aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla
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<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong><br />

<strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong><br />

klinikuri mdgomareobis marTvis saxelmwifo<br />

stan<strong>da</strong>rti<br />

(protokoli)<br />

1

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis antiretrovirusuli Terapia<br />

(protokoli)<br />

1. <strong>da</strong>avadebis/nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT<br />

gamowveul infeqciur <strong>da</strong>avadebas.<br />

2. kriteriumebi _<br />

a. <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong><br />

provirus dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis<br />

jaWvuri reaqciis meTodiT.<br />

b. gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong> Sidsis gamomricxavi kriteriumebia:<br />

<strong>aiv</strong> antisxeulebis ar arseboba sisxlis SratSi<br />

imunofermentuli meTodiT, raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an<br />

Tvisobrivad <strong>aiv</strong> provirus dnm-is ararseboba sisxlSi<br />

polimerizaciis jaWvuri reaqciis meTodiT.<br />

3. simptomebi <strong>da</strong> niSnebi _<br />

a. <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri<br />

niSnebi ar gaaCnia. igi miekuTvneba laboratoriulad<br />

sadiagnozo <strong>da</strong>avadebebs. simptomebi<strong>da</strong>n SeiZleba gamovyoT:<br />

gaxangrZlivebuli cxeleba, gaxangrZlivebuli faRaraTi,<br />

limfadenopaTia, aramotivirebuli profuzuli oflianoba,<br />

Zlieri saerTo sisuste, aramotivirebuli wonaSi kleba (erTi<br />

Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cnsis<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. atipiuri mikobaqteriebiT<br />

gamowveuli infeqciebis <strong>da</strong>ma<strong>da</strong>sturebel simptomebs<br />

ganekuTvneba cxeleba, Ramis oflianoba, diarea, abdominaluri<br />

tkivili, wonaSi kleba <strong>da</strong> kaxeqsia.<br />

b. gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba<br />

Civilebs ar warmoadgendes.<br />

2

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

laboratoriuli testebi<br />

<strong>aiv</strong> <strong>infeqcia</strong>sTan <strong>da</strong>kavSirebuli testireba:<br />

• <strong>aiv</strong> serologiuri gamokvleva (tipurad ELISA an swrafi testi),<br />

romelsac mohyveba <strong>da</strong>ma<strong>da</strong>sturebeli testi (tipiurad vestern<br />

blotingi) (11);<br />

• CD4 ujredebis ricxvi imunodeficitis xarisxis gansazRvrisTvis;<br />

orsul qalebSi CD4% (12,13) <strong>da</strong><br />

• virusuli <strong>da</strong>tvirTvis testi polimerazuli jaWvuri reaqciis (pjr)<br />

meTodiT, virusis replikaciis donis gansazRvrisTvis ;<br />

testireba sxva infeqciebze<br />

• testi sifilisze (VDRL);<br />

• vaginaluri, asos an analuri Camonafxeki gonoreisa <strong>da</strong> Chlamydia<br />

trachomatis identifikaciisTvis;<br />

• testireba toqsoplazmis IgG serologiur testze <strong>da</strong> informacia<br />

infeqciis riskis Sesaxeb Tu serologiis Sedegi uaryofiTia;<br />

• kriptokokis antigenis titri, rodesac CD4 limfocitebis ricxvi <<br />

200 mm3 <strong>da</strong> saxezea kriptokokozis klinikuri niSnebi;<br />

• CMV antigenemia (pp65 adreuli antigeni), rodesac CD4 ujredebis<br />

ricxvi < 100 mm3;<br />

• serologiuri testi B,C hepatitis virusebze (anti HCV, HBsAg)<br />

ZiriTadi laboratoriuli testebi:<br />

• eleqtrolitebi (natriumi, kaliumi); N<br />

• RviZlis funqciuri sinjebi (ALT, AST, tute fosfataza, saerTo<br />

<strong>da</strong> arapir<strong>da</strong>piri bilirubini);<br />

• Tirkmlis funqciebi (Sardovana, kreatinini);<br />

• laqtaddehidrogenaza (limfomebis dros ujredTa ZiriTadi<br />

brunva, filtvis infeqciebis niSnebi, miokardiumis infarqti,<br />

kunTebis <strong>da</strong>zianebani <strong>da</strong> a.S.);<br />

• INR an proTrombinis dro;<br />

• sisxlis saerTo analizi (formuliTa <strong>da</strong> Trombocitebis<br />

ricxviT);<br />

• orsulobis testi arv Terapiis <strong>da</strong>wyebamde.<br />

saWiroebis SemTxvevebSi:<br />

• glukoza;<br />

• qolesterini (HDL, VLDL);<br />

• trigliceridebi;<br />

• lipaza;<br />

• C-reaqtiuli cila (CRP);<br />

• Tiroid-mastimulirebeli hormoni (TSH ).<br />

3

sxva gamokvlevebi<br />

• tuberkulinis kanis testi;<br />

• naxvelis nacxis mikroskopia <strong>da</strong> gul-mkerdis rentgenologiuri<br />

gamokvleva, Tu saxezea tuberkulozis niSnebi;<br />

• ekg (gamokvleva <strong>mkurnaloba</strong>mde arT-ze myof pacientebSi gulsisxlZarRvovani<br />

<strong>da</strong>avadebis didi riskis gaTvaliswinebiT,<br />

Se<strong>da</strong>rebisTvis) (14)<br />

specialistTa konsultaciebi<br />

• nevrologiuri gamokvleva, rodesac HIV pirvelad aris<br />

diagnostirebuli (mag. periferiuli neiropaTiis<br />

identifikaciisTvis);<br />

• ofTalmologiuri gamokvleva yovel sam TveSi erTxel CMV<br />

retinitis identifikaciisTvis, rodesac CD4 ujredebis ricxvi <<br />

100mm3;<br />

• ginekologiuri gamokvleva PAP nacxis CaTvliT yovel 6 TveSi<br />

erTxel (a<strong>da</strong>mianis papilomavirusiT gamowveuli karcinoma);<br />

• sxva specialistebis konsultacia aucileblobis SemTxvevebSi.<br />

5. <strong>mkurnaloba</strong><br />

a) rekomendebuli pirveli rigis arT<br />

arT reJimi<br />

2 NRTI-s + 1 NNRTI<br />

medikamentebis kombinacia<br />

ZDV + 3TC + (EFV a or NVP)<br />

an<br />

TDF + FTC + (EFV a or NVP)<br />

an<br />

ABC + 3TC + (EFV a or NVP)<br />

b) rekomendebuli meore rigis arv reJimi mozardebisa <strong>da</strong><br />

mozrdilTaTvis<br />

pirveli rigis reJimi meore rigis reJimi<br />

LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC<br />

an<br />

ZDV + 3TC + (EFV an NVP) LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + ABC<br />

an<br />

LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + (ZDV + 3TC) b<br />

TDF + FTC + (EFV an NVP)<br />

ABC + 3TC + (EFV an NVP)<br />

LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC<br />

an<br />

LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV<br />

LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV<br />

an<br />

LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ZDV + TDF (+ 3TC) b<br />

4

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

monitoringis samizneebs warmoadgens laboratoriuli testebi<br />

antiretrovirusuli mkurnalobis efeqturobis gasakontroleblad<br />

virusuli<br />

<strong>da</strong>tvirTva<br />

CD4<br />

ujredebis<br />

ricxvi<br />

sisxlis saerTo<br />

analizi<br />

RviZlis<br />

funqciuri<br />

sinjebi<br />

qolesterini<br />

trigliceridebi<br />

Tirkmlis<br />

funqciebi<br />

2 4 8 16 24 36 48<br />

sawyisi<br />

kvira kvira kvira kvira kvira kvira kvira<br />

X X X X X<br />

X X X (X) X<br />

X X X X<br />

(ZDV)<br />

X X X<br />

(NVP)<br />

X (PI)<br />

X<br />

X<br />

(TDF)<br />

X<br />

(TDF,<br />

IDV)<br />

X<br />

(NVP,<br />

ZDV,<br />

PI)<br />

X<br />

(NVP,<br />

PI)<br />

X<br />

(PI)<br />

X (X) X<br />

X (X) X<br />

X (X) X<br />

X<br />

(PI)<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

5

<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>da</strong>avadebuli bavSvebis<br />

antiretrovirusuli <strong>mkurnaloba</strong><br />

(protokoli)<br />

1. <strong>da</strong>avadebis/nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi warmoadgens a<strong>da</strong>mianis imunodeficitis virusiT (<strong>aiv</strong>)<br />

gamowveul infeqciur <strong>da</strong>avadebas.<br />

2 kriteriumebi<br />

a. <strong>da</strong>ma<strong>da</strong>sturebeli _ 18 Tvis Semdeg <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis<br />

<strong>da</strong>ma<strong>da</strong>sturebeli kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis<br />

SratSi imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong><br />

provirus dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis<br />

jaWvuri reaqciis meTodiT.<br />

b. gamomricxavi _ 18 Tvis Semdeg <strong>aiv</strong> <strong>infeqcia</strong> Sidsis gamomricxavi<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis ar arseboba sisxlis SratSi<br />

imunofermentuli meTodiT, raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an<br />

Tvisobrivad <strong>aiv</strong> provirus dnm-is ar arseboba sisxlSi<br />

polimerizaciis jaWvuri reaqciis meTodiT.<br />

18 wlamde asakis bavSvebSi <strong>aiv</strong> infeqciis diagnostikaSemdegi sqemiT<br />

xorcieldeba<br />

• <strong>aiv</strong>-is pirveladi diagnostika xorcieldeba <strong>da</strong>badebi<strong>da</strong>n 48 sTis<br />

Semdeg. gamoiyeneba pjr meTodiT <strong>aiv</strong> dnm gansazRvra<br />

axalSobilis sisxlSi, romelic ar aris aRebuli Wiplaris<br />

veni<strong>da</strong>n, vinai<strong>da</strong>n is SeiZleba <strong>da</strong>binZurebuli iyos dedis<br />

sisxliT. am dros kvlevis substrats warmoadgens periferiuli<br />

sisxlis mononuklearebSi arsebuli provirusuli dnm.<br />

<strong>da</strong>badebi<strong>da</strong>n 48 saaTSi inficirebuli bavSvebis 38% aCvenebs<br />

<strong>da</strong>debiT pasuxs <strong>aiv</strong> dnm pjr-ze. testis mgrZnobeloba ar<br />

icvleba mniSvnelovnad pirveli 1 kviris ganmavlobaSi, magram<br />

mkveTrad matulobs sicocxlis meore kviri<strong>da</strong>n, rodesac<br />

<strong>da</strong>avadebuli bavSvebis 93% gamovlindeba. 28 dRis asakSi <strong>aiv</strong><br />

dnm pjr-s ukve aqvs 96% mgrZnobeloba <strong>da</strong> 99% specifiuroba.<br />

<strong>aiv</strong> dnm pjr gamokvlevaze uaryofiTi pasuxis miRebis<br />

SemTxvevaSi bavSvs ganmeorebiTi gamokvleva imave meTodiT<br />

utardeba 3 Tvis asakSi. miRebuli <strong>da</strong>debiTi Sedegi safuZvelia<br />

<strong>aiv</strong> infeqciis winaswari diagnozisa. saboloo diagnozi<br />

dgindeba ganmeorebiTi pjr-iT <strong>aiv</strong> –is dnm-ze sisxlis axal<br />

porciaSi.<br />

• 2-3 Tvis asakSi <strong>aiv</strong> dnm pjr meTodis alternatiul meTo<strong>da</strong>d<br />

SesaZloa CaiTvalos <strong>aiv</strong> rnm pjr diagnostikis meTodi, romlis<br />

mgrZnobeloba am asakSi 90-100%-s aRwevs, xolo specifiuroba<br />

<strong>aiv</strong> dnm pjr specifiurobis msgavsia, Tumca <strong>aiv</strong> rnm <strong>da</strong>bali<br />

doniT deteqtireba (

antisxeulebi IgG (maT Soris <strong>aiv</strong> infeqciis sawinaaRmdego)<br />

transplacenturi gziT xvdeba bavSvis organizmSi. is mTlianad<br />

iSleba 18 Tvis asakisaTvis. amdenad am asakis Semdeg <strong>aiv</strong><br />

sawinaaRmdego antisxeulebze <strong>da</strong>debiTi Sedegi miuTiTebs, rom<br />

bavSvi <strong>aiv</strong> inficirebulia.<br />

• Tu bavSvi ikvebeba dedis rZiT, maSin <strong>aiv</strong> antisxeulebze<br />

gamokvlevas azri aqvs ZuZuTi kvebis Sewyveti<strong>da</strong>n 6 Tvis Semdeg,<br />

vinai<strong>da</strong>n manamde bavSvi SeiZleba e.w. “fanjara periodSi”<br />

imyofebodes.<br />

3. simptomebi <strong>da</strong> niSnebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

saSvilosnosSi<strong>da</strong> inficirebis SemTxvevaSi aRwerilia Taviseburi<br />

simptomokompleqsi, rac xasiaTdeba zr<strong>da</strong>-ganviTarebis SeferxebiT,<br />

SesaZloa gamoxatuli iyos mravlobiTi <strong>da</strong>rRvevebi qala-saxisa <strong>da</strong> tvinis<br />

nawilebSi. <strong>aiv</strong> inficirebul axalSobilebs SesaZloa gamoxatuli<br />

hqondeT gamoweuli Subli, brtyeli cxviri, egzofTalmi mocisfro<br />

sklerebi, mikrocefalia, Tumca un<strong>da</strong> aRiniSnos, rom ganviTarebis<br />

anomaliebi ar aris mkafiod <strong>da</strong>maxasiaTebeli niSani <strong>aiv</strong> infeqciisaTvis.<br />

<strong>aiv</strong> inficirebul bavSvebSi simptomebi<strong>da</strong>n SeiZleba gamovyoT: zr<strong>da</strong>ganviTarebaSi<br />

CamorCena, aramotivirebuli cxeleba,<br />

qronikuli/morecidive yuris infeqciebi, qronikuli pnevmonia an diarea,<br />

qronikuli dermatiti, parotiduli jirkvlebis SeSupeba, sistemuri<br />

limfadenopaTia, hepatomegalia, splenomegalia. limfocituri disfunqcia<br />

safuZvlad udevs morecidive sokovan infeqciebs, rogoricaa kandidozi,<br />

rac Cveulebriv Terapias ar emorCileba. bavSvebSi yvelaze<br />

gavrcelebuli oportunistuli infeqciebia: pnevmocisturi pnevmonia (PCP)<br />

<strong>da</strong> sistemuri kandidozi, xSiria ezofagiti. pediatriuli pnevmocisturi<br />

pnevmoniis didi wili Zalian adreul asakSi iCens Tavs, rasac Tan<br />

axlavs maRali letaloba. es ki am <strong>da</strong>avadebis proflaqtikis farTod<br />

Catarebis aucileblobis safuZvels iZleva. adreuli PCP profilaqtikis<br />

Catarebis SesaZlebloba 4-6 kviris asaki<strong>da</strong>n dedis <strong>aiv</strong> statusis adreul<br />

<strong>da</strong>dgenas did mniSnelobas sZens. sxva oportunistuli infeqciebi<strong>da</strong>n<br />

aRsaniSnavia: citomegalovirusuli <strong>infeqcia</strong>, romelic iwvevs filtvebisa<br />

<strong>da</strong> gastroenteraluri traqtis <strong>da</strong>zianebas <strong>da</strong> iSviaTad iwvevs retinits.<br />

(rac xSiria mozrdilebSi), qronikuli diarea, gamowveuli<br />

kriptosporidioziT, lamblioziT, izosporaTi an iseTi virusiT,<br />

rogoricaa, adenovirusi. meningiti SesaZloa gamowveul iyos<br />

kriptokokiT, rac klinikurad naklebi simwvaviT vlindeba baqteriul<br />

meningitTan Se<strong>da</strong>rebiT. aratuberkulozuri mikobaqteria (Mycobacterium<br />

avium intracelulare) <strong>da</strong>avadebas iwvevs mogvianebiT etapebze imunitetis mZime<br />

supresiisas. is iwvevs cxelebas wonaSi klebiT an mis gareSe an SesaZloa<br />

gamovlindes malabsorbciuli diareis saxiT.<br />

oportunistuli infeqciis gar<strong>da</strong> sicocxlis pirveli wlis ganmavlobaSi<br />

<strong>aiv</strong> inficrebul bavSvebs SesaZloa gamouvlindeT limfoiduri<br />

intersticiuli pnevmonia. es nela moprogresire <strong>da</strong> xSirad asimptomuri<br />

<strong>da</strong>avadebaa. is Cveulebriv vlindeba sicocxlis pirveli wlis Tavze <strong>da</strong><br />

piks ori wlis asakisaTvis aRwevs. xSira<strong>da</strong>a asocirebuli parotiduli<br />

7

jirkvlebis SeSupebasTan <strong>da</strong> hipergamaglobulinemiasTan. bavSvs SesaZloa<br />

hqondes mxolod es gamovlinebani filtvebis <strong>da</strong>zianebis gamovlinebamde<br />

didi xniT adre. Semdgom vlindeba <strong>da</strong>qveiTebul oqsigenaciasTan<br />

