aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ... aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT daavadebuli bavSvebis antiretrovirusuli mkurnalobis marTvis saxelmwifo standarti (protokoli) 1. daavadebis/nozologiis/sindromis mokle ganmarteba - aiv infeqcia/Sidsi warmoadgens adamianis imunodeficitis virusiT (aiv) gamowveul infeqciur daavadebas. 2 . kriteriumebi a. damadasturebeli _ 18 Tvis Semdeg aiv infeqcia/Sidsis damadasturebeli kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. b. gamomricxavi _ 18 Tvis Semdeg aiv infeqcia Sidsis gamomricxavi kriteriumebia: aiv antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT, raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. 18 wlamde asakis bavSvebSi aiv infeqciis diagnostikaSemdegi sqemiT xorcieldeba • aiv-is pirveladi diagnostika xorcieldeba dabadebidan 48 sT-is Semdeg. gamoiyeneba pjr meTodiT aiv dnm gansazRvra axalSobilis sisxlSi, romelic ar aris aRebuli Wiplaris venidan, vinaidan is SeiZleba dabinZurebuli iyos dedis sisxliT. am dros kvlevis substrats warmoadgens periferiuli sisxlis mononuklearebSi arsebuli provirusuli dnm. dabadebidan 48 saaTSi inficirebuli bavSvebis 38% aCvenebs dadebiT pasuxs aiv dnm pjr-ze. testis mgrZnobeloba ar icvleba mniSvnelovnad pirveli 1 kviris ganmavlobaSi, magram mkveTrad matulobs sicocxlis meore kviridan, rodesac daavadebuli bavSvebis 93% gamovlindeba. 28 dRis asakSi aiv dnm pjr-s ukve aqvs 96% mgrZnobeloba da 99% specifiuroba. aiv dnm pjr gamokvlevaze uaryofiTi pasuxis miRebis SemTxvevaSi bavSvs ganmeorebiTi gamokvleva imave meTodiT utardeba 3 Tvis asakSi. miRebuli dadebiTi Sedegi safuZvelia aiv infeqciis winaswari diagnozisa. saboloo diagnozi dgindeba ganmeorebiTi pjr-iT aiv –is dnm-ze sisxlis axal porciaSi. • 2-3 Tvis asakSi aiv dnm pjr meTodis alternatiul meTodad SesaZloa CaiTvalos aiv rnm pjr diagnostikis meTodi, romlis mgrZnobeloba am asakSi 90-100%-s aRwevs, xolo specifiuroba aiv dnm pjr specifiurobis msgavsia, Tumca aiv rnm dabali doniT deteqtireba (
antisxeulebze dadebiTi Sedegi miuTiTebs, rom bavSvi aiv inficirebulia. • Tu bavSvi ikvebeba dedis rZiT, maSin aiv antisxeulebze gamokvlevas azri aqvs ZuZuTi kvebis Sewyvetidan 6 Tvis Semdeg, vinaidan manamde bavSvi SeiZleba e.w. “fanjara periodSi” imyofebodes. 3.simptomebi da niSnebi _ a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs. saSvilosnosSida inficirebis SemTxvevaSi aRwerilia Taviseburi simptomokompleqsi, rac xasiaTdeba zrda-ganviTarebis SeferxebiT, SesaZloa gamoxatuli iyos mravlobiTi darRvevebi qala-saxisa da tvinis nawilebSi. aiv inficirebul axalSobilebs SesaZloa gamoxatuli hqondeT gamoweuli Subli, brtyeli cxviri, egzofTalmi mocisfro sklerebi, mikrocefalia, Tumca unda aRiniSnos, rom ganviTarebis anomaliebi ar aris mkafiod damaxasiaTebeli niSani aiv infeqciisaTvis. aiv inficirebul bavSvebSi simptomebidan SeiZleba gamovyoT: zrdaganviTarebaSi CamorCena, aramotivirebuli cxeleba, qronikuli/morecidive yuris infeqciebi, qronikuli pnevmonia an diarea, qronikuli dermatiti, parotiduli jirkvlebis SeSupeba, sistemuri limfadenopaTia, hepatomegalia, splenomegalia. limfocituri disfunqcia safuZvlad udevs morecidive sokovan infeqciebs, rogoricaa kandidozi, rac Cveulebriv Terapias ar emorCileba. bavSvebSi yvelaze gavrcelebuli oportunistuli infeqciebia: pnevmocisturi pnevmonia (PCP) da sistemuri kandidozi, xSiria ezofagiti. pediatriuli pnevmocisturi pnevmoniis didi wili Zalian adreul asakSi iCens Tavs, rasac Tan axlavs maRali letaloba. es ki am daavadebis proflaqtikis farTod Catarebis aucileblobis safuZvels iZleva. adreuli PCP profilaqtikis Catarebis SesaZlebloba 4-6 kviris asakidan