Furrer Hj
Klinik und Poliklinik für Infektiologie, Universitätsspital Bern, Inselspital, Bern.
Ther Umsch. 2004 Oct;61(10):625-30. doi: 10.1024/0040-5930.61.10.625.
Opportunistic diseases have been and still are a major cause of HIV associated morbidity and mortality. Patients with undiagnosed HIV infection often present with symptoms of opportunistic infections. Therefore, all clinicians should know their clinical presentations. Patients with severe immunodeficiency, manifested by low CD4-lymphocyte count, should receive primary prophylaxis against Pneumocystis jiroveci, T. gondii und M. avium. After successful initial treatment of opportunistic infections maintenance therapy is indicated. The introduction of potent antiretroviral combination therapy has led to a decline of incidence and letality of most opportunistic diseases and allows discontinuation of established primary prophylaxis and maintenance therapy if a durable rise of CD4-lymphocyte count can be achieved. The improvement of immunocompetence due to antiretroviral therapy is also associated with new clinical manifestations of opportunistic infections, the immune reconstitution inflammatory syndromes. The framework of the multicenter Swiss HIV Cohort Study with its detailed documentation of opportunistic diseases has allowed several important studies and analyses that have had a worldwide influence on the management of these diseases.
机会性疾病一直是且仍然是与艾滋病毒相关的发病和死亡的主要原因。未被诊断出感染艾滋病毒的患者常常表现出机会性感染的症状。因此，所有临床医生都应了解其临床表现。以低CD4淋巴细胞计数为特征的严重免疫缺陷患者，应接受针对耶氏肺孢子菌、弓形虫和鸟分枝杆菌的一级预防。在成功进行机会性感染的初始治疗后，需进行维持治疗。强效抗逆转录病毒联合疗法的引入导致大多数机会性疾病的发病率和死亡率下降，并且如果能使CD4淋巴细胞计数持续上升，就可以停止既定的一级预防和维持治疗。抗逆转录病毒疗法导致的免疫能力改善还与机会性感染的新临床表现即免疫重建炎症综合征相关。瑞士艾滋病毒多中心队列研究的框架及其对机会性疾病的详细记录，使得能够开展多项重要研究和分析，这些研究和分析对这些疾病的管理在全球范围内产生了影响。
