Ziziphi izifundo zezilwanyana kunye noshwankathelo lophando olusixelela
Kukho iinkxalabo ezininzi ukuba abafazi abathintela izidakamizwa ezithile ze- antiretroviral ngexesha lokukhulelwa banokubeka ingozi eyongeziweyo yokuzalwa kweziphene. Uphando luvame ukuphikisana kunye nokuxhalaba malunga neengozi ezinokuthi zenzeke ngezinye iinkcukacha malunga nezokhuseleko.
I- Sustiva (i-efavirenz) isiqhelo senkxalabo yokuxhalabisa ngeziganeko zangaphambilini ezibonisa ukuba kufuneka kugwenywe, ubuncinane ngexesha lekota yokuqala, ngenxa yemingcipheko ye-teratogenicity (iziphene zokuzalwa).
Iingcebiso ziye zatshintshwa kwaye ngoku zivumela ukuba kusetyenziswe i-efavirenz kwi-trimester yokuqala xa kufuneka umama abe nomthwalo ongenakwenzeka .
Xa kuthethwa oko, izikhokelo ezifanayo zibonisa ukuba abafazi abangabantwana abakhulelweyo bokukhusela iminyaka banqanda naziphi na izixhobo zonyango eziqukethe i-efavirenz.
Ngoko oko kuthetha ukuthini? Ngaba iphaneli lezempilo lase-United States likhawuleza iibhendi zabo malunga neziyobisi ezinokuthi zingabonakali, okanye ngaba sifanele sizikhathalele ngoku kunye nezinye iziyobisi?
IziPhulo zezilwanyana zibonise ingozi
Ekuhloleni umngcipheko wezilwanyana zeHIV kunye neziphene zokuzalwa, uninzi lwaphando lwangoku aluveli kwizifundo zabantu kodwa luvela kuphando lwezilwanyana (ngokucacileyo kuba awukwazi ukubeka imfesane yomntu kwimithi enokuyingozi).
Ngokubhekiselele ku-Sustiva, iinkxalabo malunga ne-teratogenicity zaphakanyiswa kuqala xa iinkwenkwezi ezintathu ze-cynomolgus zibonakaliswe kwilisiza zinezinsana ezinamaqabunga kunye nenkqubo engundoqo ye-nervous malformations Ngaphezu koko, ukuxilongwa kweziyobisi kwakunezihlandlo ezi-1.3 kuphela eziphezulu kunokuba zisetyenziswe kubantu.
Okwangoku, iingqungquthela ezibonakaliswe ku-Sustiva abanomdla wokutshatyalaliswa kwentombazana, into eyenziwa ngabantwana abafayo ngexesha lokuxhatshazwa babuyiselwa ngabantwana babo.
Kwakungabikho ukukhubazeka okuzalwe kwimivundla.
Izifundo zeStatistical in Human
Izibalo ezithathwe kwiRejista yokukhulelwa kwe-Antiretroviral Pregnancy Registry (APR) ziye zatshintsha umfanekiso ohlukileyo.
Ngethuba i-APR ifumene iziphoso zokuzalwa kwabantwana abangama-18 kwabantwana abangama-766 abonakaliswe kuMastiva ngethuba lokuqala lokuqala, inani elincinci leephene ze-neural-iindidi ezibonwe kwizifundo zezilwanyana-zithandabuza ukuba ingaba isiphumo kubantu singafana neenkwenkwe kunye i ikota.
Uhlalutyo olulandelayo lwezifundo ezi-19 ezahlukeneyo, kubandakanya i-APR, sele ifumene iimpembelelo zokuzalwa ezingama-39 kubantwana abayi-1,437 abachazwe kwiSustiva. Ngokusekelwe kulawo manani, ireyithi ibonakala ingekho umahluko kunokuba kuboniswe kubantu base-United States jikelele.
Nangona inani elincinci leenkohlakalo eziqinisekisiweyo, amagosa ezempilo ahlala engafuni ukunika uSusti izitifiketi.
