aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla (klinikuri ...

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mcire mutacia muSaobs kombinaciaSi. igi SesaZloa gaxdes wamyvani rezistentobis ganviTarebaSi, an ewinaaRmdegebodes sxva araxelsayrel did an mcire mutacias. nukleozidis analogis mutacia (NAMs) mJRavndeba jvaredini rezistentobiT umetes nrti-sTvis. wertilovani mutacia warmoadgens erT cvlilebas rnm-is jaWvSi, risi Sedegic aris rezistentobis ganviTareba wamlis an wamlebis mTeli klasis mimarT. magaliTad: arT-s mkurnalobis dros 103 wertilovani mutacia niSnavs mutacias mTeli nrti-is mimarT. rezistentoba aris Sedegi rnm-is jaWvSi aminomJavebis Tanamimdevrobis cvlilebis, rac xdeba aiv-is “Raribi” replikaciis mizezi. cvlilebaTa umravlesoba ganapirobebs virusis sikvdils, zogierTi cvlilebis Sedegad ki virusi iZens unars gaumklavdes arT-s da gadarCes. mkurnalobis warmatebisTvis sasurvelia arT-s dawyebamde virusuli replikaciisa da rezistentobis testis Catareba. rezistentobis zogierTi Sedegi saboloo jamSi gamosadegia. Timidinis analogebis mutacia (TAMs) aris Sedegi zidovudiniT mkurnalobis. damateba 8. horizonts miRma arT-s kvleva grZeldeba. virusis axal mutacias da rezistentobas adgili aqvs regularulad _ rac qmnis axal warmodgenas wamlebisa da virusis urTierTobis Sesaxeb. qvemoT moyvanilia zogierTi ukanaskneli antiretrovirusuli preparatebi, romlebic mowonebulia an gadis gamocdas kombinaciaSi Zvel medikamentebTan. o dReSi erTxel fiqsirebuli doza kombinaciiT _ tenifoviri + emtricitabini + efavirenzi ufro efeqturia, vidre standartuli kombinacia zidovudini + lamivudini + efavirenzi (40). o etravirini warmoadgens axal nnrti, romelsac aqvs didi potenciali, miuxedavad mutaciisa, ramac SeiZleba ganapirobos nnrti-s klasis rezistentobis ganviTareba (135). o darunaviri (TMC 114) axali proteazas inhibitoria, romelsac gaaCnia maRali genetikuri barieri, vidre lopinavir/ritonavirs, rezistentobis ganviTareba ufro nela xdeba, vidre nelfinaviris, APV, an lopinavir/ritonaviris SemTxvevaSi. darunaviri xelmisawvdomia farTod xelmisawvdomi programisTvis (EAP) (136). is axlaxan damtkicebul iqna FDA-s mier. o kapravirini warmoadgens meore Taobis nnrti-s, romelic bevrad efeqturia miuxedavad nnrti-s klasikuri rezistentobisa. o axali koreceptoris inhibitorebi kvlevis meore fazaSia. CXCR4 da CCR5, romlebic gamoxataven virusebs, brZoloben wamlebTan, romlebsac SeuZliaT gamiowvion erTis an orives inhibicia. axali testi koreceptorebis eqspresiisa saWiroa mkurnalobis dros. gverdiTi efeqtebi amJamad SezRudulia, Tumca sawyisi gamocdilebiT am axal klasisTvis aRmoCenilia kardiotoqsiuri efeqti. aRiareba SeiZleba moxdes 2007 wels. 66
gamoyenebuli literaturis CamonaTvali: 1. Palella FJ Jr et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. The New England Journal of Medicine, 1998, 338(13):853–860. 2. Sterne JA et al. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. The Lancet, 2005, 366(9483):378–384. 3. Lewden C. Responders to antiretroviral treatment over 500 CD4/mm³ reach same mortality rates as general population: APRICO and Aquitaine Cohorts. 10th European Aids Conference, Dublin, 17–20 November, 2005 (Abstract PE18.4/8). 4. Bartlett JG, Gallant JE. 2003 Medical Management of HIV Infection. Johns Hopkins University, Division of Infectious Disease and AIDS Service. Baltimore, 2003 (http://www.hopkins-aids.edu/publications/ book/03MMHIV1to3.pdf accessed 11 September 2006). 5. Wilson IB et al. Quality of HIV care provided by nurse practitioners, physician assistants and physicians. Annals of Internal Medicine, 2005, 143(10):729–736. 6. Aberg JA et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases, 2004, 39:609–629. 7. Mellors JW et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Annals of Internal Medicine,1997, 126(12):946–954. 8. Savès M et al. Risk factors for coronary heart disease in patients treated for human immunodeficiency virus infection compared with the general population. Clinical Infectious Diseases, 2003, 37(2):292– 298. 9. Friis-Moller N et al. Combination antiretroviral therapy and the risk of myocardial infarction. The New England Journal of Medicine, 2003, 349(21):1993–2003. 10. Pragna Patel. Incidence of AIDS defining and non-AIDS defining malignancies among HIV-infected persons. 13th Annual Conference on Retroviruses and Opportunistic Infections (13th CROI), Denver, 5–8 February 2006 (Poster 813). 11. HIV testing methods. Geneva, Joint United Nations Programme on HIV/AIDS (UNAIDS), 1997 (UNAIDS Technical Update WC 503.1). 12. Mulcahy F et al. CD4 counts in pregnancy do not accurately reflect the need for long-term HAART. 13th Annual Conference on Retroviruses and Opportunistic Infections (CROI), Denver, 5–8 February 2006 (Abstract 704b). 13. Hawkins D et al. Guidelines for the management of HIV infection in pregnant women and the prevention of mother-to-child transmission of HIV. HIV Medicine, 2005, 6:107–148. 14. Friis-Moller N et al. Exposure to PI and NNRTI and risk of myocardial infarction: results from the D: A:D study. 13th Annual Conference on Retroviruses and Opportunistic Infections (CROI), Denver, 5–8 February 2006 (Abstract 144). 15. Markowity M et al. Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report. The Lancet, 2005, 365(9464):1031–1038. 