictors indicating “dead” were analyzed.

Material and methods

A total of 56 patients with a mean age of 39±0.7 years, a mean CD4+ cell count of 130±166 CD4+ cells/µl and viral load of 146,520±198,059 copies/ml were treated on a neurological intensive care unit due to different forms of neuro-AIDS.

Results

Of the patients, 34% were immigrants of whom 74% came from sub-Saharan regions. In 57% of the patients the diagnosis of HIV infection was made during therapy on the neurological intensive care unit. The median for the time between diagnosis of HIV infection and the treatment on the neurological intensive care unit was 8 days for immigrants and 10 years for residents. The most common manifestations of neuro-AIDS were cerebral toxoplasmosis, cryptococcosis and progressive multifocal leukoencephalopathy (PML). Fifty per cent of the patients (n=28) died during treatment on the neurological intensive care unit. Negative predictors for the outcome “dead” were (a) artificial ventilation, (b) antiretroviral naïve immigrant, (c) primary cerebral lymphoma and (d) missing antiretroviral therapy as a result of admission to the intensive care unit.

Discussion

The rate of death during treatment of neuro-AIDS on a neurological intensive care unit is much higher than during treatment of internal medicine problems of HIV infection. Antiretroviral naïve immigrants show a much higher rate of death compared to residents in Germany. A lot of research and effort is necessary to improve the availability of the Highly Active Anti-Retroviral Therapy (HAART) worldwide in order to improve the outcome especially for immigrants with neuro-AIDS treated on a neurological intensive care unit.

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Interessenkonflikt

Braicks: keiner, Anneken: keiner, Reichelt: Referentenhonorare von Boehringer, GSK, Gilead, Roche, Schaebitz: keiner, Dziewas: Referentenhonorare von Boehringer Ingelheim, Lilly, Pfizer, Evers: Grants und Referentenhonorare von Allergan, Berlin Chemie, Boehringer, Desitin, Dysport, Eisai, GSK, MSD, Novartis, Pfizer, UCB, Weber & Webwer, Husstedt: Advisory Board der Fa. Boehringer, BMS, Abbott; Referentenhonorare von Astra, Boehringer, BMS, GSK, Gilead, Pfizer, Grünenthal, MSD, Behring, Forschungsförderung von Gilead für Investigator initiated study.

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Authors and Affiliations

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

    O. Braicks, K. Anneken, W.R. Schäbitz, R. Dziewas, S. Evers & I.W. Husstedt

  2. Westfälische Klinik für Psychiatrie, Lengerich, Deutschland

    K. Anneken

  3. Klinik und Poliklinik für Innere Medizin D, Universitätsklinikum Münster, Münster, Deutschland

    D. Reichelt

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  1. O. Braicks
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  2. K. Anneken
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  3. D. Reichelt
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  4. W.R. Schäbitz
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  5. R. Dziewas
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  6. S. Evers
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  7. I.W. Husstedt
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Correspondence to I.W. Husstedt.

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Braicks, O., Anneken, K., Reichelt, D. et al. Behandlung von Neuro-Aids auf der neurologischen Intensivstation. Nervenarzt 82, 1290–1295 (2011). https://doi.org/10.1007/s00115-011-3298-3

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  • DOI: https://doi.org/10.1007/s00115-011-3298-3

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