Assuntos
Flunarizina/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Transtornos de Enxaqueca/prevenção & controle , Vasodilatadores/uso terapêutico , Adulto , Fatores Etários , Criança , Pré-Escolar , Contraindicações , Ensaios Clínicos Controlados como Assunto , Método Duplo-Cego , Flunarizina/administração & dosagem , Flunarizina/efeitos adversos , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Humanos , Placebos , Fatores de Tempo , Vasodilatadores/administração & dosagem , Vasodilatadores/efeitos adversosRESUMO
In up to 50% of all human immunodeficiency virus (HIV) patients, the nervous system is clinically involved. Primary or secondary manifestations of the nervous system have been found in even 90% by neuropathological investigations. We present a retrospective analysis of cerebrospinal fluid (CSF) and serum data of 238 HIV patients. Data of cross-sectional analysis in 208 patients and longitudinal analysis in 30 patients are given. In addition, the viral load in CSF and serum was determined in 29 patients. The HIV patients without opportunistic infections showed increased levels of immunoglobulins and more oligoclonal bands. In later stages of the infection, beta-2 microglobulin as a marker of HIV-associated encephalopathy was increased. In the longitudinal study with an observation period of 1 year, an increase could be observed in total CSF proteins of patients who did not receive antiretroviral treatment. In patients with new opportunistic infections of the central nervous system, similar changes in CSF parameters were noted as in comparison to patients not infected by HIV but with the same opportunistic infections. Analysis of CSF is mandatory for the diagnosis and control of opportunistic infections.
Assuntos
Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Antivirais/uso terapêutico , Comorbidade , Estudos Transversais , Feminino , Alemanha/epidemiologia , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
Highly active antiretroviral therapy (HAART) has resulted in a reduction of morbidity and mortality in HIV-associated cerebral opportunistic infection. Before HAART, up to 50% of all HIV-infected patients in Europe developed cerebral toxoplasmosis, an encephalitis caused by reactivation of Toxoplasma gondii infection. Although potent therapeutical options exist, the prognosis is still poor. We describe the course of 36 AIDS patients with cerebral toxoplasmosis and present a review of clinical signs, diagnosis, therapy, and survival times. The main criteria for differential diagnosis from other secondary neuromanifestations such as primary CNS lymphoma, progressive multifocal leukencephalopathy, abscesses, and ischemic infarctions are described. Indications and problems of stereotactic biopsy are discussed.