16. Urbina A, Jones K. Crystal methamphetamine, its analogues, and HIV infection: medical and psychiatric aspects of a new epidemic. Clinical Infectious Diseases, 2004, 38(6):890–894. 17. Gregory M et al. Illicit drug use and HIV-1 disease progression: a longitudinal study in the era of highly active antiretroviral therapy. American Journal of Epidemiology, 2006, 163(5):412–420. 18. Markowitz M et al. Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report. The Lancet, 2005, 365(9464):1031–1038. 19. Kassutto S et al. Longitudinal analysis of clinical markers following antiretroviral therapy initiated during acute or early HIV type 1 infection. Clinical Infectious Diseases, 2006, 42:1024–1031. 20. The EACS Euroguidelines Group. European guidelines for the clinical management and treatment of HIV-infected adults in Europe. AIDS, 2003, 17(Suppl.):S3–S26. 21. British HIV Association guidelines for the treatment of HIV-infected adults with antiretroviral therapy. London, British HIV Association, 2003 (http://www.bhiva.org/guidelines/2003/hiv/index.html, accessed 30 May 2006). 22. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Bethesda, United States Department of Health and Human Services (DHSS), 2004.1-35 patient evaluation and antiretroviral treatment for adults and adolescents 23. Salzberger B et al. German-Austrian recommendations for the antiretroviral therapy on HIV-infections. European Journal of Medical Research, 2004, 9:491–504 24. Egger M et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. The Lancet, 2002, 360(9327):119–129. 67
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aiv infeqcia/SidsiT avadmyofTa mkur
Page 3 and 4:
sarCevi klinikuri saxelmZRvanelo-re
Page 5 and 6:
3.2.2.cxeleba aiv inficirebulebSi 3
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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 and 42: - aqedan gamomdinare, nrti+anrti re
Page 43 and 44: igulisxmeba im medikamentebis kombi
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 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
Page 92 and 93: qimioTerapiiT (mag : B-ALL reJimi)
Page 94 and 95: • imunodeficitis mqone pacientebS
Page 96 and 97: an famcikloviri 500 mg 3-jer dReSi
Page 98 and 99: • berkitis-tipis limfoma; • naz
Page 100 and 101: 3.2.2. cxeleba aiv inficirebulebSi
Page 102 and 103: afTozuri wylulebi stomatiti qeiliti
Page 104 and 105: ganmavlobaSi 2 Tvis manZilze (xelis
Page 106 and 107: o gamonayari warmodgenilia mravlobi
Page 108 and 109: 20. Chen XM et al. Cryptosporidiosi
Page 110 and 111: Tavi IV. aiv infeqcia/SidsiT daavad
Page 112 and 113: inficirebul bavSvebSi (ramdenadac a
Page 114 and 115: 8 igulisxmeba piri, romelsac aReniS
Page 116 and 117:
4.3. daxocili da inaqtivirebuli vaq
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kerebSi A hepatiti erTeuli an mcire
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13 riski maRalia staJirebis periodS
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ganmavlobaSi, xolo SedarebiT ufro s
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4.8. tkipismieri encefalitis vaqcin
Page 126 and 127:
CvenebebiTa da doziT, rogorc imunok
Page 128 and 129:
4.11.2.3. cofis sawinaaRmdego imuno
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ekomendebulia: vaqcina rekomendebul
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8. United States Centers for Diseas
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aiv infeqcia/Sidsis antiretrovirusu
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5. mkurnaloba a) rekomendebuli pirv
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aiv infeqcia/SidsiT daavadebuli bav
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joxiseburi TiTebi. Tumca wlebis man
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* saWiroa arv preparatebis bavSvebi
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laboratoriuli monacemebis kontroli
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Tirkmlis funqciuri sinjebi, gulmker
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Page 150 and 151:
Page 152 and 153:
6. reabilitacia da dakvirveba monit
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kandidozuri ezofagitis SemTxvevebSi
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martivi herpesvirusuli infeqciis mZ
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meTodiT, sisxlis saerTo analizi, Rv
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)gamomricxavi _ aiv infeqcia/Sidsis
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aiv infeqcia/SidsiT avadmyofebSi B
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dinamikaSi dakvirveba CD4≥500/mm
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HBV mkurnalobis efeqturoba HBeAg (+
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) gamomricxavi - aiv infeqcia/Sidsi
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pegilirebuli interferonis da ribavi
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i CD4 X X X X X X X X X TSH X X X H
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)gamomricxavi - aiv infeqcia/Sidsis
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pirveli rigis antituberkulozuri med
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testebi: • sisxlis saerTo analizi
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