Isikhokelo esivela kwiSebe lezeMpilo kunye neNkonzo zoLuntu
Kwakukho ngo-1994, kwisifundo se-ACTG 076 sophando, abaphandi babonisa ngaphaya komthunzi wokungabaza ukuba ukusetyenziswa kweyeza-antiretroviral (AZT) ngexesha nangemva kokukhulelwa kunokunciphisa umngcipheko wokudluliselwa kwe-HIV kumama ukuya kumntwana ngokumangalisa 67 ekhulwini. Kwiminyaka yakutshanje, ngoncedo lwonyango lwe-antiretroviral (ART) , elo nani liphantse kumaphesenti angu-98.
Namhlanje, ukuthintela ukutshintshwa komama kunomntwana (owaziwa ngokuba ngumtshini wokuhamba) kufaka zonke izigaba zokukhulelwa, ukusuka kwintsapho yokubeletha ukuya kunakekelwa ngumntwana. Isiphambili kwimpumelelo yaso kukungenelela kwangaphambili. Ngokulawula i-ART ngexesha elide ngaphambi kokunikezelwa-kunokuba ngexesha lokunikezelwa-oomama banethuba elikhulu lokukhusela i-HIV kumanqanaba angabonakaliyo , ngaloo ndlela unciphise umngcipheko wokudluliselwa.
Ukunciphisa Umngcipheko wokuThumela kwangaphambi kokuzalwa
Izikhokelo zokubeletha kwi-ART zifana ngokufanayo nabasetyhini abakhulelwe abane-HIV njengokuba bangabakhulelwe, kunye nokuguqulwa okumbalwa ngokusekelwe kwiinkxalabo malunga nemithi ethile ye-antiretroviral.
Kubafazi abangekho ngaphambili kwonyango, iSebe laseMelika lezeMpilo kunye neNkonzo zoLuntu (DHHS) licebisa ukusetyenziswa kweRetrovir (AZT, zidovudine) kunye ne- Epivir (3TC, lamivudine) njengemva ye-ART yokuqala. Oku kungenxa yokuba i- nucleoside reverse transcriptase inhibitors (i-NRTIs) efana ne-Retrovir iboniswa ukuba ingene ngokungenele kwinqanaba le-placental, ukubonelela umntwana ongakazalwa engakhusela ukukhuselwa kwi-HIV.
Izikhokelo ngoku azincoma ukusetyenziswa kwe- Sustiva (efavirenz) okanye izidakamizwa ezisekelwe kwi- Sustiva njenge- Atripla ngexesha lokukhulelwa, nangona oku kukhulu becingwa njengendlela yokuphepha . Nangona uphando lwezilwanyana zasekuqaleni lwalubonakalisile kumlinganiselo ophezulu we-Sustiva ezihlobene neziphoso zokuzala, okufanayo akuzange kubonwe ngabantu.
Ukuba ukukhulelwa kuqinisekiswa kwintokazi esele isetyenziswa kwiSustiva, kucetyiswa ukuba isicatshulwa sitshintshwe kuphela kwiiveki zokuqala ezintlanu zokuqala. Emva koko, utshintsho aluthathwa njengoluyimfuneko.
Ezinye izinto zibandakanya:
- I-Viramune (i-nevirapine) ayifanele isetyenziswe kubafazi abane-CD4 count ngaphezu kwama-cell e-250 / μL ngenxa yengozi eyongeziweyo yokubulawa kwesifo somzimba .
- Intelence (etravirine), i- Edurant (rilpivirine), i- Aptivus (tipranavir), i- Selzentry (maraviroc), i- Lexiva (i-fosamprenavir) ne- Fuzeon (i -fufutide ) ayikhuthazwa okwangoku ngenxa yeenkcukacha ezingenakulinganiswa nokukhusela nokusebenza kwazo.
- I-Viracept (nelfinavir) ne- Crixivan (indinavir) ayinconywa ngenxa yamanqanaba e-serum aphumelele ngexesha lokukhulelwa ngaphandle kokuba kungabikho ezinye iindlela ezikhoyo.
