Zvirwere zvehutachiona zvakarongeka zvinoramba zvichiva chikonzero chikuru chekurwara uye rufu kune vanhu vane HIV, asi zvirwere zvisinganzwisisiki kana kuti zvisingaverengeki zvinowanzozivikanwa. Pakati pezvirwere zvinokonzera fungal zvinowanzobatanidzwa neHIV :
- Oral and esophageal candidiasis (thrush)
- Cryptococcosis (kusanganisira cryptococcal meningitis)
- Histoplasmosis
- Coccidioidomycosis (Valley Fever)
Zvimwe zvirwere zvinokonzera fungal (kusanganisira aspergillosis, penicillosis, uye blastomycosis) zvakare zvakataurwa, kakawanda kune vanhu vane CD4 nhamba pasi apa 250 masero / mL.
Kune huwandu hwevarume vanowanzoshandiswa kurapa zvirwere zvehutachiona hwehutachiona hweHIV. Mishonga iyi inorongwa nehutano hwavo hwekuita, uye inogona kuputsika kusvika mumapoka mana akazara:
I. Polyene Antifungals
Zvinyorwa zvePolene zvinoshanda nekuputsa kuvimbika kwemafungiro emasero emufudzi, izvo zvinozopedzisira zvaita kuti sero kufa. Iyo yakawanda inowanzoshandiswa nehutachiona iyo inoshandiswa mune HIV ndeyekuti:
- Amphotericin B : Kazhinji inobatanidzwa nekurapa kwe systemic (muviri wose) zvirwere zvakashata zvakadai se cryptococcal meningitis. Kana ikashandiswa mukati, amphotericin B inozivikanwa kuva nemigumisiro yakakomba, kazhinji nekunzwa kwakanyanya kunoitika nguva pfupi mushure mokuputika (semuviri, fever, chills, kurwisana, kusuruvara, kurutsira, musoro, uye kurwadziwa kwepfungwa). Sezvo zvakadaro, kushandiswa kwemajoka kweAmphotericin B kunowanzoratidzwa mumavhirwere akaoma-immune-anorambidzwa kana varwere vanorwara. Kugadzirira muromo kunowanikwa kushandiswa mukurapa candidiasis, iyo yakachengeteka kuti ishandiswe nehutachiona hwekutengesa zvinodhaka.
- Nystatin : Inotungamirirwa mumuromo kana pamusoro nekuda kwekunyoresa, murwere, uye vaginal candidiasis. Nystatin inogonawo kushandiswa seprophylactic (preventionative) therapy mune varwere vane utachiwana hweHIV vane ngozi yakawanda yehutachiona hwehutachiona (CD4 chiverengero chemasero 100 / mL kana pasi). Nystatin inowanikwa sematafura, mouthwash, pastilles, powders, creams, uye mafuta.
II. Azole Antifungals
Azole antifungals inopesana nehutachiona hwemadziviriro aidiwa kuchengetedza kutenderera kwemuviri wechipfuva, nokudaro kudzivisa kuti fungus 'iwedzere kukura. Migumisiro yakajairika inosanganisira kuputika, kurwadziwa musoro, chizivo, kushungurudza, kusuruvara, chirwere, chirwere chemimba, uye mazwi enzymes akakwirira.
- Diflucan (fluconazole) : Zviri pachena kuti chimwe chezvinyorwa zvinonyanya kushandiswa munyika yose, Diflucan inoshandiswa mukurapa kwepamusoro uye maitiro ehutachiona, kusanganisira candidiasis, cryptococcosis, histoplasmosis, uye coccidioidomycosis. Diflucan inowanika mufomu yepiritsi, sehupfu hwekumurambidza muromo, kana sechinangwa chisina kumira chekushandisa kushandiswa.
- Nizoral (ketoconazole) : Nizorori ndiyo yakatanga kunyora oral azole antifungal mishonga, asi yakanyanya kuwedzererwa nedzimwe azoro dzine zvidhakwa zvishoma uye zvakanyanya kuwedzerwa. Inowanikwa mufomu yepetiyumu, uyewo mumhando dzakasiyana-siyana dzinoshandiswa kuti dzishandiswe pazvirwere zvisingatauri zvakanyanya, kusanganisira candidiasis.
- Sporanox (itraconazole) : Kazhinji inoshandiswa muhutachiona hwehutachiona (zvakadai se candidiasis kana cryptococcosis) apo mamwe maitiro asingabatsiri kana asina kukodzera. Sporanox inowanikwa mune kapsule fomu kana seanorudzo remuromo (inofungidzirwa yakakwirira maererano nekunyorera uye bioavailability). Kugadzirira kwekugadzirira hakusi kuwanikwa muUnited States Nokuda kwekupinda kwaro kuderera kusvika kune cerebrospinal fluid, Sporanox inowanzoshandiswa chete mumutsara wechipiri apo inoshandisa cryptococcal meningitis.
Mimwe yenzoro inoshandiswa pakurapa zvirwere zvinokonzera mafungiro ndeyeVFend (voriconazole) uye Posanol (posaconazole).
III. Antimetabolite Antifungal
Pane imwechete antimetabolite mishonga (Ancobon) inozivikanwa kuti ine intifungal properties, iyo inozoita nekupindirana neRNA uye DNA synthesis.
- Ancobon (flucytosine) : Akashandiswa pakurapa zviitiko zvakakomba zve candidiasis uye cryptococcosis, Ancobon inogara ichigadziriswa ne fluconazole uye / kana amphotericin B sezvo kukura kwekudzivirira kwakajairika kana kushandiswa chete. Kusanganiswa kweAmphotericin B uye Ancobon kwakaratidza kufarirwa mukurapa kwe cryptococcal meningitis. Ancobon inowanikwa mune capsule fomu. Migumisiro inogona kusanganisira kusagadzikana kwepamuviri uye kusagadzikana kwemasese (kusanganisira anemia). Rash, misoro, kunyonganiswa, kukanganiswa, sedation, uye chiropa chepamusoro chebasa zvakave zvataurwawo.
IV. Echinocandins
Kirasi itsva yezvinyorwa zvinonzi echinocandins iri kushandiswawo mukurapa candidiasis uye aspergillosis. Echinocandins inoshanda kuburikidza nekudzivisa kupindirana kwemamwe polysaccharides mune fungal cell wall. Kazhinji, echinocandins inopa hutachiona hwakaderera uye zvishomanana kudyidzana kwezvinodhaka-zvinodhaka, kunyange panguva ino ivo vanowanzotarisirwa kune varwere vasingateereri kune dzimwe mishonga yemagetsi. Zvose zvitatu zvinotarisirwa mukati, pamwe nekuchengetedzwa kwakafanana, kubudirira, nekushivirira.
- Eraxis (anidulafungin)
- Cancidas (caspofungin)
- Mycamine (micafungin)
Sources:
Marty, F. uye Mylonakis, E. "Kushandiswa kwemaitiro ekutapukirwa kweHIV." Expert Opinion Pharmacotherapy. February, 2002; 3 (2): 91-102.
Mei, H ;; Kok, L .; Shariff, M .; et al. "Kushandiswa kweAntifungal For Infortunistic Infection muHIV Varwere: Kufananidza neEfficacy uye kuchengeteka." WebmedCentral AIDS. 2011; 2 (12): WMC002674.
National Institutes of Health (NIH). "Mirayiridzo Yekudzivirira uye Kurapwa Kwezvirwere Zvichida muHIV-Vakabatwa Vakuru Nevana Vari Kuyaruka." Bethesda, Maryland; yakarongedzwa musi waSeptember 27, 2013.