Mbali yotsatira ya diso ikugwira ntchito mwa kukhala ndi mawonekedwe a diso, kugwiritsira ntchito disolo pamalo, ndi kuchititsa maganizo a mitsempha ku ubongo kuchokera ku maselo a photoreceptor kumbuyo kwa maso.
Retina , choroid (minofu yambiri ya diso), ndi mitsempha ya optic imakhala ndi gawo limodzi lopitirira, ndi matenda angapo okhudzana ndi kachirombo ka HIV omwe amapezeka mkati mwa zigawo izi, nthawi zambiri pamatendawa.
Kusokonezeka kwa gawo lotsatira-makamaka kuwonetsa ndi kusintha kwakukulu kwa retina-kumawoneka mwa ochuluka 50 mpaka 70% mwa odwala omwe ali ndi kachirombo ka HIV , ndipo nthawi zina amatha kuwonongeka mosavuta kapena kovuta ku retina (yotchedwa retinopathy).
Matenda ena okhudzana ndi kachilombo ka HIV pa gawo lachimake ndi awa:
- Cytomegalovirus (yotchedwanso CMV)
- Toxoplasmosis (matenda opatsirana omwe amafala komanso ochepa)
- Cryptococcosis (kachilombo ka HIV kamene kamayambitsa matendawa)
- Chifuwa (TB)
Cytomegalovirus
Cytomegalovirus (CMV) ndi herpesvirus yomwe imabweretsa anthu oposa theka la anthu akuluakulu, osawonekera mosavuta ndi matenda omwe ali ndi mphamvu zowonongeka za thupi (kupatulapo, nthawi zina, ndi zizindikiro zonga mononucleosis ). Ngakhale kuti nthawi zambiri zimaperekedwa kuchokera kwa mayi kupita kwa mwana, zingathenso kufalikira pokhala wamkulu pogonana. Chomwecho, chiwerengero cha CMV pakati pa amuna omwe amagonana ndi amuna ndi pafupifupi 90%, monga zilili ndi anthu omwe ali ndi HIV.
CMV ikhoza kuwonetsa maso m'njira zosiyanasiyana, ngakhale kuti nthawi zambiri imachita zimenezi ndi kutukumula kwa retina, komwe kumadziwika ngati retinitis. Matendawa amapezeka kawirikawiri kwa odwala omwe CD4 yawo yagwera pansi pa maselo 50 / mL ndipo imaonetsa zizindikiro zosiyana siyana kuchokera ku lingaliro loyendayenda kupita kuwonongeka komanso ngakhale khungu.
Kamodzi kathuku kamene kamapezeka pa retina, imatha kupita patsogolo mofulumira, kawirikawiri mkati mwa masabata. Popanda chithandizo chamankhwala, zilondazi zimatha kupitirira centrifugally (kufalikira panja kuchokera pakati), kuchepetsa zooneka bwino ndipo nthawi zina zimatsogolera kuthetsa kwathunthu kwa masomphenya. Ngakhale CMV retinitis nthawi zambiri imapereka mgwirizano (m'maso onse), ikhozanso kuwonetsa unilaterally (mu diso limodzi).
Valganciclovir imatengedwa ngati mankhwala osankhidwa kuti athe kuchiritsira CMV retinitis, yomwe imayesedwa pamlomo ngati mlingo wa tsiku ndi tsiku pa nthawi yochepetsedwerako, ndipo imatsatiridwa ndi mlingo wa tsiku ndi tsiku pa nthawi yosamalira. Ganciclovir ingathenso kulamulidwa koma imaperekedwa mwachindunji, mmalo mwa mlomo, kwa masiku 21.
Momwemonso, intravitreal ganciclovir implants-kwenikweni, ndondomeko yosakanikirana yomwe imatumizidwa kumalo a kachilombo-nthawi zina imayikidwa mu diso. Kawirikawiri amagwiritsidwa ntchito pazochitika zovuta kwambiri za CMV retinitis, imathandiza kuti nthawi yayitali imwanire mankhwala osokoneza bongo mu vitreous humor (gel loyera lomwe limadzaza malo pakati pa lens ndi retina).