<strong>da</strong>kavSirebuli gamovlinebani, maT Soris dolis joxiseburi TiTebi.<br />

Tumca wlebis manZilze gamovlinebani SesaZloa Zalze mwiri iyos.<br />

xSiria morecidive baqteriuli infeqciebi, rac gamowveulia: Hemophilius<br />

influenzae, Streptococcus pyogenes, Staphylococcus epidermidis, pneumococcus, salmonellas.<br />

yvelaze xSirad morecidive baqteriul <strong>infeqcia</strong>s pnevmonia miekuTvneba,<br />

romlis xSir mizezsac S. pneumoniae warrmoadgens. mwvave pnevmoniis xSiri<br />

mizezia pnevmocisturi pnevmoniac, rac mxedvelobaSi un<strong>da</strong> gvqondes<br />

miuxe<strong>da</strong>vad pacientis imunuri statusisa <strong>da</strong> CD4 raodenobisa.<br />

tuberkulozi <strong>aiv</strong> inficirebuli bavSvebis erT-erT seriozul problemas<br />

warmoadgens. diagnostikisaTvis gamoiyeneba kanis tuberkulinuri testi<br />

<strong>da</strong> naxvelSi mJavagamZle baqteriis aRmoCena mikroskopiisa <strong>da</strong> kulturis<br />

miRebis gziT. bavSvebSi naxvelis ararsebobis dros mimarTaven kuWis<br />

amonarecxis kvlevas. <strong>aiv</strong> inficirebul bavSvebSi xSiria cns <strong>da</strong>zianeba,<br />

rac gamoixateba fsiqo-fizikuri ganviTarebis SeferxebiT,<br />

encefalopaTiiT, cerebruli <strong>da</strong>mbliT an/<strong>da</strong> spastiuri tetraplegiis<br />

saxiT. adgili aqvs Tavis garSemowerilobis zrdis SeCerebas.<br />

kompiuteruli tomograma kortiklur atrofias an kalcifikacias<br />

uCevnebs (gansakuTrebiT bazalur gangliebSi simetriulad).<br />

<strong>aiv</strong> inficirebuli bavSvebis <strong>da</strong>axloebiT 20%-Si viTardeba Trombocitebis<br />

imunuri destruqcia. anemia ganpirobebuli SeiZleba iyos <strong>aiv</strong>-is mier,<br />

iatrogenuli faqtorebiT an virusuli infeqciebis (magaliTad,<br />

parvovirus B19) supresiuli zegavleniT Zvlis tvinze, aseve SratSi<br />

eriTroepoetinis donis <strong>da</strong>qveiTebiTa <strong>da</strong> Zvlis tvinis <strong>da</strong>qveiTebuli<br />

reagirebiT eriTroepoetinze. anemias iwvevs neoplaziuri agentebic.<br />

neitropenia xSiria Rrma imunosupresiis dros <strong>da</strong> kavSirSia baqteriuli<br />

infeqciebis <strong>da</strong>rTvis maRal riskTan. neitropenia SesaZloa gamowveuli<br />

iyos medikamentebiT, romelsac bavSvi iRebs mkurnalobis procesSi.<br />

<strong>aiv</strong> azianebs gulsa <strong>da</strong> Tirkmelebs. es garTulebebi gansakuTrebiT xSiria<br />

mozrdil bavSvebSi 2-3 wlis asakis zemoT. Cveulebriv gamoxatulia<br />

qronikuli kardiomiopaTia. Tirkmlis <strong>da</strong>zianeba vlindeba nefrozuli<br />

sindromis an glomerulonefritis saxiT.<br />

4. diagnostikur-laboratoriuli testebi <strong>da</strong> specialistTa<br />

konsultaciebi<br />

a) pirvel 4 saaTSi<br />

• konsultacia stacionaruli;<br />

• sisxlis klinikuri analizi (sisxlis saerTo analizi,<br />

sisxlis jgufis <strong>da</strong> rezusis gansazRvra, transaminazebis,<br />

bilirubinis, laqtatdehidrogenazas, Sardovanas, kreatininis,<br />

glukozis, saerTo cilis <strong>da</strong> cilis fraqciebis, rkinis <strong>da</strong><br />

rkinis gajerebis unaris, proTrombinis <strong>da</strong> Trombinis drois<br />

gansazRvra);<br />

• imunologiuri analizi (CD4+, CD8+ limfocitebis CaTvliT);<br />

8

• Sardis saerTo analizi;<br />

• liqvoris saerTo analizi;<br />

• liqvoris baqterologiuri gamokvleva;<br />

• naxvelis baqterioskopuli gamokvleva;<br />

• sisxlSi Toxo IgG diagnostika;<br />

• mantus sinji.<br />

b) pirvel 24 saaTSi<br />

• gulmkerdis rentgenograma (erTi proeqcia);<br />

• rentgenologis konsultacia;<br />

• ekg;<br />

• kardiologis konsultacia;<br />

• sisxlis bioqimiuri analizi (saerTo cila, albumini, ALT,<br />

AST, bilirubini, <strong>da</strong> misi fraqciebi, CD4, CD8);<br />

• Sardis analizi;<br />

• ganavlis analizi;<br />

• sisxlis baqteriologiuri gamokvleva;<br />

• naxvelis baqteriologiuri gamokvleva.<br />

g) pirvel 3 dReSi<br />

• nevropaTologis konsultacia;<br />

• ftiziatris konsultacia;<br />

• antibiotikebisadmi mgrZnobelobis gansazRvra;<br />

• <strong>aiv</strong> virusuli <strong>da</strong>tvirTvis gansazRvra;<br />

• virusuli hepatitebis (B, C, D) diagnostika;<br />

• aTaSangis diagnostika (TPHA, RPR meTodebiT);<br />

• serologiuri gamokvlevebi sxva mikroorganizmebisaTvis.<br />

5. <strong>mkurnaloba</strong><br />

pirveli rigis arT sqema <strong>aiv</strong> inficirebul bavSvebSi<br />

arT-s anamnezi (maT Soris dedis<br />

mier arv preparatebis miReba<br />

orsulobisa <strong>da</strong> mSobiarobis<br />

dros), Tanmxlebi <strong>da</strong>avadebebi<br />

bavSvebSi, romlebic ar<br />

Rebulobdnen arv preparatebs, ar<br />

aris riski preparatebis<br />

urTierTqmedebisa <strong>da</strong> wamlismieri<br />

mdgradobis<br />

bavSvebi, romlebic imyofebodnen<br />

nevirapinis zemoqmedebis qveS,<br />

dedi<strong>da</strong>n bavSvze <strong>aiv</strong> infeqciis<br />

ga<strong>da</strong>debis profilaqtikis mizniT.<br />

tuberkuloziT <strong>da</strong>avadebulebi****<br />

pirveli rigis arT sqema*<br />

zidovudini** + lamivudini + nevirapini<br />

an<br />

zidovudini** + lamivudini + efavirenzi***<br />

zidovudini** + lamivudini +<br />

lopinaviri/ritonaviri<br />

an<br />

zidovudini** + lamivudini + nelfinaviri<br />

zidovudini** + lamivudini + abakaviri<br />

an<br />

9

zidovudini** + lamivudini + efavirenzi***<br />

* saWiroa arv preparatebis bavSvebisaTvis misaReb samkurnalwamlo<br />

formebSi miwodeba (Txevad formaSi, 6 welze patara bavSvebSi),<br />

romelic uzrunvelyofs zust dozirebas.<br />

** anemiis mqone bavSvebSi ukunaCvenebia zidovudinis Semcveli arT sqemebi.<br />

*** 3 welze didi asakis bavSvebSi<br />

**** arT un<strong>da</strong> <strong>da</strong>viwyoT 2 Tviani intensiuri antituberkulozuri Terepiis<br />

Semdeg. Tu situacia saSualebas gavaZlevs arT umjobesia <strong>da</strong>viwyoT<br />

antituberkulozuri Terapiis kursis <strong>da</strong>mTavrebisas. es Tavi<strong>da</strong>n<br />

agvacilebs rifampicinisa <strong>da</strong> arv preparatis negatiuri urTierTqmedebis<br />

Sedegebs. gar<strong>da</strong> amisa arT <strong>da</strong> antituberkulozuri preparatebis<br />

erTdrouli <strong>da</strong>niSvna zrdis Terapiis reJimis <strong>da</strong>rRvevis risks. arT-s<br />

adreuli <strong>da</strong>niSvna gamarTlebulia, Tu tuberkuloziT <strong>da</strong>avadebul <strong>aiv</strong><br />

inficirebul bavSvs aReniSneba <strong>aiv</strong> infeqciis gamoxatuli gamovlinebebi<br />

an/<strong>da</strong> mZime imunodeficiti.<br />

arT sqemis Secvlis aucilebloba ganpirobebulia an Terapiis araefeqturobiT,<br />

an SeuTavsebeli gverdiTi movlenebiT. sqema un<strong>da</strong> Secvalos im eqimma,<br />

romelmac <strong>da</strong>niSna pirveladi <strong>mkurnaloba</strong>. vidre axal sqemas <strong>da</strong>vniSnavT<br />

un<strong>da</strong> <strong>da</strong>vrwmundeT, rom bavSvi preparatebs Rebulob<strong>da</strong> mkacrad<br />

<strong>da</strong>niSnulebis mixedviT. Tu arT-s sqemis gamocvla ganpirobebulia Terapiis<br />

araefeqturobiT, saWiroa samive preparatis erTdrouli Secvla<br />

meore rigis arT sqema<br />

arT-s sawyisi sqema<br />

meore rigis rekomendebuli sqema<br />

zidovudini + lamivudini + nevirapini<br />

an<br />

zidovudini + lamivudini +<br />

ifavirenci<br />

zidovudini + lamivudini +<br />

nelfinaviri<br />

an<br />

zidovudini + lamivudini +<br />

lopinaviri/ritonaviri<br />

abakaviri + di<strong>da</strong>nozini +<br />

lopinaviri/ritonaviri<br />

an<br />

abakaviri + di<strong>da</strong>nozini +<br />

nelfinaviri<br />

abakaviri + di<strong>da</strong>nozini +<br />

nevirapini<br />

an<br />

abakaviri + di<strong>da</strong>nozini +<br />

efavirenzi<br />

* Tu bavSvs SeuZlia kafsulis ga<strong>da</strong>ylapva, xolo preparatis<br />

erTjerad doza (romelic gaTvlilia wonaze an sxeulis farTobze)<br />

Seadgens ramodenime kafsulas erTad, mas aseve SegviZlia<br />

<strong>da</strong>vuniSnoT seqvinavir/ritonaviri an indinavir/ritonaviri<br />

10

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

monitoringi samizneebi<br />

pirveli<br />

Semowmeba<br />

meore<br />

Semowmeba<br />

momdevno<br />

Semowmebebi<br />

Semowmebis<br />

va<strong>da</strong><br />

anTropometruli<br />

monacemebi<br />

Semowmeba<br />

arT-s<br />

<strong>da</strong>wyebi<strong>da</strong>n 2<br />

kviraSi + +<br />

pirveli<br />

Semowmebi<strong>da</strong>n<br />

erT TveSi + +<br />

yovel 3<br />

TveSi, Tu<br />

saWiro ar<br />

aris ufro<br />

xSiri<br />

vizitebi<br />

+ +<br />

laboratoriuli<br />

gamokvlevebi<br />

sisxlis klinikuri<br />

analizi, RviZlis<br />

fermentebis aqtivoba;<br />

Sardis saerTo<br />

analizi<br />

sisxlis klinikuri<br />

analizi, RviZlis<br />

fermentebis aqtivoba;<br />

Sardis saerTo<br />

analizi<br />

sisxlis klinikuri<br />

analizi, RviZlis<br />

fermentebis aqtivoba.<br />

CD4-is dones<br />

sazRvraven yovel 3-4<br />

TveSi, Tu ar aris<br />

Cveneba ufro xSiri<br />

gamokvlevisaTvis<br />

1 Tu sqema Seicavs nevirapins, 18 Tvis ganmavlobaSi, yovel 4 TveSi<br />

un<strong>da</strong> ganvsazRvroT RviZlis funqciuri maCveneblebi.<br />

arT-s efeqturobis kontroli<br />

klinikuri maCveneblebis kontroli (sigrZe, wona, saerTo mdgomareoba)<br />

janmrTeli bavSvis fizikuri ganviTareba mudmivad mimdinareobs <strong>da</strong><br />

wonisa <strong>da</strong> simaRlis matebiT gamovlindeba. imunodeficitis mqone <strong>aiv</strong><br />

inficirebul bavSvebSi igi Seferxebulia <strong>da</strong> arT-s <strong>da</strong>wyebis fonze<br />

mkveTrad matulobs. qvemoT mocemulia ZiriTadi klinikuri maCvenebebi,<br />

romlebic saSualebas mogvcems vimsjelod arT-s efeqtianobaze.<br />

• “wona/simaRlis” diagrama (rodesac SeuZlebelia CD4-is donis<br />

gansazRvra, mkurnalobis efeqtianobis Sesafaseblad gamoiyeneba<br />

fizikur ganviTarebis diagramebi). Tu im bavSvebis ganviTarebis<br />

fizikuri maCveneblebi, romlebsac utardebaT arT, ar Seesabameba<br />

diagramebze mocemul maCveneblebs, un<strong>da</strong> veZeboT ganviTarebis<br />

Seferxebis mizezebi. ZiriTadi mizezi oria:<br />

− oportunistuli <strong>infeqcia</strong> (am SemTxvevaSi diagramis mrudi<br />

mkveTrad ecema);<br />

− Terapiis reJimis <strong>da</strong>rRveva (am SemTxvevaSi diagramis mrudi<br />

ecema Tan<strong>da</strong>TanobiT).<br />

• fsiqomotoruli ganviTareba;<br />

11

• nevrologiuri <strong>da</strong>rRvevebi, maT Soris encefalopaTiis simptomebi;<br />

• infeqciuri <strong>da</strong>avadebebi: saxe <strong>da</strong> sixSire.<br />

laboratoriuli monacemebis kontroli<br />

• CD4-is done (Tu SesaZlebelia);<br />

• sisxlis klinikuri analizi;<br />

• RviZlis fermentebis aqtivoba (alt, ast);<br />

• <strong>da</strong>matebiTi gamokvlevebi: arT-s sqemisa <strong>da</strong> preparatebis gverdiTi<br />

efeqtebis mixedviT.<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

12

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

baqteriuli pnevmoniebi<br />

(protokoli)<br />

1. <strong>da</strong>avadebis/nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>miani imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. baqteriuli pnevmoniis yvelaze xSiri gamomwvevia<br />

Streptococcus pneumoniae. sxva gamomwvevbia: Haemophilus influenzae, Klebsiella spp.,<br />

Staphylococcus spp., Mycobacterium tuberculosis, Micobacterium avium-intracellulare.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. ze<strong>da</strong> sasunTqi gzebis baqteriuli infeqciebis diagnozi<br />

efuZneba klinikur gamovlinebebsa <strong>da</strong> rentgenologiur cvlilebebs.<br />

rentgenogramaze SeiZleba aRmoCndes filtvis parenqimis wilovani,<br />

kerovani an difuzuri <strong>da</strong>Crdilva an gamovlindes atipuri cvlilebebi.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. ze<strong>da</strong><br />

sasunTqi gzebis baqteriuli infeqciebis gamomricxavi kriteriumebia<br />

klinikuri gamovlinebebisa <strong>da</strong> rentgenologiuri cvlilebebis ar<br />

arseboba.<br />

3. simptomebi <strong>da</strong> niSnebi _<br />

a. <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. ze<strong>da</strong> sasunTqi gzebis baqteriuli<br />

infeqciebis <strong>da</strong>ma<strong>da</strong>sturebel simptomebs ganekuTvneba cxeleba, advilad<br />

<strong>da</strong>Rla, xveleba, qoSini, tkivili gulmkerdis areSi, taqipnoe.<br />

b gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. ze<strong>da</strong> sasunTqi gzebis baqteriuli infeqciebis<br />

gamomricxavi faqtoria Sesabamisi Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

13

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,<br />

eqim-pulmonologis konsultacia.<br />

5. <strong>mkurnaloba</strong> AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA<br />

baqteriuli pnevmoniis mkurnalobis pirveli rigis sqemebi<br />

antibiotiki doza MmiRebis<br />

sixSire<br />

amoqsicilini<br />

500-1000mg 3X<br />

(penicilinisa <strong>da</strong> ampicilinis<br />

mimarT SesaZlo<br />

dReSi<br />

rezistentobis<br />

SemTxvevaSi gamoiyeneT<br />

penicilini beta laqtamazas<br />

inhibitorebTan kombinaciaSi)<br />

miRebis<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

PO 7 dRe an<br />

ufro<br />

xangrZlivad<br />

morCenamde<br />

Aan<br />

eriTromicini 500mg 4X dReSi PO 7 dRe<br />

an<br />

klaritromicini 500mg 2X dReSi PO 7 dRe<br />

Aan<br />

azitromicini 500mg erTxel<br />

dReSi<br />

qinoloni pnevmokokuri aqtivobiT<br />

(mag: moqsifloqsacini)<br />

doqsiciklini<br />

an<br />

an<br />

400 mg<br />

erTxel<br />

dReSi<br />

100 mg<br />

2X dReSi<br />

PO<br />

PO<br />

PO<br />

3-4 dRe<br />

7 dRe<br />

7 dRe<br />

o Tu pirveli rigis sqemiT mkurnalobis fonze mdgomareoba 72 sT-Si<br />

ar gaumjobes<strong>da</strong> (cxelebis normalizeba, leikocitozis donis<br />

Semcireba), aucilebelia pacientis hospitalizacia <strong>da</strong> mkurnalobis<br />

