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引用次数: 0

摘要

随着时间的推移,德国感染艾滋病毒的患者人数稳步增加。这是由于死亡率下降的积极发展和新感染率几乎稳定。这一发展是基于1996年采用高效抗逆转录病毒疗法(HAART)改善了艾滋病毒/艾滋病患者的预后。考虑到这一点,有必要重新审视HIV患者作为潜在的ICU候选者。ICU治疗最常见的转诊是呼吸衰竭,其次是神经系统疾病。在极少数情况下,haart诱导的副作用需要在ICU治疗。很少有临床试验直接比较hiv阳性和hiv阴性患者的结果,而且这些数据大多是在haart前收集的。ICU结果与hiv真实参数(如CD4细胞计数)无关。因此,HIV患者可以从ICU治疗中获益。关于HAART的管理,仍然存在一些悬而未决的问题,特别是考虑到机械通气患者。实际上,只有AZT (Retrovir®)可作为静脉注射制剂。其他抗逆转录病毒药物只能在研磨片剂后使用。改变的盖伦子组成对疗效和耐药性发展的影响尚未得到充分的研究。这也适用于中断治疗与可能不适当的HAART应用的风险和益处。在这项调查中,我们还描述了HAART与镇静/抗癫痫/结核等药物之间可能的相互作用。最后,讨论了卫生保健环境中艾滋病毒暴露的特殊方面,包括受伤后的必要立即措施。给出了目前的暴露后预防建议。
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[HIV and AIDS patients in the ICU].

The number of HIV-infected patients in Germany has increased steadily over time. This is due to the positive development of decreasing death rates and a nearly stable rate of new infections. This development is based on the improved prognosis for HIV/AIDS patients due to the introduction of highly active antiretroviral therapy (HAART) in 1996. Considering this, a new look at the HIV patient as a potential ICU candidate is necessary.    The most common referral for ICU therapy is respiratory failure, followed by neurological disorders. In rare cases, HAART-induced side-effects require therapy in the ICU.    Very few clinical trials directly compare the outcome of HIV-positive and HIV-negative patients, and most of these data were collected in the pre-HAART era. The ICU outcome does not correlate with HIV-genuine parameters, such as the CD4 cell counts. Thus, a HIV patient can benefit from ICU treatment.    Regarding HAART management, open questions still exist especially considering the mechanically ventilated patient. Actually only AZT (Retrovir®) is available as an i.v. formulation. Other antiretroviral medication can only be administered after grinding the tablets. The consequenses of the altered galenic composition with regard to efficacy and development of resistance has not been sufficiently studied. This also applies to risks and benefits of interrupted therapy versus a possibly inappropriate application of HAART.    In this survey we also describe possible interactions between HAART and sedative/antiepileptic/tuberculostatic etc. medication.    Finally special aspects of HIV exposure in the health care setting are discussed, including essential immediate measures after an injury. Current recommendations for post-exposure prophylaxis are given.

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