Ukunciphisa Umngcipheko wokuThunywa ngexesha loNikezelo
Ekuqaleni kwezabasebenzi, abafazi kwi-ART yokubeletha kufuneka baqhubeke nokuthatha amayeza abo kwixesha elide kunokwenzeka. Nangona kunjalo, ukuba umfazi onika ngexesha lobasebenzi, ngubani oqinisekisileyo nge-HIV kodwa engazange athole unyango lwe-antiretroviral ye-antiretatal OR okanye unomthamo wentsholongwane ngaphezu kwama-kopi angama-400 / μL, i-zidovudine engena-intravenous iya kuqhutywa ngokuqhubekayo kulo lonke ixesha .
Ngokutsho kwamaziko e-US for Control and Prevention (CDC), ama-30 ekhulwini kwabasetyhini base-US ahlolwe i-HIV ngexesha lokukhulelwa. Ukongezelela, iipesenti ezili-15 zabantu abaneNTSHOLONGWANE KAGAWULAYO basenokungabikho nonyango okanye ubuncinane bokunakekelwa kwabantwana, nangona iipesenti ezingama-20 aziqalisi ukunakekelwa kude kube sekupheleni kwekota yesithathu.
Xa kungabikho unyango lwe-antiretroviral, umngcipheko wokudluliselwa okubonakalayo uphakathi kwama-25 ekhulwini kunye nama-30 ekhulwini.
Iindlela Zokuhambisa Iingcebiso
Ubu bungqina bubonise ukuba icandelo elithintekayo elicwangcisiweyo libeka umngcipheko ophantsi kakhulu wokusasaza kunokuba kuhanjiswa kwesisu.
Ngokwenza i-laarean phambi kokuqala komsebenzi (kunye nokugqithwa kweembumba zamamoniotic), umntwana osanda kuzalwa akanako ukusuleleka-sukuba kwiimeko apho umama akakwazanga ukuphumeza ukunyanzelwa kwe-virus.
I-DHHS icebisa ukuba ukuhanjiswa kwee-quarry kulungiselelwe kwiiveki ezingama-38 zokukhulelwa ukuba unina
- ayitholanga i-ART ngexesha lokukhulelwa kwakhe, okanye
- unomthamo wentsholongwane ngaphezu kwama-1 ikopi / μL kwiiveki ezingama-36 zokukhulelwa.
Ngokwahlukileyo, ukuhanjiswa kwezesini kunokwenzelwa oomama abaphumelele umthwalo wentsholongwane engabonakali kwiiveki ezingama-36 zokukhulelwa. Umngcipheko wokusasazeka kwala baomama ngokuqhelekileyo ungaphantsi kwama-1 ekhulwini.
Kwimeko apho ibhinqa libonisa emva kokuqhekeka kweembrane kunye nomthamo wentsholongwane ngaphezu kwe-1 000 ikopi / μL, i-zidovudine e-intravenous ilawulwa ngokubanzi, ngamanye amaxesha isebenzisa i-oxytocin ukukhawuleza ukuhanjiswa.
Iziphakamiso zangaphambi kokuzalwa
Ngethuba lokuhambisa, isiraphu yeRetrovir kufuneka ilawulwe kwiintsana ezi-6 ukuya kwe-12 zokuzalwa, ngokuqhubekayo emva kweeyure eziyi-12 kwiiveki ezizayo. Umyinge uza kulungiswa rhoqo njengoko umntwana ekhula. Ukumiswa kweViramune yomlomo kungasimiselwa kwakhona kwimeko apho umama engazange afumane i-ART ngexesha lokukhulelwa kwakhe.
Uvavanyo lwe- HIV lwe-HIV lwe-HIV kufuneka lube lubekwe isantya kwiintsuku ezili-14 ukuya ku-21, enye ukuya kweenyanga ezimbini, kunye neenyanga ezine ukuya ezintandathu. Iimvavanyo zePCR ezinobungqina beNTSHOLONGWANE KAGAWULAYO kwigazi leintsana ngokuchasene ne- ELISA epheleleyo, iimvavanyo ze- antibodies . Ekubeni ama-antibodies ayenayo "ifa" elivela kumama, ubukho babo abukwazi ukubona ukuba isifo senzeke kumntwana.
