aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ... aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
o pacientebi saWiroa iyvnen informirebulni SesaZlo oportunistuli infeqciebis niSnebze (ix. protokoli 2 aiv/Sidsis ZiriTadi simtomebis da oportunistuli infeqciebis menejmenti) o saineqcio narkotikebis momxmareblebTan unda ganvixiloT misi Sewyvetis mniSvneloba. Tu pacients ar surs an ar SeuZlia Sewyvitos saineqcio narkotikebis moxmareba maSin unda ganvumartoT zianis Semcirebis arsi; o avadmyofs unda esmodes jansaRi cxovrebis wesis kerZod, Zilis, kvebis, varjiSis mniSvneloba. o pacientebs, romelTac unda daiwyon antiretrovirusuli Terapia, unda ganemartoT Semdegi sakiTxebi: o mkurnalobis reJimis dacvis mniSvneloba; o antiretrovirusuli medikamentebis SesaZlo toqsiuroba; o medikamentebis urTrierTqmedeba; o kontracefciis aucilebloba, rodesac pacienti imyofeba efavirenzis Semcvel reJimze; o pacientebi informirebulni unda iyvnen maTi legaluri pasugismgeblobebisa da uflebebis Sesaxeb; o pacientebi informirebulni unda iyvnen imunizaciis Sesaxeb da samsaxureobrivi riskis Sesaxeb. 3. oportunistuli da sxva infeqciebis profilaqtika aiv infeqcia/SidsiT avadmyofebi imunizirebul unda iyvnen A da B hepatitis virusebisa da gripis virusis sawinaRmdegod. yvela aiv inficirebuli , romlis CD4 limfocitebis ricxvi naklebia 200 mm3 unda daewyoT profilaqtikuri mkurnaloba mTel rig infeqciebze, maT Soris pnevmocisturi pnevmoniis. ko-trimoqsazoliT profilaqtikuri Terapia unda gagrZeldes manamde, sanam CD4 ujredebis ricxvi ar gaxdeba 200 mm3 meti arv mkurnalobis dawyebidan 3 Tvis ganmavlobaSi stabilurad. 4. antiretrovirusuli Terapia 4.1. arT dawyeba arT dawyebis optimaluri dro ar aris dadasturebuli da igi ganxilvis sagania (19) (CIII). sxvadasxva kohortuli kvlevis da saxelmRvanelo rekomendaciebis mimoxilva aCvenebs farTod gavrcelebul Sexedulebas, rom am gadawyvetilebis misaRebad saukeTeso markeria CD4 ricxvi, xolo virusuli datvirTva meoradi markeria (20-30) (CIII). arT dawyebamde unda daiwyos avadmyofis mxardaWera reJimis maqsimaluri dacvis uzrunvelsayofad; janmo rekomendacias uwevs arT dawyebas klinikuri da imunologiuri kriteriumebis safuZvelze. rekomendaciebi arT dawyebis Sesaxeb Sejamebulia cxrilSi 8. 32
cxrili 8 rekomendaciebi arT dawyebis Sesaxeb janmo klinikuri stadia CD4 ricxvi rekomendacia 1 < 200/mm 3 umkurnaleT 200 - 350/mm 3 ganixileT mkurnalobis SesaZlebloba b, g 2 < 200/mm 3 umkurnaleT 200 - 350/mm 3 ganixileT mkurnalobis SesaZlebloba b, g 3 200 - 350/mm 3 umkurnaleT 4 CD4 ricxvisgan umkurnaleT damoukideblad a. ix. danarTi 2 klinikuri stadiebis aRwerilobis Sesaxeb b. rodesac CD4 ricxvi 350/mm 3 -is midamoSia, daiwyeT msjeloba pacientTan arT dawyebis saWiroebis moaxloebis da mkurnalobis sawyisi reJimis Sesaxeb. g. virusuli datvirTva dakavSirebulia CD4 ricxvis klebasTan. rodesac virusuli datvirTva maRalia (> 100000 asli/ml), maRalia CD4 ricxvis swrafad klebis albaToba. Sesabamisad, Tu virusuli datvirTva maRalia da CD4 ricxvi 350/mm 3 -ia, rekomendebulia arT dawyeba. arT dawyeba unda efuZnebodes CD4 ricxvis orjerad gansazRvras 14 – 28 dRis SualediT, raTa gamoiricxos laboratoriuli Secdoma an gadaxris sxva mizezi (magaliTad, Tanmxlebi daavadeba). 4.1.1. virusuli datvirTva virusuli datvirTva TavisTavad ar aris arT dawyebis markeri. Tumca, im SemTxvevaSi Tu virusuli datvirTva 100 000 asli/ml-ze maRalia (man SeiZleba 1 milion asli/ml-s miaRwios), SesaZloa adgili hqondes CD4 ricxvis swraf klebas. marTalia virusuli datvirTvis gansazRvra ZviradRirebulia, mniSvnelovania vicodeT misi mniSvneloba mkurnalobis dawyebamde, raTa SemdgomSi SevafasoT mkurnalobis efeqturoba. Tu virusuli datvirTva ar aris xelmisawvdomi, maSin CD4 ricxvi da klinikuri simptomebi sakmarisia mkurnalobis dawyebis gadawyvetilebis misaRebad. polimerizaciis jaWvuri reqciisa (pjr) da virusuli datvirTvis ar arseboba ar unda gaxdes mkurnalobis gadadebis kriteriumi. 4.1.2 rezistentobis testi mosazreba pirveli rigis mkurnalobamde rezistentobis testis Catarebis Sesaxeb gansxvavebulia. rezistentobaze testireba rekomendebulia im qveynebSi, sadac maRalia priveladi rezistentoba. evropaSi Catarda multicentruli kvleva axaldiagnozdasmul aiv inficirebulebSi 1996 da 2002 wlebSi. am jgufSi rezistentobis prevalentobam Seadgina 10% (31) (BII). aSS 40 qalaqSi Catarebul kvlevaSi rezistentobam 14% Seadgina (32) 33
- Page 1 and 2: aiv infeqcia/SidsiT avadmyofTa mkur
- Page 3 and 4: sarCevi klinikuri saxelmZRvanelo-re
- Page 5 and 6: 3.2.2.cxeleba aiv inficirebulebSi 3
- Page 7 and 8: aiv infeqcia/Sidsis fonze ganviTare
- Page 9 and 10: done mtkicebulebis siZlieris done (
- Page 11 and 12: 1.daavadebis definicia Sidsi abrevi
- Page 13 and 14: Sidsi registrirebulia msoflios 216
- Page 15 and 16: egistrirebul SemTxveevaTa 79% saqar
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- Page 19 and 20: aiv rnm-is koncentracia plazmaSi mk
- Page 21 and 22: SeuZlebelia da gadamwyveti misi dia
- Page 23 and 24: persistuli generalizebuli limfadeno
- Page 25 and 26: signalis amplifikacia komplementuri
- Page 27 and 28: • vizitamde rezistentobis testis
- Page 29 and 30: • adamianis papilomavirusi (maxvi
- Page 31: etinitis identifikaciisTvis, rodesa
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- Page 66 and 67: mcire mutacia muSaobs kombinaciaSi.
