aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ... aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
sxva anrti-ebi ver aitaneba an arsebobs rezistentobis gansakuTrebuli forma. - ori nrti da erTi anrti-s alternativa SeiZleba iyos erTi klasisgan Sedgenili reJimi – “sammagi nukleozidi” 3 an “oTxmagi nuklezidi”, romlebic mxolod sami an oTxi nrti-sgan Sedgeba. marTalia, am reJimze sawyisi pasuxi kargia, 24 kviris Semdeg rezistentobis ganviTarebis meti albaTobaa (48) (AI). Sesabamisad, sami nrti-s kombinacia unda gamoiyenebodes gansakuTrebul situaciebSi, magaliTad TB an HCV koinfeqciis SemTxvevaSi, rodesac erTdrouli mkurnalobaa saWiro, an alternativis saxiT, Tu antri ar aris xelmisawvdomi. - ori anrti-s da erTi nrti-s kombinacia ar aris rekomendebuli (53) (AI). - bustirebuli proteazas inhibitori (pi) or nrti-sTan erTad SesaZloa gamoyenebul iqnes pirveli rigis arT saxiT, Tu ukunaCvenebia anrti-ebi (anu verc efavirenzi da verc nevirapini ver iniSneba): - fsiqiatriuli daavadebebi da alt-s mateba 3-5-jer; - cirozi; - orsuloba, Tu CD4 ricxvia 250 - 350 ujrdi/mm 3 . - pi Semcveli pirveli rigis arT-s araefeqturobis dros naklebi arCevania Semdgomi reJimisTvis. zogadad rekomendebulia, rom pi Semonaxul iqnes meore rigis reJimisTvis. 3 “sammagi nukleozidi”: fiqsirebuli dozis tableti, romelic Seicavs ZDV da 3TC da ABC. igi miiReba dReSi orjer (zidovudini ar aris rekomendebuli dReSi erTxel miRebisTvis). amJamad igi yvelaze martivi sammagi Terapiuli reJimia. 4.3. arT reJimis dacva mkurnalobis optimaluri Sedegis misaRebad saWiroa mkurnalobis reJimis dacva. kargad aris cnobili, rom arT reJimis maRal doneze dacva dakavSirebulia aiv asocirebuli avadobis da sikvdilianobis mkveTr SemcirebasTan (54) (AI), xolo reJimis arasaTanado dacva aiv-is wamlebis mimarT rezistentobis swraf ganviTarebas iwvevs (55) (AI). arTsTvis ar aris gansazRvruli reJimis dacvis efeqturi done (arsebobs sxvaoba reJimebs Soris), Tumca reJimis dacva 95%-ze nakleb doneze dakavSirebulia cud virusologiur da imunologiur pasuxTan, xolo reJimis 100%-iT dacvas kidev ufro meti sargebeli moaqvs, vidre 95%-iT dacvas (56, 57) (AI). uaxlesi monacemebi aCveneben korelacias reJimis dacvasa da arv sxvadasxva klasis mimarT rezistentobas Soris (58) (AI). dabal an arasakmaris reJimis dacvas mohyveba arasaxarbielo Sedegebi pacientisTvis, sazogadoebrivi jandacvisTvis da qveynis ekonomikisTvis. kerZod, - pacientebi arian mniSvnelovani safrTxis winaSe rezistentobis ganviTarebis, mkurnalobis araefeqturobis da daavadebis progresirebis TvalsazrisiT (59, 60) (AI). axali kombinacia erTi reJimis araefeqturobis SemTxvevaSi umetesad ufro rTulia dacvis TvalsazrisiT (meti tabletebis ricxvi dReSi, gverdiT movlenebi, dieturi SezRudevebi, toqsiuroba da dozirebis sirTule). - rezistentuli virusis gavrceleba gamoiwvevs mis gadacemas axlad inficirebul pirebSi. aSS (61) (AI) da evropis (62) (AI) monacemebi 36