Ukuba iimvavanyo zamakhwenkwe zingasebenzi kwinyanga enye ukuya kwezimbini, i-PCR yesibili iya kwenziwa ubuncinane inyanga emva koko. Isiphumo sesibini esingalunganga siya kusebenza njengoqinisekiso lokuba isifo asizange senzeke.
Ngakolunye uhlangothi, usana lufunyaniswa ukuba lunentsholongwane kaGawulayo emva kokuvavanywa kweemvavanyo ezi-PCR ezintle. Kwimeko apho umntwana enesifo se-HIV, i-ART iya kuchongwa ngokukhawuleza kunye ne-Bactrim prophylaxis (isetyenziswe ukukhusela ukuphuhliswa kwe-pneumonia ye-PCP).
Ukuxhatshazwa okanye Ungaboniswa?
Impendulo emide neyifutshane kukuba oomama abane-HIV e-US kufuneka baphephe ukuncelisa kunyaka, nokuba ngaba bakwazi ukugcina ukunyanzeliswa kwegciwane elipheleleyo. Emazweni athuthukileyo afana ne-US, apho ubisi lwefestile lukhuselekile kwaye lufumaneka ngokulula, ukuncelisa kubangela umngcipheko okhuselekayo ogqithisileyo ngaphezu kweenzuzo zayo ezinxulumene (umzekelo, ukudibanisa umama, umgaqo-mzimba womzimba, njl.
Nangona uphando malunga nokusetyenziswa kwee-antiretrovirals ngexesha lokuncelisa i-postpartum lucacisiwe, izifundo ezininzi e-Afrika ziye zabonisa amaxabiso okudlulisa naphi phakathi kwama-2.8 ekhulwini ukuya kuma-5.9 ekhulwini emva kweenyanga ezintandathu zokuncelisa.
Uku-pre-chewing (okanye ukuqala-ukutshatyalaliswa) kokutya kweintsana akukhuthazwa ngabazali abane-HIV okanye ngabagcini-nkonzo. Nangona kubekho amacandelo amancinci athatywayo okuhanjiswa ngethuba lokupasa, kukho iimeko ezinokubangelwa kwintsholongwane yegazi kunye nezilonda ezinokuvela kwiindawo ezihlambulukileyo zamazinyo, kunye nokucutshulwa kunye nokuhlaselwa okwenzeka ngexesha lexesha.
> Imithombo:
> Connor, E .; Sperling, R .; Gelber, R .; okqhubekayo. "Ukunciphisa Ukuthunyelwa kwabantwana baseMantal-Child Immunodeficiency Type 1 nge-Zidovudine Treatment. Iprogram ye-AIDS Clinic Trials Group I-Protocol ye-076 yeqela lokuFunda." I-New England Journal of Medicine. Novemba 3, 1994; 331 (18): 1173-1180.
> Dominquez, K .; Rakhmanina, N .; I-Juliano, A. kunye ne-al. "Ukuqapheliswa njengendlela yoThutho lweNtsholongwane kaGawulayo: I-Case-Control kunye noPhando oluPhezulu." I- Journal ye-Immune Deficiency Syndrome .
> Funda, J. kunye noNewell, M. "Ukusebenza kunye noKhuseleko lweSaarey Delivery for Prevention of Mother to Child Transmission of HIV-1 (Ukuhlaziywa)." I-Cochrane Database yeeNkqubo eziPhezulu. Oktobha 9, 2005; (4): CD005479.
> Amasebe ase-US okuLawula nokuVikela (i-CDC) yezifo. "I-HIV phakathi kwabantwana abakhulelweyo, iintsana kunye nabantwana." Atlanta, Georgia.
> Isebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu (DHHS). "Iziphakamiso zokusetyenziswa kwezidakamizwa ze-Antiretroviral Izidakamizwa kwi-HIV-1-abafazi abachaphazelekayo kwiMpilo kaMama kunye neNguqulelo ekunciphiseni ukuhanjiswa kwe-HIV kwi-United States." Rockville, Maryland. Ukuhlaziywa okukhutshwe ngoMeyi 21, 2013.