aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ... aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...
- ar warmoebulia LPV/r–is pirdapiri Sedareba amprenaviris axal forma fosamprenavirTan, dReSi erTxel misaReb atazanavirTan (93) (CIII) da seqvinaviris axal 500mg-ian formasTan, arsebobs mxolod arapirdapiri monacemebi (94) (DIV). saWiroa damatebiTi kvlevebi. - pi-s SerCevisas gaTvaliswinebul unda iqnas gverdiTi movlenebi, Tanmxlebi daavadebebi, wamlebTan urTierTqmedeba da pacientis individualuri ganwyoba. cxrili 11 rekomendebuli meore rigis arv reJimi mozardebis mozrdilTaTvis pirveli rigis reJimi meore rigis reJimi LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC an ZDV + 3TC + (EFV an NVP) LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + ABC an LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + (ZDV + 3TC) b LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC TDF + FTC + (EFV an NVP) an LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV ABC + 3TC + (EFV an NVP) an LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ZDV + TDF (+ 3TC) b a LPV/r mocemulia rogorc upiratesi pi bustirebuli ritonaviriT, Tumca sxva pi-ebi SesaZloa gamoyenebul iqnas programis individualuri prioritetebis mixedviT. SesaZloa nebismieris gamoyeneba CamoTvlilTagan: ATV/r, SQV/r, FPV/r, da IDV/r. civi jaWvis ararsebobis SemTxvevaSi SesaZloa nelfinaviris gamoyeneba, Tumca igi ganixileba, rogorc naklebad potenturi, vidre bustirebuli pi-ebi. b ZDV da 3TC gamoyeneba naCvenebia strategiuli mizniT, radgan pirveli rigis araefeqturobis SemTxvevaSi maT mimarT virusi rezistentuli iqneba. kerZod, ZDV SesaZloa Tavidan agvacilos an Seaferxos K65R mutaciis ganviTareba; xolo 3TC SeinarCunebs M184V mutacias, romelic amcirebis virusis replikaciis unars da garkveulwilad zrdis sensitiurobas ZDV mimarT. unda aRiniSnos, rom am strategiis klinikuri Rirebuleba ar aris dadasturebuli. - Tu ganviTarda pi-s Semcveli pirveli rigis arT-s araefeqturoba, meore rigis reJimis SerCeva efuZneba rezistentobis profils. Tu rezistentobis profili ar aris xelmisawvdomi, navaraudebi unda iqnas rezistentoba pirveli rigis reJimSi Semavali pi-s mimarT. pi-s Semcveli pirveli rigis arT-s araefeqturobis dros SesaZlo arCevania: - ZDV + 3TC + SQV/r (an ATV/r, FPV/r, IDV/r) ➔ ABC + ddI + LPV/r - ZDV + 3TC + LPV/r ➔ ABC + ddI + anrti (darunaviri (TMC11)) an bustirebuli tipranaviri (TPV/r) - kidev erTi arCevania ori pi-s kombinacia, magaliTad SQV + ATV/r (95). ar aris rekomendebuli ormagi pi-ebis kombniacaSi TPV/r gamoyeneba. 4.6. gadarCenis (Salvage) reJimebi dadasturebuli meore rigis araefeqturobis SemTxvevebSi (virusologiuri, imunologiuri, klinikuri araefeqturobis kriteriumebiT) ganixileba gadarCenis reJimebi. gadarCenis reJimebSi 42