Secvla II rigis sqemiT,. saWiroebis SemTxvevaSi _ JangbadiT<br />

inhalacia.<br />

baqteriuli pnevmoniebis mkurnalobis meore rigis sqemebi<br />

antibiotiki doza M miRebis<br />

sixSire<br />

ceftriaqsoni 2g dReSi erTxel<br />

+<br />

eriTromicini 500mg 4X dReSi<br />

an<br />

ampicilin/<br />

1500mg 3X dReSi<br />

sulbaqtami<br />

+<br />

eriTromicini 500mg 4X dReSi<br />

an<br />

14<br />

MmiRebis<br />

gza<br />

IV<br />

IV<br />

mkurnalobis<br />

xangrZlivoba<br />

7 dRe<br />

7 dRe

qinoloni<br />

pnevmokokuri<br />

aqtivobiT<br />

(mag:<br />

moqsifloqsacini)<br />

qloramfenikoli<br />

(mxolod sxva<br />

pre-paratebis ar<br />

arse-bobis dros)<br />

400 mg erTxel dReSi IV/PO 7 dRe<br />

an<br />

12,5 mg/kg 4X dReSi IV 7 dRe<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

15

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli atipiuri<br />

mikobaqteriozebis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis/nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. atipiuri mikobaqteriozebi ewodeba Mycobacterium<br />

avium complex gamowveul infeqciebs.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. atipiuri mikobaqteriebiT gamowveuli infeqciebis diagnozi<br />

ismeba klinikuri suraTisa <strong>da</strong> laboratoriuli gamokvlevebis mixedviT.<br />

misi <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumia Mycobacterium avium complex -is aRmoCena<br />

specialur nia<strong>da</strong>gze <strong>da</strong>Tesil sisxlSi, ganavalSi, RviZlisa <strong>da</strong> Zvlis<br />

tvinis bioptatSi.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. atipiuri<br />

mikobaqteriebiT gamowveul infeqciebis gamomricxavi kriteriumia<br />

klinikuri suraTisa <strong>da</strong> Mycobacterium avium complex -is ar arseboba<br />

specialur nia<strong>da</strong>gze <strong>da</strong>Tesil sisxlSi, ganavalSi, RviZlisa <strong>da</strong> Zvlis<br />

tvinis bioptatSi.<br />

3. simptomebi <strong>da</strong> niSnebi _<br />

a. <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. atipiuri mikobaqteriebiT gamowveuli<br />

infeqciebis <strong>da</strong>ma<strong>da</strong>sturebel simptomebs ganekuTvneba cxeleba, wonaSi<br />

kleba, Ramis oflianoba, diarea, ganleva.<br />

b. gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. atipiuri mikobaqteriebiT gamowveuli infeqciebis<br />

gamomricxavi faqtoria Sesabamisi Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

16

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,<br />

Mycobacterium avium complex-is aRmoCena specialur nia<strong>da</strong>gze <strong>da</strong>Tesil<br />

sisxlSi, ganavalSi, RviZlsa <strong>da</strong> Zvlis tvinis bioptatSi.<br />

5. atipuri mikobaqteriozebis <strong>mkurnaloba</strong><br />

antibiotiki doza MmiRebis<br />

sixSire<br />

miRebis<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis preparatebi<br />

klaritromicini 500-1000 mg 2-jer dReSi PO 6 Tve ;<br />

<strong>da</strong>mokidebulia<br />

klinikur<br />

mdgomareobaze<br />

+<br />

etambutoli 15 mg/kg dReSi<br />

erTxel<br />

+<br />

rifabutini 300-450 mg dReSi<br />

erTxel<br />

PO 6 Tve ;<br />

<strong>da</strong>mokidebulia<br />

klinikur<br />

mdgomareobaze<br />

PO 6 Tve ;<br />

<strong>da</strong>mokidebulia<br />

klinikur<br />

mdgomareobaze<br />

sxva preparatebi, rimlebic moqmedeben atipiur mikobaqteriebze<br />

azitromicini 500-1200 mg dReSi PO<br />

6 Tve<br />

erTxel<br />

ciprofloqsacini 500 mg 2-jer dReSi PO<br />

6 Tve<br />

amikacini 15 mg/kg/dR dReSi 1X i/v<br />

an 7,5 2-jer dReSi i/v<br />

mg/kg/dR<br />

ara umetes 4<br />

kvirisa<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

• Tu atipiuri mikobaqteriozebis mkurnalobis fonze mdgomareoba<br />

gaumjobes<strong>da</strong> <strong>da</strong> preparatebi kargad ga<strong>da</strong>itaneba un<strong>da</strong> <strong>da</strong>iwyos arT.<br />

• atipiuri mikobaqteriozebis mkurnalobo<strong>da</strong>n 4-6- kviraSi iwyeba arT.<br />

6 Tvis Semdeg imunuri pasuxis gaumjobesebis Semdeg (CD4<br />

ricxvi>100mm3) Cerdeba atipiuri mikobaqteriozebis <strong>mkurnaloba</strong> <strong>da</strong><br />

gamoiyeneba meoradi profilaqtika.<br />

• meoradi profilaqtikis Sewyveta SesaZlebelia, rodesac imunuri<br />

sistema stabiluria 3-6- Tvis manZilze.<br />

17

• atipiuri mikobaqteriozebis <strong>mkurnaloba</strong> <strong>da</strong> meoradi profilaqtika<br />

grZeldeba 6 Tve, rac aris mkurnalobis warmatebis <strong>da</strong> relapsis<br />

Tavi<strong>da</strong>n acilebis sawin<strong>da</strong>ri.<br />

• didi mniSvneloba aqvs atipiuri mikobaqteriozebis mkurnalobis<br />

<strong>da</strong>wyebas arv Terapiis <strong>da</strong>wyebamde.<br />

• arsebobs albaToba imunuri rekonstituciis anTebiTi sindromis<br />

ganviTarebis arT-s <strong>da</strong>wyebis Semdeg.D<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

18

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

pnevmocisturi pnevmoniis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis/nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. pnevmocisturi pnevmoniis gamomwvevia Pneumocystis<br />

jiroveci.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. pnevmocisturi pnevmoniis diagnozi ismeba klinikuri suraTisa<br />

<strong>da</strong> rentgenologiuri cvlilebebis mixedviT. pnevmocisturi pnevmoniis<br />

klinikuri gamovlinebebia: xvela, qoSini, cxeleba, respiratoruli<br />

distresi – cianoziT. rentgenologiuri niSani - orive filtvis qvemo<br />

wilSi gamWvirvalobis Rrubliseburi <strong>da</strong>qveiTeba - yvela pacients ar<br />

aReniSneba. pnevmocisturi pnevmoniis <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumia<br />

Pneumocystis jiroveci-is cistis aRmoCena naxvelSi an bronqoalveolaruli<br />

lavaJiT miRebul siTxeSi.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

pnevmocisturi pnevmoniis gamomricxavi kriteriumebia klinikuri<br />

gamovlinebebisa <strong>da</strong> Pneumocystis jiroveci-is cistis ar arseboba naxvelSi an<br />

bronqoalveolaruli lavaJiT miRebul siTxeSi.<br />

3. simptomebi <strong>da</strong> niSnebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. pnevmocisturi pnevmoniis <strong>da</strong>ma<strong>da</strong>sturebel<br />

simptomebs ganekuTvneba xvela, qoSini, cxeleba, respiratoruli<br />

distresi – cianoziT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. pnevmocisturi pnevmoniis gamomricxavi faqtoria<br />

Sesabamisi Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

19

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,<br />

Pneumocystis jiroveci-is cistis aRmoCena naxvelSi an bronqoalveolaruli<br />

lavaJiT miRebul siTxeSi, eqim-pulmonologis konsultacia.<br />

5. pnevmocisturi pnevmoniis <strong>mkurnaloba</strong><br />

tardeba stacionarSi. aucilebelia <strong>da</strong>mxmare Terapia JangbadiT<br />

inhalaciis CaTvliT.<br />

pnevmocisturi pnevmoniis pirveli rigis <strong>mkurnaloba</strong><br />

antimikrobuli<br />

agenti<br />

timetoprimi/<br />

sulfametoqsazoli<br />

doza M miRebis M miRebis mkurnalobis<br />

sixSire gza xangrZlivoba<br />

400/80 mg 4X dReSi PO/IV 21 dRe<br />

pnevmocisturi pnevmoniis meore rigis <strong>mkurnaloba</strong><br />

Kklin<strong>da</strong>micini<br />

+<br />

primaqini<br />

600mg<br />

15 mg<br />

4X dReSi<br />

2X dReSi<br />

PO/IV<br />

PO<br />

21 dRe<br />

an<br />

pentamidini (farTo 4 mg/kg IV<br />

speqtris<br />

dReSi. doza<br />

antibiotikTan mcir 2 mg/kg<br />

kombinaciaSi 5 dRis<br />

baqteriuli<br />

superinfeqciis<br />

mkurnalobis<br />

Semdeg (18)<br />

profilaqtikisTvis<br />

mag. ampicilin+<br />

sulbaqtami 10 dRe)<br />

dReSi<br />

erTxel<br />

IV<br />

21 dRe<br />

• mZime mdgomareobaSi myof avadmofebSi iniSneba prednizoloni, 80-<br />

250 mg PO/IV dReSi 1-2 kvira (amcirebs intersticiul SeSupebas).<br />

• mZime SemTxvevebSi ganixileba kombinirebuli <strong>mkurnaloba</strong>, mag. kotrimoqsazoli<br />

<strong>da</strong> pen<strong>da</strong>midini mxolod erTeuli Setyobinebuli<br />

SemTxvevebis mixedviT <strong>da</strong>kavSirebulia toqsiurobis maRal riskTan.<br />

pnevmocisturi pnevmoniis mZime SemTxvevebi moiTxovs xelovnur<br />

ventilacias an oqsigeniT saturacias (SO2)

pnevmocisturi pnevmoniis mwvave SemTxvevis warmatebiT mkurnalobis<br />

Semged :<br />

• meoradi profilaqtikis mizniT <strong>aiv</strong> inficirebulma pacientebma un<strong>da</strong><br />

miiRon trimetoprim/sulfametoqsazoli 160/800 mg doziT erTxel<br />

dReSi xangrZlivad ;<br />

• aRniSnuli preparatebis miReba pacientma SeiZleba Sewyvitos Tu<br />

CD4 limfocitebis raodenoba stabilurad aRemateba 200 mm3-s sul<br />

mcire sami Tvis ganmavlobaSi.<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

21

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

kandidozebis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis/nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. kandidozebis gamomwvevia Candi<strong>da</strong> albicans.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. orofaringeuli kandidozis diagnostika efuZneba klinikur<br />

niSnebs, gasinjvas <strong>da</strong> <strong>da</strong>zianebuli ubnebi<strong>da</strong>n aRebuli masalis<br />

mikroskopul <strong>da</strong>Tvalierebas. piris Rrus <strong>da</strong>Tvalierebisas vnaxulobT<br />

balTis formis TeTr nadebs SewiTlebul <strong>da</strong> anTebad lorwovan garsze.<br />

anTeba SeiZleba gavrceldes sasaze, xaxaze, RrZilebze, enasa <strong>da</strong> loyis<br />

lorwovanze. ena <strong>da</strong>zianebisas xdeba gluvi, wiTeli <strong>da</strong> dvrilebi<br />

swordeba. kandidozuri ezofagitis SemTxvevebSi diagnozis<br />

<strong>da</strong><strong>da</strong>sturebisTvis aucilebelia qsovilis bioptatis histologiuri<br />

gamokvleva.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

kandidozebis gamomricxavi kriteriumebia Sesabamisi klinikuri<br />

gamovlinebebis ararseboba.<br />

3. simptomebi <strong>da</strong> niSnebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. piris Rrus kandidozi moicavs: loyis<br />

lorwovan garss, enas, pir-xaxas, RrZilebs, rbil <strong>da</strong> magar sasas.<br />

avadmyofs SeiZleba ar hqondes Civilebi an aRniSnavdes Wamis dros wvis<br />

SegrZnebas. zogierTi avadmyofi uCivis pirSi TeTri nadebis arsebobas.<br />

roca kandidozi vrceldeba saylapavze pacienti uCivis: tkivils ylapvis<br />

dros, retrosternalur tkivils, hipersalivacias.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. kandidozebis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

22

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,<br />

kandidozuri ezofagitis SemTxvevebSi diagnozis <strong>da</strong><strong>da</strong>sturebisTvis<br />

aucilebelia qsovilis bioptatis histologiuri gamokvleva.<br />

5. kandidozebis <strong>mkurnaloba</strong><br />

piris Rrus kandidozis <strong>mkurnaloba</strong><br />

antimikozuri<br />

agenti<br />

doza<br />

M miRebis<br />

sixSire<br />

mkurnalobis pirveli rigis sqemebi<br />

mikonazoli tabletebi dReSi<br />

gasawovad erTxel<br />

an<br />

flukonazoli 100 mg 2-jer dReSi<br />

3 dRe<br />

Semdeg<br />

erTxel<br />

dReSi 4 dRe<br />

mkurnalobis meore rigis sqemebi<br />

itrakonazoli 200-400 mg dReSi<br />

erTxel<br />

miRebis gza<br />

adgilobrivad<br />

PO<br />

PO<br />

mkurnalobis<br />

xangrZlivoba<br />

7 dRe<br />

7 dRe<br />

7 dRe<br />

vaginaluri kandidozis <strong>mkurnaloba</strong><br />

antimikozuri<br />

agenti<br />

doza M miRebis<br />

sixSire<br />

miRebis<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

flukonazoli 100 mg erTjera<strong>da</strong>d PO erTjera<strong>da</strong>d<br />

klotrimazoli 500 mg erTjera<strong>da</strong>d vaginalurad erTjera<strong>da</strong>d<br />

meore rigis sqemebi<br />

ketokonazoli 200 mg 2-jer dReSi PO 3 dRe<br />

ketokonazoli 200 mg dReSi PO<br />

7 dRe<br />

erTxel<br />

SemanarCunebeli Terapia<br />

nistatini 2-4 mln IU 2-jer dReSi PO 10 dRe<br />

Aan<br />

flukonazoli 50-200 mg dReSi PO<br />

yoveldRe<br />

erTxel<br />

mesame rigis sqemebi<br />

ketokonazoli 200 mg dReSi<br />

erTxel<br />

23<br />

PO<br />

<strong>da</strong>mokidebuli<br />

pasuxze,<br />

Cveulebriv 7-<br />

10 dRe

itrakonazoli 100 mg dReSi<br />

erTxel<br />

PO<br />

<strong>da</strong>mokidebuli<br />

pasuxze,<br />

Cveulebriv 7-<br />

10 dRe<br />

ezofaguri <strong>da</strong> diseminirebuli kandidozebis <strong>mkurnaloba</strong><br />

antimikozuri<br />

agenti<br />

doza M miRebis<br />

sixSire<br />

miRebis<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

ketokonazoli 200-400 mg 2-jer dReSi PO 21 dRe<br />

Aan<br />

flukonazoli<br />

(ketokonazolze<br />

efeqturia)<br />

200-400 mg<br />

Semcirdes<br />

klinikuri<br />

Sedegis<br />

mixedviT 3<br />

dRis Semdeg<br />

100 mg/dReSi<br />

dReSi<br />

erTxel<br />

PO/IV<br />

14 dRe<br />

meore rigis sqemebi<br />

amfotericini B 0,3-0,5 mg/kg IV 10-14 dRe<br />

Aan<br />

itrakonazoli 200-400 mg dReSi<br />

erTxel<br />

PO<br />

2 kvira<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

kandidozuri ezofagitis mkurnalobis Semdeg saWiroa xangrZlivi<br />

SemanarCunebeli Terapia flukonazoliT 50-100 mg/dReSi yoveldRe, an<br />

itrakonazoliT 100 mg/dReSi yoveldRe, an ketokonazoliT 200<br />

mg/dReSi yoveldRe.<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

24

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

kriptokokuli meningitis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. kriptokokuli meningitis gamomwvevia soko<br />

Criptococcus neoformans.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. kriptokokozis diagnozis <strong>da</strong><strong>da</strong>sturebisTvis liqvors<br />

acentrifugireben, miRebul naleqs ikvleven mikroskopis qveS tuSis<br />

wveTis India ink <strong>da</strong>matebis Semdeg. preparatSi naxuloben sqeli kafsuliT<br />

