aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
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- aqe<strong>da</strong>n gamomdinare, nrti+anrti reJimis Sewyvetisas SesaZloa Sewydes<br />
jer anrti <strong>da</strong> mogvianebiT, <strong>da</strong>axloebiT 7 dRis Semdeg, nrti-ebi. Tumca am<br />
sakiTxTan <strong>da</strong>kavSirebiT sakmarisi monacemebi ar arsebobs.<br />
4.5.1. nrti komponenti<br />
- Tu pirveli rigis arT Seicav<strong>da</strong> ZDV + 3TC, maSin meore rigSi SesaZloa<br />
gamoyenebul iqnas ABC ddI–Tan kombinaciaSi (an TDF <strong>da</strong> moxdes ddI dozis<br />
modifikacia <strong>da</strong> mWidro monitoringi) (83) (CIII).<br />
- Tu pacients pirveli rigis Terapia utardebo<strong>da</strong> TDF an ABC, maT mimarT<br />
rezistentobis maRali albaTobis gaTvaliswinebiT meore rigSi<br />
sasargeblo iqneba ZDV (84) (BII). K65R mutacia, romelsac iwves TDF <strong>da</strong><br />
ABC, zrdis mgrZnobelobas ZDV–s mimarT (85, 86) (BII)..<br />
- 3TC agreTve sasargebloa mis mimarT rezistentobis dros, vinai<strong>da</strong>n mis<br />
mier gamowveuli 184V mutacia amcirebs virusis replikaciis unars <strong>da</strong>,<br />
agreTve, zrdis mgrZnobelobas ZDV mimarT.<br />
4.5.2 pi komponenti<br />
- Tu pirveli rigis Terapia Seicav<strong>da</strong> anrti-s, meore rigSi gamoyenebul<br />
un<strong>da</strong> iqnes pi.<br />
- pi-ebis umravlesoba Zlierdeba (bustirdeba) ritonaviris (RTV an /r)<br />
<strong>da</strong>bali doziT - 100mg 2-jer dReSi. ritonaviri TavisTavad pi-ia.<br />
ritonaviriT ar bustirdeba nelfinaviri, romelic Zlierdeba ara<br />
qimiurad, aramed – sakvebiT. bustirebis meqanizmia ritonaviris mier<br />
citoqrom P450 (CYP) 3A4 izoenzimis inhibireba. Sedegad izrdeba pi<br />
medikamentebis done, gar<strong>da</strong> nelfinavirisa (87) (BII).. ritonaviri<br />
gamoiyeneba mxolod sxva pi-ebis bustirebisTvis <strong>da</strong> ar aris efeqturi<br />
rogorc <strong>da</strong>moukidebeli arv medikamenti.<br />
- pi-ebs Soris gansxvaveba mdgomareobs maT mimarT rezistentobis<br />
ganviTarebisTvis saWiro mutaciebis ricxvSi <strong>da</strong> gverdiTi movlenebis<br />
profilSi.<br />
- yvelaze maRali barieri rezistentobis ganviTarebisTvis aReniSneba<br />
bustirebul lopinavirs (LPV/r) (88).<br />
- ritonaviriT bustirebuli atazanaviris (ATV/r), fosamprenviris (FPV/r),<br />
indinaviris (IDV/r) <strong>da</strong> seqvinaviris (SQV/r) rezistentobis profili<br />
umniSvnelod gansxvavdeba, risi <strong>klinikuri</strong> efeqtic mcirea an saerTod ar<br />
aris.<br />
- atazanaviri SesaZloa gamoyenebul iqnes ritonaviriT bustirebis<br />
gareSec (400 mg/dReSi).<br />
- nelfinaviri efeqturobiT naklebia sxva pi-ebTan Se<strong>da</strong>rebiT. Tumca misi<br />
gamoyeneba kargad dokumentirebulia orsulebSi. misi araefeqturobis<br />
dros SeirCeva D30N mutacia, romelic ar iwvevs jvaredin rezistnetobas<br />
sxva pi-ebis mimarT (89, 90) (BII)..<br />
- arCevis pi-ia LPV/r misi kargad dokumentirebuli efeqturobis gamo (91).<br />
evropaSi registrir<strong>da</strong> LPV/r axali formulireba, romelic gamoiyeneba 2-<br />
jer dReSi <strong>da</strong> ar esaWiroeba macivari (92) (AI).<br />
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