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/Sidsis fonze ganviTarebuli martivi herpesiT gamowveuli infeqciebis marTvis saxelmwifo standarti (protokoli) 1.daavadebis /nozologiis / sindromis mokle ganmarteba _ aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul infeqciur daavadebas. SidsiT avadmyofebSi martivi herpesis virusi HSV I da II tipis iwvevs vrcel, persistul an diseminirebul infeqcias, meningitsa da meningoencefalits. 2.kriteriumebi _ a)damadasturebeli _ 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. lokaluri martivi herpesis disgnozi ismeba klinikurad, xolo diseminirebuli martivi herpesiT gamowveuli infeqciis diagnostikisTvis aucilebelia virusis kulturis gamoyofa, radio-imunoblotingis meTodi, imunofluoroescencia da monoklonuri antisxeulebiT testireba. herpesul encefalits mivyavarT Tavis tvinSi dazianebis mravlobiTi kerebis ganviTarebamde, romelic TvalsaCinoa CAT skanirebiT; aseve martivi herpesiT gamowveuli cns-is diagnostikisTvis gamoiyeneba Tavzurg-tvinis siTxeSi dnm-is aRmoCena pjr meodiT. b)gamomricxavi _ 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. martivi herpesiT gamowveuli diseminirebuli infeqciis gamomricxavi kriteriumebia martivi herpesis virusis kulturis, radio-imunoblotingis meTodis, imunofluoroescenciis da monoklonuri antisxeulebiT, Tav-zurg-tvinis siTxeSi martivi herpesis virusis dnm-ze pjr testirebis negatiuri Sedegi. 3.simptomebi da niSnebi a)damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs. simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba, gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is atipiuri dazianebebi da sxva. herpesuli gamonayari Cveulebriv warmodgenilia vezikulebiTa da mtkvneuli eroziebiT, romlebic ganlagebulia piris irgvliv, cxviris nestoebze, tuCebsa da sasqeso organoebze. diseminirebuli martivi herpesiT gamowveuli infeqciis diagnozis dasma xSirad Znelia. saxezea meningitisa an/da meningoencefalitis suraTi, Sesabamisi cvlilebebiT CAT skanirebisas. b)gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar warmoadgendes. lokaluri da diseminirebuli martivi herpesiT 166
gamowveuli infeqciis gamomricxavi faqtoria Sesabamisi Civilebisa da simptomebis ar arseboba. 4.diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi o CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi, Tirkmlis funqciuri sinjebi, martivi herpesis virusis kulturis gamoyofa, martivi herpesis deteqcia radioimunoblotingis meTodi, imunofluoroescenciis an/da monoklonuri antisxeulebiT testirebis meTodebiT, herpesul encefalitze eWvis SemTxvevebSi - Tavis tvinis MAC an MRI skanireba da Tav-zurg-tvinis siTxeSi martivi herpesis dnm-is aRmoCena pjr meTodiT. 5. martivi herpesvirusuli infeqciis msubuqi formis mkurnaloba antivirusuli agenti doza MmiRebis sixSire M miRebi gza mkurnalobis xangrZlivoba pirveli rigis sqemebi acikloviri 400 mg 3-jer dReSi PO 7-10 dRe an famcikloviri 250 mg 3-jer dReSi PO 7-10 dRe an valacikloviri 1 g 2-jer dReSi PO 7-10 dRe martivi herpesvirusuli infeqciis recidivis mkurnaloba antivirusuli agenti doza MmiRebis sixSire M miRebi gza mkurnalobis xangrZlivoba pirveli rigis sqemebi acikloviri 800 mg 5-jer dReSi PO 7-10 dRe an famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe an valacikloviri 1 g 2-jer dReSi per os 7-10 dRe martivi herpesvirusuli infeqciis mZime formis mkurnaloba antivirusuli agenti doza MmiRebis sixSire M miRebis gza mkurnalobis xangrZlivoba pirveli rigis sqemebi acikloviri 10 mg/kg 3-jer dReSi IV 7-10 dRe an valacikloviri 1 g 2-jer dReSi PO 7-10 dRe 167