Toxoplasma
Matenda a toxoplasma ndi omwe amachititsa kuti anthu ambiri azikhala ndi kachilombo ka HIV (matenda a retina ndi / kapena choroid).
Chifukwa cha tizilombo toyambitsa matenda, Toxoplasma gondii , matendawa amakhudza anthu oposa 200,000 ku US chaka ndi chaka, ndipo amafalitsidwa mwachisawawa kapena mwa kuthira nyama yonyansa. Nthawi zambiri zimayanjanitsidwa ndi amphaka (ngakhale kuti amakhalapo mwazilombo zambiri zotentha), kukhudzana ndi makoswe a khungu amawonanso kuti ndi chifukwa chachikulu cha kutumiza kwa T. gondii .
Pamene toxoplasmosis imakhala m'diso, imakhala ndi chikasu choyera choyera ndipo chimakhala ndi kutupa kwa vitreous humor. Kuzindikiritsa kawirikawiri kumapangidwira ndi kuyesedwa kwa diso, ndi mayesero a magazi opatsirana ndi antibody omwe amapereka chitsimikizo cha serological.
Nthawi zina steroids amagwiritsidwa ntchito pochizira milandu yoopsa ya toxoplasma retinochoroiditis, pamene milandu yambiri imatchulidwa kuphatikiza pyrimethamine, folinic acid ndi sulfadiazine. Kwa anthu omwe ali ndi kachilombo koyambitsa matenda a HIV, pakufunika chithandizo chamankhwala chamakono, nthawi zambiri pogwiritsa ntchito trimethoprim-sulfamethoxazole, kuphatikizapo komwe kumalekerera.
Cryptococcosis
Cryptococcosis ndi matenda omwe amabwera chifukwa chotsitsimutsa mpweya, Cryptococcal neoformans spores, zomwe nthawi zambiri zimawoneka ndi matenda a meningitis (nthawi zina kutupa kwa moyo kumatenda oteteza ubongo ndi msana). Kuphatikizana kwambili kumaphatikizapo kufotokozera kachiwiri pa nthawi yovuta kwambiri ya cryptococcal meningitis , makamaka poyenda ndi septicemia.
Matenda opatsirana ammimba amatha kupitilizidwa kudzera m'katikati mwa mitsempha ya m'mitsempha (CNS) kudzera m'mitsempha ya optic kapena kudzera mwazi pamene matendawa amafalitsidwa.
Pofufuza, zilonda zambiri zachikasu zimatha kudziwika pa choroid ndi / kapena retina. Ngati simunasamalidwe, kufalikira kwa kachilomboka kwa mitsempha ya mitsempha ya optic nthawi zina kukhoza kutayika.
Chithandizo chodziwika cha cryptococcal meningitis nthawi zambiri amaperekedwa kudzera mu intravenous amphotericin B ndi flucytosine, amawona chithandizo cha kusankha. Mankhwala a antitifungal amalembedwa kawirikawiri pamene akuganiza kuti akugwirizanitsa.
Chifuwa chachikulu
Chifuwa chachikulu cha TB (TB) chimakhala chochepa kwambiri kuposa matenda ena a maso omwe ali ndi kachilombo ka HIV koma nthawi zina amawoneka ndi odwala kachilombo ka HIV omwe ali ndi TB. Zimakhala ngati granuloma ngati galauloma pa choroid ndipo zingathe kuwonetsa pa ma CD4 apamwamba (oposa 150 maselo / mL) kusiyana ndi matenda ena okhudzana ndi kachilombo ka HIV. Mankhwala othandiza ndi mankhwala opatsirana pogwiritsa ntchito TB amatchulidwa ngati njira zoyenera kuchita.
Zotsatira:
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