dedis aiv statusis adreul dadgenas did mniSnelobas sZens. sxva oportunistuli infeqciebidan aRsaniSnavia: citomegalovirusuli infeqcia, romelic iwvevs filtvebisa da gastroenteraluri traqtis dazianebas da iSviaTad iwvevs retinits. (rac xSiria mozrdilebSi), qronikuli diarea, gamowveuli kriptosporidioziT, lamblioziT, izosporaTi an iseTi virusiT, rogoricaa, adenovirusi. meningiti SesaZloa gamowveul iyos kriptokokiT, rac klinikurad naklebi simwvaviT vlindeba baqteriul meningitTan SedarebiT. aratuberkulozuri mikobaqteria (Mycobacterium avium intracelulare) daavadebas iwvevs mogvianebiT etapebze imunitetis mZime supresiisas. is iwvevs cxelebas wonaSi klebiT an mis gareSe an SesaZloa gamovlindes malabsorbciuli diareis saxiT. oportunistuli infeqciis garda sicocxlis pirveli wlis ganmavlobaSi aiv inficrebul bavSvebs SesaZloa gamouvlindeT limfoiduri intersticiuli pnevmonia. es nela moprogresire da xSirad asimptomuri daavadebaa. is Cveulebriv vlindeba sicocxlis pirveli wlis Tavze da piks ori wlis asakisaTvis aRwevs. xSiradaa asocirebuli parotiduli jirkvlebis SeSupebasTan da hipergamaglobulinemiasTan. bavSvs SesaZloa hqondes mxolod es gamovlinebani filtvebis dazianebis gamovlinebamde didi xniT adre. Semdgom vlindeba daqveiTebul oqsigenaciasTan dakavSirebuli gamovlinebani, maT Soris dolis 139
- Page 88 and 89: o eqspoziciis Sedegad daavadebis ga
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- Page 96 and 97: an famcikloviri 500 mg 3-jer dReSi
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- Page 104 and 105: ganmavlobaSi 2 Tvis manZilze (xelis
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- Page 108 and 109: 20. Chen XM et al. Cryptosporidiosi
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- Page 114 and 115: 8 igulisxmeba piri, romelsac aReniS
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- Page 130 and 131: ekomendebulia: vaqcina rekomendebul
- Page 132 and 133: 8. United States Centers for Diseas
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- Page 136 and 137: 5. mkurnaloba a) rekomendebuli pirv
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- Page 142 and 143: * saWiroa arv preparatebis bavSvebi
- Page 144 and 145: laboratoriuli monacemebis kontroli
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antisxeulebze <strong>da</strong>debiTi Sedegi miuTiTebs, rom bavSvi <strong>aiv</strong><br />
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 <strong>klinikuri</strong> 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<br />
filtvebisa <strong>da</strong> gastroenteraluri traqtis <strong>da</strong>zianebas <strong>da</strong> iSviaTad<br />
iwvevs retinits. (rac xSiria mozrdilebSi), qronikuli diarea,<br />
gamowveuli kriptosporidioziT, lamblioziT, izosporaTi an iseTi<br />
virusiT, 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<br />
ganmavlobaSi <strong>aiv</strong> inficrebul bavSvebs SesaZloa gamouvlindeT<br />
limfoiduri intersticiuli pnevmonia. es nela moprogresire <strong>da</strong> xSirad<br />
asimptomuri <strong>da</strong>avadebaa. is Cveulebriv vlindeba sicocxlis pirveli<br />
wlis Tavze <strong>da</strong> piks ori wlis asakisaTvis aRwevs. xSira<strong>da</strong>a asocirebuli<br />
parotiduli jirkvlebis SeSupebasTan <strong>da</strong> hipergamaglobulinemiasTan.<br />
bavSvs SesaZloa hqondes mxolod es gamovlinebani filtvebis <strong>da</strong>zianebis<br />
gamovlinebamde didi xniT adre. Semdgom vlindeba <strong>da</strong>qveiTebul<br />
oqsigenaciasTan <strong>da</strong>kavSirebuli gamovlinebani, maT Soris dolis<br />
139
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