Matenda opatsirana opitirirabe akupitirirabe chifukwa chachikulu cha matenda ndi imfa mwa anthu omwe ali ndi kachilombo ka HIV, pomwe matenda opatsirana kapena osavuta amadziwika bwino. Mwazirombo zomwe zimapezeka mwachangu nthawi zambiri zokhudzana ndi HIV :
- Mankhwala osokoneza bongo ndi ochepa omwe amapezeka m'madzi (thrush)
- Cryptococcosis (kuphatikizapo cryptococcal meningitis)
- Histoplasmosis
- Coccidioidomycosis (Chigwa cha Chigwa)
Matenda ena a fungus (kuphatikizapo aspergillosis, penicillosis, ndi blastomycosis) awonetsanso, nthawi zambiri mwa anthu omwe ali ndi CD4 chiwerengero pansi pa maselo 250 / mL.
Pali antchito angapo omwe amagwiritsidwa ntchito pochiza matenda opatsirana pogonana. Mankhwalawa amagawidwa ndi njira yawo yeniyeni, ndipo akhoza kuthyoledwa m'magulu anayi:
I. Zochita Zambiri
Zizindikiro zapuloteni zimagwira ntchito pochotsa umphumphu wa mitsempha ya fungalomu, yomwe pamapeto pake imayambitsa selo kufa. Ambiri omwe amagwiritsidwa ntchito pa HIV ndi awa:
- Amphotericin B : Kawirikawiri amagwirizanitsidwa ndi chithandizo cha systemic (thupi lonse) matenda opatsirana monga cryptococcal meningitis. Pamene amachititsa intravenously, amphotericin B imadziwika kuti imakhala ndi zotsatira zoyipa, nthawi zambiri zimakhala zowawa kwambiri pakapita nthawi yochepa (kutentha thupi, kupweteka, kupweteka, kupweteka, kupweteka mutu, ndi kupweteka). Choncho, kuyendetsa mwachisawawa kwa amphotericin B kumawonetsedwa kawirikawiri ndi odwala amphamvu kwambiri omwe amateteza thupi lawo kapena omwe akudwala kwambiri. Kukonzekera kwaukhondo kumapezeka kuti mugwiritse ntchito pochiza candidiasis, yomwe ili yoyenera kugwiritsidwa ntchito ndi mankhwala ochepetsa mankhwala osokoneza bongo.
- Nystatin : Amagwiritsidwa ntchito pamlomo kapena pamutu kuti amve pamlomo, osatopa, komanso vaginja. Nystatin ingagwiritsidwe ntchito ngati mankhwala a prophylactic (preventionative) omwe ali ndi kachilombo ka HIV omwe ali ndi chiopsezo chachikulu cha matenda a fungal (CD4 chiwerengero cha maselo 100 / ml kapena osachepera). Nystatin imapezeka ngati mapiritsi, mouthwash, pastilles, powders, creams, ndi mafuta.
II. Azole Antifungals
Mankhwala a Azole amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda. Zotsatira zoyipa zimaphatikizapo kupweteka, kumutu, chizungulire, kunyoza, kusanza, kutsegula m'mimba, kumimba kwa m'mimba, ndi michere yambiri ya chiwindi.
- Diflucan (fluconazole) : Mosakayikira, imodzi mwazidziwitso kwambiri padziko lonse lapansi, Diflucan imagwiritsidwa ntchito pochizira mwapadera komanso machitidwe opangidwa ndi fungal, kuphatikizapo candidiasis, cryptococcosis, histoplasmosis, ndi coccidioidomycosis. Diflucan imapezeka mu mawonekedwe a piritsi, monga ufa wothandizira pakamwa, kapena ngati njira yothetsera yogwiritsira ntchito mankhwala.
