1
aiv infeqcia/SidsiT avadmyofTa
mkurnaloba da movla
klinikuri mdgomareobis marTvis saxelmwifo
standarti
(protokoli)
2
aiv infeqcia/Sidsis antiretrovirusuli Terapia
(protokoli)
1. daavadebis/nozologiis/sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT
gamowveul infeqciur daavadebas.
2. kriteriumebi _ a. damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv
provirus dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis
jaWvuri reaqciis meTodiT.
b. gamomricxavi _ aiv infeqcia Sidsis gamomricxavi kriteriumebia:
aiv antisxeulebis ar arseboba sisxlis SratSi
imunofermentuli meTodiT, raodenobrivad aiv rnm-is da/an
Tvisobrivad aiv provirus dnm-is ararseboba sisxlSi
polimerizaciis jaWvuri reaqciis meTodiT.
3. simptomebi da niSnebi _ a. damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri
niSnebi ar gaaCnia. igi miekuTvneba laboratoriulad
sadiagnozo daavadebebs. simptomebidan SeiZleba gamovyoT:
gaxangrZlivebuli cxeleba, gaxangrZlivebuli faRaraTi,
limfadenopaTia, aramotivirebuli profuzuli oflianoba,
Zlieri saerTo sisuste, aramotivirebuli wonaSi kleba (erTi
Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-
is atipiuri dazianebebi da sxva. atipiuri mikobaqteriebiT
gamowveuli infeqciebis damadasturebel simptomebs
ganekuTvneba cxeleba, Ramis oflianoba, diarea, abdominaluri
tkivili, wonaSi kleba da kaxeqsia.
b. gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba
Civilebs ar warmoadgendes.
3
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
laboratoriuli testebi
aiv infeqciasTan dakavSirebuli testireba:
• aiv serologiuri gamokvleva (tipurad ELISA an swrafi testi),
romelsac mohyveba damadasturebeli testi (tipiurad vestern
blotingi) (11);
• CD4 ujredebis ricxvi imunodeficitis xarisxis gansazRvrisTvis;
orsul qalebSi CD4% (12,13) da
• virusuli datvirTvis testi polimerazuli jaWvuri reaqciis (pjr)
meTodiT, virusis replikaciis donis gansazRvrisTvis ;
testireba sxva infeqciebze
• testi sifilisze (VDRL); • vaginaluri, asos an analuri Camonafxeki gonoreisa da Chlamydia
trachomatis identifikaciisTvis;
• testireba toqsoplazmis IgG serologiur testze da informacia
infeqciis riskis Sesaxeb Tu serologiis Sedegi uaryofiTia;
• kriptokokis antigenis titri, rodesac CD4 limfocitebis ricxvi <
200 mm3 da saxezea kriptokokozis klinikuri niSnebi;
• CMV antigenemia (pp65 adreuli antigeni), rodesac CD4 ujredebis
ricxvi < 100 mm3;
• serologiuri testi B,C hepatitis virusebze (anti HCV, HBsAg) ZiriTadi laboratoriuli testebi:
• eleqtrolitebi (natriumi, kaliumi); N
• RviZlis funqciuri sinjebi (ALT, AST, tute fosfataza, saerTo
da arapirdapiri bilirubini);
• Tirkmlis funqciebi (Sardovana, kreatinini);
• laqtaddehidrogenaza (limfomebis dros ujredTa ZiriTadi
brunva, filtvis infeqciebis niSnebi, miokardiumis infarqti,
kunTebis dazianebani da a.S.);
• INR an proTrombinis dro;
• sisxlis saerTo analizi (formuliTa da Trombocitebis
ricxviT);
• orsulobis testi arv Terapiis dawyebamde.
saWiroebis SemTxvevebSi:
• glukoza;
• qolesterini (HDL, VLDL); • trigliceridebi;
• lipaza;
• C-reaqtiuli cila (CRP); • Tiroid-mastimulirebeli hormoni (TSH ).
4
sxva gamokvlevebi
• tuberkulinis kanis testi;
• naxvelis nacxis mikroskopia da gul-mkerdis rentgenologiuri
gamokvleva, Tu saxezea tuberkulozis niSnebi;
• ekg (gamokvleva mkurnalobamde arT-ze myof pacientebSi gul-
sisxlZarRvovani daavadebis didi riskis gaTvaliswinebiT,
SedarebisTvis) (14)
specialistTa konsultaciebi
• nevrologiuri gamokvleva, rodesac HIV pirvelad aris
diagnostirebuli (mag. periferiuli neiropaTiis
identifikaciisTvis);
• ofTalmologiuri gamokvleva yovel sam TveSi erTxel CMVretinitis identifikaciisTvis, rodesac CD4 ujredebis ricxvi <
100mm3;
• ginekologiuri gamokvleva PAP nacxis CaTvliT yovel 6 TveSi
erTxel (adamianis papilomavirusiT gamowveuli karcinoma);
• sxva specialistebis konsultacia aucileblobis SemTxvevebSi.
5. mkurnaloba
a) rekomendebuli pirveli rigis arT
arT reJimi medikamentebis kombinacia
2 NRTI-s + 1 NNRTI
ZDV + 3TC + (EFVa or NVP) an
TDF + FTC + (EFVa or NVP) an
ABC + 3TC + (EFVa or NVP)
b)
rekomendebuli meore rigis arv reJimi mozardebisa da
mozrdilTaTvis
pirveli rigis reJimi meore rigis reJimi
ZDV + 3TC + (EFV an NVP)
LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC an LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + ABC an LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + TDF + (ZDV + 3TC)b
TDF + FTC + (EFV an NVP)
LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ABC an LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV
ABC + 3TC + (EFV an NVP)
LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + ddI + ZDV an LPV/ra (an ATV/r, SQV/r, FPV/r, IDV/r) + ZDV + TDF (+ 3TC)b
5
6. reabilitacia da dakvirveba
monitoringis samizneebs warmoadgens laboratoriuli testebi
antiretrovirusuli mkurnalobis efeqturobis gasakontroleblad
sawyisi
2
kvira
4
kvira
8
kvira
16
kvira 24
kvira 36
kvira
48
kvira
virusuli
datvirTva
X
X X X X
CD4 ujredebis
ricxvi
X X X (X) X
sisxlis saerTo
analizi
X X X X
(ZDV) X (X) X
RviZlis
funqciuri
sinjebi
X X
(NVP) X X
(NVP, ZDV, PI)
X
(NVP, PI)
X (X) X
qolesterini
triglice-
ridebi
X (PI) X
(PI) X
(PI)
Tirkmlis
funqciebi
X X
(TDF) X
(TDF, IDV)
X (X) X
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
6
aiv infeqcia/SidsiT daavadebuli bavSvebis antiretrovirusuli mkurnaloba
(protokoli)
1. daavadebis/nozologiis/sindromis mokle ganmarteba
aiv infeqcia/Sidsi warmoadgens adamianis imunodeficitis virusiT (aiv)
gamowveul infeqciur daavadebas.
2 kriteriumebi
a. damadasturebeli _ 18 Tvis Semdeg aiv infeqcia/Sidsis
damadasturebeli kriteriumebia: aiv antisxeulebis arseboba sisxlis
SratSi imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv
provirus dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis
jaWvuri reaqciis meTodiT.
b. gamomricxavi _ 18 Tvis Semdeg aiv infeqcia Sidsis gamomricxavi
kriteriumebia: aiv antisxeulebis ar arseboba sisxlis SratSi
imunofermentuli meTodiT, raodenobrivad aiv rnm-is da/an
Tvisobrivad aiv provirus dnm-is ar arseboba sisxlSi
polimerizaciis jaWvuri reaqciis meTodiT.
18 wlamde asakis bavSvebSi aiv infeqciis diagnostikaSemdegi sqemiT
xorcieldeba
• aiv-is pirveladi diagnostika xorcieldeba dabadebidan 48 sT-
is Semdeg. gamoiyeneba pjr meTodiT aiv dnm gansazRvra
axalSobilis sisxlSi, romelic ar aris aRebuli Wiplaris
venidan, vinaidan is SeiZleba dabinZurebuli iyos dedis
sisxliT. am dros kvlevis substrats warmoadgens periferiuli
sisxlis mononuklearebSi arsebuli provirusuli dnm.
dabadebidan 48 saaTSi inficirebuli bavSvebis 38% aCvenebs
dadebiT pasuxs aiv dnm pjr-ze. testis mgrZnobeloba ar
icvleba mniSvnelovnad pirveli 1 kviris ganmavlobaSi, magram
mkveTrad matulobs sicocxlis meore kviridan, rodesac
daavadebuli bavSvebis 93% gamovlindeba. 28 dRis asakSi aiv
dnm pjr-s ukve aqvs 96% mgrZnobeloba da 99% specifiuroba.
aiv dnm pjr gamokvlevaze uaryofiTi pasuxis miRebis
SemTxvevaSi bavSvs ganmeorebiTi gamokvleva imave meTodiT
utardeba 3 Tvis asakSi. miRebuli dadebiTi Sedegi safuZvelia
aiv infeqciis winaswari diagnozisa. saboloo diagnozi
dgindeba ganmeorebiTi pjr-iT aiv –is dnm-ze sisxlis axal
porciaSi.
• 2-3 Tvis asakSi aiv dnm pjr meTodis alternatiul meTodad
SesaZloa CaiTvalos aiv rnm pjr diagnostikis meTodi, romlis
mgrZnobeloba am asakSi 90-100%-s aRwevs, xolo specifiuroba
aiv dnm pjr specifiurobis msgavsia, Tumca aiv rnm dabali
doniT deteqtireba (<10 000 asli/ml) SesaZloa ar iyos
dasayrdnobi da interpretacia unda moxdes sifrTxiliT.
• Tu pjr ar aris xelmisawvdomi, 15-18 Tvis asakSi tardeba
bavSvis sisxlis analizi aiv antisxeulebze. dedis
7
antisxeulebi IgG (maT Soris aiv infeqciis sawinaaRmdego)
transplacenturi gziT xvdeba bavSvis organizmSi. is mTlianad
iSleba 18 Tvis asakisaTvis. amdenad am asakis Semdeg aiv
sawinaaRmdego antisxeulebze dadebiTi Sedegi miuTiTebs, rom
bavSvi aiv inficirebulia.
• Tu bavSvi ikvebeba dedis rZiT, maSin aiv antisxeulebze
gamokvlevas azri aqvs ZuZuTi kvebis Sewyvetidan 6 Tvis Semdeg,
vinaidan manamde bavSvi SeiZleba e.w. “fanjara periodSi”
imyofebodes.