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<strong>aiv</strong> <strong>infeqcia</strong>/Sidsis fonze ganviTarebuli martivi herpesiT<br />
gamowveuli infeqciebis marTvis saxelmwifo stan<strong>da</strong>rti<br />
(protokoli)<br />
1.<strong>da</strong>avadebis /nozologiis / sindromis mokle ganmarteba _ <strong>aiv</strong><br />
<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<br />
HSV I <strong>da</strong> II tipis iwvevs vrcel, persistul an diseminirebul<br />
<strong>infeqcia</strong>s, 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><br />
provirus dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis<br />
jaWvuri reaqciis meTodiT. lokaluri martivi herpesis disgnozi<br />
ismeba klinikurad, xolo diseminirebuli martivi herpesiT<br />
gamowveuli infeqciis diagnostikisTvis aucilebelia virusis<br />
kulturis gamoyofa, radio-imunoblotingis meTodi,<br />
imunofluoroescencia <strong>da</strong> monoklonuri antisxeulebiT testireba.<br />
herpesul encefalits mivyavarT Tavis tvinSi <strong>da</strong>zianebis mravlobiTi<br />
kerebis ganviTarebamde, romelic TvalsaCinoa CAT skanirebiT; aseve<br />
martivi herpesiT gamowveuli cns-is diagnostikisTvis gamoiyeneba Tavzurg-tvinis<br />
siTxeSi dnm-is aRmoCena pjr meodiT.<br />
b)gamomricxavi _ <strong>aiv</strong> <strong>infeqcia</strong>/Sidsis gamomricxavi kriteriumebia: <strong>aiv</strong><br />
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli<br />
meTodiT, raodenobrivad <strong>aiv</strong> rnm-is <strong>da</strong>/an Tvisobrivad <strong>aiv</strong> provirus<br />
dnm-is ar arseboba sisxlSi polimerizaciis jaWvuri reaqciis<br />
meTodiT. martivi herpesiT gamowveuli diseminirebuli infeqciis<br />
gamomricxavi kriteriumebia martivi herpesis virusis kulturis,<br />
radio-imunoblotingis meTodis, imunofluoroescenciis <strong>da</strong><br />
monoklonuri antisxeulebiT, Tav-zurg-tvinis siTxeSi martivi<br />
herpesis virusis dnm-ze 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 <strong>klinikuri</strong><br />
niSnebi ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo<br />
<strong>da</strong>avadebebs. simptomebi<strong>da</strong>n SeiZleba gamovyoT: gaxangrZlivebuli<br />
cxeleba, gaxangrZlivebuli faRaraTi, limfadenopaTia,<br />
aramotivirebuli profuzuli oflianoba, Zlieri saerTo sisuste,<br />
aramotivirebuli wonaSi kleba (erTi Tvis ganmavlobaSi sxeulis<br />
wonis 10% <strong>da</strong> meti), sxva<strong>da</strong>sxva gamonayari kansa <strong>da</strong> lorwovanze,<br />
kandidozuri ezofagiti, cns-is atipiuri <strong>da</strong>zianebebi <strong>da</strong> sxva.<br />
herpesuli gamonayari Cveulebriv warmodgenilia vezikulebiTa <strong>da</strong><br />
mtkvneuli eroziebiT, romlebic ganlagebulia piris irgvliv, cxviris<br />
nestoebze, tuCebsa <strong>da</strong> sasqeso organoebze. diseminirebuli martivi<br />
herpesiT gamowveuli infeqciis diagnozis <strong>da</strong>sma xSirad Znelia.<br />
saxezea meningitisa an/<strong>da</strong> meningoencefalitis suraTi, Sesabamisi<br />
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<br />
ar warmoadgendes. lokaluri <strong>da</strong> diseminirebuli martivi herpesiT<br />
166
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