Malangizo Aposachedwapa Kuchokera ku Dipatimenti ya Zaumoyo ku United States
Anali mu 1994, mu phunziro la ACTG 076 la masabata, omwe ofufuza adawonetsa mopanda kukayikira kuti kugwiritsa ntchito mankhwala osokoneza bongo (AZT) pa nthawi yomwe ali ndi mimba kungachepetse chiopsezo chotenga HIV kuchokera kwa mayi kupita kwa mwana ndi zodabwitsa 67 peresenti. M'zaka zaposachedwapa, pothandizidwa ndi mankhwala a antiretroviral (ART) , chiwerengerochi tsopano chili pafupi ndi 98 peresenti.
Masiku ano, kupewa kutsekula kwa amayi kupita kwa mwana (komwe kumatchedwanso kutengapo mbali) kumaphatikizapo magawo onse a mimba, kuchokera kuchipatala kupita kuchipatala. Chinsinsi cha kupambana kwake ndiko kuthandizira koyambirira. Pogwiritsa ntchito ART nthawi yayitali pasanafike nthawi yobereka-amayi amatha kukhala ndi mwayi waukulu wothetsera HIV m'magulu osawoneka , motero kuchepetsa chiopsezo chotenga kachilombo ka HIV.
Kuchepetsa Kuopsa kwa Kugonana kwa Amuna
Malangizo omwe ali ndi kachilombo ka HIV kwa amayi omwe ali ndi kachilombo ka HIV ali ofanana ndi omwe ali ndi HIV omwe ali nawo omwe alibe mimba, ndi zochepa zomwe amasintha malinga ndi nkhawa za mankhwala ena opatsirana pogonana.
Kwa amayi omwe sankachiritsidwa kale, Dipatimenti ya Umoyo wa Anthu ku United States (DHHS) ikuyamikira kugwiritsa ntchito Retrovir (AZT, zidovudine) komanso Epivir (3TC, lamivudine) monga msana wa ART woyamba. Izi zili choncho chifukwa nucleoside reverse transcriptase inhibitors (NRTIs) ngati Retrovir amawonetsedwa bwino kuti alowe mkati mwachitsulo chachikulu, kupereka mwana wosabadwa kutetezedwa kwambiri ku HIV.
Zotsatirazi sizitanthauza kuti ntchito ya Sustiva (efavirenz) kapena mankhwala a Sustiva monga Atripla pa nthawi yomwe ali ndi pakati, ngakhale kuti izi zimawoneka ngati zodziletsa. Pamene maphunziro oyambirira a zinyama adasonyezeratu kuti ali ndi vuto lalikulu la kubadwa kwa Sustiva, zomwezo sizinaoneke mwa anthu.
Ngati mimba imatsimikiziridwa ndi mayi yemwe ali kale pa Sustiva, akulangizidwa kuti mankhwalawa amasinthidwa kokha m'masabata asanu kapena asanu oyambirira a mimba. Pambuyo pake, kusintha sikofunikira.
Zinthu zina ndizo:
- Viramune (nevirapine) sayenera kugwiritsidwa ntchito kwa amayi omwe ali ndi CD4 count kuposa 250 maselo / μL chifukwa cha chiopsezo chowonjezeka cha hepatotoxicity.
- Intelence (etravirine), Edurant (rilpivirine), Aptivus (tipranavir), Selzentry (maraviroc), Lexiva (fosamprenavir) ndi Fuzeon (enfuvirtide) sakuvomerezedwa pakali pano chifukwa cha deta yosakwanira pachitetezo chawo.
- Viracept (nelfinavir) ndi Crixivan (indinavir) siziyamikiridwa chifukwa chokhala ndi ma seramu omwe amapezeka pamimba pokhapokha palibe njira zina zomwe zilipo.
Kuchepetsa Kuopsa kwa Kutumiza Panthawi Yotumizidwa
Poyamba, amayi omwe ali ndi kachilombo ka HIV ayenera kupitiliza kumwa mankhwala awo panthawi yomwe angathe. Komabe, ngati mayi yemwe amapereka nthawi yothandizira, ndi ndani yemwe amatsimikizira kuti ali ndi kachilombo ka HIV koma sanalandire mankhwala opatsirana pogonana kapena ali ndi kachilombo koposa 400 makilogalamu / μL, zidovudine zamkati zikhoza kuperekedwa nthawi zonse .
Malingana ndi US Centers for Disease Control and Prevention (CDC), pafupifupi 30 peresenti ya amayi ku US sagwilitsidwe kachirombo ka HIV panthawi yoyembekezera. Komanso, 15 peresenti ya anthu omwe ali ndi kachilombo ka HIV samalandira chithandizo chochepetsera chithandizo cha amayi, ngakhale 20 peresenti samayambitsa chisamaliro mpaka patatha zaka zitatu.
Ngati palibe mankhwala ochepetsa kachilombo ka HIV, chiwopsezo chotenga mawonekedwe chiyenera kukhala pakati pa 25 peresenti ndi 30 peresenti.
Malangizo Othandizira Otsatsa
Umboni wawonetsa kuti gawo lokonzekera lachitetezo limapangitsa kuti kachilombo ka HIV kasatenge kachilomboka kusiyana ndi kubereka kwa amayi.
Pogwiritsa ntchito mankhwala osokoneza bongo asanayambe kugwira ntchito (komanso kupweteka kwa amniotic nembanemba), mwana wakhanda sangathe kutenga kachilombo ka HIV makamaka makamaka pamene amayi sangathe kukwaniritsa kachilombo ka HIV.
