Nhasi Nhungamiro Inobva kuDhipatimendi reHutano neHuman Services
Yaiva muna 1994, mumutambo ACTG 076 kuongororwa, izvo vatsvakurudzi vakaratidza kunze kwemumvuri wekusava nechokwadi kuti kushandiswa kwemishonga inorwisa mabhakitiriya (AZT) munguva uye shure kwekuita pamuviri kunogona kuderedza ngozi yekutapurirwa kweHIV kubva kuna amai kuenda kumwana nechishamiso 67 muzana. Mumakore achangopfuura, nekupindira kweraretroviral therapy (ART) , iyo nhamba ikozvino yava pedyo ne98 muzana.
Nhasi, kudzivirirwa kwekutapurirwa kweamai kuenda kumwana (inozivikanwawo sekutenderera kwemashure) kunosanganisira zvikamu zvose zvekudzivirira, kubva kune chibereko chekuberekwa kusvikira pakuzvarwa. Chinokosha pakubudirira kwacho ndiko kupindira kwekutanga. Nokupa chirongwa cheHIV pane nguva yakareba nguva isati yatanga kuberekwa-panzvimbo pane panguva yekuberekwa-vanaamai vane mukana wakakura zvikuru wokudzivisa HIV kuti ive isina kuonekwa , zvichiita kuti kuderedza dambudziko rekutumirwa.
Kuderedza Dambudziko rekutengesa kweAtenatal
Mazano ekuberekwa kweAIDS anowanikwa zvakafanana kune vakadzi vane pamuviri vane HIV, sezvavari kune avo vasina pamuviri, uye zvishomanana kuchinjwa zvichienderana nekunetseka pamusoro pezvimwe zvirwere zvinorwisa ma antiretroviral.
Kune vakadzi vasati vagara vachirapa, US Department of Health and Human Services (DHHS) inokurudzira kushandiswa kweRetrovir (AZT, zidovudine) pamwe neEpivir (3TC, lamivudine) sechitsva chekutanga-line ART. Izvi ndezvokuti nucleoside reverse transcriptase inhibitors (NRTIs) yakafanana neRetrovir inoratidzwa kuti inopinda nepakati pemuganhu wepakati, kupa mwana asati aberekwa kudzivirira kukuru kubva kune HIV.
Nhungamiro iyi haisati ikurudzira kushandiswa kweSusvava (efavirenz) kana Sustiva-based drugs zvakadai seAtripla panguva yekuzvimba , kunyange izvi zvinowanzoonekwa sechikonzero chekuchengetedza. Kunyange zvazvo zvidzidzo zvedzidzo zvekare zvange zvaratidza muhuwandu hwakareba hweSusti-zvine chokuita nekuremara kwekuberekwa, zvakafanana hazvina kuonekwa kuvanhu.
Kana kuve nekudzivirira kunotsigirwa kumudzimai atova kuSusva, inorayirwa kuti mishonga inoshandurwa chete mukati memavhiki mashanu kusvika matanhatu ekuberekwa. Mushure meizvozvo, kuchinja hakusi kudiwa.
Zvimwe zvikonzero zvinosanganisira:
- Viramune (nevirapine) haifaniri kushandiswa kuvakadzi vane CD4 count kupfuura 250 masero / μL nekuda kwehuwandu hwehutano hwehupenyu hunotyisa hepatotoxicity.
- Intelence (etravirine), Edurant (rilpivirine), Aptivus (tipranavir), Selzentry (maraviroc), Lexiva (fosamprenavir) uye Fuzeon (enfuvirtide) havakurudziri iye zvino nekuda kwekushaya kukwana kwekuchengetedza uye kubudirira kwavo.
- Viracept (nelfinavir) neCrixivan (indinavir) hazvikurudzirwi pamusana pehuwandu hwema seramu hunobudirira panguva yekudzivirira kunze kwekunge pasina dzimwe sarudzo dziripo.
Kuderedza Dambudziko Rokutengesa Panguva Yakaendeswa
Pakutanga kwebasa, vakadzi pavanenge vachiita zvekuberekwa ART vanofanira kupfuurira kutora mishonga yavo purogiramu kwenguva yakareba. Zvisinei, kana mukadzi anopa panguva yekushanda, ndiani anotsigira HIV-asi asi asina kutora antiretroviral therapy OR ane utachiona hwepamusoro huwandu kupfuura mazana mana / μL, zidovudine dzomukati dzinenge dzichiendeswa mberi nguva dzose munguva yebasa .
Maererano neU.S. Centers for Disease Control and Prevention (CDC), vanenge makumi matatu kubva muzana yevakadzi vari muUnited States havana kuongororwa neHIV panguva yekuzvitakura. Uyezve, 15 muzana yevaya vane utachiona hweHIV vanogamuchira kana kwete kana kuti vasati vatariswa, asi 20 muzana havatangi kutarisira kusvika munguva yechitatu yevatatu.
Kana pasina antiretroviral, hutachiona hwekutengesa hunofungidzirwa kuva pakati pe25 ne30 muzana.
Nzira Yokuendesa Zvirongwa
Uchapupu hwakaratidza kuti chikamu chekudzivirirwa chinorongwa chinokonzera njodzi yakaderera yekutapurirwa kupfuura yekubereka.
Nekuita chigamba chisati chavapo kusati kwatanga kushanda (uye kupera kweamniotic membranes), mwana achangoberekwa haatombove nehutachiona-kunyanya mumamiriro ezvinhu apo amai vakakundikana kuwana hutachiona hwekuderedza.
