Zomwe nyama ndi kufufuza kafukufuku zimatiuza
Pali nthawi yayitali kuti amayi omwe amamwa mankhwala ochepetsa kachilombo ka HIV pa nthawi yomwe ali ndi mimba akhoza kuika chiopsezo chowonjezereka cha zilema zobereka. Kafufuzidwe kawiri kawiri kawiri kawiri kawiri kawiri kawiri kawiri kawiri,
Mankhwala osokoneza bongo Sustiva (efavirenz) akhala akudandaula kwambiri ndi malamulo oyambirira omwe amasonyeza kuti ayenera kupeŵa, panthawi yoyamba ya trimester, chifukwa cha chiopsezo cha kutayika.
Malangizowa asintha ndipo tsopano amalola kugwiritsa ntchito efavirenz mu trimester yoyamba mayi ayenera kukhala ndi mphamvu yosawerengeka ya tizilombo .
Ndizomwe zikunenedwa, mfundo zomwezo zimasonyeza kuti amayi omwe alibe amayi omwe ali ndi pakati akupewa mankhwala omwe ali ndi efavirenz.
Ndiye kodi izi zikutanthauza chiyani kwenikweni? Kodi gulu la zaumoyo ku United States likungoyendetsa mabedi awo pa mankhwala omwe sangakhale oopsa kapena osayenera, kapena kodi tiyenera kuda nkhawa ndi izi ndi mankhwala ena?
Zinyama Zimasonyeza Zowopsa Kwambiri
Pofufuza za chiopsezo cha mankhwala osokoneza bongo komanso zolepheretsa kubereka, kafukufuku wambiri samachokera ku maphunziro aumunthu koma kuchokera ku kafukufuku wa zinyama (momveka chifukwa simungathe kuwonetsa mwana wamwamuna kuti adziwe mankhwala oopsa).
Ponena za Sustiva, nkhaŵa zokhudzana ndi kutayika kwa nthaka zinayambanso kukwezedwa pamene anyani atatu a 20 a cynomolgus adagwiritsa ntchito mankhwalawa ali ndi ana omwe ali ndi ziphuphu komanso machitidwe oopsya a mitsempha. Komanso, mankhwalawa anali oposa 1.3 okha kuposa omwe amagwiritsidwa ntchito mwa anthu.
Pakadali pano, makoswe omwe anadziwitsidwa kuti Sustiva adakali mwana, zomwe zimachitika kuti ana omwe amamwalira panthawi yogonana adabwezeretsedwanso ndi abale awo otsala.
Panalibe zilema zobereka zomwe zinkapezeka akalulu.
Mawerengero Othandizira Anthu
Masamba atengedwa kuchokera ku Registry Pregnancy Registry (APR) ajambula chithunzi chosiyana.
Pamene apolisi anazindikira kuti pali ana 18 pa ana asanu ndi awiri (766) omwe anadziwika ndi Sustiva m'zaka zitatu zoyambirira, chiwerengero chachikulu cha neural tube defects - mitundu yowonedwa mu maphunziro a nyama - kukayikira ngati momwe anthu angakhalire ndi ofanana ndi anyani makoswe.
Kufufuza kwapadera kwa maphunziro 19, kuphatikizapo APR, kuyambira kale anazindikira zofooka 39 kuchokera kwa ana 1,437 opezeka ku Sustiva. Malingana ndi ziwerengerozi, mlingowo umawoneka kuti si wosiyana kusiyana ndi umene umawonedwa ku United States ambiri.
Ngakhale kuti chiwerengero chochepa chazidziwitso zatsimikizika, akuluakulu azaumoyo adakayikira kupatsa Sustiva thumbs.