- Nizoral (ketoconazole) : Nizoral ndiyo yoyamba kumwa mankhwala azole antifungal, koma yayamba kwambiri ndi azulu ena omwe ali ndi poizoni wambiri komanso omwe amamwa kwambiri. Zilipo mu mawonekedwe a piritsi, komanso m'magulu osiyanasiyana omwe amagwiritsidwa ntchito pogwiritsa ntchito matenda opatsirana, kuphatikizapo candidiasis.
- Sporanox (itraconazole) : Kawirikawiri amagwiritsidwa ntchito mu matenda opatsirana (monga candidiasis kapena cryptococcosis) pamene zina zowopsya siziwathandiza kapena zosayenera. Sporanox ikupezeka mu mawonekedwe a kapsule kapena ngati njira yothetsera pakamwa (yooneka ngati yopambana mukutenga ndi bioavailability). Kukonzekera kosakonzekera sikuliponso ku US Chifukwa cha kulowera kwake kolowera ku cerebrospinal fluid, Sporanox imagwiritsidwa ntchito pamzere wachiwiri pamene mukuchiritsa cryptococcal meningitis.
Mankhwala ena omwe amagwiritsidwa ntchito pochiza matenda opatsiranawa ndi VFend (voriconazole) ndi Posanol (posaconazole).
III. Antimetabolite Antifungal
Pali mankhwala amodzi okha a antimetabolite (Ancobon) omwe amadziwika kuti ali ndi mavitamini, omwe amachititsa kuti asokonezeke ndi RNA ndi DNA.
- Ancobon (flucytosine) : Amagwiritsidwa ntchito pochiza matenda akuluakulu a candidiasis ndi cryptococcosis, Ancobon nthawizonse imayendetsedwa ndi fluconazole ndi / kapena amphotericin B monga chitukuko chotsutsana chimagwiritsidwa ntchito pokhapokha. Kuphatikizidwa kwa amphotericin B ndi Ancobon kwatsimikiziridwa kukhala kovomerezeka pochiza cryptococcal meningitis. Ancobon imapezeka mu mawonekedwe a capsule. Zotsatira zake zingaphatikizepo kusasamalana kwa m'mimba komanso kuperewera kwa mafupa (kuphatikizapo kuchepa kwa magazi). Mphuno, kupweteka mutu, chisokonezo, hallucination, sedation, ndi chiwindi chokwanira chikuchitikanso.
IV. Echinocandins
Kalasi yatsopano yotsutsana ndi ma chinocandin ikugwiritsidwanso ntchito pochiza candidiasis ndi aspergillosis. Majekinki amagwira ntchito mwa kulepheretsa kuti poizoni ena aphatikcharides apangidwe pakhoma. Kawirikawiri, majekinki amapereka mankhwala ochepetsa mankhwala osokoneza bongo ndi ocheperako mankhwala osokoneza bongo, ngakhale pakalipano nthawi zambiri amauzidwa odwala osagwirizana ndi mankhwala ena amtunduwu. Zonse zitatuzi zimagwiritsidwa ntchito mwachangu, ndi chitetezo chomwecho, mphamvu, ndi kulekerera.
- Eraxis (anidulafungin)
- Cancidas (caspofungin)
- Mycamine (micafungin)
Zotsatira:
Marty, F. ndi Mylonakis, E. "Ntchito yogwiritsira ntchito kachirombo ka HIV." Maganizo a akatswiri Pharmacotherapy. February, 2002; 3 (2): 91-102.
Mei, H .; Kok, L .; Shariff, M .; et al. Kugwiritsira Ntchito Mwamphamvu kwa Matenda Opatsirana Omwe Ali ndi kachilombo ka HIV: Kuyerekezera za Kuchita bwino ndi Chitetezo. " AIDS. 2011; 2 (12): WMC002674.
National Institutes of Health (NIH). "Malangizo Othandizira Kupewa ndi Kuchiza Matenda Oponderezedwa Omwe Akhudzidwa ndi kachilombo ka HIV ndi Achinyamata." Bethesda, Maryland; zasinthidwa pa September 27, 2013.