Mirayiridzo Ipai CD4 Kuongorora Kungasarudzwa
Nekuwedzera kwehutano hwemazuva ano antiretroviral therapy (ART) , kusimbiswa hakufaniri kushandiswa pakushandisa nhamba dzeCD4 sechiyero chekubudirira kweART. Maererano nemitemo yakabudiswa neDhipatimendi reMweya weUnited States uye Human Services (DHHS) musi waMay 1, 2014, mitoro yevirari inofanira kunge yakashandiswa kusarudza izvi.
Kunyange zvazvo izvi zvingaita shanduko isinganzwisisi kune vamwe, inobvuma zvinhu zviviri zvinokosha:
- Kuti kurwara kwehutachiona kweAIDS (sekuenzaniswa neCD4 count) kunogona kuchinja zvakasiyana kunyange mukutarisana kwekuchengetedzwa kwehutachiwana hwehutachiona.
- Iyo CD4 kuongorora haibatsiri zvakanyanya kuti ART inotarisirwa sei kune vanorapwa.
Pamberi pezvishoma zvechizvarwa chekare chinonzi antiretrovirals , zvakanga zvisiri zvisingaiti kuti vamwe vanachiremba vachinje zvirongwa zveART zvichienderana nekushaya kwehutano kwemuviri wekudzivirirwa kwezvirwere. Izvi zvaiwanzoguma nekuregerera kusati kwapera kwerapi, kakawanda pasinei nekuchengetedzwa kwe virologic (sekuenzaniswa nehutachiona hwehutachiwana) uye kazhinji makore asati achinjwa saizvozvo.
Mukudhinda mazano anongororwa, DHHS yakagumisa kuti "kupindura kweCD4 yakaipa mumurwere ane kuperesa kwehutachiona hakuwanzo chiratidzo chekuchinja hurumende (antiretroviral)." Yakaramba ichibvuma kuti kukwanisa kugadzirisa zvirwere zvemuviri wemurwere zvinowanzosvibiswa nezvinhu zvinowedzera zvakanyanya kudarika zvinosvika pamishonga-zvinosanganisira low low CD4 count pakutanga kwerapi, kukwegura kana nhoroondo yezvirwere zvinokonzerwa neHIV.
Mune varwere vane mhando dzematambudziko aya, kuchinja zvirongwa zveART zvinowanikwa kune CD4 count zvingangodaro zvinokuvadza zvakanyanya pane zvakanaka, zvichiwedzera dambudziko rekusagadzikana kwezvinodhaka nekushandura zvirongwa zvakare kare kana kuti kazhinji.
Kurwiswa kweCD4 Count Monitoring
Maererano neDHHS, nhamba yeCD4 yemurwere inofanira kushandiswa kune chimwe chezvinangwa zvitatu zvakakosha:
- Kubatsira kuziva kuti ndeipi nguva yekutanga ma ART mune munhu ane HIV
- Kutungamira apo kutanga kana kumira prophylactic therapy kuti zviri nani kudzivirira kukura kwehutachiona hunopfurikidza (OIs)
- Kuongorora kana chirwere chemuviri chirwere cheAIDS chiri chakakwana (chinotsanangurwa sekuwedzera kweCD4 count by 50-150 masero mukati megore rokutanga remishonga, pamwe nekuwedzera kwakafanana gore negore kusvikira hukama hwakasimba huripo)
Kune vatsva vaongororwa vasati vasvika paAIDS, kuongorora CD4 kunofanirwa kuitwa panguva yekupinda mukutarisirwa uye mushure memwedzi mitatu nemasere matanhatu.
Kune vanorwara vane ART inoratidzwa, kuongorora kweCD4 kunofanira kudzokororwa kwemwedzi mitatu mushure mekurohwa kwerapi uyezve mwedzi mitatu nemasere kubva ipapo.
Pakupedzisira, kune varwere vanga vari muART kwenguva yemakore maviri uye vave vakachengetedza zvisingaoneki zvehutachiona, zvinokurudzirwa kuti
- CD4 kuongororwa kunoitwa mwedzi gumi nembiri kune avo vane CD4 dzepamusoro pakati pe 300 ne500 masero / mL, uye;
- CD4 kuongororwa inofungidzirwa seyakasarudzwa kune avo vane CD4 dzinopfuura masero 500 / mL.
Mukutaura, CD4 kutarisa inofanira kutangazve kune varwere vane virologic rebound; chirwere chinokonzerwa neHIV; kana chero imwe mamiriro ezvinhu kana chirwere chinogona kukanganisa CD4 yemunhu.
Kuongororwa kweimwe mishonga yemaitiro (eg, CD8, CD19) haisati yakurudzirwa sezvo zviedzo zvose zvinodhura uye hazvipi kupa kliniki chaiyo yeiyo.
Kurwiswa kweViral Load Monitoring
Kune varwere vachangobva kuongororwa vane HIV, kuongororwa kwehutachiona hwemagetsi kunofanira kuitwa panguva yekupinda mukutarisirwa. Kana zvichionekwa kuti ART inogona kuderedzwa, kudzokorora kuedzwa kunogona kufungidzirwa pane dzimwe nguva.
Kune varwere vane chirwere cheART chinoratidzwa, chirwere chemuviri wekutaridzika chinofanira kuitwa musati watanga kurapwa (kupa chirongwa chekutanga chekuyera kurapwa kwemishonga). Iko inofanira kudzokororwa 2 kusvika 4 masvondo mushure mekutangwa kweART uye masvondo ose kusvika 4 kusvika ipapo kusvikira mutachiona uwandu hwakanyatsopedzwa.
Kune varwere vane mishonga isingaoneki yehutachiwana yakawanikwa, kuedza kunofanira kudzokororwa kwemwedzi mitatu kusvika ku4. Kana kuvharirwa kwehutachiona kuchichengetedzwa kwemakore maviri, kuongorora kunogona kuwedzerwa kumwedzi mitanhatu.
Sources:
Dhipatimendi reUnited Health (Health Services) uye Human Services (DHHS). " Mirayiridzo yeKushandiswa kweAntiretroviral Agents muHIV-1-Vakabatwa Vakuru Nevana Vari Kuyaruka." Bethesda, Maryland.