<strong>da</strong>farul safuaris ujredebs. SesaZlebelia kriptokokis kulturis<br />

gamoyofa Tavzurgtvinis siTxi<strong>da</strong>n. gamoiyeneba Sratis <strong>da</strong> Tavzurgtvinis<br />

siTxis gamokvleva kriptokokul antigenze.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

kriptokokozis gamomricxavi kriteriumebia liqvorSi sqeli kafsuliT<br />

<strong>da</strong>faruli safuaris ujredebis ararseboba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. kriptokokuli meningitis dros pacienti<br />

uCivisL Tavis tkivils, cxelebas, saxezea kefis kunTebis regidoba, Tavis<br />

qalis nervebis <strong>da</strong>zianeba, cnobierebis <strong>da</strong>rRveva, komatozuri<br />

mdgomareoba. xSirad meningitis niSnebi arc aRiniSneba, maT Soris,<br />

cxeleba <strong>da</strong> kefis kunTebis rigidoba.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. kriptokokuli meningitis gamomricxavi faqtoria<br />

Sesabamisi Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

25

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, Tavzurgtvinis siTxis aReba <strong>da</strong> naleqis<br />

gamokvleva mikroskopis qveS tuSis wveTis India ink <strong>da</strong>matebis Semdeg an,<br />

kriptokokis kulturis gamoyofa Tavzurgtvinis siTxi<strong>da</strong>n an, Sratsa<br />

<strong>da</strong>/an Tavzurgtvinis siTxeSi kriptokokuli antigenis aRmoCena.<br />

5. kriptokokuli meningitis <strong>mkurnaloba</strong><br />

antimikozuri<br />

agenti<br />

doza M miRebis<br />

sixSire<br />

miRebis<br />

gza<br />

pirveli rigis sqemebi (27)<br />

amfotericini B 0,7-1,0 mg/kg erTxel IV<br />

+<br />

dReSi<br />

5-flucitozini 25 mg/kg 4X dReSi<br />

mkurnalobis<br />

xangrZlivoba<br />

14 dRe<br />

Semdeg<br />

flukonazoli 400 mg erTxel<br />

dReSi<br />

Semdeg<br />

flukonazoli 200mg erTxel<br />

dReSi<br />

meore rigis sqemebi<br />

amfotericini B 0,7-1,0 mg/kg<br />

+<br />

5-flucitozini 25 mg/kg<br />

erTxel<br />

dReSi<br />

4X dReSi<br />

PO sul mcire 10<br />

kvira<br />

PO<br />

IV<br />

mTeli<br />

cxovreba<br />

6-10 kvira<br />

an<br />

amfotericini B 0,7-1,0 mg/kg erTxel<br />

dReSi<br />

IV<br />

an (msubuq SemTxvevebSi)<br />

flukonazoli 400-800 mg erTxel PO<br />

dReSi<br />

Semdeg<br />

flukonazoli 200 mg erTxel PO<br />

dReSi<br />

6-10 kvira<br />

10-12 kvira<br />

mTeli<br />

cxovreba<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

aucilebelia mTeli cxovrebis manZilze Catardes kriptokokozis<br />

meoradiAqimioprofilaqtika. am mizniT iniSneba flukonazoli 200<br />

mg/dReSiAyoveldRe. alternativas warmoadgens itrakonazoli 200<br />

mg/dReSiAyoveldRe. SemanarCunebeli Terapiis aucilebloba pacientebSi,<br />

romelTa imunuri sistema aRdga (CD4 ricxvi >200 mm3) ar aris <strong>da</strong>mxmare<br />

<strong>da</strong> ar arsebobs raime sawinaaRmdego mosazreba am konkretuli<br />

SemTxvevisTvis.<br />

26

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

27

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

histoplazmozis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. histoplazmozis gamomwvevia soko Histoplazma<br />

capsulatum inhalaciuri sporebi.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. histoplazmozis diagnostika <strong>da</strong>sturdeba sokos kulturiT an<br />

qsovilis bioptatis histologiuri gamokvleviT. hispoplazmozis<br />

diagnostisTvis un<strong>da</strong> Catardes sisxlis <strong>da</strong> kanis testebi, Tumca isini ar<br />

aris farTod gamoyenebuli.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

histoplazmozis gamomricxavi kriteriumebia sokos ararseboba qsovilis<br />

bioptatis histologiuri gamokvleviT.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. histoplazmiT gamowveuli mwvave <strong>da</strong>avadeba<br />

gripismagvaria <strong>da</strong> axasiaTebs: cxeleba, anoreqsia, arTralgia, mialgia,<br />

mSrali xveleba, tkivili gul-mkerdis areSi. diseminacia imunosupresiul<br />

avadmyofSi swrafad viTardeba <strong>da</strong> axasiaTebs: wonaSi <strong>da</strong>kleba, oraluri<br />

<strong>da</strong> kanis <strong>da</strong>zianebuli ubnebi, RviZlis, elenTis <strong>da</strong> limfuri kvanZebis<br />

gadideba. oraluri ubnebisTvis <strong>da</strong>maxasiaTebelia nekrozuli wylulebi.<br />

SesaZlebelia ganviTareds sasis perforacia <strong>da</strong> rbili qsovilis<br />

destruqcia.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. histoplazmozis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

28

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, qsovilis bioptatis histologiuri<br />

gamokvleva histoplazmozis diagnostikisTvis.<br />

5. histoplazmozis <strong>mkurnaloba</strong><br />

antifungaluri<br />

agenti<br />

dozireba miRebis<br />

sixSire<br />

amfotericni B 0.7-1 mg/kg erTxel<br />

dReSi<br />

miRebis gza<br />

IV<br />

xangrZlivoba<br />

10 dRe<br />

sawyis <strong>mkurnaloba</strong>s mohyveba 3 Tviani <strong>mkurnaloba</strong> imunorekonstituciamde<br />

>100 CD4 ujrediT, Sedegi medikamentebiT:<br />

• itrakonazoli 200 mg 2X dReSi PO<br />

• flukonazoli 200 mg 2X dReSi PO<br />

• amfotericini B 1 mg/kg IV kviraSi erTxel.<br />

alternatiul reJims warmoadgens itrakonazoli 200 mg samjer dReSi - 3<br />

dRe, Semdeg 200 mg 2X dReSi 12 kvira (sakvebTan erTad).<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

29

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli kapoSis<br />

sarkomis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. kapoSis sarkoma avTvisebiani simsivnea, romlis<br />

gamomwvevia gamomwvevia me-8 tipis herpes virusi (HHV8 an KSHV).<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. kapoSis sarkomis diagnozi <strong>da</strong>sturdeba kanis <strong>da</strong>zianebuli<br />

ubnebi<strong>da</strong>n aRebuli bioptatis histologiuri gamokvleviT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. kapoSis<br />

sarkomis gamomricxavi kriteriumebia kanis <strong>da</strong>zianebuli ubnebi<strong>da</strong>n<br />

aRebul bioptatSi <strong>da</strong>ignozis histologiurad ar <strong>da</strong><strong>da</strong>stureba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. kanze elementebi warmodgenilia cisferi<br />

an mewamuli feris papulebiT an kvanZebiT, araiSviaTad garSemo<br />

arsebuli kanis limfuri SeSupebiT. xSirad ziandeba sasa, filtvebi kuWnawlavis<br />

traqti <strong>da</strong> limfuri kvanZebi. piris RruSi kapoSis sarkomis<br />

elementebi yvelaze xSirad ganlagebulia magar sasaze, iSviaTad enaze,<br />

xaxaze, nuSura jirkvlebsa <strong>da</strong> RrZilebze. isini warmoadgenen mewamuli<br />

feris papulebs, romlebic Cveulebriv ar aris mtkivneuli. xan<strong>da</strong>xan<br />

SeiZleba Segvxvdes msxvili elementebic <strong>da</strong> elementebi kanze. filtvis<br />

parenqimis <strong>da</strong>zianeba atarebs infiltraciul xasiaTs. xSirad viTardeba<br />

sunTqvis ukmarisoba. filtvis infiltraciuli <strong>da</strong>zianebis mqone<br />

avadmyofebs arakeTilsaimedo prognozi aqvT <strong>da</strong> maTSi maRalia<br />

sikvdilianoba.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. kapoSis sarkomis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

30

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, kapoSis sarkomiT <strong>da</strong>zianebuli kanis<br />

ubnebis biopsia <strong>da</strong> histologiuri gamokvleva.<br />

5. kapoSis sarkomis <strong>mkurnaloba</strong><br />

kapoSis sarkomis <strong>mkurnaloba</strong> tardeba onkologis mier. lokaluri<br />

formis samkurnalod gamoiyeneba sxivuri Terapia. generalizirebuli<br />

formis samkurnalod iniSneba citotoqsiuri qimioTerapia. efeqturobis<br />

sxva<strong>da</strong>sxva xarisxiT gamoiyeneba simsivnis sawinaaRmdego preparatebis<br />

Semdegi kombinaciebi: liposomuri doksorubiciniT monoTerapia,<br />

bleomicini, vinkristini, <strong>da</strong>unorubicini, vinblastini, etopozidi.<br />

calkeuli elementebi SeiZleba moSordes qirurgiulad an lazeris,<br />

Txevadi azotis <strong>da</strong> <strong>da</strong>sxivebis zemoqmedebiT. demonstrirebuli iyo<br />

uSualod kapoSis sarkomatozul kvanZSi bleomicinis Seyvanis<br />

efeqturoba. kapoSis sarkoma SesaZloa <strong>da</strong>eqvemdebaros mxolod arT-s <strong>da</strong><br />

nel-nela alagdes.<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

31

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

arahojkinis limfomebis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. arahojkinis lomfomebi limfuri sistemis<br />

avTvisebiani simsivneebia, romlebic Sidsis fonze xSir SemTxvevaSi<br />

asocirebulia epStein-baris virusTan (EBV).<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. arahojkinis limfomebis diagnozi <strong>da</strong>sturdeba<br />

hipereplazirebuli limfuri kvanZis biofsiiT, histologiuri<br />

gamokvleviT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

arahojkinis limfomis gamomricxavi kriteriumebia simsivnis<br />

morfologiuri substratis ararseboba hiperplazirebuli limfuri<br />

kvanZis bioptatSi.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. arahojkinis limfomebis dros simptomebi<br />

mravalferovania: hiperplazirebuli limfuri kvanZebi SesaZlebelia<br />

palpirdebodes sxva<strong>da</strong>sxva adgilze; cxeleba, wonaSi kleba <strong>da</strong> sisuste<br />

xSiria, Tumca ara aucilebeli; <strong>da</strong>avadebis stadiis gansazRvrisTvis (I-IV)<br />

aucilebelia Semdegi gamokvlevebi: cerebruli, cervikaluri,<br />

Torakaluri <strong>da</strong> abdominaluri kompiuterul-aqsialuri tomografiuli<br />

(CAT) skanireba, Zvlis tvinis <strong>da</strong> Tav-zurg-tvinis siTxis aspiracia <strong>da</strong><br />

gastroskopia.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. arahojkinis limfomis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

32

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, hiperplazirebuli limfuri kvanZis<br />

biofsia <strong>da</strong> histologiuri gamokvleviT simsivnis morfologiuri<br />

substratis aRmoCena.<br />

5. arahojkinis limfomebis (maT Soris berkitis tipis <strong>da</strong><br />

cns-is limfomebis) <strong>mkurnaloba</strong><br />

ara-hojkinis limfomebis samkurnalod efeqturia CHOP reJimi, un<strong>da</strong><br />

Catardes 6 kursi (ganmeorebebi aucilebelia sruli remisiis misaRebad):<br />

‣ prednizoloni 100 mg/dReSi erTxel 5 dRe<br />

‣ vinkristini (onkovini) 1,4 mg/m2 (maqsimum 2 mg/dReSi) erTi doza<br />

mkurnalobis pirvel dRes<br />

‣ ciklofosfamidi 750 mg/m2/dReSi erTi doza mkurnalobis pirvel<br />

dRes<br />

‣ doqsorubicini (hidroqsi<strong>da</strong>unomicini) 50 mg/m2/dReSi erTi doza<br />

mkurnalobis pirvel dRes.<br />

meore cikli iwyeba yovel 21-e dRes (dRe 22-e mohyveba I dRes)<br />

‣ EPOCH reJimi, romelic moicavs etopozids, prednozolons,<br />

vinkristins, ciklofisfamids <strong>da</strong> <strong>da</strong>unorubicins an doqsirubicins<br />

efeqturia arT-sTan kombinaciaSi. igi efuZneba gagrZelebiT<br />

infuzias 96 saaTis ganmavlobaSi, romelic Semdegia:<br />

‣ etopozidi 50 mg/m2 dReSi (centraluri venuri xaziT)<br />

‣ doqsorubucuni 10 mg/m2/dReSi (centraluri venuri xaziT)<br />

‣ vinkristini 0,4 mg/m2/dReSi (maqs 2 mg/kviraSi) (centraluri venuri<br />

xaziT)<br />

‣ ciklofosfamidi 375 mg/m2 me-5 dRes mxolod, bolusiT<br />

(centraluri venuri xaziT)<br />

‣ prednizoloni 100 mg/dReSi pirveli 5 dRe erTxel dReSi.<br />

reJimi un<strong>da</strong> ganmeordes yovel 21 dReSi sanam ar Catardeba 6 cikli.<br />

‣ berkitis–tipis limfomis menejmenti ar gansxvavdeba sxva<br />

limfomebis mkurnalobisgan <strong>da</strong> pasuxobs CHOP <strong>da</strong> EPOCH reJimebs.<br />

swrafad mzardi limfomis <strong>mkurnaloba</strong> ufro agresiuli<br />

qimioTerapiiT (mag : B-ALL reJimi) diskusiis Temas warmoadgens <strong>da</strong><br />

specifikuri rekomen<strong>da</strong>ciebi dRevandeli dRisTvis ar arsebobs.<br />

‣ berkitis–tipis limfomebis SemTxvevebSi qimioTerapias Tan un<strong>da</strong><br />

axldes savaraudo pirveladi keris <strong>da</strong>sxiveba.<br />

‣ arahojkinis limfomebis <strong>mkurnaloba</strong> SesaZlebelia CD4 ujredebis<br />

ricxvisgan <strong>da</strong>moukideblad, Tumca mkurnalobis efeqturobisTvis<br />

arT un<strong>da</strong> <strong>da</strong>iniSnos ufro adre. qimioTerapiis ganmavlobaSi CD4<br />

ujredebis ricxvi >350 mm3 <strong>da</strong>kavSirebulia relapsis maRal<br />

maCveneblebTan arT gareSe (37).<br />

33

‣ intakranialuri limfomebis (metastazebi) arsebobisas sasurvelia<br />

Tavis <strong>da</strong>sxiveba, simsivnis sawinaaRmdego preparatebTan <strong>da</strong><br />

glukokortikoidebTan erTad (38).<br />

cns-is pirveladi limfomis dros erTaderTi efeqturi mtkicebulebaze<br />

<strong>da</strong>fuZnebuli Terapiaa sxivuri Terapia. <strong>da</strong>uyonebliv un<strong>da</strong> <strong>da</strong>iwyos arT<br />

(39,40).<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

34

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

toqsoplazmozis marTvis saxelmwifo stan<strong>da</strong>rti<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. <strong>da</strong>avadeba toqsoplazmozis gamomwvevia paraziti<br />

Toxoplasma gondii. <strong>SidsiT</strong> avadmyofebSi toqsoplazma iwvevs Tavis tvinSi<br />

mravlobiTi anTebadi ubnebis warmoqmnas <strong>da</strong> gamovlindeba encefalitis<br />

an diseminirebuli <strong>da</strong>avadebis saxiT.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. toqsoplazmozis dros Tavis tvinis MAC an MRI skanirebiT<br />

aRmoCndeba mravlobiTi rgoliseburi kerebi. Tu es meTodebi ar aris<br />

xelmisawvdomi diagnozis <strong>da</strong>dgenaSi gvexmareba serologiuri testebi<br />

toqsoplazmis sawinaaRmdegod gamomuSavebul antisxeulebze (IgG klasis).<br />

cerebraluri toqsoplazmozis mqone pacientebis umravlesobas<br />

aReniSneba Toxoplasma gondii-iT gamowveuli infeqciis ga<strong>da</strong>tanis<br />

serologiuri niSnebi. diagnozs a<strong>da</strong>sturebs Tavis tvinis qsovilis<br />

histologiuri gamokvleva.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

toqsoplazmozis gamomricxavi kriteriumebia Tavis tvinis MAC an MRI<br />

skanirebiT aRmoCndeba mravlobiTi rgoliseburi kerebis ar arseboba,<br />

negatiuri serologiuri testebi toqsoplazmis sawinaaRmdegod<br />

gamomuSavebul antisxeulebze (IgG klasis).<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. toqsoplazmozis dros saxezea Semdegi<br />

klinikuri suraTi: cnobierebis <strong>da</strong>rRveva, cxeleba, krunCxvebi, Tavis<br />

tkivili, kerovani nevrologiuri simptomatika motoruli deficitis,<br />

35

kraniuli nervis parezis, moZraobis SezRudvis, dismetriis, mxedvelobis<br />

<strong>da</strong>kargvis <strong>da</strong> afaziis CaTvliT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. toqsoplazmozis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, Tavis tvinis MAC an MRI skanireba,<br />

serologiuri testebi toqsoplazmis sawinaaRmdegod gamomuSavebul<br />

antisxeulebze (IgG klasis), Tavis tvinis biofsia <strong>da</strong> qsovilis<br />

histologiuri gamokvleva.<br />

5. toqsoplazmozis <strong>mkurnaloba</strong><br />

preparati doza M miRebis<br />

sixSire<br />

miRebis<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

<strong>mkurnaloba</strong><br />

pirimetamini 200 mg erTjera<strong>da</strong>d PO<br />

erTjera<strong>da</strong>d<br />

(gajerebiTi doza)<br />

Semdeg<br />

pirimetamini 25 mg<br />

3-jer dReSi PO<br />

6-8 kvira<br />

an 50 mg 2-jer dReSi<br />

+<br />

foliumis 15 mg dReSi PO<br />

6-8 kvira<br />

mJava<br />

erTxel<br />

+<br />

sulfadiazini 1 g 4-jer dReSi PO 6-8 kvira<br />

am sqemaSi sulfadiazini SeiZleba Seicvalos:<br />

• klin<strong>da</strong>miciniT 600 mg i/v an PO dReSi 4-jer 6 kvira<br />

• azitromiciniT 1200 mg PO dReSi erTxel 6 kvira<br />

• klariTromiciniT 1 g PO 2-jer dReSi 6 kvira<br />

• atovakvoniT 750 mg PO 4-jer dReSi 6 kvira.<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

zogierT pacients sWirdeba xangrZlivi <strong>mkurnaloba</strong> toqsoplazmozis<br />

gamo. ga<strong>da</strong>wyvetileba efuZneba klinikur mdgomareobas <strong>da</strong> ganmeorebiT<br />