aCveneben, rom pirveladi rezistentobis sixSire imatebs, da SeZenil rezistentobas uaryofiTi gavlena aqvs arT pasuxze. - rezistentuli Stamis arsebobas mohyveba meore rigis, mesame rigis da e.w. gadarCenis (salvage) reJimi, romlebic, Cveulebriv, ufro Zviria pirveli rigis reJimebTan SedarebiT. - reJimis arasakmarisi dacva, agreTve, moaswavebs daavadebis progresirebis maRal risks, rac met danaxarjebs moiTxovs oportunistuli infeqciebis samkurnalod (63) (AI). 4.3.1. barierebi reJimis dacvaSi da maTi sawinaaRmdego zomebi 4.3.1.1. pacientTan dakavSirebuli faqtorebi da strategiebi pacients ZiriTadi roli akisria reJimis dacvaSi. SeuZlebelia pacientis mier reJimis dacvis potencialis prognozireba. kvlevebma, romlebic Seiswavlidnen sqess, rasas, asaks, aiv gadacemis gzas da ganaTlebis dones, rogorc reJimis dacvis indikatorebs, gansxvavebuli Sedegebi aCvenes (64) (BII). individualuri reJimis dacvis donec SesaZloa sxvadasxva dros gansxvavdebodes (65) (BII). umravlesi aiv inficirebuli raRac dros gamoavlens reJimis dacvis dabal xarisxs. reJimis dacvis dabali donis SesaZlo mizezebia: - narkotikebis da alkoholis moxmareba - cudi kveba siRaribis gamo - religiuri mosazrebebi (66) (DIV) - aiv statusis gamJRavnebis SiSi medikamentebis rutinuli miRebisas - fsiqiatriuli mdgomarebebi (67) (DIV) - gverdiTi movlenebis SiSi da eWvi mkurnalobis saWiroebis Sesaxeb (68) (DIV). SesaZlo sawinaaRmdego strategiebi: - ganaTleba arT saWiroebis Sesaxeb - swrafi reagireba pacientis araswor Sexedulebaze - arT-s mimarT pacientis ganwyobis regularuli Sefaseba - “peer” (Tanasworis) Careva (pacientTa jgufebi) - fsiqiatriuli problemebis regularuli Sefaseba - reJimis dacvisTvis saWiro Cvevebis Sefaseba 4 - specializirebuli socialuri samsaxuris an dawesebulebebis CarTva. 4 es SesaZloa gaZlierdes im pirebis CarTviT, vinc kontaqtSia pacientTan (eqTani, farmacevti, ojaxi), agreTve, grafikis (cxrilebis), saaTiani tabletebis yuTebis gamoyenebiT, mogzaurobisas gegmis SemuSavebiT, Tu rogor miiRos medikamentebi garSemomyofebisTvis SeumCnevlad. 4.3.1.2. jandacvis muSakTan dakavSirebuli faqtorebi jandacvis muSakebi naTlad unda acnobierebdnen reJimis dacvis mniSvnelobas da mis rols rezistentobis ganviTarebaSi. aiv/Sidsis dargSi momuSave profesionali unda iRebdes mudmiv ganaTlebas reJimis dacvis sakiTxebSi. arsebobs ramdenime strategia, romelic unda gamoiyenos jandacvis muSakma reJimis dacvis xarisxis asamaRleblad. 37
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- 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
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- Page 11 and 12: 1.daavadebis definicia Sidsi abrevi
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- Page 66 and 67: mcire mutacia muSaobs kombinaciaSi.