3. simptomebi da niSnebi _
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
saSvilosnosSida inficirebis SemTxvevaSi aRwerilia Taviseburi
simptomokompleqsi, rac xasiaTdeba zrda-ganviTarebis SeferxebiT,
SesaZloa gamoxatuli iyos mravlobiTi darRvevebi qala-saxisa da tvinis
nawilebSi. aiv inficirebul axalSobilebs SesaZloa gamoxatuli
hqondeT gamoweuli Subli, brtyeli cxviri, egzofTalmi mocisfro
sklerebi, mikrocefalia, Tumca unda aRiniSnos, rom ganviTarebis
anomaliebi ar aris mkafiod damaxasiaTebeli niSani aiv infeqciisaTvis.
aiv inficirebul bavSvebSi simptomebidan SeiZleba gamovyoT: zrda-
ganviTarebaSi CamorCena, aramotivirebuli cxeleba,
qronikuli/morecidive yuris infeqciebi, qronikuli pnevmonia an diarea,
qronikuli dermatiti, parotiduli jirkvlebis SeSupeba, sistemuri
limfadenopaTia, hepatomegalia, splenomegalia. limfocituri disfunqcia
safuZvlad udevs morecidive sokovan infeqciebs, rogoricaa kandidozi,
rac Cveulebriv Terapias ar emorCileba. bavSvebSi yvelaze
gavrcelebuli oportunistuli infeqciebia: pnevmocisturi pnevmonia (PCP) da sistemuri kandidozi, xSiria ezofagiti. pediatriuli pnevmocisturi
pnevmoniis didi wili Zalian adreul asakSi iCens Tavs, rasac Tan
axlavs maRali letaloba. es ki am daavadebis proflaqtikis farTod
Catarebis aucileblobis safuZvels iZleva. adreuli PCP profilaqtikis
Catarebis SesaZlebloba 4-6 kviris asakidan dedis aiv statusis adreul
dadgenas did mniSnelobas sZens. sxva oportunistuli infeqciebidan
aRsaniSnavia: citomegalovirusuli infeqcia, romelic iwvevs filtvebisa
da gastroenteraluri traqtis dazianebas da iSviaTad iwvevs retinits.
(rac xSiria mozrdilebSi), qronikuli diarea, gamowveuli
kriptosporidioziT, lamblioziT, izosporaTi an iseTi virusiT,
rogoricaa, adenovirusi. meningiti SesaZloa gamowveul iyos
kriptokokiT, rac klinikurad naklebi simwvaviT vlindeba baqteriul
meningitTan SedarebiT. aratuberkulozuri mikobaqteria (Mycobacterium avium intracelulare) daavadebas iwvevs mogvianebiT etapebze imunitetis mZime
supresiisas. is iwvevs cxelebas wonaSi klebiT an mis gareSe an SesaZloa
gamovlindes malabsorbciuli diareis saxiT.
oportunistuli infeqciis garda sicocxlis pirveli wlis ganmavlobaSi
aiv inficrebul bavSvebs SesaZloa gamouvlindeT limfoiduri
intersticiuli pnevmonia. es nela moprogresire da xSirad asimptomuri
daavadebaa. is Cveulebriv vlindeba sicocxlis pirveli wlis Tavze da
piks ori wlis asakisaTvis aRwevs. xSiradaa asocirebuli parotiduli
8
jirkvlebis SeSupebasTan da hipergamaglobulinemiasTan. bavSvs SesaZloa
hqondes mxolod es gamovlinebani filtvebis dazianebis gamovlinebamde
didi xniT adre. Semdgom vlindeba daqveiTebul oqsigenaciasTan
dakavSirebuli gamovlinebani, maT Soris dolis joxiseburi TiTebi.
Tumca wlebis manZilze gamovlinebani SesaZloa Zalze mwiri iyos.
xSiria morecidive baqteriuli infeqciebi, rac gamowveulia: Hemophilius influenzae, Streptococcus pyogenes, Staphylococcus epidermidis, pneumococcus, salmonellas. yvelaze xSirad morecidive baqteriul infeqcias pnevmonia miekuTvneba,
romlis xSir mizezsac S. pneumoniae warrmoadgens. mwvave pnevmoniis xSiri mizezia pnevmocisturi pnevmoniac, rac mxedvelobaSi unda gvqondes
miuxedavad pacientis imunuri statusisa da CD4 raodenobisa.
tuberkulozi aiv inficirebuli bavSvebis erT-erT seriozul problemas
warmoadgens. diagnostikisaTvis gamoiyeneba kanis tuberkulinuri testi
da naxvelSi mJavagamZle baqteriis aRmoCena mikroskopiisa da kulturis
miRebis gziT. bavSvebSi naxvelis ararsebobis dros mimarTaven kuWis
amonarecxis kvlevas. aiv inficirebul bavSvebSi xSiria cns dazianeba,
rac gamoixateba fsiqo-fizikuri ganviTarebis SeferxebiT,
encefalopaTiiT, cerebruli dambliT an/da spastiuri tetraplegiis
saxiT. adgili aqvs Tavis garSemowerilobis zrdis SeCerebas.
kompiuteruli tomograma kortiklur atrofias an kalcifikacias
uCevnebs (gansakuTrebiT bazalur gangliebSi simetriulad).
aiv inficirebuli bavSvebis daaxloebiT 20%-Si viTardeba Trombocitebis
imunuri destruqcia. anemia ganpirobebuli SeiZleba iyos aiv-is mier,
iatrogenuli faqtorebiT an virusuli infeqciebis (magaliTad,
parvovirus B19) supresiuli zegavleniT Zvlis tvinze, aseve SratSi
eriTroepoetinis donis daqveiTebiTa da Zvlis tvinis daqveiTebuli
reagirebiT eriTroepoetinze. anemias iwvevs neoplaziuri agentebic.
neitropenia xSiria Rrma imunosupresiis dros da kavSirSia baqteriuli
infeqciebis darTvis maRal riskTan. neitropenia SesaZloa gamowveuli
iyos medikamentebiT, romelsac bavSvi iRebs mkurnalobis procesSi.
aiv azianebs gulsa da Tirkmelebs. es garTulebebi gansakuTrebiT xSiria
mozrdil bavSvebSi 2-3 wlis asakis zemoT. Cveulebriv gamoxatulia
qronikuli kardiomiopaTia. Tirkmlis dazianeba vlindeba nefrozuli
sindromis an glomerulonefritis saxiT.
4. diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi
a) pirvel 4 saaTSi
• konsultacia stacionaruli;
• sisxlis klinikuri analizi (sisxlis saerTo analizi,
sisxlis jgufis da rezusis gansazRvra, transaminazebis,
bilirubinis, laqtatdehidrogenazas, Sardovanas, kreatininis,
glukozis, saerTo cilis da cilis fraqciebis, rkinis da
rkinis gajerebis unaris, proTrombinis da Trombinis drois
gansazRvra);
• imunologiuri analizi (CD4+, CD8+ limfocitebis CaTvliT);
9
• Sardis saerTo analizi;
• liqvoris saerTo analizi;
• liqvoris baqterologiuri gamokvleva;
• naxvelis baqterioskopuli gamokvleva;
• sisxlSi Toxo IgG diagnostika;
• mantus sinji.
b) pirvel 24 saaTSi
• gulmkerdis rentgenograma (erTi proeqcia);
• rentgenologis konsultacia;
• ekg;
• kardiologis konsultacia;
• sisxlis bioqimiuri analizi (saerTo cila, albumini, ALT, AST, bilirubini, da misi fraqciebi, CD4, CD8);
• Sardis analizi;
• ganavlis analizi;
• sisxlis baqteriologiuri gamokvleva;
• naxvelis baqteriologiuri gamokvleva.
g) pirvel 3 dReSi
• nevropaTologis konsultacia;
• ftiziatris konsultacia;
• antibiotikebisadmi mgrZnobelobis gansazRvra;
• aiv virusuli datvirTvis gansazRvra;
• virusuli hepatitebis (B, C, D) diagnostika; • aTaSangis diagnostika (TPHA, RPR meTodebiT);
• serologiuri gamokvlevebi sxva mikroorganizmebisaTvis.
5. mkurnaloba
ppiirrvveellii rriiggiiss aarrTT ssqqeemmaa aaiivv iinnffiicciirreebbuull bbaavvSSvveebbSSii
aarrTT--ss aannaammnneezzii ((mmaaTT SSoorriiss ddeeddiiss
mmiieerr aarrvv pprreeppaarraatteebbiiss mmiiRReebbaa
oorrssuulloobbiissaa ddaa mmSSoobbiiaarroobbiiss
ddrrooss)),, TTaannmmxxlleebbii ddaaaavvaaddeebbeebbii
ppiirrvveellii rriiggiiss aarrTT ssqqeemmaa**
bavSvebSi, romlebic ar
Rebulobdnen arv preparatebs, ar
aris riski preparatebis
urTierTqmedebisa da wamlismieri
mdgradobis
zidovudini** + lamivudini + nevirapini
an
zidovudini** + lamivudini + efavirenzi***
bavSvebi, romlebic imyofebodnen
nevirapinis zemoqmedebis qveS,
dedidan bavSvze aiv infeqciis
gadadebis profilaqtikis mizniT.
zidovudini** + lamivudini +
lopinaviri/ritonaviri
an
zidovudini** + lamivudini + nelfinaviri
tuberkuloziT daavadebulebi**** zidovudini** + lamivudini + abakaviri
an
10
zidovudini** + lamivudini + efavirenzi***
* saWiroa arv preparatebis bavSvebisaTvis misaReb samkurnalwamlo
formebSi miwodeba (Txevad formaSi, 6 welze patara bavSvebSi),
romelic uzrunvelyofs zust dozirebas.
** anemiis mqone bavSvebSi ukunaCvenebia zidovudinis Semcveli arT sqemebi.
*** 3 welze didi asakis bavSvebSi
**** arT unda daviwyoT 2 Tviani intensiuri antituberkulozuri Terepiis
Semdeg. Tu situacia saSualebas gavaZlevs arT umjobesia daviwyoT
antituberkulozuri Terapiis kursis damTavrebisas. es Tavidan
agvacilebs rifampicinisa da arv preparatis negatiuri urTierTqmedebis
Sedegebs. garda amisa arT da antituberkulozuri preparatebis
erTdrouli daniSvna zrdis Terapiis reJimis darRvevis risks. arT-s
adreuli daniSvna gamarTlebulia, Tu tuberkuloziT daavadebul aiv
inficirebul bavSvs aReniSneba aiv infeqciis gamoxatuli gamovlinebebi
an/da mZime imunodeficiti.
arT sqemis Secvlis aucilebloba ganpirobebulia an Terapiis araefeqturobiT,
an SeuTavsebeli gverdiTi movlenebiT. sqema unda Secvalos im eqimma,
romelmac daniSna pirveladi mkurnaloba. vidre axal sqemas davniSnavT
unda davrwmundeT, rom bavSvi preparatebs Rebulobda mkacrad
daniSnulebis mixedviT. Tu arT-s sqemis gamocvla ganpirobebulia Terapiis
araefeqturobiT, saWiroa samive preparatis erTdrouli Secvla
mmeeoorree rriiggiiss aarrTT ssqqeemmaa
aarrTT--ss ssaawwyyiissii ssqqeemmaa mmeeoorree rriiggiiss rreekkoommeennddeebbuullii ssqqeemmaa
zidovudini + lamivudini + nevirapini
an
zidovudini + lamivudini +
ifavirenci
abakaviri + didanozini +
lopinaviri/ritonaviri
an
abakaviri + didanozini +
nelfinaviri
zidovudini + lamivudini +
nelfinaviri
an
zidovudini + lamivudini +
lopinaviri/ritonaviri
abakaviri + didanozini +
nevirapini
an
abakaviri + didanozini +
efavirenzi
* Tu bavSvs SeuZlia kafsulis gadaylapva, xolo preparatis
erTjerad doza (romelic gaTvlilia wonaze an sxeulis farTobze)
Seadgens ramodenime kafsulas erTad, mas aseve SegviZlia
davuniSnoT seqvinavir/ritonaviri an indinavir/ritonaviri
11
6. reabilitacia da dakvirveba mmoonniittoorriinnggii ssaammiizznneeeebbii
SSeemmoowwmmeebbiiss
vvaaddaa
aannTTrrooppoommee--
ttrruullii
mmoonnaacceemmeebbii
SSeemmoowwmmeebbaallaabboorraattoorriiuullii
ggaammookkvvlleevveebbii
pirveli
Semowmeba
arT-s
dawyebidan 2
kviraSi + +
sisxlis klinikuri
analizi, RviZlis
fermentebis aqtivoba;
Sardis saerTo
analizi
meore
Semowmeba
pirveli
Semowmebidan
erT TveSi + +
sisxlis klinikuri
analizi, RviZlis
fermentebis aqtivoba;
Sardis saerTo
analizi
momdevno
Semowmebebi
yovel 3
TveSi, Tu
saWiro ar
aris ufro
xSiri
vizitebi
+ +
sisxlis klinikuri
analizi, RviZlis
fermentebis aqtivoba.