CAT skanirebas.<br />

meoradi profilaqtika grZeldeba efeqturi reJimis ganaxevrebuli<br />

dozebiT manamde sanam CD4 ujredebs ricxvi sami Tvis ganmavlobaSi<br />

stabilurad ar moimatebs (200 ujredi <strong>da</strong> meti).<br />

36

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

37

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli martivi<br />

herpesiT gamowveuli infeqciebis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. <strong>SidsiT</strong> avadmyofebSi martivi herpesis virusi HSV I<br />

<strong>da</strong> II tipis iwvevs vrcel, persistul an diseminirebul <strong>infeqcia</strong>s,<br />

meningitsa <strong>da</strong> meningoencefalits.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. lokaluri martivi herpesis diagnozi ismeba klinikurad,<br />

xolo diseminirebuli martivi herpesiT gamowveuli infeqciis<br />

diagnostikisTvis aucilebelia virusis kulturis gamoyofa, radioimunoblotingis<br />

meTodi, imunofluoroescencia <strong>da</strong> monoklonuri<br />

antisxeulebiT testireba. herpesul encefalits mivyavarT Tavis tvinSi<br />

<strong>da</strong>zianebis mravlobiTi kerebis ganviTarebamde, romelic TvalsaCinoa<br />

CAT skanirebiT; aseve martivi herpesiT gamowveuli cns-is<br />

diagnostikisTvis gamoiyeneba Tav-zurg-tvinis siTxeSi dnm-is aRmoCena<br />

pjr meodiT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. martivi<br />

herpesiT gamowveuli diseminirebuli infeqciis gamomricxavi<br />

kriteriumebia martivi herpesis virusis kulturis, radioimunoblotingis<br />

meTodis, imunofluoroescenciis <strong>da</strong> monoklonuri<br />

antisxeulebiT, Tav-zurg-tvinis siTxeSi martivi herpesis virusis dnm-ze<br />

pjr testirebis negatiuri Sedegi.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. herpesuli gamonayari Cveulebriv<br />

warmodgenilia vezikulebiTa <strong>da</strong> mtkivneuli eroziebiT, romlebic<br />

ganlagebulia piris irgvliv, cxviris nestoebze, tuCebsa <strong>da</strong> sasqeso<br />

organoebze. diseminirebuli martivi herpesiT gamowveuli infeqciis<br />

38

diagnozis <strong>da</strong>sma xSirad Znelia. saxezea meningitisa an/<strong>da</strong><br />

meningoencefalitis suraTi, Sesabamisi cvlilebebiT CAT skanirebisas.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. lokaluri <strong>da</strong> diseminirebuli martivi herpesiT<br />

gamowveuli infeqciis gamomricxavi faqtoria Sesabamisi Civilebisa <strong>da</strong><br />

simptomebis ar arseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, martivi herpesis virusis kulturis<br />

gamoyofa, martivi herpesis deteqcia radio-imunoblotingis meTodi,<br />

imunofluoroescenciis an/<strong>da</strong> monoklonuri antisxeulebiT testirebis<br />

meTodebiT, herpesul encefalitze eWvis SemTxvevebSi - Tavis tvinis MAC<br />

an MRI skanireba <strong>da</strong> Tav-zurg-tvinis siTxeSi martivi herpesis dnm-is<br />

aRmoCena pjr meTodiT.<br />

5. martivi herpesvirusuli infeqciis msubuqi formis<br />

<strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

acikloviri 400 mg 3-jer dReSi PO 7-10 dRe<br />

an<br />

famcikloviri 250 mg 3-jer dReSi PO 7-10 dRe<br />

an<br />

valacikloviri 1 g 2-jer dReSi PO 7-10 dRe<br />

martivi herpesvirusuli infeqciis recidivis <strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

acikloviri 800 mg 5-jer dReSi PO 7-10 dRe<br />

an<br />

famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe<br />

an<br />

valacikloviri 1 g 2-jer dReSi per os 7-10 dRe<br />

39

martivi herpesvirusuli infeqciis mZime formis <strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebis<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

acikloviri 10 mg/kg 3-jer dReSi IV 7-10 dRe<br />

an<br />

valacikloviri 1 g 2-jer dReSi PO 7-10 dRe<br />

martivi herpesvirusuli infeqciis mZime visceraluri formebis<br />

<strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

acikloviri 10 mg/kg 3-jer dReSi IV 14-21 dRe<br />

meore rigis sqema<br />

foskarneti<br />

(aciklovirze<br />

rezistentobis<br />

SemTxvevebSi)<br />

40-60 mg/kg 3-jer dReSi IV 14 dRe<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

40

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

sartyliseburi liqenis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. <strong>da</strong>avadeba sartyliseburi liqenis gamomwvevia<br />

herpesis jgufis mesame tipis virusi Variccela zoster virus (VZV) . <strong>SidsiT</strong><br />

avadmyofebSi sartyliseburi liqeni multidermatomulia, persistirebs,<br />

axasiaTebs Zlieri tkivili <strong>da</strong> sisuste; SesaZloa moxdes infeqciis<br />

diseminacia kanis, nervuli sistemis, filtvebis, lorwovani garsebis<br />

CarTviT paTologiur procesSi.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

(pjr) meTodiT. sartylisebuli liqenis <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumia<br />

<strong>da</strong>maxasiaTebeli vezikuluri gamonayaris arseboba dermatomis gaswvriv;<br />

cns-is <strong>da</strong>zianebisas Tav-zurg-tvinis siTxeSi VZV dnm-is aRmoCena pjr<br />

meTodiT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

sartyliseburi liqenis gamomricxavi kriteriumebia <strong>da</strong>maxasiaTebeli<br />

vezikuluri gamonayaris ararseboba kanze.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. sartyliseburi liqenis dros saxezea<br />

vezikuluri gamonayari dermatomis gaswvriv, romelsac Tan axlavs<br />

Zlieri mtkivneuloba, zogjer cxeleba, regionuli limfadenopaTia,<br />

Zlieri sisuste; SesaZloa moxdes infeqciis diseminacia<br />

multidermatomuli formis ganviTarebiT, nervuli sistemis, filtvebis<br />

<strong>da</strong> lorwovani garsebis CarTviT paTologiur procesSi.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. sartyliseburi liqenis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

41

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, VZV sawinaaRmdego antisxeulebis<br />

gansazRvra sisxlSi (IgM <strong>da</strong> IgG klasis), cns-is <strong>da</strong>zianebisas VZV dnm-is<br />

aRmoCena Tav-zurg-tvinis siTxeSi pjr meTodiT.<br />

5. sartyliseburi liqenis sxva<strong>da</strong>sxva formebis <strong>mkurnaloba</strong><br />

sartyliseburi liqenis (kanis formis) <strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

acikloviri 800 mg 5-jer dReSi PO 7-10 dRe an<br />

vezikulis<br />

gaSrobamdeE<br />

an<br />

famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe<br />

an<br />

valacikloviri 1 g 3-jer dReSi PO 7-10 dRe<br />

Tvalis sartyliseburi liqenis, infeqciis diseminirebuli <strong>da</strong> visceruli<br />

formebis <strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqemebi<br />

acikloviri 10 mg/kg 3-jer dReSi IV 7-10 dRe<br />

an<br />

valacikloviri 1 gr 3-jer dReSi PO 7-10 dRe<br />

an<br />

famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe<br />

meore rigis sqema<br />

foskarneti<br />

60 mg/kg<br />

an<br />

40 mg/kg<br />

2-jer dReSi<br />

an<br />

3-jer dReSi<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

IV<br />

7-10 dRe<br />

post-herpesuli nevralgia xSiri <strong>da</strong> seriozuli problemaa. <strong>da</strong>zianebul<br />

dermatomebSi viTardeba Zlieri tkivili.<br />

tkivilis kontroli mniSvnelovania <strong>da</strong> tkivilis kupirebis mizniT<br />

iniSneba arasteroidul anTebis sawinaaRmdego preparatebi.<br />

Tu tkivili gaxangrZliv<strong>da</strong> iniSneba amitriptilini, karbamazepini an<br />

fenitoini.<br />

42

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

43

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

citomegalovirusuli infeqciis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. citomegalovirusuli <strong>da</strong>avadebis gamomwvevia<br />

herpesis jgufis me-4 tipis virusi CMV. <strong>SidsiT</strong> avadmyofebSi<br />

citomegalovirusma SieZleba <strong>da</strong>azaianos sxva<strong>da</strong>sxa organoebi <strong>da</strong><br />

sistemebi.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. citomegalovirusis deteqciisTvis gamoiyeneba misi adreuli<br />

antigenis pp65 aRmoCena sisxlSi; pacientebs, romelTa CD4

• citomegalovirusulma <strong>infeqcia</strong>m SeiZleba gamoiwvios piris<br />

Rrus lorwovanis mtkivneuli wylulebi, rac iwvevs kvebis<br />

reJimis <strong>da</strong>rRvevas.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. citomegalovirusuli infeqciis gamomricxavi faqtoria<br />

Sesabamisi Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, CMV pp65 adreuli antigenis aRmoCena<br />

sisxlSi, <strong>da</strong>zianebuli organoebis bioptatis gamokvleva, CMV dnm-is<br />

aRmoCena pjr meTodiT, ofTalmologis konsultacia,<br />

gastroenterologis konsultacia, nevropaTologis konsultacia.<br />

5. citomegalovirusuli infeqciebis sxva<strong>da</strong>sxva formebis<br />

<strong>mkurnaloba</strong><br />

citomegalovirusuli infeqciiT gamowveuli kuW-nawlavis traqtisa <strong>da</strong><br />

cns-is <strong>da</strong>zianebebis <strong>da</strong> retinitis <strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

pirveli rigis sqema<br />

gancikloviri 5 mg/kg 2-jer dReSi IV 2-3 kvira<br />

meoradi profilaqtikisTvis aucilebelia gancikloviriT 5 mg/kg IV<br />

dReSi <strong>mkurnaloba</strong>.<br />

citomegalovirusuli infeqciiT gamowveuli kuW-nawlavis traqtisa <strong>da</strong><br />

cns-is <strong>da</strong>zianebebis <strong>mkurnaloba</strong><br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

mkurnalobis<br />

xangrZlivoba<br />

meore rigis sqemebi<br />

foskarneti 90 mg/kg 2-jer dReSi IV 3 kvira<br />

meoradi profialqtikisTvis aucilebelia foskarnetiT mkurnalobis<br />

xangrZlivi kursi doziT 90mg/kg IV erTxel dReSi.<br />

45

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

citomegalovirusuli retinitis meoradi profilaqtika<br />

antivirusuli<br />

agenti<br />

doza MmiRebis<br />

sixSire<br />

M miRebi<br />

gza<br />

meore rigis sqemebi<br />

Tvalis implantanti, romelic gamoyofs ganciklovirs<br />

+<br />

valgancikloviri 900 mg<br />

erTxel<br />

dReSi<br />

mkurnalobis<br />

xangrZlivoba<br />

PO manamde sanam CD4<br />

ujredebi ricxvi ar<br />

moimatebs 100-150 mm3<br />

minimum 3 Tvis<br />

ganmavlobaSi<br />

meoradi profilaqtikis Sewyveta SesaZlebelia 6 Tvis Semdeg <strong>da</strong><br />

imunorekonstituciisas - CD4 100-150 mm3.<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

46

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

dermatomikozebis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. dermatomikozebi ewodeba kanis sokovan <strong>da</strong>zianebas,<br />

romelic SeiZleba gaCndes sxeulis nebismier adgilze, gamonayari<br />

mSralia, aqercvladi, Tan axlavs qavili.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis ratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. dermatomikozebis <strong>da</strong><strong>da</strong>sturebisTvis aucilebelia <strong>da</strong>zianebuli<br />

kanis anafxekis mikroskopuli gamokvleva.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

dermatomikozis gamomricxavi kriteriumia <strong>da</strong>zianebuli kanis anafxekis<br />

mikroskopiiT gamomnvevis ar arseboba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. dermatomikozebis dros saxezea sxeulis<br />

nebismier adgilze ganviTarebuli mSrali <strong>da</strong> aqercvladi ubani,<br />

romelsac Tan axlavs qavili.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. dermatomikozis gamomricxavi faqtoria Sesabamisi<br />

gamonayaris ar arseboba kanze.<br />

47

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, virusli hepatitebis diagnostika, kanis<br />

<strong>da</strong>zianebuli ubnis anafxekis mikroskopuli <strong>da</strong>Tvaliereba, dermatologis<br />

konsultacia.<br />

5. dermatomikozebis <strong>mkurnaloba</strong><br />

antifungaluri doza<br />

preparati<br />

pirveli rigis sqemebi<br />

Mmikonazoli<br />

(adgilobrivad<br />

gamoyenebisTvis)<br />

klotrimazoli<br />

(adgilobrivad<br />

gamoyenebisTvis)<br />

MmiRebis<br />

sixSire<br />

3-jer dReSi<br />

meore rigis sqemebi<br />

ketokonazoli 200 mg dReSi<br />

erTxel<br />

an<br />

itrakonazoli 100 mg dReSi<br />

erTxel<br />

M miRebi<br />

gza<br />

Aadgilobrivad 21 dRe<br />

an<br />

3-jer dReSi adgilobrivad 21 dRe<br />

PO<br />

PO<br />

mkurnalobis<br />

xangrZlivoba<br />

1-3 Tve<br />

1-3 Tve<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

48

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

oniqomikozebis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. oniqomikozebi warmoadgens frCxilis sokovan<br />

<strong>da</strong>zianebebs, romlebic iwveven frCxilis firfitebis deformaciasa <strong>da</strong><br />

rRvevas.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. oniqomikozebis <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumia gamomwvevis<br />

aRmoCena frCxilis firfitis qvevi<strong>da</strong>n aRebul <strong>da</strong> kaliumis hidroqsidiT<br />

<strong>da</strong>muSavebul masalaSi mikroskopuli gamokvleviT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

oniqomikozebis gamomricxavi kriteriumia <strong>da</strong>zianebuli frCxilis<br />

firfitis qvevi<strong>da</strong>n aRebul <strong>da</strong> kaliumis hidroqsidiT <strong>da</strong>muSavebul<br />

masalaSi gamomwvevis ararseboba mikroskopuli <strong>da</strong>TvalierebiT.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. oniqomikozebi iwveven frCxilis<br />

firfitebis deformaciasa <strong>da</strong> rRvevas.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. oniqomikozebis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ar arseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

49

Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, masalis<br />

aReba <strong>da</strong>zianebuli frCxilis firfitis qvevi<strong>da</strong>n, kaliumis hidroqsidiT<br />

<strong>da</strong>muSaveba <strong>da</strong> mikroskopuli <strong>da</strong>Tvaliereba, dermatologis konultacia.<br />

5. oniqomikozebis <strong>mkurnaloba</strong><br />

pirveli rigis sqemebi<br />

antifungaluri<br />

preparati<br />

doza MmiRebis<br />

sixSire<br />

MmiRebi<br />

gza<br />

terbinafini 250 mg dReSi PO<br />

erTxel<br />

mkurnalobis<br />

xangrZlivoba<br />

6 kvira xelis<br />

TiTebis<br />

<strong>da</strong>zianebisas an<br />

12 kvira fexis<br />

TiTebis<br />

<strong>da</strong>zianebisas<br />

an<br />

itrakonazoli 200 mg 2-jer dReSi PO yoveli Tvis I<br />

kviris<br />

ganmavlobaSi 2<br />

Tvis manZilze<br />

(xelis TiTebis<br />

<strong>da</strong>zianebisas),<br />

3-4 Tve (fexis<br />

TiTebi<br />

<strong>da</strong>zianebisas)<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