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aCveneben, rom pirveladi rezistentobis sixSire imatebs, <strong>da</strong> SeZenil<br />
rezistentobas uaryofiTi gavlena aqvs arT pasuxze.<br />
- rezistentuli Stamis arsebobas mohyveba meore rigis, mesame rigis <strong>da</strong><br />
e.w. ga<strong>da</strong>rCenis (salvage) reJimi, romlebic, Cveulebriv, ufro Zviria<br />
pirveli rigis reJimebTan Se<strong>da</strong>rebiT.<br />
- reJimis arasakmarisi <strong>da</strong>cva, agreTve, moaswavebs <strong>da</strong>avadebis<br />
progresirebis maRal risks, rac met <strong>da</strong>naxarjebs moiTxovs<br />
oportunistuli infeqciebis samkurnalod (63) (AI).<br />
4.3.1. barierebi reJimis <strong>da</strong>cvaSi <strong>da</strong> maTi sawinaaRmdego zomebi<br />
4.3.1.1. pacientTan <strong>da</strong>kavSirebuli faqtorebi <strong>da</strong> strategiebi<br />
pacients ZiriTadi roli akisria reJimis <strong>da</strong>cvaSi. SeuZlebelia pacientis<br />
mier reJimis <strong>da</strong>cvis potencialis prognozireba. kvlevebma, romlebic<br />
Seiswavlidnen sqess, rasas, asaks, <strong>aiv</strong> ga<strong>da</strong>cemis gzas <strong>da</strong> ganaTlebis<br />
dones, rogorc reJimis <strong>da</strong>cvis indikatorebs, gansxvavebuli Sedegebi<br />
aCvenes (64) (BII). individualuri reJimis <strong>da</strong>cvis donec SesaZloa<br />
sxva<strong>da</strong>sxva dros gansxvavdebodes (65) (BII). umravlesi <strong>aiv</strong> inficirebuli<br />
raRac dros gamoavlens reJimis <strong>da</strong>cvis <strong>da</strong>bal xarisxs.<br />
reJimis <strong>da</strong>cvis <strong>da</strong>bali donis SesaZlo mizezebia:<br />
- narkotikebis <strong>da</strong> alkoholis moxmareba<br />
- cudi kveba siRaribis gamo<br />
- religiuri mosazrebebi (66) (DIV)<br />
- <strong>aiv</strong> statusis gamJRavnebis SiSi medikamentebis rutinuli miRebisas<br />
- fsiqiatriuli mdgomarebebi (67) (DIV)<br />
- gverdiTi movlenebis SiSi <strong>da</strong> eWvi mkurnalobis saWiroebis Sesaxeb (68)<br />
(DIV).<br />
SesaZlo sawinaaRmdego strategiebi:<br />
- ganaTleba arT saWiroebis Sesaxeb<br />
- swrafi reagireba pacientis araswor Sexedulebaze<br />
- arT-s mimarT pacientis ganwyobis regularuli Sefaseba<br />
- “peer” (Tanasworis) Careva (pacientTa jgufebi)<br />
- fsiqiatriuli problemebis regularuli Sefaseba<br />
- reJimis <strong>da</strong>cvisTvis saWiro Cvevebis Sefaseba 4<br />
- specializirebuli socialuri samsaxuris an <strong>da</strong>wesebulebebis CarTva.<br />
4 es SesaZloa gaZlierdes im pirebis CarTviT, vinc kontaqtSia pacientTan (eqTani,<br />
farmacevti, ojaxi), agreTve, grafikis (cxrilebis), saaTiani tabletebis yuTebis<br />
gamoyenebiT, mogzaurobisas gegmis SemuSavebiT, Tu rogor miiRos medikamentebi<br />
garSemomyofebisTvis SeumCnevlad.<br />
4.3.1.2. jan<strong>da</strong>cvis muSakTan <strong>da</strong>kavSirebuli faqtorebi<br />
jan<strong>da</strong>cvis muSakebi naTlad un<strong>da</strong> acnobierebdnen reJimis <strong>da</strong>cvis<br />
mniSvnelobas <strong>da</strong> mis rols rezistentobis ganviTarebaSi. <strong>aiv</strong>/Sidsis<br />
<strong>da</strong>rgSi momuSave profesionali un<strong>da</strong> iRebdes mudmiv ganaTlebas reJimis<br />
<strong>da</strong>cvis sakiTxebSi. arsebobs ramdenime strategia, romelic un<strong>da</strong><br />
gamoiyenos jan<strong>da</strong>cvis muSakma reJimis <strong>da</strong>cvis xarisxis asamaRleblad.<br />
37
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