CD4-is dones sazRvraven yovel 3-4
TveSi, Tu ar aris
Cveneba ufro xSiri
gamokvlevisaTvis
1 Tu sqema Seicavs nevirapins, 18 Tvis ganmavlobaSi, yovel 4 TveSi
unda ganvsazRvroT RviZlis funqciuri maCveneblebi.
aarrTT--ss eeffeeqqttuurroobbiiss kkoonnttrroollii
kklliinniikkuurrii mmaaCCvveenneebblleebbiiss kkoonnttrroollii ((ssiiggrrZZee,, wwoonnaa,, ssaaeerrTToo mmddggoommaarreeoobbaa))
janmrTeli bavSvis fizikuri ganviTareba mudmivad mimdinareobs da
wonisa da simaRlis matebiT gamovlindeba. imunodeficitis mqone aiv
inficirebul bavSvebSi igi Seferxebulia da arT-s dawyebis fonze
mkveTrad matulobs. qvemoT mocemulia ZiriTadi klinikuri maCvenebebi,
romlebic saSualebas mogvcems vimsjelod arT-s efeqtianobaze.
• “wona/simaRlis” diagrama (rodesac SeuZlebelia CD4-is donis
gansazRvra, mkurnalobis efeqtianobis Sesafaseblad gamoiyeneba
fizikur ganviTarebis diagramebi). Tu im bavSvebis ganviTarebis
fizikuri maCveneblebi, romlebsac utardebaT arT, ar Seesabameba
diagramebze mocemul maCveneblebs, unda veZeboT ganviTarebis
Seferxebis mizezebi. ZiriTadi mizezi oria:
− oportunistuli infeqcia (am SemTxvevaSi diagramis mrudi
mkveTrad ecema);
− Terapiis reJimis darRveva (am SemTxvevaSi diagramis mrudi
ecema TandaTanobiT).
• fsiqomotoruli ganviTareba;
12
• nevrologiuri darRvevebi, maT Soris encefalopaTiis simptomebi;
• infeqciuri daavadebebi: saxe da sixSire.
llaabboorraattoorriiuullii mmoonnaacceemmeebbiiss kkoonnttrroollii
• CD4-is done (Tu SesaZlebelia);
• sisxlis klinikuri analizi;
• RviZlis fermentebis aqtivoba (alt, ast);
• damatebiTi gamokvlevebi: arT-s sqemisa da preparatebis gverdiTi
efeqtebis mixedviT.
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
13
aiv infeqcia/Sidsis fonze ganviTarebuli baqteriuli pnevmoniebi
(protokoli)
1. daavadebis/nozologiis/sindromis mokle ganmarteba aiv infeqcia/Sidsi ewodeba adamiani imunodeficitis virusiT gamowveul
infeqciur daavadebas. baqteriuli pnevmoniis yvelaze xSiri gamomwvevia
Streptococcus pneumoniae. sxva gamomwvevbia: Haemophilus influenzae, Klebsiella spp., Staphylococcus spp., Mycobacterium tuberculosis, Micobacterium avium-intracellulare. 2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. zeda sasunTqi gzebis baqteriuli infeqciebis diagnozi
efuZneba klinikur gamovlinebebsa da rentgenologiur cvlilebebs.
rentgenogramaze SeiZleba aRmoCndes filtvis parenqimis wilovani,
kerovani an difuzuri daCrdilva an gamovlindes atipuri cvlilebebi.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. zeda
sasunTqi gzebis baqteriuli infeqciebis gamomricxavi kriteriumebia
klinikuri gamovlinebebisa da rentgenologiuri cvlilebebis ar
arseboba.
3. simptomebi da niSnebi _
a. damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. zeda sasunTqi gzebis baqteriuli
infeqciebis damadasturebel simptomebs ganekuTvneba cxeleba, advilad
daRla, xveleba, qoSini, tkivili gulmkerdis areSi, taqipnoe.
b gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. zeda sasunTqi gzebis baqteriuli infeqciebis
gamomricxavi faqtoria Sesabamisi Civilebisa da simptomebis ar arseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
14
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,
eqim-pulmonologis konsultacia.
5. mkurnaloba AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
baqteriuli pnevmoniis mkurnalobis pirveli rigis sqemebi
antibiotiki doza MmiRebis
sixSire
miRebis
gza
mkurnalobis
xangrZlivobaamoqsicilini
(penicilinisa da ampicilinis
mimarT SesaZlo
rezistentobis
SemTxvevaSi gamoiyeneT
penicilini beta laqtamazas
inhibitorebTan kombinaciaSi)
500-1000mg 3X
dReSi
PO 7 dRe an
ufro
xangrZlivad
morCenamde
Aan
eriTromicini 500mg 4X dReSi PO 7 dRe
an
klaritromicini 500mg 2X dReSi PO 7 dRe
Aan
azitromicini 500mg erTxel
dReSi
PO 3-4 dRe
an
qinoloni pnevmokokuri aqtivobiT
(mag: moqsifloqsacini)
400 mg
erTxel
dReSi
PO 7 dRe
an
doqsiciklini 100 mg
2X dReSi
PO 7 dRe
o Tu pirveli rigis sqemiT mkurnalobis fonze mdgomareoba 72 sT-Si
ar gaumjobesda (cxelebis normalizeba, leikocitozis donis
Semcireba), aucilebelia pacientis hospitalizacia da mkurnalobis
Secvla II rigis sqemiT,. saWiroebis SemTxvevaSi _ JangbadiT
inhalacia.
baqteriuli pnevmoniebis mkurnalobis meore rigis sqemebi
antibiotiki doza M miRebis
sixSire
MmiRebis
gza
mkurnalobis
xangrZlivoba
ceftriaqsoni
+
eriTromicini
2g
500mg
dReSi erTxel
4X dReSi
IV
7 dRe
an
ampicilin/
sulbaqtami
+
eriTromicini
1500mg
500mg
3X dReSi
4X dReSi
IV
7 dRe
an
15
qinoloni
pnevmokokuri
aqtivobiT
(mag:
moqsifloqsacini)
400 mg
erTxel dReSi
IV/PO
7 dRe
an
qloramfenikoli
(mxolod sxva
pre-paratebis ar
arse-bobis dros)
12,5 mg/kg
4X dReSi
IV
7 dRe
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
16
aiv infeqcia/Sidsis fonze ganviTarebuli atipiuri mikobaqteriozebis marTva
(protokoli)
1. daavadebis/nozologiis/sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. atipiuri mikobaqteriozebi ewodeba Mycobacterium avium complex gamowveul infeqciebs.
2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. atipiuri mikobaqteriebiT gamowveuli infeqciebis diagnozi
ismeba klinikuri suraTisa da laboratoriuli gamokvlevebis mixedviT.
misi damadasturebeli kriteriumia Mycobacterium avium complex -is aRmoCena specialur niadagze daTesil sisxlSi, ganavalSi, RviZlisa da Zvlis
tvinis bioptatSi.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. atipiuri
mikobaqteriebiT gamowveul infeqciebis gamomricxavi kriteriumia
klinikuri suraTisa da Mycobacterium avium complex -is ar arseboba
specialur niadagze daTesil sisxlSi, ganavalSi, RviZlisa da Zvlis
tvinis bioptatSi.
3. simptomebi da niSnebi _
a. damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. atipiuri mikobaqteriebiT gamowveuli
infeqciebis damadasturebel simptomebs ganekuTvneba cxeleba, wonaSi
kleba, Ramis oflianoba, diarea, ganleva.
b. gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. atipiuri mikobaqteriebiT gamowveuli infeqciebis
gamomricxavi faqtoria Sesabamisi Civilebisa da simptomebis ar arseboba.
17
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,
Mycobacterium avium complex-is aRmoCena specialur niadagze daTesil
sisxlSi, ganavalSi, RviZlsa da Zvlis tvinis bioptatSi.
5. atipuri mikobaqteriozebis mkurnaloba
antibiotiki doza MmiRebis
sixSire
miRebis
gza
mkurnalobis
xangrZlivoba
pirveli rigis preparatebi
klaritromicini 500-1000 mg 2-jer dReSi PO 6 Tve ;
damokidebulia
klinikur
mdgomareobaze
+
etambutoli 15 mg/kg dReSi
erTxel
PO 6 Tve ;
damokidebulia
klinikur
mdgomareobaze
+
rifabutini 300-450 mg dReSi
erTxel
PO 6 Tve ;
damokidebulia
klinikur
mdgomareobaze
sxva preparatebi, rimlebic moqmedeben atipiur mikobaqteriebze
azitromicini 500-1200 mg dReSi
erTxel
PO 6 Tve
6 Tve
ara umetes 4
kvirisa
ciprofloqsacini 500 mg 2-jer dReSi POamikacini 15 mg/kg/dR dReSi 1X i/v
an 7,5
mg/kg/dR
2-jer dReSi i/v
6. reabilitacia da dakvirveba
• Tu atipiuri mikobaqteriozebis mkurnalobis fonze mdgomareoba
gaumjobesda da preparatebi kargad gadaitaneba unda daiwyos arT.
• atipiuri mikobaqteriozebis mkurnalobodan 4-6- kviraSi iwyeba arT.
6 Tvis Semdeg imunuri pasuxis gaumjobesebis Semdeg (CD4
ricxvi>100mm3) Cerdeba atipiuri mikobaqteriozebis mkurnaloba da
gamoiyeneba meoradi profilaqtika.
• meoradi profilaqtikis Sewyveta SesaZlebelia, rodesac imunuri
sistema stabiluria 3-6- Tvis manZilze.
18
• atipiuri mikobaqteriozebis mkurnaloba da meoradi profilaqtika
grZeldeba 6 Tve, rac aris mkurnalobis warmatebis da relapsis
Tavidan acilebis sawindari.
• didi mniSvneloba aqvs atipiuri mikobaqteriozebis mkurnalobis
dawyebas arv Terapiis dawyebamde.
• arsebobs albaToba imunuri rekonstituciis anTebiTi sindromis
ganviTarebis arT-s dawyebis Semdeg.D
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
19
aiv infeqcia/Sidsis fonze ganviTarebuli pnevmocisturi pnevmoniis marTva
(protokoli)
1. daavadebis/nozologiis/sindromis mokle ganmarteba aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. pnevmocisturi pnevmoniis gamomwvevia Pneumocystis jiroveci.