igulisxmeba im medikamentebis kombinacia, romlebic SesaZloa muSaobdes an virusi maT mimarT iyos nawilobriv rezistentuli. yvela reJimi meore rigis Semdgom garTulebulia da moiTxovs arT-codnis maRal dones da unar-Cvevebs. genotipuri rezistentobis testis monacemebi am situaciaSi aucilebelia. zogierT SemTxvevebSi gadarCenis Terapiis dawyebamde umjobesia ramodenime TviT mocda, Tumca es strategia SesaZloa iyos saSiSi, kerZod, Tu CD4 ujredebis ricxvi dabalia. o Tu SesaZlebelia, unda CaerTos ori medikamentis efeqturi kombinacia mag; SeWris inhibitori enfurvitidi (ENF) (96) (CIII), romelic iniSneba 2-jer dReSi kanqveSa aplikaciis saxiT da axali pi TPV (97,90) (CIII), an axali pi TCM114 (99,100) (CIII). o TPV- genetikuri barieri ufro maRalia, vidre LPV/r da monacemebi gviCveneben mis efeqturobas am ukanasknelTan SedarebiT. dRevandel dRes TPV gamoiyeneba mxolod gadarCenis Terapiis reJimebSi. o sxva SesaZleblobaa ori pi kombinacia (102-104) (CIII), gamonaklisia TPV, romelic ar unda gamoviyenoT sxva pi–sTan kombinaciaSi. 4.7. mkurnalobis dagegmili Sewyveta bevri ewinaaRmdegeba arT dagegmil Sewyvetas, Tumca dasabuTeba SesaZlebelia. mag. CD4>500 mm 3 mudmivi done da virusis supresia mravali wlebis ganmavlobaSi abrkolebs oportunistuli infeqciebis ganviTarebas. mkurnalobis dagegmili Sewyveta, mkurnalobis reJimis araadeqvaturad dacvis SemTxvevaSi, Tavidan agvacilebs rezistentuli Stamebis ganviTarebas. mkurnalobis Sewyvetis Semdeg CD4 limfocitebis ricxvi Camodis pre-arv Terapiis donemde , amdenad aucilebelia pirveli sami Tvis ganmavlobaSi CD4 limfocitebis ricxvis monitoringi. zogierT pacientSi limfocitebis ricxvi >350 mm 3 da dabali virusuli datvirTva (1000-5000 asli/ml) Tveebisa da wlebis ganmavlobaSia SenarCunebuli. mkurnalobis dagegmili Sewyvetis sargebelze arasakmao informaciis arsebobis gamo janmos mier igi ar aris rekomendebuli. 5.aiv inficirebul pacientTa klinikuri monitoringi mas Semdeg rac adamians daesmeba aiv infeqciis diagnozi is uzrunvelyofili unda iyos monitoringiTa da movliT. 5.1. laboratoriuli indikatorebi arT dawyebamde CD4 ujredebis ricxvi o gaimeoreT yovel 6 TveSi, Tu aris amouxsneli Sedegebi (CD4 ujredebis swrafi daqveiTeba an oportunistuli infeqciebis ganviTareba); o Tu mimdinareobs msjeloba arT dawyebaze (CD4 ujredebi tolia an
- 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
- Page 17 and 18: adamianis imunodeficitis virusis sa
- 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 and 32: etinitis identifikaciisTvis, rodesa
- Page 33 and 34: cxrili 8 rekomendaciebi arT dawyebi
- Page 35 and 36: arv medikamentebi arseboben Semdegi
- Page 37 and 38: aCveneben, rom pirveladi rezistento
- Page 39 and 40: - tabletebis Cveneba pacientisTvis
- Page 41: - aqedan gamomdinare, nrti+anrti re
- Page 45 and 46: X (arv): testebi, romlebic unda Cat
- Page 47 and 48: maRali mgrZnobeloba abakaviri (ABC
- Page 49 and 50: transaminazebis elevacia anrti (all
- Page 51 and 52: ARV toqsiuroba menejmenti nefrotoqs
- Page 53 and 54: xSiri oportonistuli infeqciebia, ma
- Page 55 and 56: cxrilebis wakiTxvis magaliTi 1. cxr
- Page 57 and 58: damateba2. jandacvis msoflio organi
- Page 59 and 60: damateba 4. ZiriTadi informacia ant
- Page 62 and 63: damateba 5. mkurnalobis reJimis dac
- Page 64 and 65: saerTaSoriso saxeli stavudini (d4T)
- Page 66 and 67: mcire mutacia muSaobs kombinaciaSi.