50

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

seboreuli dermatitis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. varaudoben, rom seboreuli dermatitis gamomwvevia<br />

soko Pitysporu ovale (aseve cnobilia rogorc Malassezia furfur). elementi<br />

warmoadgens wiTeli feris laqas, romelic iqercleba.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. seboreuli dermatitis diagnozi <strong>da</strong>sturdeba sokos aRmoCeniT<br />

kanis <strong>da</strong>zianebuli ubni<strong>da</strong>n anafxeki masalis mikroskopuli gamokvlevisas.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. seboreuli<br />

dermatitis diagnozi gamoiricxeba, Tu kanis <strong>da</strong>zianebuli ubni<strong>da</strong>n<br />

anafxeki masalis mikroskopuli gamokvlevisas gamomwvevi ar aRmoCndeba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. seboreuli dermatitis dros saxezea<br />

aqerclili wiTeli feris laqa saxeze, cxviris nestoebis irgvliv,<br />

cxvir-tuCis naoWze, warbebze, Tavis Tmian nawilze, gul-mkerdis areSi<br />

iRliebSi, tanis ze<strong>da</strong> nawilsa <strong>da</strong> sazardulis areSi.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. seboreuli dermatitis gamomricxavi faqtoria Sesabamisi<br />

Civilebisa <strong>da</strong> simptomebis ararseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

51

Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, <strong>da</strong>zianebuli<br />

kanis anafxekis mikroskopuli gamokvleva, dermatologis konsultacia.<br />

5. seboreuli dermatitis <strong>mkurnaloba</strong><br />

rekomendebulia <strong>da</strong>zianebuli ubnebis xSirad <strong>da</strong>bana qerclis<br />

mosaSoreblad,<br />

karg Sedegs iZleva selenis sulfidis Semcveli samkurnalo Sampunebis<br />

gamoyeneba.<br />

SesaZloa yvelaze efeqturi aRmoCndes hidrokortizonis 1%-ani mazis<br />

aplikaciebi. aseve karg Sedegs iZleva ketokonazolis 2%-ani kremi.<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

52

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli munis<br />

marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. <strong>da</strong>avadeba munis gamomwvevia tkipa Sarkoptes scabiei.<br />

mdedr tkipas kanSi gahyavs gasasvleli, romelsac aqvs ramodenime sm<br />

sigrZis ze<strong>da</strong>piri<strong>da</strong>n wamoweuli wiTeli nawiburis Sesaxe<strong>da</strong>oba. mdedri<br />

tkipa gayvanil gasasvlelSi debs kvercxebs <strong>da</strong> Semdeg ga<strong>da</strong>adgildeba<br />

sxeulis sxva nawilSi. kvercxebi<strong>da</strong>n gamodis tkipebis axali Taoba,<br />

romlebic izrdebian, jvardebian, gahyavT axali gasasvlelebi <strong>da</strong> deben<br />

axal kvercxebs.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. munis diagnozi diagnozi ismeba klinikuri gamovlinebebisa <strong>da</strong><br />

<strong>da</strong>zianebuli keris anafxekis mikroskopuli gamokvlevis safuZvelze.<br />

mikroskopiisas aRmoCndeba tkipebi an/<strong>da</strong> maTi kvercxebi.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong> /Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. munis<br />

gamomricxavi kriteriumebia anafxekis mikroskopisas tkipebis an/<strong>da</strong> maTi<br />

kvercxebis ararseboba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. munis dros kanqveSa gasasvlelis adgilze<br />

viTardeba gamonayari, romelic xSirad gvxvdeba:<br />

• xelebze - mtevnebze (gansakuTrebiT TiTebs Soris),<br />

• majis, i<strong>da</strong>yvis, muxlismomxrel ze<strong>da</strong>pirebze,<br />

• winamxris i<strong>da</strong>yviskena ze<strong>da</strong>pirze,<br />

• sasqeso asoze,<br />

• sarZeve jirkvlebsa <strong>da</strong><br />

• beWebze.<br />

• avadmyofs ZiriTa<strong>da</strong>d awuxebs tanis Zlieri qavili,<br />

gansakuTrebiT RamiT.<br />

53

• imunodeficitis mqone pacientebs xSirad uviTardebaT munis<br />

mZime forma, romelsac uwodeben norvegiuls. misTvis<br />

<strong>da</strong>maxasiaTebelia vezikuluri gamonayari <strong>da</strong> sqeli fufxebis<br />

warmoqmna mTel sxeulze. munis am formis dros qavili ar aris<br />

gamoxatuli.<br />

• qavilis gamo muni xSirad rTuldeba meoradi infeqciebiT.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. munis gamomricxavi faqtoria Sesabamisi Civilebisa <strong>da</strong><br />

simptomebis ararseboba.<br />

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, <strong>da</strong>zianebuli<br />

keris anafxekis mikroskopuli Seswavla, dermatologis konsultacia.<br />

5. munis <strong>mkurnaloba</strong>A<br />

SerCevis preparats warmoadgens adgilobrivad gamosayenebeli 1%-ani<br />

gamabenzen heqsaqloridi, romelic ismeba mTels tanze, Tavis gar<strong>da</strong>,<br />

mozrdilebSi Camoibaneba 24 sT-Si, xolo bavSvebSi _ 8sT-Si. sakmarisia<br />

erTjeradi <strong>da</strong>muSaveba.<br />

aseve SesaZlebelia kanis <strong>da</strong>muSaveba 1%-ani permetriniT an 1%-ani<br />

lin<strong>da</strong>niT; es preparatebic ismeba mTels tanze <strong>da</strong> Camoibaneba 8 sT-Si.<br />

permetrinisa <strong>da</strong> lin<strong>da</strong>nis gamoyeneba ar SeiZleba orsulebisaTvis,<br />

meZuZuri dedebisa <strong>da</strong> bavSvebisaTvis.<br />

norvegiuli munis samkurnalod, imunodeficitis mqone pacientebSi,<br />

efeqturia ivermeqtini, 200 mg/kg PO erTjera<strong>da</strong>d.<br />

tansacmeli, TeTreuli <strong>da</strong> pirsaxocebi un<strong>da</strong> gamoixarSos <strong>da</strong> <strong>da</strong>uTovdes<br />

gaSrobis Semdeg.<br />

munis <strong>mkurnaloba</strong> un<strong>da</strong> Cautardes sqesobriv partniors <strong>da</strong> yvelas vinc<br />

sayofacxovrebo kontaqtSi iyo <strong>avadmyofTa</strong>n.<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

54

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

stafilokokuri folikulitis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. folikuliti _ kanis <strong>infeqcia</strong>a, romlis drosac<br />

procesi Tmis folikulSia lokalizebuli. <strong>aiv</strong> inficirebulebs xSirad<br />

uviTardebaT pustularuli perifolikuliti. folikulits, rogorc<br />

wesi, iwvevs Staphylococcus aureus, magram sxva mikroorganizmebsac SeuZlia<br />

misi gamowveva.<br />

2. kriteriumebi _<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. stafilokokuri folikulitis diagnozi ismeba klinikuri<br />

gamovlinebebis safuZvelze. gamonayari warmodgenilia mravlobiTi<br />

wvrili (5 mm diametris), hiperemiuli folikulebiT, romlebic centrSi<br />

<strong>da</strong>Cirqebulia. xSirad elementebs aqvT midrekileba gaerTianebisaken.<br />

kanis <strong>da</strong>zianebas Tan axlavs qavili.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is<br />

ararseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

stafilokokuri folikulitis gamomricxavi kriteriumia Sesabamisi<br />

klinikuri suraTis ar arseboba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. stafilokokuri folikulitis dros<br />

gamonayari warmodgenilia mravlobiTi wvrili (5 mm diametris),<br />

hiperemiuli folikulebiT, romlebic centrSi <strong>da</strong>Cirqebulia. xSirad<br />

elementebs aqvT midrekileba gaerTianebisaken. kanis <strong>da</strong>zianebas Tan<br />

axlavs qavili.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. stafilokokuri folikulitis gamomricxavi faqtoria<br />

Sesabamisi gamonayaris ararseboba.<br />

55

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, pustulis<br />

SigTavsis baqteriologiuri gamokvleva, dermatologis konsultacia.<br />

5. stafilokokuri folikulitis <strong>mkurnaloba</strong><br />

I rigis preparati<br />

cefaleqsini 500 mg PO 4-jer dReSi 7-21 dRe.<br />

alternatiuli preparati<br />

kloksacilini 500 mg PO 4-jer dReSi 7-21 dRe.<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

56

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli<br />

kontagiozuri moluskis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT gamowveul<br />

infeqciur <strong>da</strong>avadebas. kontagiozuri moluski _ kanis ze<strong>da</strong>piruli<br />

<strong>infeqcia</strong>a, romelsac iwvevs kontagiozuri moluskis virusi. <strong>aiv</strong><br />

inficirebulebSi <strong>aiv</strong> negatiurebisgan gansxvavebiT: elementebi<br />

raodenobrivad bevria, xangrZlivad persistirebs, ufro msxvilia <strong>da</strong><br />

Znelad eqvemdebareba <strong>mkurnaloba</strong>s.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirus<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT. kontagiozuri moluskis diagnozi ismeba <strong>da</strong>maxasiaTebeli<br />

elementis aRmoCenisas. specifikuri diagnostikuri testi virusis<br />

aRmosaCenad ar arsebobs.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is ar<br />

arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

kontagiozuri moluski gamomricxavi kriteriumia Sesabamisi gamonayaris<br />

ararseboba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva. kontagiozuri moluskis gamomwvevi kanSi<br />

SeRwevisas iwvevs 2-5 mm diametris kanisferi mkvrivi papulebis<br />

ganviTarebas. papulebi Seicavs TeTr cximovan sekrets. gamonayaris<br />

elementebi SeiZleba ganviTardes sxeulis nebismier adgilas, xSirad<br />

iyos ucvlelad mravali Tvis manZilze <strong>da</strong>/an gaqres <strong>da</strong> Semdeg kvlav<br />

gaCndes.<br />

b) gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar<br />

arsebobs, <strong>aiv</strong> inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar<br />

warmoadgendes. kontagiozuri moluskis gamomricxavi faqtoria<br />

Sesabamisi gamonayaris ar arseboba.<br />

57

4. diagnostikur _ laboratoriuli testebi <strong>da</strong><br />

specialistTa konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra polimerizaciis jaWvuri reaqciis<br />

meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,<br />

Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, eqim<br />

dermatologis konultacia.<br />

5. kontagiozuri moluskis <strong>mkurnaloba</strong><br />

kontagiozuri moluskis <strong>mkurnaloba</strong> mdgomareobs papulis rbili<br />

SigTavsis mocilebaSi, romlis Semdeg papula qreba. mkurnalobis taqtika<br />

yvela SemTxvevaSi individualuria. arsebobs kanis <strong>da</strong>zianebuli ubnis<br />

<strong>da</strong>muSavebis sxva<strong>da</strong>sxva meTodi. elementebs <strong>da</strong>muSaveba SesaZlebelia<br />

Semdegi meTodebis gamoyenebiT:<br />

_ kiuretaJi;<br />

_ qimiuri destruqcia fenolis koncentrirebuli xsnariT;<br />

_ krioTerapia;<br />

_ eleqtrokoagulacia.<br />

cnobilia, rom <strong>aiv</strong> inficirebulebSi arT-s <strong>da</strong>wyeba xels uwyobs<br />

kontagiozuri moluskis eliminacias. naCvenebi iyo, rom antivirusuli<br />

preparati – cidofoviri, romelsac aqvs Zlieri antiretrovirusuli<br />

moqmedeba, aseve efeqturia kontagiozuri moluskis samkurnalod<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

7. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

58

<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> avadmyofebSi B hepatitis<br />

virusiT ko-infeqciis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis/sindromis mokle ganmarteba<br />

B hepatiti a<strong>da</strong>mianis B hepatitis virusiT gamowveuli infeqciuri<br />

<strong>da</strong>avadebaa. <strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis<br />

virusiT gamowveul infeqciur <strong>da</strong>avadebas. orive paTogeniT erTdroulad<br />

<strong>da</strong>avadebisas saubaria <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong> B hepatitis virusiT<br />

ko<strong>infeqcia</strong>ze.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli – <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is <strong>da</strong>/an <strong>aiv</strong> provirusis dnm-is aRmoCena<br />

sisxlSi polimerizaciis jaWvuri reaqciis meTodiT; BB hepatitis<br />

virusiT <strong>da</strong>avadebis <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumia HBsAg-is arseboba<br />

sisxlis SratSi. imunofermentuli analizis meTodiT. HBsAg-is arseboba<br />

> 6 Tveze meti xangrZlivobiT qronikuli HBV infeqciis maCvenebelia.<br />

qronikuli HBV infeqciis sxva<strong>da</strong>sxva variantis sadiagnostiko markerebia:<br />

HBeAg, Anti-HBe <strong>da</strong> HBV DNA.<br />

b) gamomricxavi – <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: A<strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli analizis<br />

meTodiT, <strong>aiv</strong> rnm-is <strong>da</strong>/an <strong>aiv</strong> provirus dnm-is ararseboba sisxlSi<br />

polimerizaciis jaWvuri reaqciis meTodiT. B hepatitis virusiT<br />

infeqciis gamomricxavi kriteriumebia: HBsAg-is <strong>da</strong> Anti-HBc<br />

antisxeulebis ararseboba sisxlis SratSi.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli - <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia, igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SesaZloa gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (1 Tvis ganmavlobaSi sxeulis wonis 10% an meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi. B hepatiti mwvave stadiaze SesaZloa usimptomod<br />

mimdinareobs, umetes SemTxvevaSi mwvave B hepatitis dros avadmyofs<br />

aReniSneba zoga<strong>da</strong>d hepatitis niSnebi, rogoricaa: siyviTle, saerTo<br />

sisuste, Sardis gamuqeba, ganavlis gaRiaveba, zogjer sxeulis<br />

temperatutis momateba, diskomforti muclis RruSi, gulisrevis<br />

SegrZneba, Rebineba <strong>da</strong> sxva intoqsikaciis movlenebi. <strong>da</strong>avadebam 1.4%-Si<br />

SesaZloa miiRos fulminanturi mimdinareoba. <strong>avadmyofTa</strong> 10-15%-Si<br />

<strong>da</strong>avadeba qronikul mimdinareobas Rebulobs <strong>da</strong> qronikuli B hepatiti<br />

59

praqtikulad xasiaTdeba usimptomo mimdinareobiT, SesaZlebelia<br />

gamoxatuli iyos mxolod zogadi saerTo sisuste.<br />

b) gamomricxavi - qronikul B hepatitis iseve rogorc <strong>aiv</strong><br />

<strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi ar arsebobs, qronikul B<br />

hepatitiTa <strong>da</strong> <strong>aiv</strong>-iT koinficirebuli pacienti wlebis ganmavlobaSi<br />

SeiZleba Civilebs ar warmoadgendes.<br />

4. diagnostikur-laboratoriuli testebi<br />

yvela HIV <strong>da</strong>debiT avadmyofs un<strong>da</strong> Cautardes gamokvleva HBsAg-ze <strong>da</strong><br />

anti-HBc antisxeulebze(AII). im SemTxvevaSi, Tu HBsAg uaryofiTia <strong>da</strong> anti-<br />

HBc <strong>da</strong>debiTi, maSin avadmyofs un<strong>da</strong> Cautardes gamokvleva anti-HBs-ze(AII)<br />

<strong>da</strong> ga<strong>da</strong>wydes esaWiroeba Tu ara avadmyofs HBV vaqcinacia.<br />

yvela avadmyofs, romelsac aqvs <strong>da</strong>debiTi HBsAg un<strong>da</strong> Cautardes<br />

gamokvleva anti-HDV-ze(AII).<br />

yvela avadmyofs, romelsac aqvs <strong>da</strong>debiTi HBsAg un<strong>da</strong> Cautardes Semdegi<br />

gamokvlevebi:<br />

HBeAg <strong>da</strong> anti-HBe, HBV dnm-is gansazRvra, RviZlis ultrabgeriTi<br />

gamokvleva, RviZlis biofsia an fibrozis arainvaziuri markerebis<br />

gansazRvra RviZlis <strong>da</strong>avadebis simZimis Sesafaseblad, ALT-is gansazRvra<br />

(seriuli), CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra,<br />

<strong>aiv</strong> virusuli <strong>da</strong>tvirTvis gansazRvra, sisxlis saerTo analizi.<br />

5. <strong>mkurnaloba</strong><br />

HBV infeqciis mkurnalobis SemTxvevaSi HIV koinfeqciT avadmyofebSi<br />

gaTvaliswinebul un<strong>da</strong> iqnas 2 ZiriTadi varianti:<br />

60

1. HBV mkurnalobis algoriTmi HIV koinfeqciiT avadmyofebisTvis,<br />

romelTac ar esaWiroebaT arv <strong>mkurnaloba</strong>. H<br />

HBV/HIV koinfeqciiT<br />

avadmyofebi HAART-is<br />

Cvenebis gareSeE.<br />

HBV DNA, ALT,<br />

HBeAg<br />

ALT-is normaluri<br />

done, HBV DNA-is<br />

<strong>da</strong>bali done<br />

HBVaqtiuri<br />

<strong>da</strong>avadeba, maRali<br />

HBV DNA.*<br />

dinamikaSi<br />

<strong>da</strong>kvirveba<br />

RviZlis <strong>da</strong>avadebis<br />

statusi<br />

RviZlis araaqtiuri<br />

an msubuqi <strong>da</strong>avadeba**<br />

aqtiuri <strong>da</strong>/an<br />

progresirebadi <strong>da</strong>avadeba***<br />

dinamikaSi<br />

<strong>da</strong>kvirveba<br />

CD4≥500/mm 3 CD420000IU/ml HBeAg(+) pozitiurisTvis, HBV DNA>2000IU/ml HBeAg(-) negatiurisTvis.<br />