2. kriteriumebi a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. pnevmocisturi pnevmoniis diagnozi ismeba klinikuri suraTisa
da rentgenologiuri cvlilebebis mixedviT. pnevmocisturi pnevmoniis
klinikuri gamovlinebebia: xvela, qoSini, cxeleba, respiratoruli
distresi – cianoziT. rentgenologiuri niSani - orive filtvis qvemo
wilSi gamWvirvalobis Rrubliseburi daqveiTeba - yvela pacients ar
aReniSneba. pnevmocisturi pnevmoniis damadasturebeli kriteriumia
Pneumocystis jiroveci-is cistis aRmoCena naxvelSi an bronqoalveolaruli
lavaJiT miRebul siTxeSi.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
pnevmocisturi pnevmoniis gamomricxavi kriteriumebia klinikuri
gamovlinebebisa da Pneumocystis jiroveci-is cistis ar arseboba naxvelSi an
bronqoalveolaruli lavaJiT miRebul siTxeSi.
3. simptomebi da niSnebi _
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. pnevmocisturi pnevmoniis damadasturebel
simptomebs ganekuTvneba xvela, qoSini, cxeleba, respiratoruli
distresi – cianoziT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. pnevmocisturi pnevmoniis gamomricxavi faqtoria
Sesabamisi Civilebisa da simptomebis ar arseboba.
20
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,
Pneumocystis jiroveci-is cistis aRmoCena naxvelSi an bronqoalveolaruli
lavaJiT miRebul siTxeSi, eqim-pulmonologis konsultacia.
5. pnevmocisturi pnevmoniis mkurnaloba
tardeba stacionarSi. aucilebelia damxmare Terapia JangbadiT
inhalaciis CaTvliT.
pnevmocisturi pnevmoniis pirveli rigis mkurnaloba
antimikrobuli
agenti
doza M miRebis
sixSire
M miRebis
gza
mkurnalobis
xangrZlivoba
timetoprimi/
sulfametoqsazoli
400/80 mg 4X dReSi PO/IV
21 dRe
pnevmocisturi pnevmoniis meore rigis mkurnaloba
Kklindamicini
+
primaqini
600mg
15 mg
4X dReSi
2X dReSi
PO/IV
PO
21 dRe
an
pentamidini (farTo
speqtris
antibiotikTan
kombinaciaSi
baqteriuli
superinfeqciis
profilaqtikisTvis
mag. ampicilin+
sulbaqtami 10 dRe)
4 mg/kg IV
dReSi. doza
mcir 2 mg/kg
5 dRis
mkurnalobis
Semdeg (18)
dReSi
erTxel
IV 21 dRe
• mZime mdgomareobaSi myof avadmofebSi iniSneba prednizoloni, 80-
250 mg PO/IV dReSi 1-2 kvira (amcirebs intersticiul SeSupebas).
• mZime SemTxvevebSi ganixileba kombinirebuli mkurnaloba, mag. ko-
trimoqsazoli da pendamidini mxolod erTeuli Setyobinebuli
SemTxvevebis mixedviT dakavSirebulia toqsiurobis maRal riskTan.
pnevmocisturi pnevmoniis mZime SemTxvevebi moiTxovs xelovnur
ventilacias an oqsigeniT saturacias (SO2)<92%.
6. reabilitacia da dakvirveba
monitoringis samizneebs warmoadgens Tirkmlebis, parkreasis
(pendamidiniT mkurnalobisas), Zvlis tvinis (ko-trimoqsazoliT
mkurnalobisas) laboratoriuli gamokvlevebi 2 kviraSi erTxel.
21
pnevmocisturi pnevmoniis mwvave SemTxvevis warmatebiT mkurnalobis
Semged :
• meoradi profilaqtikis mizniT aiv inficirebulma pacientebma unda
miiRon trimetoprim/sulfametoqsazoli 160/800 mg doziT erTxel
dReSi xangrZlivad ;
• aRniSnuli preparatebis miReba pacientma SeiZleba Sewyvitos Tu
CD4 limfocitebis raodenoba stabilurad aRemateba 200 mm3-s sul
mcire sami Tvis ganmavlobaSi.
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
22
aiv infeqcia/Sidsis fonze ganviTarebuli kandidozebis marTva
(protokoli)
1. daavadebis/nozologiis/sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. kandidozebis gamomwvevia Candida albicans.
2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. orofaringeuli kandidozis diagnostika efuZneba klinikur
niSnebs, gasinjvas da dazianebuli ubnebidan aRebuli masalis
mikroskopul daTvalierebas. piris Rrus daTvalierebisas vnaxulobT
balTis formis TeTr nadebs SewiTlebul da anTebad lorwovan garsze.
anTeba SeiZleba gavrceldes sasaze, xaxaze, RrZilebze, enasa da loyis
lorwovanze. ena dazianebisas xdeba gluvi, wiTeli da dvrilebi
swordeba. kandidozuri ezofagitis SemTxvevebSi diagnozis
dadasturebisTvis aucilebelia qsovilis bioptatis histologiuri
gamokvleva.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
kandidozebis gamomricxavi kriteriumebia Sesabamisi klinikuri
gamovlinebebis ararseboba.
3. simptomebi da niSnebi _ a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. piris Rrus kandidozi moicavs: loyis
lorwovan garss, enas, pir-xaxas, RrZilebs, rbil da magar sasas.
avadmyofs SeiZleba ar hqondes Civilebi an aRniSnavdes Wamis dros wvis
SegrZnebas. zogierTi avadmyofi uCivis pirSi TeTri nadebis arsebobas.
roca kandidozi vrceldeba saylapavze pacienti uCivis: tkivils ylapvis
dros, retrosternalur tkivils, hipersalivacias.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. kandidozebis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
23
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, gulmkerdis rentgenologiuri gamokvleva,
kandidozuri ezofagitis SemTxvevebSi diagnozis dadasturebisTvis
aucilebelia qsovilis bioptatis histologiuri gamokvleva.
5. kandidozebis mkurnaloba
piris Rrus kandidozis mkurnaloba
antimikozuri
agenti
doza
M miRebis
sixSire
miRebis gza
mkurnalobis
xangrZlivoba
mkurnalobis pirveli rigis sqemebi
mikonazoli tabletebi
gasawovad
dReSi
erTxel
adgilobrivad 7 dRe
an
flukonazoli 100 mg 2-jer dReSi
3 dRe
Semdeg
erTxel
dReSi 4 dRe
PO 7 dRe
mkurnalobis meore rigis sqemebi
itrakonazoli 200-400 mg dReSi
erTxel
PO 7 dRe
vaginaluri kandidozis mkurnaloba
antimikozuri
agenti
doza M miRebis
sixSire
miRebis
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
flukonazoli 100 mg erTjeradad PO erTjeradad
klotrimazoli 500 mg erTjeradad vaginalurad erTjeradad
meore rigis sqemebi
ketokonazoli 200 mg 2-jer dReSi PO 3 dRe
ketokonazoli 200 mg dReSi
erTxel
PO 7 dRe
SemanarCunebeli Terapia
nistatini 2-4 mln IU 2-jer dReSi PO 10 dRe
Aan
flukonazoli 50-200 mg dReSi
erTxel
PO yoveldRe
mesame rigis sqemebi
ketokonazoli 200 mg dReSi
erTxel
PO damokidebuli
pasuxze,
Cveulebriv 7-
10 dRe
24
itrakonazoli 100 mg dReSi
erTxel
PO damokidebuli
pasuxze,
Cveulebriv 7-
10 dRe
ezofaguri da diseminirebuli kandidozebis mkurnaloba
antimikozuri
agenti
doza M miRebis
sixSire
miRebis
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
ketokonazoli 200-400 mg 2-jer dReSi PO 21 dRe
Aan
flukonazoli
(ketokonazolze
efeqturia)
200-400 mg
Semcirdes
klinikuri
Sedegis
mixedviT 3
dRis Semdeg
100 mg/dReSi
dReSi
erTxel
PO/IV
14 dRe
meore rigis sqemebi
amfotericini B 0,3-0,5 mg/kg IV 10-14 dRe
Aan
itrakonazoli 200-400 mg dReSi
erTxel
PO 2 kvira
6. reabilitacia da dakvirveba
kandidozuri ezofagitis mkurnalobis Semdeg saWiroa xangrZlivi
SemanarCunebeli Terapia flukonazoliT 50-100 mg/dReSi yoveldRe, an
itrakonazoliT 100 mg/dReSi yoveldRe, an ketokonazoliT 200
mg/dReSi yoveldRe.
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
25
aiv infeqcia/Sidsis fonze ganviTarebuli kriptokokuli meningitis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. kriptokokuli meningitis gamomwvevia soko
Criptococcus neoformans. 2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. kriptokokozis diagnozis dadasturebisTvis liqvors
acentrifugireben, miRebul naleqs ikvleven mikroskopis qveS tuSis
wveTis India ink damatebis Semdeg. preparatSi naxuloben sqeli kafsuliT
dafarul safuaris ujredebs. SesaZlebelia kriptokokis kulturis
gamoyofa Tavzurgtvinis siTxidan. gamoiyeneba Sratis da Tavzurgtvinis
siTxis gamokvleva kriptokokul antigenze.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
kriptokokozis gamomricxavi kriteriumebia liqvorSi sqeli kafsuliT
dafaruli safuaris ujredebis ararseboba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. kriptokokuli meningitis dros pacienti
uCivisL Tavis tkivils, cxelebas, saxezea kefis kunTebis regidoba, Tavis
qalis nervebis dazianeba, cnobierebis darRveva, komatozuri
mdgomareoba. xSirad meningitis niSnebi arc aRiniSneba, maT Soris,
cxeleba da kefis kunTebis rigidoba.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. kriptokokuli meningitis gamomricxavi faqtoria
Sesabamisi Civilebisa da simptomebis ar arseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
26
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, Tavzurgtvinis siTxis aReba da naleqis
gamokvleva mikroskopis qveS tuSis wveTis India ink damatebis Semdeg an, kriptokokis kulturis gamoyofa Tavzurgtvinis siTxidan an, Sratsa
da/an Tavzurgtvinis siTxeSi kriptokokuli antigenis aRmoCena.
5. kriptokokuli meningitis mkurnaloba
antimikozuri
agenti
doza M miRebis
sixSire
miRebis
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi (27)
amfotericini B + 5-flucitozini
0,7-1,0 mg/kg
25 mg/kg
erTxel
dReSi
4X dReSi
IV
14 dRe
Semdeg
flukonazoli 400 mg erTxel
dReSi
PO sul mcire 10
kvira
Semdeg
flukonazoli 200mg erTxel
dReSi
PO mTeli
cxovreba
meore rigis sqemebi
amfotericini B + 5-flucitozini
0,7-1,0 mg/kg
25 mg/kg
erTxel
dReSi
4X dReSi
IV 6-10 kvira
an
amfotericini B 0,7-1,0 mg/kg erTxel
dReSi
IV 6-10 kvira
an (msubuq SemTxvevebSi)
flukonazoli 400-800 mg erTxel
dReSi
PO 10-12 kvira
Semdeg
flukonazoli 200 mg erTxel
dReSi
PO mTeli
cxovreba
6. reabilitacia da dakvirveba
aucilebelia mTeli cxovrebis manZilze Catardes kriptokokozis
meoradiAqimioprofilaqtika. am mizniT iniSneba flukonazoli 200
mg/dReSiAyoveldRe. alternativas warmoadgens itrakonazoli 200
mg/dReSiAyoveldRe. SemanarCunebeli Terapiis aucilebloba pacientebSi,
romelTa imunuri sistema aRdga (CD4 ricxvi >200 mm3) ar aris damxmare da ar arsebobs raime sawinaaRmdego mosazreba am konkretuli
SemTxvevisTvis.
