aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
sxva anrti-ebi ver aitaneba an arsebobs rezistentobis gansakuTrebuli<br />
forma.<br />
- ori nrti <strong>da</strong> erTi anrti-s alternativa SeiZleba iyos erTi klasisgan<br />
Sedgenili reJimi – “sammagi nukleozidi” 3 an “oTxmagi nuklezidi”,<br />
romlebic mxolod sami an oTxi nrti-sgan Sedgeba. marTalia, am reJimze<br />
sawyisi pasuxi kargia, 24 kviris Semdeg rezistentobis ganviTarebis meti<br />
albaTobaa (48) (AI). Sesabamisad, sami nrti-s kombinacia un<strong>da</strong><br />
gamoiyenebodes gansakuTrebul situaciebSi, magaliTad TB an HCV<br />
koinfeqciis SemTxvevaSi, rodesac erTdrouli <strong>mkurnaloba</strong>a saWiro, an<br />
alternativis saxiT, Tu antri ar aris xelmisawvdomi.<br />
- ori anrti-s <strong>da</strong> erTi nrti-s kombinacia ar aris rekomendebuli (53) (AI).<br />
- bustirebuli proteazas inhibitori (pi) or nrti-sTan erTad SesaZloa<br />
gamoyenebul iqnes pirveli rigis arT saxiT, Tu ukunaCvenebia anrti-ebi<br />
(anu verc efavirenzi <strong>da</strong> verc nevirapini ver iniSneba):<br />
- fsiqiatriuli <strong>da</strong>avadebebi <strong>da</strong> alt-s mateba 3-5-jer;<br />
- cirozi;<br />
- orsuloba, Tu CD4 ricxvia 250 - 350 ujrdi/mm 3 .<br />
- pi Semcveli pirveli rigis arT-s araefeqturobis dros naklebi<br />
arCevania Semdgomi reJimisTvis. zoga<strong>da</strong>d rekomendebulia, rom pi<br />
Semonaxul iqnes meore rigis reJimisTvis.<br />
3 “sammagi nukleozidi”: fiqsirebuli dozis tableti, romelic Seicavs ZDV <strong>da</strong> 3TC <strong>da</strong><br />
ABC. igi miiReba dReSi orjer (zidovudini ar aris rekomendebuli dReSi erTxel<br />
miRebisTvis). amJamad igi yvelaze martivi sammagi Terapiuli reJimia.<br />
4.3. arT reJimis <strong>da</strong>cva<br />
mkurnalobis optimaluri Sedegis misaRebad saWiroa mkurnalobis<br />
reJimis <strong>da</strong>cva. kargad aris cnobili, rom arT reJimis maRal doneze<br />
<strong>da</strong>cva <strong>da</strong>kavSirebulia <strong>aiv</strong> asocirebuli avadobis <strong>da</strong> sikvdilianobis<br />
mkveTr SemcirebasTan (54) (AI), xolo reJimis arasaTanado <strong>da</strong>cva <strong>aiv</strong>-is<br />
wamlebis mimarT rezistentobis swraf ganviTarebas iwvevs (55) (AI). arTsTvis<br />
ar aris gansazRvruli reJimis <strong>da</strong>cvis efeqturi done (arsebobs<br />
sxvaoba reJimebs Soris), Tumca reJimis <strong>da</strong>cva 95%-ze nakleb doneze<br />
<strong>da</strong>kavSirebulia cud virusologiur <strong>da</strong> imunologiur pasuxTan, xolo<br />
reJimis 100%-iT <strong>da</strong>cvas kidev ufro meti sargebeli moaqvs, vidre 95%-iT<br />
<strong>da</strong>cvas (56, 57) (AI). uaxlesi monacemebi aCveneben korelacias reJimis<br />
<strong>da</strong>cvasa <strong>da</strong> arv sxva<strong>da</strong>sxva klasis mimarT rezistentobas Soris (58) (AI).<br />
<strong>da</strong>bal an arasakmaris reJimis <strong>da</strong>cvas mohyveba arasaxarbielo Sedegebi<br />
pacientisTvis, sazogadoebrivi jan<strong>da</strong>cvisTvis <strong>da</strong> qveynis ekonomikisTvis.<br />
kerZod,<br />
- pacientebi arian mniSvnelovani safrTxis winaSe rezistentobis<br />
ganviTarebis, mkurnalobis araefeqturobis <strong>da</strong> <strong>da</strong>avadebis progresirebis<br />
TvalsazrisiT (59, 60) (AI). axali kombinacia erTi reJimis araefeqturobis<br />
SemTxvevaSi umetesad ufro rTulia <strong>da</strong>cvis TvalsazrisiT (meti<br />
tabletebis ricxvi dReSi, gverdiT movlenebi, dieturi SezRudevebi,<br />
toqsiuroba <strong>da</strong> dozirebis sirTule).<br />
- rezistentuli virusis gavrceleba gamoiwvevs mis ga<strong>da</strong>cemas axlad<br />
inficirebul pirebSi. aSS (61) (AI) <strong>da</strong> evropis (62) (AI) monacemebi<br />
36
Change language