- Page 68 and 69: 25. Phillips AN et al. Viral load o
- Page 70 and 71: Suppl 2:S171-176. 73. Altice FL, Mo
- Page 72 and 73: 122. Koval CE et al. Immune reconst
- Page 74 and 75: kandidozi dRe yovel dRe - ko-trimoq
- Page 76 and 77: karcinoma (ara SidsTan perikardiuli
- Page 78 and 79: o cxeleba o wonaSi kleba o Ramis of
- Page 80 and 81: indikatorebi filtvis darRveuli funq
- Page 82 and 83: o yvelaze xSirad viTardeba diarea,
- Page 84 and 85: o glukokortikoidebis sistematiuri m
- Page 86 and 87: 100 mg/dReSi meore rigis sqemebi am
- Page 88 and 89: o eqspoziciis Sedegad daavadebis ga
- Page 90 and 91: o remisiis miRweva Zalian Znelia da
- ar warmoebulia LPV/r–is pir<strong>da</strong>piri Se<strong>da</strong>reba amprenaviris axal forma<br />
fosamprenavirTan, dReSi erTxel misaReb atazanavirTan (93) (CIII) <strong>da</strong><br />
seqvinaviris axal 500mg-ian formasTan, arsebobs mxolod arapir<strong>da</strong>piri<br />
monacemebi (94) (DIV). saWiroa <strong>da</strong>matebiTi kvlevebi.<br />
- pi-s SerCevisas gaTvaliswinebul un<strong>da</strong> iqnas gverdiTi movlenebi,<br />
Tanmxlebi <strong>da</strong>avadebebi, wamlebTan urTierTqmedeba <strong>da</strong> pacientis<br />
individualuri ganwyoba.<br />
cxrili 11 rekomendebuli meore rigis arv reJimi mozardebis<br />
mozrdilTaTvis<br />
pirveli rigis reJimi meore rigis reJimi<br />
LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC<br />
an<br />
ZDV + 3TC + (EFV an NVP) LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + ABC<br />
an<br />
LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + (ZDV + 3TC) b<br />
LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC<br />
TDF + FTC + (EFV an NVP) an<br />
LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV<br />
LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV<br />
ABC + 3TC + (EFV an NVP) an<br />
LPV/r a (an ATV/r, SQV/r, FPV/r, IDV/r) + ZDV + TDF (+ 3TC) b<br />
a LPV/r mocemulia rogorc upiratesi pi bustirebuli ritonaviriT, Tumca sxva pi-ebi<br />
SesaZloa gamoyenebul iqnas programis individualuri prioritetebis mixedviT.<br />
SesaZloa nebismieris gamoyeneba CamoTvlilTagan: ATV/r, SQV/r, FPV/r, <strong>da</strong> IDV/r. civi<br />
jaWvis ararsebobis SemTxvevaSi SesaZloa nelfinaviris gamoyeneba, Tumca igi<br />
ganixileba, rogorc naklebad potenturi, vidre bustirebuli pi-ebi.<br />
b ZDV <strong>da</strong> 3TC gamoyeneba naCvenebia strategiuli mizniT, radgan pirveli rigis<br />
araefeqturobis SemTxvevaSi maT mimarT virusi rezistentuli iqneba. kerZod, ZDV<br />
SesaZloa Tavi<strong>da</strong>n agvacilos an Seaferxos K65R mutaciis ganviTareba; xolo 3TC<br />
SeinarCunebs M184V mutacias, romelic amcirebis virusis replikaciis unars <strong>da</strong><br />
garkveulwilad zrdis sensitiurobas ZDV mimarT. un<strong>da</strong> aRiniSnos, rom am strategiis<br />
<strong>klinikuri</strong> Rirebuleba ar aris <strong>da</strong><strong>da</strong>sturebuli.<br />
- Tu ganviTar<strong>da</strong> pi-s Semcveli pirveli rigis arT-s araefeqturoba, meore<br />
rigis reJimis SerCeva efuZneba rezistentobis profils. Tu<br />
rezistentobis profili ar aris xelmisawvdomi, navaraudebi un<strong>da</strong> iqnas<br />
rezistentoba pirveli rigis reJimSi Semavali pi-s mimarT.<br />
pi-s Semcveli pirveli rigis arT-s araefeqturobis dros SesaZlo<br />
arCevania:<br />
- ZDV + 3TC + SQV/r (an ATV/r, FPV/r, IDV/r) ➔ ABC + ddI + LPV/r<br />
- ZDV + 3TC + LPV/r ➔ ABC + ddI + anrti (<strong>da</strong>runaviri (TMC11)) an bustirebuli<br />
tipranaviri (TPV/r)<br />
- kidev erTi arCevania ori pi-s kombinacia, magaliTad SQV + ATV/r (95). ar<br />
aris rekomendebuli ormagi pi-ebis kombniacaSi TPV/r gamoyeneba.<br />
4.6. ga<strong>da</strong>rCenis (Salvage) reJimebi<br />
<strong>da</strong><strong>da</strong>sturebuli meore rigis araefeqturobis SemTxvevebSi<br />
(virusologiuri, imunologiuri, <strong>klinikuri</strong> araefeqturobis<br />
kriteriumebiT) ganixileba ga<strong>da</strong>rCenis reJimebi. ga<strong>da</strong>rCenis reJimebSi<br />
42
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