27
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
28
aiv infeqcia/Sidsis fonze ganviTarebuli histoplazmozis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. histoplazmozis gamomwvevia soko Histoplazma capsulatum inhalaciuri sporebi. 2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. histoplazmozis diagnostika dasturdeba sokos kulturiT an
qsovilis bioptatis histologiuri gamokvleviT. hispoplazmozis
diagnostisTvis unda Catardes sisxlis da kanis testebi, Tumca isini ar
aris farTod gamoyenebuli.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
histoplazmozis gamomricxavi kriteriumebia sokos ararseboba qsovilis
bioptatis histologiuri gamokvleviT.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. histoplazmiT gamowveuli mwvave daavadeba
gripismagvaria da axasiaTebs: cxeleba, anoreqsia, arTralgia, mialgia,
mSrali xveleba, tkivili gul-mkerdis areSi. diseminacia imunosupresiul
avadmyofSi swrafad viTardeba da axasiaTebs: wonaSi dakleba, oraluri
da kanis dazianebuli ubnebi, RviZlis, elenTis da limfuri kvanZebis
gadideba. oraluri ubnebisTvis damaxasiaTebelia nekrozuli wylulebi.
SesaZlebelia ganviTareds sasis perforacia da rbili qsovilis
destruqcia.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. histoplazmozis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
29
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, qsovilis bioptatis histologiuri
gamokvleva histoplazmozis diagnostikisTvis.
5. histoplazmozis mkurnaloba
antifungaluri
agenti
dozireba miRebis
sixSire
miRebis gza xangrZlivoba
amfotericni B 0.7-1 mg/kg erTxel
dReSi
IV 10 dRe
sawyis mkurnalobas mohyveba 3 Tviani mkurnaloba imunorekonstituciamde
>100 CD4 ujrediT, Sedegi medikamentebiT:
• itrakonazoli 200 mg 2X dReSi PO • flukonazoli 200 mg 2X dReSi PO • amfotericini B 1 mg/kg IV kviraSi erTxel.
alternatiul reJims warmoadgens itrakonazoli 200 mg samjer dReSi - 3
dRe, Semdeg 200 mg 2X dReSi 12 kvira (sakvebTan erTad).
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
30
aiv infeqcia/Sidsis fonze ganviTarebuli kapoSis sarkomis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. kapoSis sarkoma avTvisebiani simsivnea, romlis
gamomwvevia gamomwvevia me-8 tipis herpes virusi (HHV8 an KSHV). 2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. kapoSis sarkomis diagnozi dasturdeba kanis dazianebuli
ubnebidan aRebuli bioptatis histologiuri gamokvleviT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. kapoSis
sarkomis gamomricxavi kriteriumebia kanis dazianebuli ubnebidan
aRebul bioptatSi daignozis histologiurad ar dadastureba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. kanze elementebi warmodgenilia cisferi
an mewamuli feris papulebiT an kvanZebiT, araiSviaTad garSemo
arsebuli kanis limfuri SeSupebiT. xSirad ziandeba sasa, filtvebi kuW-
nawlavis traqti da limfuri kvanZebi. piris RruSi kapoSis sarkomis
elementebi yvelaze xSirad ganlagebulia magar sasaze, iSviaTad enaze,
xaxaze, nuSura jirkvlebsa da RrZilebze. isini warmoadgenen mewamuli
feris papulebs, romlebic Cveulebriv ar aris mtkivneuli. xandaxan
SeiZleba Segvxvdes msxvili elementebic da elementebi kanze. filtvis
parenqimis dazianeba atarebs infiltraciul xasiaTs. xSirad viTardeba
sunTqvis ukmarisoba. filtvis infiltraciuli dazianebis mqone
avadmyofebs arakeTilsaimedo prognozi aqvT da maTSi maRalia
sikvdilianoba.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. kapoSis sarkomis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
31
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, kapoSis sarkomiT dazianebuli kanis
ubnebis biopsia da histologiuri gamokvleva.
5. kapoSis sarkomis mkurnaloba
kapoSis sarkomis mkurnaloba tardeba onkologis mier. lokaluri
formis samkurnalod gamoiyeneba sxivuri Terapia. generalizirebuli
formis samkurnalod iniSneba citotoqsiuri qimioTerapia. efeqturobis
sxvadasxva xarisxiT gamoiyeneba simsivnis sawinaaRmdego preparatebis
Semdegi kombinaciebi: liposomuri doksorubiciniT monoTerapia,
bleomicini, vinkristini, daunorubicini, vinblastini, etopozidi.
calkeuli elementebi SeiZleba moSordes qirurgiulad an lazeris,
Txevadi azotis da dasxivebis zemoqmedebiT. demonstrirebuli iyo
uSualod kapoSis sarkomatozul kvanZSi bleomicinis Seyvanis
efeqturoba. kapoSis sarkoma SesaZloa daeqvemdebaros mxolod arT-s da
nel-nela alagdes.
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
32
aiv infeqcia/Sidsis fonze ganviTarebuli arahojkinis limfomebis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. arahojkinis lomfomebi limfuri sistemis
avTvisebiani simsivneebia, romlebic Sidsis fonze xSir SemTxvevaSi
asocirebulia epStein-baris virusTan (EBV).
2. kriteriumebi a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. arahojkinis limfomebis diagnozi dasturdeba
hipereplazirebuli limfuri kvanZis biofsiiT, histologiuri
gamokvleviT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
arahojkinis limfomis gamomricxavi kriteriumebia simsivnis
morfologiuri substratis ararseboba hiperplazirebuli limfuri
kvanZis bioptatSi.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. arahojkinis limfomebis dros simptomebi
mravalferovania: hiperplazirebuli limfuri kvanZebi SesaZlebelia
palpirdebodes sxvadasxva adgilze; cxeleba, wonaSi kleba da sisuste
xSiria, Tumca ara aucilebeli; daavadebis stadiis gansazRvrisTvis (I-IV)
aucilebelia Semdegi gamokvlevebi: cerebruli, cervikaluri,
Torakaluri da abdominaluri kompiuterul-aqsialuri tomografiuli
(CAT) skanireba, Zvlis tvinis da Tav-zurg-tvinis siTxis aspiracia da
gastroskopia.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. arahojkinis limfomis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
33
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, hiperplazirebuli limfuri kvanZis
biofsia da histologiuri gamokvleviT simsivnis morfologiuri
substratis aRmoCena.
5. arahojkinis limfomebis (maT Soris berkitis tipis da cns-is limfomebis) mkurnaloba
ara-hojkinis limfomebis samkurnalod efeqturia CHOP reJimi, unda
Catardes 6 kursi (ganmeorebebi aucilebelia sruli remisiis misaRebad):
prednizoloni 100 mg/dReSi erTxel 5 dRe
vinkristini (onkovini) 1,4 mg/m2 (maqsimum 2 mg/dReSi) erTi doza
mkurnalobis pirvel dRes
ciklofosfamidi 750 mg/m2/dReSi erTi doza mkurnalobis pirvel
dRes
doqsorubicini (hidroqsidaunomicini) 50 mg/m2/dReSi erTi doza
mkurnalobis pirvel dRes.
meore cikli iwyeba yovel 21-e dRes (dRe 22-e mohyveba I dRes)
EPOCH reJimi, romelic moicavs etopozids, prednozolons,
vinkristins, ciklofisfamids da daunorubicins an doqsirubicins
efeqturia arT-sTan kombinaciaSi. igi efuZneba gagrZelebiT
infuzias 96 saaTis ganmavlobaSi, romelic Semdegia:
etopozidi 50 mg/m2 dReSi (centraluri venuri xaziT)
doqsorubucuni 10 mg/m2/dReSi (centraluri venuri xaziT)
vinkristini 0,4 mg/m2/dReSi (maqs 2 mg/kviraSi) (centraluri venuri
xaziT)
ciklofosfamidi 375 mg/m2 me-5 dRes mxolod, bolusiT
(centraluri venuri xaziT)
prednizoloni 100 mg/dReSi pirveli 5 dRe erTxel dReSi.
reJimi unda ganmeordes yovel 21 dReSi sanam ar Catardeba 6 cikli.
berkitis–tipis limfomis menejmenti ar gansxvavdeba sxva
limfomebis mkurnalobisgan da pasuxobs CHOP da EPOCH reJimebs. swrafad mzardi limfomis mkurnaloba ufro agresiuli
qimioTerapiiT (mag : B-ALL reJimi) diskusiis Temas warmoadgens da
specifikuri rekomendaciebi dRevandeli dRisTvis ar arsebobs.
berkitis–tipis limfomebis SemTxvevebSi qimioTerapias Tan unda
axldes savaraudo pirveladi keris dasxiveba.
arahojkinis limfomebis mkurnaloba SesaZlebelia CD4 ujredebis
ricxvisgan damoukideblad, Tumca mkurnalobis efeqturobisTvis
arT unda dainiSnos ufro adre. qimioTerapiis ganmavlobaSi CD4 ujredebis ricxvi >350 mm3 dakavSirebulia relapsis maRal
maCveneblebTan arT gareSe (37).
34
intakranialuri limfomebis (metastazebi) arsebobisas sasurvelia
Tavis dasxiveba, simsivnis sawinaaRmdego preparatebTan da
glukokortikoidebTan erTad (38).
cns-is pirveladi limfomis dros erTaderTi efeqturi mtkicebulebaze
dafuZnebuli Terapiaa sxivuri Terapia. dauyonebliv unda daiwyos arT
(39,40).
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
35
aiv infeqcia/Sidsis fonze ganviTarebuli
toqsoplazmozis marTvis saxelmwifo standarti
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. daavadeba toqsoplazmozis gamomwvevia paraziti
Toxoplasma gondii. SidsiT avadmyofebSi toqsoplazma iwvevs Tavis tvinSi
mravlobiTi anTebadi ubnebis warmoqmnas da gamovlindeba encefalitis
an diseminirebuli daavadebis saxiT.
2. kriteriumebi a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. toqsoplazmozis dros Tavis tvinis MAC an MRI skanirebiT
aRmoCndeba mravlobiTi rgoliseburi kerebi. Tu es meTodebi ar aris
xelmisawvdomi diagnozis dadgenaSi gvexmareba serologiuri testebi
toqsoplazmis sawinaaRmdegod gamomuSavebul antisxeulebze (IgG klasis).
cerebraluri toqsoplazmozis mqone pacientebis umravlesobas
aReniSneba Toxoplasma gondii-iT gamowveuli infeqciis gadatanis
serologiuri niSnebi. diagnozs adasturebs Tavis tvinis qsovilis
histologiuri gamokvleva.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
toqsoplazmozis gamomricxavi kriteriumebia Tavis tvinis MAC an MRI skanirebiT aRmoCndeba mravlobiTi rgoliseburi kerebis ar arseboba,
negatiuri serologiuri testebi toqsoplazmis sawinaaRmdegod
gamomuSavebul antisxeulebze (IgG klasis).