** Metavir _F2<br />

61

HBV/HIV koinfeqciiT avadmyofebisTvis, romelTac ar esaWiroebaT arv<br />

<strong>mkurnaloba</strong> HBV infeqciis samkurnalod SerCevis preparati aris<br />

interferoni.<br />

mkurnalobis reJimebi aris Semdegi:<br />

1. HBeAg (+) pozitiuri avadmyofebisTvis.<br />

stan<strong>da</strong>rtuli INF 5-6 MU/dReSi an 10 MU 3-jer kviraSi 4-6 Tve.<br />

2. HBeAg (-) negatiuri avadmyofebisTvis.<br />

stan<strong>da</strong>rtuli INF 3-6 MU 3-jer kviraSi 12 Tve.<br />

an<br />

3. PEG-INF 2a 180mkg 1- jer kviraSi 12 Tve. HBeAg/ anti-HBe statusisgan<br />

<strong>da</strong>moukideblad.<br />

4. im SemTxvevaSi Tu interferoni ukunaCvenebia gamoyenebul un<strong>da</strong> iqnas<br />

adefoviri 10mg dReSi.<br />

2. HBV mkurnalobis algoriTmi HIV koinfeqciiT avadmyofebisTvis,<br />

romelTac WirdebaT arv <strong>mkurnaloba</strong>. H<br />

HBV/HIV koinfeqciiT<br />

avadmyofebi romelTac<br />

WirdebaT HAART .<br />

maRali HBV DNA<br />

<strong>da</strong>bali HBV DNA<br />

avadmyofebi<br />

ciroziT<br />

avadmyofebi<br />

lamivudinis mimarT<br />

rezistentobis<br />

gareSi<br />

lamivudin rezistentuli<br />

avadmyofebi<br />

HAART SerCevis reJimi<br />

HAART romelSic<br />

Sedis tenofoviri +<br />

lamivudini an<br />

emtricitabini<br />

HAART romelSic<br />

Sedis tenofoviri<br />

+ lamivudini an<br />

emtricitabini<br />

un<strong>da</strong> Canacvldes erTi<br />

NRTI tenofoviriT an<br />

<strong>da</strong>ematos tenofoviri<br />

62

HBV/HIV koinfeqciiT avadmyofebisTvis, romelTac esaWiroebaT arv<br />

<strong>mkurnaloba</strong> <strong>da</strong> HBV <strong>mkurnaloba</strong> gaTvaliswinebul un<strong>da</strong> iqnas Semdegi:<br />

a) Tu HBV DNA aris maRali koncentraciiT, maSin HAART aucileblad<br />

un<strong>da</strong> Seicavdes or medicaments, romelsac gaaCnia ormagi aqtivoba<br />

rogorc HBV aseve HIV mimarT.<br />

b) lamivudinis mimarT rezistentobis SemTxvevaSi, roca HIV <strong>infeqcia</strong><br />

kontrolirebadia, erT-erTi NRTI un<strong>da</strong> Seicvalos tenofoviriT.<br />

g) lamivudinis mimarT rezistentobis SemTxvevaSi, roca HIV <strong>infeqcia</strong><br />

kargad ar kontroldeba, pirvel rigSi yuradreba un<strong>da</strong> mieqces HAART-s,<br />

romelic kargad gaakontrolebs <strong>aiv</strong> <strong>infeqcia</strong>s <strong>da</strong> <strong>da</strong>ematos tenofoviri.<br />

d) avadmyofebSi, romelTac aqvT cirozi HBV mkurnalobis sakiTxi un<strong>da</strong><br />

ga<strong>da</strong>wydes HBV DNA-s <strong>da</strong>bali maCveneblis dros. (HBV DNA>200IU/ml). aseT<br />

avadmyofebSi interferoni ukunaCvenebia.<br />

fulminanturi mwvave B hepatitis <strong>mkurnaloba</strong> HIV koinfeqciiT<br />

avadmyofebSi<br />

Cveulebriv mwvave B hepatiti SemTxvevaTa maRal procentSi mTavrdeba<br />

gamojanmrTelebiT <strong>da</strong> amitom <strong>mkurnaloba</strong>s ar saWiroebs.<br />

fulminanturi mwvave B hepatitis SemTxvevaSi lamivudiniT <strong>mkurnaloba</strong><br />

un<strong>da</strong> iqnas ganxiluli, miuxe<strong>da</strong>vad <strong>aiv</strong>-is mimarT rezistentobis<br />

ganviTarebis riskisa.<br />

tenofoviris <strong>da</strong> adefoviris <strong>da</strong>niSvnisgan Tavi un<strong>da</strong> iqnas Sekavebuli am<br />

medikamentebis gamoxatuli nefrotoqsiurobis gamo.<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

HBV mkurnalobis efeqturoba HBeAg (+) pozitiur avadmyofebSi fasdeba<br />

anti-HBe-is myari serokonversiiT, xolo HBeAg (-) negatiur avadmyofebSi<br />

ALT-s myari normalizebiT <strong>da</strong> HBV dnm-is myari supresiiT(

<strong>infeqcia</strong>/<strong>SidsiT</strong> avadmyofebSi C hepatitis virusiT<br />

ko-infeqciis marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis/sindromis mokle ganmarteba<br />

C hepatiti a<strong>da</strong>mianis C hepatitis virusiT gamowveuli infeqciuri<br />

<strong>da</strong>avadebaa. <strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis<br />

virusiT gamowveul infeqciur <strong>da</strong>avadebas. orive paTogeniT erTdroulad<br />

<strong>da</strong>avadebisas saubaria <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong> C hepatitis virusiT<br />

ko<strong>infeqcia</strong>ze.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli – <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is <strong>da</strong>/an <strong>aiv</strong> provirusis dnm-is aRmoCena<br />

sisxlSi polimerizaciis jaWvuri reaqciis meTodiT; C hepatitis virusiT<br />

<strong>da</strong>avadebis <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumebia: C hepatitis virusis<br />

sawinaaRmdego antisxeulebis arseboba sisxlis SratSi imunofermentuli<br />

analizis meTodiT <strong>da</strong>/an C hepatitis virusis rnm-is aRmoCena sisxlSi<br />

polimerizaciis jaWvuri reaqciis meTodiT..<br />

b) gamomricxavi – <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: A<strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli analizis<br />

meTodiT, <strong>aiv</strong> rnm-is <strong>da</strong>/an <strong>aiv</strong> provirus dnm-is ararseboba sisxlSi<br />

polimerizaciis jaWvuri reaqciis meTodiT. C hepatitis virusiT<br />

infeqciis gamomricxavi kriteriumebia: C hepatitis virusis sawinaaRmdego<br />

antisxeulebis ararseboba, <strong>da</strong>/an C hepatitis virusis rnm-is ararseboba<br />

sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli - <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia, igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SesaZloa gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (1 Tvis ganmavlobaSi sxeulis wonis 10% an meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi; C hepatiti mwvave stadiaze ZiriTa<strong>da</strong>d usimptomod<br />

mimdinareobs, mxolod SemTxvevaTa 25%-Si SeasaZloa gamovlindes<br />

simptomebi: siyviTle, saerTo sisuste, Sardis gamuqeba, ganavlis<br />

gaRiaveba, zogjer sxeulis temperatutis momateba, diskomforti muclis<br />

RruSi, gulisrevis SegrZneba, Rebineba <strong>da</strong> sxva intoqsikaciis movlenebi.<br />

<strong>da</strong>avadeba SemTxvevaTa 80%-Si qronikul mimdinareobas Rebulobs <strong>da</strong><br />

qronikuli C hepatiti praqtikulad xasiaTdeba usimptomo mimdinareobiT,<br />

SesaZlebelia gamoxatuli iyos mxolod zogadi saerTo sisuste. aqe<strong>da</strong>n<br />

gamomdinare C hepatitic miekuTvneba laboratiriulad <strong>da</strong>siagnostiko<br />

<strong>da</strong>avadebebs.<br />

64

) gamomricxavi - <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi <strong>da</strong> niSnebi<br />

ar arsebobs, <strong>aiv</strong> inficirebuls wlebis ganmavlobaSi SesaZloa simptomebi<br />

ar aReniSnebodes; C hepatitis virusiT infeqciis simptomebi <strong>da</strong> niSnebi<br />

aseve ar arsebobs <strong>da</strong> avadmyofs wlebis ganmavlobaSi SesaZloa ar<br />

aReniSnebodes araviTari simptomi.<br />

4. diagnostikur-laboratoriuli testebi.<br />

yvela HIV <strong>da</strong>debiT avadmyofs udna Cautardes gamokvleva anti-HCV<br />

antisxeulebze(AII). Anti-HCV (+) pozitiuri Sedegis SemTxvevaSi un<strong>da</strong><br />

Catardes HCV RNA-s gansazRvra.<br />

yvela avadmyofs, romelsac aqvs HCV RNA (+) pozitiuri un<strong>da</strong> Catardes<br />

Semdegi gamokvlevebi:<br />

1. ΗCV genotipis gansazRvra .<br />

2. HCV virusuli <strong>da</strong>tvirTvis gansazRvra.<br />

3. sisxlis saerTo analizi, ALT, AST, G-GT, kreatinini.<br />

4. RviZlis ultrabgeriTi gamokvleva.<br />

5. RviZlis biofsia an fibrozis arainvaziuri markerebis<br />

gansazRvra RviZlis <strong>da</strong>avadebis simZimis Sesafaseblad<br />

6 CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra,<br />

<strong>aiv</strong> virusuli <strong>da</strong>tvirTvis gansazRvra.<br />

5. <strong>mkurnaloba</strong><br />

HCV infeqciis samkurnalod HCV/HIV ko-infeqciiT avadmyofbSi gamoiyeneba<br />

kombinirebuli antivirusuli <strong>mkurnaloba</strong> pegilirebuli alfa<br />

interferoniT <strong>da</strong> ribaviriniT.<br />

mwvave C hepatitis mkurnalobis sakiTxi ko_infeqciiT avadmyofebSi jerjerobiT<br />

sabolood ga<strong>da</strong>Wrili ar aris.<br />

qronikuli C hepatitis <strong>mkurnaloba</strong>: Tu qronikuli C hepatitis diagnozi<br />

ganisazRvra <strong>aiv</strong> infeqciis adreul stadiaze (manamde, sanam avadmyofs ar<br />

Wirdeba HAART <strong>mkurnaloba</strong>) HCV infeqciis <strong>mkurnaloba</strong> <strong>da</strong>wyebul un<strong>da</strong><br />

iqnas. (AIII).<br />

Tu ko-infeqciT avadmyofebs aqvT Rrma imunodeficiti, jer <strong>da</strong>wyebul<br />

un<strong>da</strong> iqnas HAART <strong>da</strong> HCV mkurnalobis sakiTxi ganxilul un<strong>da</strong> iqnas<br />

mxolod CD4 ujredebis raodenobis momatebis Semdeg. (AII).<br />

HCV infeqciis mkurnalobis rejimi HIV koinfeqciiT avadmyofebSi<br />

interferoni:<br />

- PEG-IFN alpha 2α- 180 mkg 1 Xjer kviraSi an PEG-IFN alpha 2b 1.5 mkg/kg<br />

kviraSi erTxel.<br />

ribavirini<br />

- HCV 1 <strong>da</strong> HCV 4 genotipiT avadmyofebisTvis maRali virusuli<br />

<strong>da</strong>tvirTviT ribavirini 1000-1200 mg dReSi 1-jer (mkurnalobis<br />

<strong>da</strong>wyeba) (BIII)<br />

65

- yvela sxva SemTxvevaSi (maT Soris HCV 1 <strong>da</strong> HCV 4 genotipiT<br />

avadmyofebisTvis <strong>da</strong>bali virusuli <strong>da</strong>tvirTviT) ribavirini 800 mg<br />

dReSi 1-jer (AII).<br />

HIV/HCV ko-infeqciiT avadmyofebSi, genotipisgan <strong>da</strong>moukideblad<br />

mkurnalobis xangrZlivoba Seadgens 48 kviras (BI).<br />

HCV infeqciis mkurnalobis algoriTmi HCV/HIV koinfeqciiT<br />

avadmyofebSi<br />

HCV/HIV ko<strong>infeqcia</strong><br />

HCV RNA (+) <strong>da</strong>debiTi<br />

CD4+ >200/mm 3<br />

( 200-350 mm 3 )<br />

CD4+ 800, 000 IU/ml)<br />

HCV 1 genotipi<br />

virsuli <strong>da</strong>tvirTva<br />

(

pegilirebuli interferonis <strong>da</strong> ribavirinis dozis cvlilebebi<br />

mkurnalobis dros ganviTarebuli hematologiuri cvlilebebis dros<br />

ribavirinis Semcireba<br />

600 mg -mde<br />

medikamentebis dozis cvlilebebi<br />

ribavirin<br />

is<br />

Sewyveta<br />

PEG-IFN-is<br />

Semcireba<br />

70%,50%, 25%-iT<br />

PEG-IFN<br />

Sewyveta<br />

neitrofilebi

menejmenti<br />

(seleqtiuri serotoninis<br />

ukumitacebis inhibitori)<br />

Tireoiduli hormoni<br />

gverdiTi movlenebi<br />

hipoTireozis dros (AII).<br />

β-blokatorebi<br />

hiperTireozis dros (CIII).<br />

Tanmxlebi antiretrovirusuli medikamentebis<br />

gamoyeneba.<br />

PEG- intrferoniT <strong>da</strong> ribaviriniT kombinirebuli mkurnalobis dros<br />

cirozian avadmyofebSi di<strong>da</strong>nozini (ddI) ukunaCvenebia (EI) <strong>da</strong> aseve<br />

sasurvelia ar iqnas gamoyenebuli RviZlis naklebad mZime <strong>da</strong>zianebis<br />

dros. (EII).<br />

PEG- intrferoniT <strong>da</strong> ribaviriniT kombinirebuli mkurnalobis dros<br />

stavudini (d4T) gansakuTrebiT di<strong>da</strong>nozinTan (ddI) kombinaciaSi ar un<strong>da</strong><br />

iqnas gamoyenebuli, radgan am dros izrdeba laqtat acidozis<br />

ganviTarebis riski. (EII).<br />

aseve HCV –s kombinirebuli antivirusuli mkurnalobis dros HIV koinfeqciiT<br />

avadmyofebSi zidovudinis gamoyenebisgan Tavi un<strong>da</strong> iqnas<br />

Sekavebuli, radgan zidovudini zrdis anemiis <strong>da</strong> neitropeniis<br />

ganviTarebis risks (DII).<br />

PI –s gamoyeneba amcirebs myari virusuli pasuxis(SVR) ganviTarebis<br />

albaTobas HIV/HCV ko-infeqciiT avadmyofebSi, Tumca jer-jerobiT<br />

kategoriuli uaryofiTi rekomen<strong>da</strong>ciebi PI –s gamoyenebis mimarT ar aris.<br />

NVP (nevirapini) sifrTxiliT un<strong>da</strong> iqnas gamoyenebuli (AII).<br />

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

HCV antivirusul <strong>mkurnaloba</strong>ze myofi avadmyofebis<br />

monitoringi, mkurnalobis tolerantobis <strong>da</strong> mkurnalobis<br />

efeqturobis Sefasebis mizniT<br />

maCveneblebi<br />

1,2 4 8 12 16 20 24 28 32 34 36 48 72<br />

mkurnalobis<br />

tolerantoba<br />

sisxlis<br />

saerTo<br />

Trombocite<br />

bi<br />

X<br />

X<br />

X X X X X X X X X X X<br />

CD4 X X X X X X X X X<br />

TSH X X X<br />

68

HCV RNA<br />

raodenobri<br />

vi (VL)<br />

X<br />

mkurnalobis<br />

efeqturoba<br />

HCV RNA<br />

Tvisobrivi X X X<br />

‣ antivirusuli mkurnalobis <strong>da</strong>wyebi<strong>da</strong>n 12 kviraze, Tu HCV virusuli<br />

<strong>da</strong>tvirTva gax<strong>da</strong> aragansazRvradi an Semcir<strong>da</strong> sul cota 2 log 10 -iT, es<br />

niSnavs, rom <strong>mkurnaloba</strong>ze adreuli virusuli pasuxi (EVR)<br />

miRebulia <strong>da</strong> <strong>mkurnaloba</strong> un<strong>da</strong> gagrZeldes.<br />

‣ Tu HCV virusuli <strong>da</strong>tvirTva ar Semcir<strong>da</strong> sul cota 2 log 10 -iT,<br />

<strong>mkurnaloba</strong> un<strong>da</strong> Sewydes, radgan aseT SemTxvevaSi myari virusuli<br />

pasuxis(SVR) ar miReba mosalodnelia <strong>da</strong>axloebiT 99-100%-Si. (AII).<br />