Ubungozi obunobungqina bokuzalwa kwezinye izidakamizwa ze-HIV
Ngo-2014, abaphandi abavela kwiCorin Perinatal Cohort bapapasha isifundo esakhangela inani lokukhubazeka ekuzalweni kubonwa kubantwana abonakaliswe kwiindidi ezahlukeneyo zezidakamizwa ngexesha lokukhulelwa. Ukufundwa kwezizwe ngezizwe kwabandakanya abantwana abangama-13 1212 abazalwa ngabafazi abane-HIV ukususela ngo-1986.
Iziphumo zazinomdla: ngelixa ukunyuka kweziphene zokuzalwa kwahlanganiswa nezidakamizwa ezithile ze-antiretroviral, ezifana ne- Crixivan (indinavir) , isantya asizange ihluke kunokuba ibonwa ngabantu bonke. Ngaphezu koko, akukho mzekelo othize ngohlobo okanye ubunzima beziphene zokuzalwa onokufumaneka.
Okwangoku, abantwana abangama-372 abonakaliswe kwiSusva kwi-trimester yokuqala, akukho mhlangano onokufumaneka phakathi kweziyobisi kunye neziphene zokuzalwa.
Oko akuthethi ukuba iziyobisi azithatha ingozi. Abaphandi baseFransi baqaphela ukunyuka kweentliziyo ezimbini kwiintsana ezichazwe kwi- AZT (zidovudine) . Abaninzi babandakanyeka isiphako se-septal defect, isifo esingaqhelekanga sokuzalwa esiswini apho kuvela imingxuma phakathi kwamagumbi amabini aphantsi entliziyo.
Uphando oluvela kwiSikolo seHarvard yezeMpilo zikaRhulumente, olupapashwe ngo-2014, luqinisekisile ezininzi iziphumo zeFransi. Ukufunda, okubandakanya abantwana abangama-2 580 baseMerika abachazwe kwizidakamizwa zokulwa ne-antiretroviral ngexesha lokuqala kwe-trimester, bafumanise ukuba amachiza ambalwa kunye neklasi yeklasi edibeneyo inxulumene nobungozi obuninzi bokukhubazeka kokuzalwa.
Nangona kunjalo, abaphandi bakaHarvard baqaphele ingozi ephakamileyo yokukhathazeka kwesikhumba kunye ne-musculoskeletal kubantwana abavelele kwi- ritonavir- evuselelwe iReyataz (atazanavir) ngexesha lekota yokuqala. Ngoxa abaphandi bacebisa ukuba kuphinde kufuneke uphando olongezelelweyo ukuvavanya umngcipheko weReyataz ekukhulelweni, basagqiba ekubeni ingozi ebanzi ihlala iphantsi.
kwaye wagqiba ekubeni, nangona uphando olongezelelweyo lufanelekile kwiReyataz ngexesha lokukhulelwa, "kunikezelwa umngcipheko ophantsi (ubungozi bokuzalwa), ukusetyenziswa kwezibonelelo zonyango lwe-ARV ngexesha lokukhulelwa kusengaphezu kweengozi ezinjalo."
> Imithombo:
> 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." EWashington, DC; hlaziywa ngoMatshi 28, 2014.
> IKomiti yeKomiti yokuLawula i-Antiretroviral Pregnancy. Umbiko wexeshana we-Regretryviral Pregnancy Pregnancy Registry 1 Januwari 1989 ukuya kuJanuwari 2017. " Wilmington, North Carolina; hlaziywa ngoJanuwari 2017.
> Sibiude, J; okqhubekayo. "Umanyano phakathi kokuboniswa kokubeleka kweNtsholongwane kaGawulayo kunye noLwaphulo lokuzalwa: Uhlalutyo lwesiFundo seCorin Pertinatal Study (ANRS CO1 / CO11)." PLoS | Amachiza. Aprili 29, 2014; INGXELO: 10.1371 / iphephandaba.pmed.1001635.
> Williams, P .; Ukukrakra, M .; Yildirim, C; okqhubekayo. "Ama-Anomalies angama-Congenital nakwi-Utero Antiretroviral Exposure kwi-Human Immunodeficiency Virus-Exposed Infants Uninected ". JAMA Pediatrics . 2014; INGXELO: 10.1001 / jamapediatrics.2014.