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. toqsoplazmozis dros saxezea Semdegi
klinikuri suraTi: cnobierebis darRveva, cxeleba, krunCxvebi, Tavis
tkivili, kerovani nevrologiuri simptomatika motoruli deficitis,
36
kraniuli nervis parezis, moZraobis SezRudvis, dismetriis, mxedvelobis
dakargvis da afaziis CaTvliT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. toqsoplazmozis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, Tavis tvinis MAC an MRI skanireba,
serologiuri testebi toqsoplazmis sawinaaRmdegod gamomuSavebul
antisxeulebze (IgG klasis), Tavis tvinis biofsia da qsovilis
histologiuri gamokvleva.
5. toqsoplazmozis mkurnaloba
preparati doza M miRebis
sixSire
miRebis
gza
mkurnalobis
xangrZlivoba
mkurnaloba
pirimetamini 200 mg erTjeradad (gajerebiTi doza)
PO erTjeradad
Semdeg
pirimetamini 25 mg
an 50 mg
3-jer dReSi
2-jer dReSi
PO 6-8 kvira
+
foliumis
mJava
15 mg dReSi
erTxel
PO 6-8 kvira
+
sulfadiazini 1 g 4-jer dReSi PO 6-8 kvira
am sqemaSi sulfadiazini SeiZleba Seicvalos:
• klindamiciniT 600 mg i/v an PO dReSi 4-jer 6 kvira
• azitromiciniT 1200 mg PO dReSi erTxel 6 kvira
• klariTromiciniT 1 g PO 2-jer dReSi 6 kvira
• atovakvoniT 750 mg PO 4-jer dReSi 6 kvira.
6. reabilitacia da dakvirveba
zogierT pacients sWirdeba xangrZlivi mkurnaloba toqsoplazmozis
gamo. gadawyvetileba efuZneba klinikur mdgomareobas da ganmeorebiT
CAT skanirebas.
meoradi profilaqtika grZeldeba efeqturi reJimis ganaxevrebuli
dozebiT manamde sanam CD4 ujredebs ricxvi sami Tvis ganmavlobaSi
stabilurad ar moimatebs (200 ujredi da meti).
37
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
38
aiv infeqcia/Sidsis fonze ganviTarebuli martivi herpesiT gamowveuli infeqciebis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. SidsiT avadmyofebSi martivi herpesis virusi HSV I
da II tipis iwvevs vrcel, persistul an diseminirebul infeqcias,
meningitsa da meningoencefalits.
2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. lokaluri martivi herpesis diagnozi ismeba klinikurad,
xolo diseminirebuli martivi herpesiT gamowveuli infeqciis
diagnostikisTvis aucilebelia virusis kulturis gamoyofa, radio-
imunoblotingis meTodi, imunofluoroescencia da monoklonuri
antisxeulebiT testireba. herpesul encefalits mivyavarT Tavis tvinSi
dazianebis mravlobiTi kerebis ganviTarebamde, romelic TvalsaCinoa
CAT skanirebiT; aseve martivi herpesiT gamowveuli cns-is
diagnostikisTvis gamoiyeneba Tav-zurg-tvinis siTxeSi dnm-is aRmoCena
pjr meodiT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. martivi
herpesiT gamowveuli diseminirebuli infeqciis gamomricxavi
kriteriumebia martivi herpesis virusis kulturis, radio-
imunoblotingis meTodis, imunofluoroescenciis da monoklonuri
antisxeulebiT, Tav-zurg-tvinis siTxeSi martivi herpesis virusis dnm-ze
pjr testirebis negatiuri Sedegi.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. herpesuli gamonayari Cveulebriv
warmodgenilia vezikulebiTa da mtkivneuli eroziebiT, romlebic
ganlagebulia piris irgvliv, cxviris nestoebze, tuCebsa da sasqeso
organoebze. diseminirebuli martivi herpesiT gamowveuli infeqciis
39
diagnozis dasma xSirad Znelia. saxezea meningitisa an/da
meningoencefalitis suraTi, Sesabamisi cvlilebebiT CAT skanirebisas.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. lokaluri da diseminirebuli martivi herpesiT
gamowveuli infeqciis gamomricxavi faqtoria Sesabamisi Civilebisa da
simptomebis ar arseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, martivi herpesis virusis kulturis
gamoyofa, martivi herpesis deteqcia radio-imunoblotingis meTodi,
imunofluoroescenciis an/da monoklonuri antisxeulebiT testirebis
meTodebiT, herpesul encefalitze eWvis SemTxvevebSi - Tavis tvinis MAC an MRI skanireba da Tav-zurg-tvinis siTxeSi martivi herpesis dnm-is
aRmoCena pjr meTodiT.
5. martivi herpesvirusuli infeqciis msubuqi formis mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
acikloviri 400 mg 3-jer dReSi PO 7-10 dRe
an
famcikloviri 250 mg 3-jer dReSi PO 7-10 dRe
an
valacikloviri 1 g 2-jer dReSi PO 7-10 dRe
martivi herpesvirusuli infeqciis recidivis mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
acikloviri 800 mg 5-jer dReSi PO 7-10 dRe
an
famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe
an
valacikloviri 1 g 2-jer dReSi per os 7-10 dRe
40
martivi herpesvirusuli infeqciis mZime formis mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebis
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
acikloviri 10 mg/kg 3-jer dReSi IV 7-10 dRe
an
valacikloviri 1 g 2-jer dReSi PO 7-10 dRe
martivi herpesvirusuli infeqciis mZime visceraluri formebis
mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
acikloviri 10 mg/kg 3-jer dReSi IV 14-21 dRe
meore rigis sqema
foskarneti
(aciklovirze
rezistentobis
SemTxvevebSi)
40-60 mg/kg 3-jer dReSi IV 14 dRe
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
41
aiv infeqcia/Sidsis fonze ganviTarebuli sartyliseburi liqenis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. daavadeba sartyliseburi liqenis gamomwvevia
herpesis jgufis mesame tipis virusi Variccela zoster virus (VZV) . SidsiT
avadmyofebSi sartyliseburi liqeni multidermatomulia, persistirebs,
axasiaTebs Zlieri tkivili da sisuste; SesaZloa moxdes infeqciis
diseminacia kanis, nervuli sistemis, filtvebis, lorwovani garsebis
CarTviT paTologiur procesSi.
2. kriteriumebi a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
(pjr) meTodiT. sartylisebuli liqenis damadasturebeli kriteriumia
damaxasiaTebeli vezikuluri gamonayaris arseboba dermatomis gaswvriv;
cns-is dazianebisas Tav-zurg-tvinis siTxeSi VZV dnm-is aRmoCena pjr
meTodiT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
sartyliseburi liqenis gamomricxavi kriteriumebia damaxasiaTebeli
vezikuluri gamonayaris ararseboba kanze.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. sartyliseburi liqenis dros saxezea
vezikuluri gamonayari dermatomis gaswvriv, romelsac Tan axlavs
Zlieri mtkivneuloba, zogjer cxeleba, regionuli limfadenopaTia,
Zlieri sisuste; SesaZloa moxdes infeqciis diseminacia
multidermatomuli formis ganviTarebiT, nervuli sistemis, filtvebis
da lorwovani garsebis CarTviT paTologiur procesSi.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. sartyliseburi liqenis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
42
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, VZV sawinaaRmdego antisxeulebis
gansazRvra sisxlSi (IgM da IgG klasis), cns-is dazianebisas VZV dnm-is
aRmoCena Tav-zurg-tvinis siTxeSi pjr meTodiT.
5. sartyliseburi liqenis sxvadasxva formebis mkurnaloba
sartyliseburi liqenis (kanis formis) mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
acikloviri 800 mg 5-jer dReSi PO 7-10 dRe an
vezikulis
gaSrobamdeE
an
famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe
an
valacikloviri 1 g 3-jer dReSi PO 7-10 dRe
Tvalis sartyliseburi liqenis, infeqciis diseminirebuli da visceruli
formebis mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
acikloviri 10 mg/kg 3-jer dReSi IV 7-10 dRe
an
valacikloviri 1 gr 3-jer dReSi PO 7-10 dRe
an
famcikloviri 500 mg 3-jer dReSi PO 7-10 dRe
meore rigis sqema
foskarneti 60 mg/kg
an
40 mg/kg
2-jer dReSi
an
3-jer dReSi
IV 7-10 dRe
6. reabilitacia da dakvirveba
post-herpesuli nevralgia xSiri da seriozuli problemaa. dazianebul
dermatomebSi viTardeba Zlieri tkivili.
tkivilis kontroli mniSvnelovania da tkivilis kupirebis mizniT
iniSneba arasteroidul anTebis sawinaaRmdego preparatebi.
Tu tkivili gaxangrZlivda iniSneba amitriptilini, karbamazepini an
fenitoini.
43
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
44
aiv infeqcia/Sidsis fonze ganviTarebuli
citomegalovirusuli infeqciis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. citomegalovirusuli daavadebis gamomwvevia
herpesis jgufis me-4 tipis virusi CMV. SidsiT avadmyofebSi
citomegalovirusma SieZleba daazaianos sxvadasxa organoebi da
sistemebi.
2. kriteriumebi a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. citomegalovirusis deteqciisTvis gamoiyeneba misi adreuli
antigenis pp65 aRmoCena sisxlSi; pacientebs, romelTa CD4<100 mm3 yovel
3 TveSi unda CautardeT ofTalmoskopia, raTa droulad gamovlindes
citomegalovirusuli retiniti. citomegalovirusuli infeqciis sxva
lokalizaciis SemTxvevebSi diagnozis dasadgenad saWiroa
ZviradRirebuli gamokvlevebis Catareba, maT Soris dazianebuli
organoebis bioptatis gamokvleva, dnm-is hibridizaciis meTodis
gamoyeneba.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
citomegalovirusuli infeqcia gamoricxulia, rodesac CD4 ujredebis
ricxvi metia 200 mm3.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. citomegalovirusuli infeqciis dros
simptomebi moicavs:
• cxeleba da diarea - citomegalovirusuli kolitis Ddros; • dispnoe - pnevmoniis dros; • sibrmave - retinitis dros;
45
• citomegalovirusulma infeqciam SeiZleba gamoiwvios piris
Rrus lorwovanis mtkivneuli wylulebi, rac iwvevs kvebis
reJimis darRvevas.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. citomegalovirusuli infeqciis gamomricxavi faqtoria
Sesabamisi Civilebisa da simptomebis ar arseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, CMV pp65 adreuli antigenis aRmoCena
sisxlSi, dazianebuli organoebis bioptatis gamokvleva, CMV dnm-is aRmoCena pjr meTodiT, ofTalmologis konsultacia,
gastroenterologis konsultacia, nevropaTologis konsultacia.