DHHS imalimbikitsa kuti kupezeka kwapadera kumachitika masabata 38 a mimba ngati mayi
- sanalandire ART panthawi ya mimba yake, kapena
- ali ndi kachilombo koposa makopi 1,000 / μL pa masabata 36 a mimba.
Mosiyana ndi zimenezi, amayi amatha kubereka amayi omwe ali ndi ma ARV pa masabata 36 a mimba. Kuopsa kwa kupatsirana kwa amayiwa nthawi zambiri kumakhala osachepera 1 peresenti.
Mzimayi akamapereka chiwindi ndi mazira oposa 1,000 / μL, nthawi zambiri zidovudine zimagwiritsidwa ntchito, nthawi zina pogwiritsira ntchito oxytocin kuthamangitsidwa.
Malangizo apabanja
Pa nthawi yobereka, madzi a Retrovir ayenera kuperekedwa kwa mwana wakhanda pakangotha maola asanu ndi limodzi kapena khumi ndi awiri obadwa, kupitirira pamenepo pambuyo pa maola 12 pa masabata asanu ndi amodzi otsatira. Mwanayo amakula nthawi zonse pamene mwanayo akukula. Kutsekedwa kwa kachilombo ka Viramune kungathenso kuperekedwa ngati mayiyo sanalandire ART pa nthawi ya mimba yake.
Kuyezetsa kachilombo ka HIV PCR kumayenera kukonzekera mwanayo masiku 14-21, miyezi umodzi kapena miyezi, ndi miyezi inayi kapena sikisi. Mayeso oyenerera a PCR chifukwa cha kukhalapo kwa HIV m'magazi a mwana wotsutsana ndi odwala ELISA , omwe amayesa ma antibodies . Popeza kuti ma antibodies ambiri "amabadwa" kuchokera kwa amayi, kupezeka kwawo sikungathe kudziwa ngati matendawa achitika mwa khanda.
Ngati mwanayo akayezetsa miyezi iwiri kapena iwiri, PCR yachiwiri idzachitidwa patatha mwezi umodzi. Chotsatira chachiwiri chimakhala ngati chitsimikizo chakuti matenda sakhala nawo.
Mosiyana ndi zimenezi, khanda limapezeka kuti liri ndi kachilombo ka HIV pambuyo poyesedwa ma PCR abwino. Ngati mwanayo ali ndi kachilombo ka HIV, ART idzaperekedwa nthawi yomweyo pamodzi ndi Bactrim prophylaxis (yomwe imatetezedwa kuti ipitirize kukula kwa PCP chibayo).
Kuyamwitsa Kapena Kusamalidwa?
Yankho lalitali ndi lalifupi ndilokuti amayi omwe ali ndi kachilombo ka HIV ku US ayenera kupewa kuyamwa ngakhale atatha kusunga ma ARV. M'mayiko otukuka monga US, kumene mkaka wachinyamata umakhala wotetezeka ndipo umapezeka mosavuta, kuyamwa kumawopseza kwambiri zomwe zimapindulitsa kwambiri phindu lawo (monga ubale wamayi, malamulo a chitetezo cha ana, etc.)
Ngakhale kuti kafukufuku wogwiritsira ntchito mankhwala ochepetsa kachilombo ka HIV pamapeto pa kuyamwitsa kwachepa pambuyo pake, zochepa pa maphunziro a ku Africa zasonyeza maulendo opatsirana pakati pa 2.8 peresenti ndi 5.9 peresenti patatha miyezi isanu ndi umodzi yoyamwitsa.
Kuyambula (kapena kusankhwima) kwa chakudya kwa makanda sikuvomerezedwanso kwa makolo omwe ali ndi kachilombo ka HIV kapena osamalira. Ngakhale kuti pangokhala maulendo angapo ovomerezeka omwe amatulutsidwa ndi chisanafike, pali zifukwa zomwe zimachokera chifukwa cha mfupa yamagazi ndi zilonda zomwe zingabwere kuchokera ku ukhondo wabwino wa ma mano, komanso kudulidwa ndi kuvulaza kumene kumachitika panthawi yovuta.
> Zotsatira:
> Connor, E ;; Sperling, R .; Gelber, R .; et al. "Kuchepetsa Kubereka kwa Amayi Amayi Amuna Omwe Amayambitsa Matenda a Edzi Amodzi ndi Zidovudine Treatment. New England Journal of Medicine. November 3, 1994; 331 (18): 1173-1180.
> Dominquez, K ;; Rakhmanina, N .; Juliano, A. "et al." Kuwonetseratu kuti ndi Njira Yopereka Matenda a Edzi: Kutenga Mlandu ndi Kufufuza Zogwirizana. " Journal of Acquired Immune Deficiency Syndrome February 12, 2012; 59 (2): 207-212.
> Werengani, J. ndi Newell, M. "Kuchita bwino ndi Chitetezo cha Kafukufuku wa Kafukufuku Woperewera kwa Kuletsa Kuchipatala kwa Mayi ndi Mwana kwa HIV-1." Dongosolo la Cochrane la Zosintha Zogwirizana. October 9, 2005; (4): CD005479.
> Zomwe Zilikulu za US Zokhudza Kuletsa ndi Kupewa Matenda (CDC). "HIV pakati pa amayi oyembekezera, makanda, ndi ana." Atlanta, Georgia.
> Dipatimenti ya US Health and Human Services (DHHS). "Malangizo a Gwiritsirani Ntchito Mankhwala Ochepetsa Matenda a Edzi Amayi Oyembekezera omwe ali ndi kachirombo ka HIV kwa amayi omwe ali ndi kachilombo ka HIV komanso njira zothandizira kuchepetsa kufala kwa HIV ku United States." Rockville, Maryland. Zomwe zinatulutsidwa pa May 21, 2013.