DHHS inokurudzira kuti kuendesa kwekudzivirira kwezvirongwa kunorongwa pamasvondo makumi matatu nematatu ekuberekwa kana amai
- haana kugamuchira ART munguva yekusununguka kwake, kana
- ine hutachiona huwandu hunopfuura 1 000 makopi / μL pamasvondo makumi matanhatu ekuberekwa.
Kusiyana neizvi, kubata kwevakadzi kunogona kuitwa kune vanaamai vakagadzirisa utachiona husingaoneki mumavhiki makumi matatu nemaviri ekuzvitakura. Dambudziko rekutapurirwa kwevakadzi ava rinowanzopfuura 1 muzana.
Muchiitiko icho mukadzi anopa mushure mekupera kwemuviri uye nehutachiona huwandu hunopfuura 1 000 makopi / μL, zidovudine dzomukati dzinowanzogadziriswa, dzimwe nguva nekushandiswa kwe oxytocin kuti dzikurumidze kutakura.
Postnatal Recommendations
Pamusoro pokutora, Sirasi yeRetrovir inofanira kuendeswa kumwana achangoberekwa mukati maawa matanhatu kusvika pa12 ekuberekwa, achienderera mberi shure kwemaawa gumi nerimwe nemavhiki matanhatu anotevera. Nhamba yacho icharamba ichigadziriswa sezvo mwana achiri kuyaruka. Kuvhiringidzwa kweViramune muromo kunogonawo kupiwa mumamiriro ezvinhu apo amai vakanga vasina kugamuchira ART munguva yekusununguka kwake.
Chirongwa cheHIV PCR chekufanirwa chenguva inofanira kurongerwa kumucheche pamazuva 14-21, kusvika kumwedzi miviri, nemwedzi mina kusvika kumatanhatu. Iko kunyanzvi kwePCR miedzo yekuvapo kwe HIV muropa recheche rinopesana neE standard ELISA , iyo inoongororwa neHIV antibodies . Sezvo zvirwere zvakanyanya "zvakagara nhaka" kubva kuna amai, kuvapo kwavo hakugoni kuziva kana chirwere chakaitika mumwana.
Kana mucheche achiedza kutora mwedzi mumwe chete kusvika maviri, PCR yechipiri yaizoitwa mwedzi unotevera gare gare. Chimwe chechipiri chakaipa chinogona kushanda sekusimbisa kuti chirwere hachina kuitika.
Kusiyana neizvi, mucheche anongorapwa chete ane HIV kana mushure meviri maitiro akanaka eCPR anogamuchirwa. Muchiitiko icho mwana ane HIV, ART inogona kupiwa nokukurumidza pamwe neBactrim prophylaxis (inoshandiswa kudzivirira kufambiswa kwePPM pneumonia).
Kuberekwa kana Kuti Kusabatwa?
Mhinduro yakareba-uye-pfupi ndeyokuti vanaamai vane HIV mukati meUnited States havafaniri kunwisa kana vachikwanisa kuchengetedza kukonzerwa kwehutachiona hwakakwana. Mune dzimwe nyika dzakabudirira kufanana neU.S., apo mazamu emucheche ari akachengeteka uye anowanikwa nyore nyore, kunwisa kunomwisa dambudziko rinodzivirirwa iro rinopfuuresa kupfuura zvaro zvinobatsira (semuenzaniso kubatana kwekuberekwa, kubatana kwekudzivirira muviri, etc.)
Kunyange zvazvo kutsvakurudza kunoshandiswa kwemishonga inorwisa mabhakitiriya munguva yekuyamwisa pashure pekuberekwa kunopera, zvidzidzo zvakawanda muAfrica zvakaratidza huwandu hwehutachiona huri pakati pe2,8 kubva kune 5.9 muzana mushure mwedzi mitanhatu yekuyamwisa.
Iko kusati-chewing (kana kuti pre-mastication) yezvokudya zvecheche hazvikurudzirwi nevabereki vane HIV kana vatarisi. Kunyange zvazvo paine mazana mashomanana akasimbiswa ekutapurirwa ne pre-mastication, kune chikonzero chinokonzerwa nekubuda ropa uye zvironda zvinogona kubva pakusachena kwemazino, pamwe nekucheka uye kubhurwa kunowanikwa panguva yekutengesa.
> Sources:
> Connor, E ;; Sperling, R .; Gelber, R .; et al. "Kuderedza Kuberekwa Kwemucheche-Kubhekwa Kwemwana weAnmunodeficiency Virus Type 1 NeZidovudine Treatment. Vanachiremba AIDS Clinical Trials Group Protocol 076 Chidzidzo Chekudzidza." New England Journal of Medicine. November 3, 1994; 331 (18): 1173-1180.
> Dominquez, K .; Rakhmanina, N .; Juliano, A. "uye al." Kufungidzirwa seGwara reMwana Kutapukirwa kweHIV: Case-Control uye Cross-Sectional Investigations. "February 12, 2012; 59 (2): 207-212.
> Verenga, J. uye Newell, M. "Kubudirira uye kuchengeteka kweCesarea Kutengeswa kwekudzivirira kubuda kweMwana kusvika kune Mwana weHIV-1 (Kudzokorora)." Cochrane Database yekuongorora kwakarongeka. October 9, 2005; (4): CD005479.
> US Centers for Disease Control and Prevention (CDC). "HIV pakati pevakadzi vane pamuviri, vacheche, nevana." Atlanta, Georgia.
> Dhipatimendi reUnited Health of Health and Human Services (DHHS). "Zvirongwa zveKushandisa Antiretroviral Zvinodhaka Madzimai Akaberekwa neHIV-1-Akabatwa neHana hweMadzimai uye Matongerwo Ekuita Kuti Kuderedza Kupararira kweAIDS kuPininatal muUnited States." Rockville, Maryland. Chirongwa chakabudiswa musi waMay 21, 2013.