5. citomegalovirusuli infeqciebis sxvadasxva formebis mkurnaloba
citomegalovirusuli infeqciiT gamowveuli kuW-nawlavis traqtisa da
cns-is dazianebebis da retinitis mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqema
gancikloviri 5 mg/kg 2-jer dReSi IV 2-3 kvira
meoradi profilaqtikisTvis aucilebelia gancikloviriT 5 mg/kg IV
dReSi mkurnaloba.
citomegalovirusuli infeqciiT gamowveuli kuW-nawlavis traqtisa da
cns-is dazianebebis mkurnaloba
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
meore rigis sqemebi
foskarneti 90 mg/kg 2-jer dReSi IV 3 kvira
meoradi profialqtikisTvis aucilebelia foskarnetiT mkurnalobis
xangrZlivi kursi doziT 90mg/kg IV erTxel dReSi.
46
6. reabilitacia da dakvirveba
citomegalovirusuli retinitis meoradi profilaqtika
antivirusuli
agenti
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
meore rigis sqemebi
Tvalis implantanti, romelic gamoyofs ganciklovirs
+
valgancikloviri 900 mg erTxel
dReSi
PO manamde sanam CD4ujredebi ricxvi ar
moimatebs 100-150 mm3
minimum 3 Tvis
ganmavlobaSi
meoradi profilaqtikis Sewyveta SesaZlebelia 6 Tvis Semdeg da
imunorekonstituciisas - CD4 100-150 mm3.
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
47
aiv infeqcia/Sidsis fonze ganviTarebuli dermatomikozebis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. dermatomikozebi ewodeba kanis sokovan dazianebas,
romelic SeiZleba gaCndes sxeulis nebismier adgilze, gamonayari
mSralia, aqercvladi, Tan axlavs qavili.
2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis ratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. dermatomikozebis dadasturebisTvis aucilebelia dazianebuli
kanis anafxekis mikroskopuli gamokvleva.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
dermatomikozis gamomricxavi kriteriumia dazianebuli kanis anafxekis
mikroskopiiT gamomnvevis ar arseboba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. dermatomikozebis dros saxezea sxeulis
nebismier adgilze ganviTarebuli mSrali da aqercvladi ubani,
romelsac Tan axlavs qavili.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. dermatomikozis gamomricxavi faqtoria Sesabamisi
gamonayaris ar arseboba kanze.
48
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, virusli hepatitebis diagnostika, kanis
dazianebuli ubnis anafxekis mikroskopuli daTvaliereba, dermatologis
konsultacia.
5. dermatomikozebis mkurnaloba
antifungaluri
preparati
doza MmiRebis
sixSire
M miRebi
gza
mkurnalobis
xangrZlivoba
pirveli rigis sqemebi
Mmikonazoli
(adgilobrivad
gamoyenebisTvis)
3-jer dReSi Aadgilobrivad 21 dRe
an
klotrimazoli
(adgilobrivad
gamoyenebisTvis)
3-jer dReSi adgilobrivad 21 dRe
meore rigis sqemebi
ketokonazoli 200 mg dReSi
erTxel
PO 1-3 Tve
an
itrakonazoli 100 mg dReSi
erTxel
PO 1-3 Tve
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
49
aiv infeqcia/Sidsis fonze ganviTarebuli oniqomikozebis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. oniqomikozebi warmoadgens frCxilis sokovan
dazianebebs, romlebic iwveven frCxilis firfitebis deformaciasa da
rRvevas.
2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. oniqomikozebis damadasturebeli kriteriumia gamomwvevis
aRmoCena frCxilis firfitis qvevidan aRebul da kaliumis hidroqsidiT
damuSavebul masalaSi mikroskopuli gamokvleviT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
oniqomikozebis gamomricxavi kriteriumia dazianebuli frCxilis
firfitis qvevidan aRebul da kaliumis hidroqsidiT damuSavebul
masalaSi gamomwvevis ararseboba mikroskopuli daTvalierebiT.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. oniqomikozebi iwveven frCxilis
firfitebis deformaciasa da rRvevas.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. oniqomikozebis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ar arseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
50
Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, masalis
aReba dazianebuli frCxilis firfitis qvevidan, kaliumis hidroqsidiT
damuSaveba da mikroskopuli daTvaliereba, dermatologis konultacia.
5. oniqomikozebis mkurnaloba
pirveli rigis sqemebi
antifungaluri
preparati
doza MmiRebis
sixSire
MmiRebi
gza
mkurnalobis
xangrZlivoba
terbinafini 250 mg dReSi
erTxel
PO 6 kvira xelis
TiTebis
dazianebisas an
12 kvira fexis
TiTebis
dazianebisas
an
itrakonazoli 200 mg 2-jer dReSi PO yoveli Tvis I
kviris
ganmavlobaSi 2
Tvis manZilze
(xelis TiTebis
dazianebisas),
3-4 Tve (fexis
TiTebi
dazianebisas)
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
51
aiv infeqcia/Sidsis fonze ganviTarebuli seboreuli dermatitis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. varaudoben, rom seboreuli dermatitis gamomwvevia
soko Pitysporu ovale (aseve cnobilia rogorc Malassezia furfur). elementi
warmoadgens wiTeli feris laqas, romelic iqercleba.
2. kriteriumebi
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. seboreuli dermatitis diagnozi dasturdeba sokos aRmoCeniT
kanis dazianebuli ubnidan anafxeki masalis mikroskopuli gamokvlevisas.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. seboreuli
dermatitis diagnozi gamoiricxeba, Tu kanis dazianebuli ubnidan
anafxeki masalis mikroskopuli gamokvlevisas gamomwvevi ar aRmoCndeba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. seboreuli dermatitis dros saxezea
aqerclili wiTeli feris laqa saxeze, cxviris nestoebis irgvliv,
cxvir-tuCis naoWze, warbebze, Tavis Tmian nawilze, gul-mkerdis areSi
iRliebSi, tanis zeda nawilsa da sazardulis areSi.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. seboreuli dermatitis gamomricxavi faqtoria Sesabamisi
Civilebisa da simptomebis ararseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
52
Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, dazianebuli
kanis anafxekis mikroskopuli gamokvleva, dermatologis konsultacia.
5. seboreuli dermatitis mkurnaloba
rekomendebulia dazianebuli ubnebis xSirad dabana qerclis
mosaSoreblad,
karg Sedegs iZleva selenis sulfidis Semcveli samkurnalo Sampunebis
gamoyeneba.
SesaZloa yvelaze efeqturi aRmoCndes hidrokortizonis 1%-ani mazis
aplikaciebi. aseve karg Sedegs iZleva ketokonazolis 2%-ani kremi.
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
53
aiv infeqcia/Sidsis fonze ganviTarebuli munis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. daavadeba munis gamomwvevia tkipa Sarkoptes scabiei. mdedr tkipas kanSi gahyavs gasasvleli, romelsac aqvs ramodenime sm
sigrZis zedapiridan wamoweuli wiTeli nawiburis Sesaxedaoba. mdedri
tkipa gayvanil gasasvlelSi debs kvercxebs da Semdeg gadaadgildeba
sxeulis sxva nawilSi. kvercxebidan gamodis tkipebis axali Taoba,
romlebic izrdebian, jvardebian, gahyavT axali gasasvlelebi da deben
axal kvercxebs.
2. kriteriumebi
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. munis diagnozi diagnozi ismeba klinikuri gamovlinebebisa da
dazianebuli keris anafxekis mikroskopuli gamokvlevis safuZvelze.
mikroskopiisas aRmoCndeba tkipebi an/da maTi kvercxebi.
b) gamomricxavi _ aiv infeqcia /Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT. munis
gamomricxavi kriteriumebia anafxekis mikroskopisas tkipebis an/da maTi
kvercxebis ararseboba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. munis dros kanqveSa gasasvlelis adgilze
viTardeba gamonayari, romelic xSirad gvxvdeba:
• xelebze - mtevnebze (gansakuTrebiT TiTebs Soris),
• majis, idayvis, muxlismomxrel zedapirebze,
• winamxris idayviskena zedapirze,
• sasqeso asoze,
• sarZeve jirkvlebsa da
• beWebze.
• avadmyofs ZiriTadad awuxebs tanis Zlieri qavili,
gansakuTrebiT RamiT.
54
• imunodeficitis mqone pacientebs xSirad uviTardebaT munis
mZime forma, romelsac uwodeben norvegiuls. misTvis
damaxasiaTebelia vezikuluri gamonayari da sqeli fufxebis
warmoqmna mTel sxeulze. munis am formis dros qavili ar aris
gamoxatuli.
• qavilis gamo muni xSirad rTuldeba meoradi infeqciebiT.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. munis gamomricxavi faqtoria Sesabamisi Civilebisa da
simptomebis ararseboba.
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, dazianebuli
keris anafxekis mikroskopuli Seswavla, dermatologis konsultacia.
5. munis mkurnalobaA
SerCevis preparats warmoadgens adgilobrivad gamosayenebeli 1%-ani
gamabenzen heqsaqloridi, romelic ismeba mTels tanze, Tavis garda,
mozrdilebSi Camoibaneba 24 sT-Si, xolo bavSvebSi _ 8sT-Si. sakmarisia
erTjeradi damuSaveba.
aseve SesaZlebelia kanis damuSaveba 1%-ani permetriniT an 1%-ani
lindaniT; es preparatebic ismeba mTels tanze da Camoibaneba 8 sT-Si.
permetrinisa da lindanis gamoyeneba ar SeiZleba orsulebisaTvis,
meZuZuri dedebisa da bavSvebisaTvis.
norvegiuli munis samkurnalod, imunodeficitis mqone pacientebSi,
efeqturia ivermeqtini, 200 mg/kg PO erTjeradad.
tansacmeli, TeTreuli da pirsaxocebi unda gamoixarSos da dauTovdes
gaSrobis Semdeg.
munis mkurnaloba unda Cautardes sqesobriv partniors da yvelas vinc
sayofacxovrebo kontaqtSi iyo avadmyofTan.
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
55
aiv infeqcia/Sidsis fonze ganviTarebuli stafilokokuri folikulitis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. folikuliti _ kanis infeqciaa, romlis drosac
procesi Tmis folikulSia lokalizebuli. aiv inficirebulebs xSirad
uviTardebaT pustularuli perifolikuliti. folikulits, rogorc
wesi, iwvevs Staphylococcus aureus, magram sxva mikroorganizmebsac SeuZlia
misi gamowveva.
2. kriteriumebi _
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. stafilokokuri folikulitis diagnozi ismeba klinikuri
gamovlinebebis safuZvelze. gamonayari warmodgenilia mravlobiTi
wvrili (5 mm diametris), hiperemiuli folikulebiT, romlebic centrSi
daCirqebulia. xSirad elementebs aqvT midrekileba gaerTianebisaken.
kanis dazianebas Tan axlavs qavili.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ar arseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is
ararseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
stafilokokuri folikulitis gamomricxavi kriteriumia Sesabamisi
klinikuri suraTis ar arseboba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. stafilokokuri folikulitis dros
gamonayari warmodgenilia mravlobiTi wvrili (5 mm diametris),
hiperemiuli folikulebiT, romlebic centrSi daCirqebulia. xSirad
elementebs aqvT midrekileba gaerTianebisaken. kanis dazianebas Tan
axlavs qavili.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. stafilokokuri folikulitis gamomricxavi faqtoria
Sesabamisi gamonayaris ararseboba.
56
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, pustulis
SigTavsis baqteriologiuri gamokvleva, dermatologis konsultacia.