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o pacientebi saWiroa iyvnen informirebulni SesaZlo<br />
oportunistuli infeqciebis niSnebze (ix. protokoli 2 <strong>aiv</strong>/Sidsis<br />
ZiriTadi simtomebis <strong>da</strong> oportunistuli infeqciebis menejmenti)<br />
o saineqcio narkotikebis momxmareblebTan un<strong>da</strong> ganvixiloT misi<br />
Sewyvetis mniSvneloba. Tu pacients ar surs an ar SeuZlia<br />
Sewyvitos saineqcio narkotikebis moxmareba maSin un<strong>da</strong><br />
ganvumartoT zianis Semcirebis arsi;<br />
o avadmyofs un<strong>da</strong> esmodes jansaRi cxovrebis wesis kerZod, Zilis,<br />
kvebis, varjiSis mniSvneloba.<br />
o pacientebs, romelTac un<strong>da</strong> <strong>da</strong>iwyon antiretrovirusuli Terapia,<br />
un<strong>da</strong> ganemartoT Semdegi sakiTxebi:<br />
o mkurnalobis reJimis <strong>da</strong>cvis mniSvneloba;<br />
o antiretrovirusuli medikamentebis SesaZlo toqsiuroba;<br />
o medikamentebis urTrierTqmedeba;<br />
o kontracefciis aucilebloba, rodesac pacienti imyofeba<br />
efavirenzis Semcvel reJimze;<br />
o pacientebi informirebulni un<strong>da</strong> iyvnen maTi legaluri<br />
pasugismgeblobebisa <strong>da</strong> uflebebis Sesaxeb;<br />
o pacientebi informirebulni un<strong>da</strong> iyvnen imunizaciis Sesaxeb <strong>da</strong><br />
samsaxureobrivi riskis Sesaxeb.<br />
3. oportunistuli <strong>da</strong> sxva infeqciebis profilaqtika<br />
<strong>aiv</strong> <strong>infeqcia</strong>/<strong>SidsiT</strong> avadmyofebi imunizirebul un<strong>da</strong> iyvnen A <strong>da</strong> B<br />
hepatitis virusebisa <strong>da</strong> gripis virusis sawinaRmdegod.<br />
yvela <strong>aiv</strong> inficirebuli , romlis CD4 limfocitebis ricxvi naklebia 200<br />
mm3 un<strong>da</strong> <strong>da</strong>ewyoT profilaqtikuri <strong>mkurnaloba</strong> mTel rig infeqciebze,<br />
maT Soris pnevmocisturi pnevmoniis. ko-trimoqsazoliT profilaqtikuri<br />
Terapia un<strong>da</strong> gagrZeldes manamde, sanam CD4 ujredebis ricxvi ar gaxdeba<br />
200 mm3 meti arv mkurnalobis <strong>da</strong>wyebi<strong>da</strong>n 3 Tvis ganmavlobaSi<br />
stabilurad.<br />
4. antiretrovirusuli Terapia<br />
4.1. arT <strong>da</strong>wyeba<br />
arT <strong>da</strong>wyebis optimaluri dro ar aris <strong>da</strong><strong>da</strong>sturebuli <strong>da</strong> igi ganxilvis<br />
sagania (19) (CIII). sxva<strong>da</strong>sxva kohortuli kvlevis <strong>da</strong> saxelmRvanelo<br />
rekomen<strong>da</strong>ciebis mimoxilva aCvenebs farTod gavrcelebul Sexedulebas,<br />
rom am ga<strong>da</strong>wyvetilebis misaRebad saukeTeso markeria CD4 ricxvi, xolo<br />
virusuli <strong>da</strong>tvirTva meoradi markeria (20-30) (CIII). arT <strong>da</strong>wyebamde un<strong>da</strong><br />
<strong>da</strong>iwyos avadmyofis mxar<strong>da</strong>Wera reJimis maqsimaluri <strong>da</strong>cvis<br />
uzrunvelsayofad;<br />
janmo rekomen<strong>da</strong>cias uwevs arT <strong>da</strong>wyebas <strong>klinikuri</strong> <strong>da</strong> imunologiuri<br />
kriteriumebis safuZvelze. rekomen<strong>da</strong>ciebi arT <strong>da</strong>wyebis Sesaxeb<br />
Sejamebulia cxrilSi 8.<br />
32
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