‣ zemoT aRniSnuli vrceldeba HCV nebismieri genotipiT avadmyofze.<br />

‣ amis Semdeg mkurnalobis <strong>da</strong>wyebi<strong>da</strong>n 24 kviraze rekomendebulia HCV<br />

RNA –is (Tvisobrivi) gansazRvra <strong>da</strong> im avadmyofebSi, romlebic am<br />

etapze rCebian HCV RNA (+) pozitiuri, <strong>mkurnaloba</strong> un<strong>da</strong> Sewydes.<br />

(radgan aseT SemTxvevaSi myari virusuli pasuxis(SVR) ar miiReba<br />

mosalodnelia <strong>da</strong>axloebiT 99-100%-Si.)<br />

‣ mkurnalobis <strong>da</strong>wyebi<strong>da</strong>n 48 kviraze un<strong>da</strong> ganisazRvros HCV RNA<br />

(Tvisobrivi) <strong>da</strong> miRebuli Sedegi <strong>da</strong>afiqsirebs mkurnalobis bolo<br />

pasuxs. (EOT)<br />

‣ mkurnalobis <strong>da</strong>mTavrebi<strong>da</strong>n 6 Tvis Semdeg kvlav un<strong>da</strong> ganisazRvros<br />

HCV RNA (Tvisobrivi). negatiuri HCV RNA mianiSnebs myari virusuli<br />

pasuxis (SVR) miRebaze, ris Semdegac <strong>da</strong>avadebis recidivis ganviTareba<br />

Zalian iSviaTia.<br />

‣ Semdgomi gamokvleva SesaZloa Catardes 12-24 Tvis Semdeg mkurnalobis<br />

<strong>da</strong>mTavrebi<strong>da</strong>n.<br />

7. gaidlaini romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

69

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong> tuberkulozis koinfeqciis<br />

marTva<br />

(protokoli)<br />

1. <strong>da</strong>avadebis /nozologiis/sindromis mokle ganmarteba<br />

<strong>aiv</strong> <strong>infeqcia</strong>/Sidsi ewodeba a<strong>da</strong>mianis imunodeficitis virusiT<br />

gamowveul infeqciur <strong>da</strong>avadebas. tuberkulozis gamomwvevia<br />

tuberkulozis mikobaqteria. orive paTogeniT erTdroulad <strong>da</strong>avadebisas<br />

saubaria <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong> tuberkuloziT ko<strong>infeqcia</strong>ze.<br />

2. kriteriumebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli – <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis <strong>da</strong>ma<strong>da</strong>sturebeli<br />

kriteriumebia: <strong>aiv</strong> antisxeulebis arseboba sisxlis SratSi<br />

imunoblotingis meTodiT, <strong>aiv</strong> rnm-is raodenobrivad <strong>da</strong>/an <strong>aiv</strong> provirusis<br />

dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis<br />

meTodiT; tuberkuloziT <strong>da</strong>avadebis <strong>da</strong>ma<strong>da</strong>sturebeli kriteriumia:<br />

avadmyofis biologiur masalaSi (maT Soris naxvelis nacxSi) mJavagamZle<br />

baqteriebis (mgb) arseboba, biologiur masalaSi kulturaluri meTodiT<br />

tuberkulozis mikobaqteriis aRmoCena.<br />

b) gamomricxavi – <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: A<strong>aiv</strong><br />

antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,<br />

raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus dnm-is<br />

ararseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT;<br />

tuberkulozis gamomricxavi kriteriumebia: tuberkulozis<br />

<strong>da</strong>maxasiaTebeli klinikuri niSnebisa <strong>da</strong> simptomebis ararseboba,<br />

biologiur masalaSi (maT Soris naxvelis nacxSi) baqterioskopiiT mgbsa<br />

<strong>da</strong> kulturaluri gamokvleviT tub.mikobaqteriis ararseboba.<br />

3. simptomebi <strong>da</strong> niSnebi<br />

a) <strong>da</strong>ma<strong>da</strong>sturebeli - <strong>aiv</strong> <strong>infeqcia</strong>/Sidss paTognomuri klinikuri niSnebi<br />

ar gaaCnia, igi miekuTvneba laboratoriulad sadiagnozo <strong>da</strong>avadebebs.<br />

simptomebi<strong>da</strong>n SesaZloa gamovyoT: gaxangrZlivebuli cxeleba,<br />

gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli<br />

profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi<br />

kleba (1 Tvis ganmavlobaSi sxeulis wonis 10% an meti), sxva<strong>da</strong>sxva<br />

gamonayari kansa <strong>da</strong> lorwovanze, kandidozuri ezofagiti, cns-is<br />

atipiuri <strong>da</strong>zianebebi; tuberkulozis <strong>da</strong>ma<strong>da</strong>sturebel simptomebs<br />

miekuTvneba: zogadi niSnebi: subfebriliteti, Ramis oflianoba, advilad<br />

<strong>da</strong>Rla, saerTo sisuste, Sromis unaris <strong>da</strong>qveiTeba, taqikardia.<br />

tuberkulozis filtvis formis dros zogad simptomatikas emateba: 2<br />

kviris an meti xangrZlivobis xveleba (produqtiuli, mSrali an<br />

sisxliani), haeris ukmarisoba, usiamovno SegrZneba an tkivili<br />

gulmkerdSi; tuberkulozis filtvgareSe formebis dros ki zogado<br />

intoqsikaciis niSnebs emateba ama Tu im organos <strong>da</strong>zianebisaTvis<br />

<strong>da</strong>maxasiaTebeli lokaluri simptomatika.<br />

70

) gamomricxavi - <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi simptomebi <strong>da</strong> niSnebi<br />

ar arsebobs, <strong>aiv</strong> inficirebuls wlebis ganmavlobaSi SesaZloa simptomebi<br />

ar aReniSnebodes; tuberkulozis gamomricxavi niSnebi <strong>da</strong> simptobebia<br />

Civilebis ararseboba, kontaqtis ararseboba aqtiuri tuberkuloziT<br />

<strong>da</strong>avadebulTan;<br />

mdgomareobebi <strong>da</strong>kavSirebuli aqtiur tuberkulozTan bavSvebSi<br />

tuberkulozi saeWvoa, rodesac adgili aqvs:<br />

• anamnezSi kontaqts filtvis tuberkulozis <strong>da</strong><strong>da</strong>sturebul<br />

SemTxvevasTan<br />

• wiTelas ga<strong>da</strong>tanis Semdeg imunosupresiul mdgomareobas<br />

• wonaSi klebas, xvelas, paTologiur auskultaciur monacemebs<br />

filtvebSi, romelic ar <strong>da</strong>eqvemdebara farTo speqtris<br />

antibiortikoTerapias<br />

• ze<strong>da</strong>piruli limfuri kvanZebis umtkivneulo SeSupebas<br />

tuberkulozi savaraudoa, roca adgili aqvs saeWvo tuberkulozis<br />

SemTxevevas <strong>da</strong> erT-erT niSans qvemoT CamoTvlilTagan<br />

• tuberkulozis kanis testi 5 mm-ze meti induraciiT<br />

• Sesabamisi cvlilebebi gulmkerdis rentgenogramaze<br />

• Sesabamisi histologiuri cvlilebebi biofsiur masalaSi<br />

• <strong>da</strong>debiTi Sedegi antituberkulozur <strong>mkurnaloba</strong>ze<br />

tuberkulozi <strong>da</strong><strong>da</strong>sturebulia, roca<br />

• tuberkulozis mikobaqteria identificirebulia biologiur<br />

sekretebSi an qsovilebSi<br />

• naxvelis nacxis samjeradi pir<strong>da</strong>piri mikroskopiiT minimum or<br />

preparatSi aRmoCenilia mJavagamZle mikobaqteria<br />

4. diagnostikur-laboratoriuli testebi <strong>da</strong> specialistTa<br />

konsultaciebi<br />

CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, <strong>aiv</strong><br />

virusuli <strong>da</strong>tvirTvis gansazRvra, sisxlis saerTo analizi, RviZlis<br />

funqciuri sinjebi, Tirkmlis funqciuri sinjebi, virusuli hepatitis<br />

markerebis gansazRvra, naxvelis nacxis gamokvleva mgb-ze, gul-mkerdis<br />

rentgenologiuri gamokvleva, muclis Rrus eqoskopia; eqiminfeqcionistis<br />

konsultacia, eqim-fTiziatris konsultacia;<br />

5. <strong>mkurnaloba</strong><br />

tuberkulozis <strong>mkurnaloba</strong> <strong>aiv</strong> inficirebul pacientebSi un<strong>da</strong> <strong>da</strong>iwyos<br />

aqtiuri tuberkulozis diagnozis <strong>da</strong><strong>da</strong>sturebi<strong>da</strong>n rac SeiZleba male.<br />

71

aqtiuri tuberkulozis mkurnalobisTvis rekomendirebuli reJimebi <strong>aiv</strong><br />

inficirebul pacientebSi<br />

tuberkulozis SemTxvevis tipi<br />

axali tbB pacienti<br />

adre tb-namkurnalebi pacienti, maT<br />

Soris<br />

• relafsi<br />

• <strong>mkurnaloba</strong> misi Sewyvetis<br />

Semdeg<br />

• sxva SemTxveva<br />

• uSedego <strong>mkurnaloba</strong> 4<br />

qronikuli (ze<strong>da</strong>mxedvelobis qveS<br />

Catarebuli ganmeorebiTi mkurnalobis<br />

Semdeg naxveli isev mgb pozitiuria)<br />

mrtb (aRiniSneba rezistentoba minimum H <strong>da</strong> R)<br />

tuberkulozis mkurnalobis<br />

reJimebi 1<br />

intensiuri faza 2 gagrZelebis<br />

faza<br />

HRZE 2 Tvis HR 4 Tvis<br />

ganmavlobaSi 3 ganmavlobaSi<br />

HRZES 2 Tvis<br />

ganmavlobaSi<br />

an<br />

HRZE 1 Tvis<br />

ganmavlobaSi<br />

specialuri reJimi<br />

HRE 5 Tvis<br />

ganmavlobaSi<br />

H –izoniazidi, R – rifampicini, Z – pirazinamidi, E – etambutoli, S- streptomicini.<br />

1 – <strong>aiv</strong> inficirebuli pacientebisaTvis aqtiuri tuberkuloziT mkurnalobis<br />

yoveldRiuri reJimia rekomendirebuli;<br />

2 - rekomendebulia <strong>mkurnaloba</strong> uSualo ze<strong>da</strong>mxedvelobis qveS Catarebuli<br />

qimioTerapiis mTeli kursis ganmavlobaSi.<br />

3 – streptomicini SesaZloa gamoyenebul iqnes etambutolis nacvlad. tuberkulozuri<br />

meningitisas etambutoli un<strong>da</strong> Seicvalos streptomiciniT.<br />

4- yvela SemTxvevaSi un<strong>da</strong> Catardes wamlebis mimarT mikroorganizmis mgrZnobelobis<br />

Seswavla mkurnalobis reJimis individualuri wesiT SesarCevad.<br />

tuberkulozis mkurnalobisTvis <strong>aiv</strong> inficirebul bavSvebSi<br />

rekomendirebulia igive reJimebi, rac mozrdilebSi. preparatebis<br />

dozireba xdeba sxeulis masis Sesabamisad.<br />

72

pirveli rigis antituberkulozuri medikamentebis rekomendebuli dozebi<br />

medikamentebi dRiuri dozebi 1<br />

(Cveuli doza an<br />

zRvruli)<br />

izoniazidi<br />

rifampicini<br />

pirazinamidi<br />

etambutoli<br />

streptomicini<br />

5 mg/kg<br />

(Cveulebriv 300 mg)<br />

10 mg/kg<br />

(450 mg TuU 50 kg)<br />

25 mg/kg<br />

(20-30 mg/kg)<br />

15 mg/kg<br />

(15-20 mg/kg)<br />

15 mg/kg<br />

(12-18 mg/kg)<br />

kviraSi samjer<br />

miRebisTvis<br />

gaTvaliswinebuli<br />

dozebi<br />

(Cveuli doza an<br />

zRvruli)<br />

10 mg/kg<br />

(Cveulebriv 900 mg)<br />

10 mg/kg<br />

(450 mg TuU 50 kg)<br />

35 mg/kg<br />

(30-40 mg/kg)<br />

30 mg/kg<br />

(20-35 mg/kg)<br />

15 mg/kg<br />

(12-18 mg/kg)<br />

1. rodesac rifampicini gamoiyeneba antiretrovirusul<br />

medikamentebTan erTad, rekomendebulia yoveldRiuri reJimiT<br />

<strong>mkurnaloba</strong><br />

rekomendebuli pirveli rigis maarT reJimi tb<br />

pacientebisaTvis, romlebsac eZlevaT rifampicini 1<br />

maarT<br />

arv preparatebis<br />

sasurvelia 2 nrti<br />

(nukleoziduri revers<br />

transkriftazas inhibitori)<br />

+<br />

1 antri (aranukleoziduri<br />

revers trankriftazas<br />

inhibitori)<br />

alternatiuli 3 nrti<br />

kombinacia<br />

ZDV (an TDF)+ 3TC (an<br />

FTC) + EFV 2<br />

ZDV+ 3TC + ABC(an TDF)<br />

1 – dozireba ix me-2 <strong>da</strong>matebaSi<br />

2 - rekomendebulia efavirenzis dozireba 600 mg/dR gansakuTrebiT 60kg<br />

pacientebSi, Tumca es debuleba saWiroebs Semdgom kvlevas.<br />

nevirapini SesaZloa gamoyenebul iqnas (200 mg erTxel 2 kviris<br />

ganmavlobaSi, Semdeg 200 mg orjer), RviZlis funqciuri testebis <strong>da</strong><br />

wamlis toqsiurobis kontroliT.<br />

73

ekomendebuli meore rigis maarT reJimi tb pacientebisaTvis<br />

maarT<br />

sasurvelia 2 nrti<br />

+<br />

2 pi (maT Soris erTi<br />

bustirebuli)<br />

alternatiuli 2 nrti<br />

+<br />

2 pi<br />

arv preparatebis<br />

kombinacia<br />

ABC+ ddI + LPV/r +RTV<br />

an<br />

TDF+ ddI + LPV/r +RTV<br />

ABC+ ddI + SQV +RTV<br />

an<br />

TDF+ ddI + SQV +RTV<br />

rekomendebuli tb reJimebi Tirkmlis <strong>da</strong>avadebis mqone pacientebisTvis 1<br />

intensiuri faza gagrZelebis faza<br />

SerCevis preparati HRZ 2 Tve HR 4 Tve<br />

alternatiuli HRZE 2 Tve HR 4 Tve<br />

1. zemoT aRniSnuli rekomen<strong>da</strong>ciebi un<strong>da</strong> iqnes gaTvaliswinebuli,<br />

rodesac kreatininis done miaRwevs 130-160 mkm/l.<br />

rekomendebuli tb reJimebi pacientebSi RviZlis <strong>da</strong>avadebebiT 1<br />

intensiuri faza gagrZelebis faza<br />

SerCevis preparati SHRE 2 Tve HR 6 Tve<br />

I alternativa SHE 2 Tve HE 10 Tve<br />

II alternativa<br />

RE 9 Tve<br />

1. RviZlis <strong>da</strong>avadebad iwodeba mdgomareoba, rodesac<br />

alaninaminotransferaza samjer aRemateba normis maCvenebels an Tu<br />

saxezea qronikuli hepatiti an cirozi.<br />

74

6. reabilitacia <strong>da</strong> <strong>da</strong>kvirveba<br />

arv <strong>da</strong> tb <strong>mkurnaloba</strong>ze myofi pacientebis monitoringi<br />

Sefaseba kvira Tve<br />

0 2 4 8 3 4 5 6 7 8 9 10 11 12<br />

tb/ <strong>aiv</strong> <strong>da</strong>avadebebis istoria X X<br />

fizikaluri gamokvleva X X X X X X X<br />

komorbiduli <strong>da</strong>avadebebi X X X X<br />

ginekologiuri gamokvleva X X X X X<br />

rutinuli laboratoriuli X X X X<br />

testebi:<br />

• sisxlis saerTo analizi<br />

• RviZlis funqciuri sinjebi<br />

(alt, ast, bilirubinebi)<br />

• kreatinini<br />

• Sardovana<br />

CD4 ujredebi X X X X<br />

virusuli <strong>da</strong>tvirTva X X X X<br />

gul-mkerdis rentgenologiuri X X<br />

gamokvleva<br />

orsulobis testi X X<br />

naxvelis-nacxis gamokvleva 1 X X X X X X<br />

mkurnalobis reJimis <strong>da</strong>cvis X X X X X X X X X X X X X X<br />

Sefaseba (orive <strong>da</strong>avadebis: tb <strong>da</strong><br />

<strong>aiv</strong> infeqciis)<br />

7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _<br />

`<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> <strong>avadmyofTa</strong> <strong>mkurnaloba</strong> <strong>da</strong> <strong>movla</strong>~.<br />

8. a<strong>da</strong>mianuri <strong>da</strong> materialur-teqnikuri resursi _ eqimiinfeqcionisti,<br />

eqimi-epidemiologi, eqimi-laboranti, virusologiuri,<br />

imunologiuri, klinikuri bioqimiis <strong>da</strong> molekuluri medicinis<br />

laboratoriebi.<br />

75

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