Kuopsa kwa Kubadwa Kwachilombo kwa Ma ARV Ena
Mu 2014, ofufuza ochokera ku French Perinatal Cohort adafalitsa kafukufuku omwe amawonekeratu chiwerengero cha zilema zoberekera ana omwe ali ndi mankhwala osiyanasiyana ochepetsa kachilombo ka HIV pa nthawi ya mimba. Kuphunzira m'mayiko osiyanasiyana kunaphatikizapo ana 13,124 omwe anabadwa ndi amayi omwe ali ndi HIV kuyambira 1986.
Zotsatirazo zinali zosangalatsa: pamene kuwonjezeka kwa zilema zobereka kunayanjanitsidwa ndi mankhwala ena ochepetsa kachilombo ka HIV, monga Crixivan (indinavir) , mlingowo unali wosiyana kwambiri ndi wa anthu ambiri. Komanso, palibe mtundu weniweni wa mtundu kapena zolepheretsa zolepheretsa kubadwa.
Pakalipano, ana 372 anawonekera ku Sustiva m'zaka zitatu zoyambirira, palibe mgwirizano womwe ungapezeke pakati pa zolepheretsa mankhwala ndi kubadwa.
Izi sizikutanthauza kuti mankhwalawa alibe pangozi. Akatswiri ofufuza a ku France anazindikira kuwonjezeka kwa mtima kamodzi kwa ana opezeka ku AZT (zidovudine) . Ambiri amagwiritsidwa ntchito ndi vuto la sevaloli, lomwe ndi lofala kwambiri lomwe chimakhala pakati pa zipinda ziwiri zapansi za mtima.
Kafukufuku wochokera ku Harvard School of Public Health, yomwe inafalitsidwa mu 2014, inatsimikizira zambiri zomwe zapezeka ku France. Phunzirolo, lomwe linaphatikizapo ana 2,580 a ku America omwe adayambitsidwa ndi mankhwala ochepetsa kachilombo ka HIV m'zaka zitatu zoyambirira, adapeza kuti mankhwala ochepa chabe komanso mankhwala osokoneza bongo anali ndi chiopsezo chowonjezereka chokwanira.
Komabe, akatswiri ofufuza a Harvard adawona kuti pangakhale vuto lalikulu la matenda ndi khungu la ana omwe ali ndi reitatavir- atazanavir (atazanavir) m'zaka zitatu zoyambirira. Ngakhale ofufuzawa adafuna kuti kufufuza kwina kukhale kofunikira kuti tiwone ngozi ya Reyataz pamene ali ndi mimba, komabe iwo adatsimikiza kuti chiopsezo chachikulu chikhalabe chochepa.
ndipo anamaliza kunena kuti, pamene kufufuza kwina kuli kofunika ku ntchito ya Reyataz panthawi ya mimba, "atapatsidwa chiopsezo chotsika (congenital anomaly), phindu la mankhwala opatsirana pogwiritsa ntchito ARV pamene ali ndi mimba akadali oopsa kwambiri."
> Zotsatira:
> 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." Washington, DC; zasinthidwa pa March 28, 2014.
> Komiti Yoyang'anira Malamulo olerera ma ARV. "Lipoti laling'ono la Registry International Pregnancy Pregnancy Pregnancy Pregnancy Pregnancy Pregnancy for 1 January 1989-31 January 2017." Wilmington, North Carolina; zasinthidwa mwezi wa 2017.
> Sibiude, J .; et al. "Mgwirizano pakati pa Kugonana kwa Pakati pa Pakati pa Pakati pa Matenda a Antiretroviral ndi Matenda a Kubadwa: Kusanthula Phunziro la Ophunzira a ku Perinatal (ANRS CO1 / CO11)." PLoS | Mankhwala. April 29, 2014; DOI: 10.1371 / magazini.pmed.1001635.
> Williams, P .; Kuda, M .; Yildirim, C ;; et al. "Matenda a Khungu ndi Utero Antiretroviral Immusodeficiency Virus-Ana Osaoneka Osaoneka ." JAMA Matenda . 2014; DOI: 10.1001 / jamapediatrics.2014.