5. stafilokokuri folikulitis mkurnaloba
I rigis preparati
cefaleqsini 500 mg PO 4-jer dReSi 7-21 dRe.
alternatiuli preparati
kloksacilini 500 mg PO 4-jer dReSi 7-21 dRe. 6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
57
aiv infeqcia/Sidsis fonze ganviTarebuli kontagiozuri moluskis marTva
(protokoli)
1. daavadebis /nozologiis / sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT gamowveul
infeqciur daavadebas. kontagiozuri moluski _ kanis zedapiruli
infeqciaa, romelsac iwvevs kontagiozuri moluskis virusi. aiv
inficirebulebSi aiv negatiurebisgan gansxvavebiT: elementebi
raodenobrivad bevria, xangrZlivad persistirebs, ufro msxvilia da
Znelad eqvemdebareba mkurnalobas.
2. kriteriumebi
a) damadasturebeli _ aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirus
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT. kontagiozuri moluskis diagnozi ismeba damaxasiaTebeli
elementis aRmoCenisas. specifikuri diagnostikuri testi virusis
aRmosaCenad ar arsebobs.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi kriteriumebia: aiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is ar
arseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
kontagiozuri moluski gamomricxavi kriteriumia Sesabamisi gamonayaris
ararseboba.
3. simptomebi da niSnebi
a) damadasturebeli _ aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia. igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SeiZleba gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (erTi Tvis ganmavlobaSi sxeulis wonis 10% da meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi da sxva. kontagiozuri moluskis gamomwvevi kanSi
SeRwevisas iwvevs 2-5 mm diametris kanisferi mkvrivi papulebis
ganviTarebas. papulebi Seicavs TeTr cximovan sekrets. gamonayaris
elementebi SeiZleba ganviTardes sxeulis nebismier adgilas, xSirad
iyos ucvlelad mravali Tvis manZilze da/an gaqres da Semdeg kvlav
gaCndes.
b) gamomricxavi _ aiv infeqcia/Sidsis gamomricxavi simptomebi ar
arsebobs, aiv inficirebuli wlebis ganmavlobaSi SeiZleba Civilebs ar
warmoadgendes. kontagiozuri moluskis gamomricxavi faqtoria
Sesabamisi gamonayaris ar arseboba.
58
4. diagnostikur _ laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra polimerizaciis jaWvuri reaqciis
meTodiT, sisxlis saerTo analizi, RviZlis funqciuri sinjebi,
Tirkmlis funqciuri sinjebi, virusuli hepatitis markerebi, eqim
dermatologis konultacia.
5. kontagiozuri moluskis mkurnaloba
kontagiozuri moluskis mkurnaloba mdgomareobs papulis rbili
SigTavsis mocilebaSi, romlis Semdeg papula qreba. mkurnalobis taqtika
yvela SemTxvevaSi individualuria. arsebobs kanis dazianebuli ubnis
damuSavebis sxvadasxva meTodi. elementebs damuSaveba SesaZlebelia
Semdegi meTodebis gamoyenebiT:
_ kiuretaJi;
_ qimiuri destruqcia fenolis koncentrirebuli xsnariT;
_ krioTerapia;
_ eleqtrokoagulacia.
cnobilia, rom aiv inficirebulebSi arT-s dawyeba xels uwyobs
kontagiozuri moluskis eliminacias. naCvenebi iyo, rom antivirusuli
preparati – cidofoviri, romelsac aqvs Zlieri antiretrovirusuli
moqmedeba, aseve efeqturia kontagiozuri moluskis samkurnalod
6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
7. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
59
aiv infeqcia/SidsiT avadmyofebSi B hepatitis virusiT ko-infeqciis marTva
(protokoli)
1. daavadebis /nozologiis/sindromis mokle ganmarteba
B hepatiti adamianis B hepatitis virusiT gamowveuli infeqciuri
daavadebaa. aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis
virusiT gamowveul infeqciur daavadebas. orive paTogeniT erTdroulad
daavadebisas saubaria aiv infeqcia/Sidsis da B hepatitis virusiT
koinfeqciaze.
2. kriteriumebi
a) damadasturebeli – aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is da/an aiv provirusis dnm-is aRmoCena
sisxlSi polimerizaciis jaWvuri reaqciis meTodiT; BB hepatitis
virusiT daavadebis damadasturebeli kriteriumia HBsAg-is arseboba
sisxlis SratSi. imunofermentuli analizis meTodiT. HBsAg-is arseboba > 6 Tveze meti xangrZlivobiT qronikuli HBV infeqciis maCvenebelia.
qronikuli HBV infeqciis sxvadasxva variantis sadiagnostiko markerebia: HBeAg, Anti-HBe da HBV DNA. b) gamomricxavi – aiv infeqcia/Sidsis gamomricxavi kriteriumebia: Aaiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli analizis
meTodiT, aiv rnm-is da/an aiv provirus dnm-is ararseboba sisxlSi
polimerizaciis jaWvuri reaqciis meTodiT. B hepatitis virusiT
infeqciis gamomricxavi kriteriumebia: HBsAg-is da Anti-HBc antisxeulebis ararseboba sisxlis SratSi.
3. simptomebi da niSnebi
a) damadasturebeli - aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia, igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SesaZloa gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (1 Tvis ganmavlobaSi sxeulis wonis 10% an meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi. B hepatiti mwvave stadiaze SesaZloa usimptomod
mimdinareobs, umetes SemTxvevaSi mwvave B hepatitis dros avadmyofs
aReniSneba zogadad hepatitis niSnebi, rogoricaa: siyviTle, saerTo
sisuste, Sardis gamuqeba, ganavlis gaRiaveba, zogjer sxeulis
temperatutis momateba, diskomforti muclis RruSi, gulisrevis
SegrZneba, Rebineba da sxva intoqsikaciis movlenebi. daavadebam 1.4%-Si
SesaZloa miiRos fulminanturi mimdinareoba. avadmyofTa 10-15%-Si
daavadeba qronikul mimdinareobas Rebulobs da qronikuli B hepatiti
60
praqtikulad xasiaTdeba usimptomo mimdinareobiT, SesaZlebelia
gamoxatuli iyos mxolod zogadi saerTo sisuste.
b) gamomricxavi - qronikul B hepatitis iseve rogorc aiv
infeqcia/Sidsis gamomricxavi simptomebi ar arsebobs, qronikul B hepatitiTa da aiv-iT koinficirebuli pacienti wlebis ganmavlobaSi
SeiZleba Civilebs ar warmoadgendes.
4. diagnostikur-laboratoriuli testebi
yvela HIV dadebiT avadmyofs unda Cautardes gamokvleva HBsAg-ze da anti-HBc antisxeulebze(AII). im SemTxvevaSi, Tu HBsAg uaryofiTia da anti-HBc dadebiTi, maSin avadmyofs unda Cautardes gamokvleva anti-HBs-ze(AII) da gadawydes esaWiroeba Tu ara avadmyofs HBV vaqcinacia.
yvela avadmyofs, romelsac aqvs dadebiTi HBsAg unda Cautardes
gamokvleva anti-HDV-ze(AII).
yvela avadmyofs, romelsac aqvs dadebiTi HBsAg unda Cautardes Semdegi gamokvlevebi:
HBeAg da anti-HBe, HBV dnm-is gansazRvra, RviZlis ultrabgeriTi
gamokvleva, RviZlis biofsia an fibrozis arainvaziuri markerebis
gansazRvra RviZlis daavadebis simZimis Sesafaseblad, ALT-is gansazRvra (seriuli), CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra,
aiv virusuli datvirTvis gansazRvra, sisxlis saerTo analizi.
5. mkurnaloba
HBV infeqciis mkurnalobis SemTxvevaSi HIV koinfeqciT avadmyofebSi
gaTvaliswinebul unda iqnas 2 ZiriTadi varianti:
61
1. HBV mkurnalobis algoriTmi HIV koinfeqciiT avadmyofebisTvis,
romelTac ar esaWiroebaT arv mkurnaloba. H
*HBV DNA>20000IU/ml HBeAg(+) pozitiurisTvis, HBV DNA>2000IU/ml HBeAg(-) negatiurisTvis.
** Metavir <A2 da/an<F2 *** Metavir >_A2 da/an>_F2
HBV/HIV koinfeqciiT
avadmyofebi HAART-is Cvenebis gareSeE.
HBV DNA, ALT, HBeAg
ALT-is normaluri
done, HBV DNA-is dabali done
RviZlis araaqtiuri
an msubuqi daavadeba**
aqtiuri da/an
progresirebadi daavadeba***
RviZlis daavadebis
statusi
HBVaqtiuri
daavadeba, maRali
HBV DNA.*
dinamikaSi
dakvirveba
CD4≥500/mm3 CD4<500/mm3
IFN/Peg IFN/ adefoviri HAART romelSic Sedis
tenofoviri+lamivudini an emtricitabini
dinamikaSi
dakvirveba
62
HBV/HIV koinfeqciiT avadmyofebisTvis, romelTac ar esaWiroebaT arv
mkurnaloba HBV infeqciis samkurnalod SerCevis preparati aris
interferoni.
mkurnalobis reJimebi aris Semdegi:
1. HBeAg (+) pozitiuri avadmyofebisTvis.
standartuli INF 5-6 MU/dReSi an 10 MU 3-jer kviraSi 4-6 Tve.
2. HBeAg (-) negatiuri avadmyofebisTvis.
standartuli INF 3-6 MU 3-jer kviraSi 12 Tve.
an
3. PEG-INF 2a 180mkg 1- jer kviraSi 12 Tve. HBeAg/ anti-HBe statusisgan damoukideblad.
4. im SemTxvevaSi Tu interferoni ukunaCvenebia gamoyenebul unda iqnas
adefoviri 10mg dReSi.
2. HBV mkurnalobis algoriTmi HIV koinfeqciiT avadmyofebisTvis,
romelTac WirdebaT arv mkurnaloba. H
HBV/HIV koinfeqciiT
avadmyofebi romelTac
WirdebaT HAART .
maRali HBV DNA dabali HBV DNA
HAART SerCevis reJimi HAART romelSic
Sedis tenofoviri + lamivudini an
emtricitabini
avadmyofebi
ciroziT
avadmyofebi
lamivudinis mimarT
rezistentobis
gareSi
lamivudin rezistentuli
avadmyofebi
HAART romelSic
Sedis tenofoviri + lamivudini an
emtricitabini
unda Canacvldes erTi
NRTI tenofoviriT an
daematos tenofoviri
63
HBV/HIV koinfeqciiT avadmyofebisTvis, romelTac esaWiroebaT arv
mkurnaloba da HBV mkurnaloba gaTvaliswinebul unda iqnas Semdegi:
a) Tu HBV DNA aris maRali koncentraciiT, maSin HAART aucileblad
unda Seicavdes or medicaments, romelsac gaaCnia ormagi aqtivoba
rogorc HBV aseve HIV mimarT.
b) lamivudinis mimarT rezistentobis SemTxvevaSi, roca HIV infeqcia kontrolirebadia, erT-erTi NRTI unda Seicvalos tenofoviriT.
g) lamivudinis mimarT rezistentobis SemTxvevaSi, roca HIV infeqcia kargad ar kontroldeba, pirvel rigSi yuradreba unda mieqces HAART-s, romelic kargad gaakontrolebs aiv infeqcias da daematos tenofoviri.
d) avadmyofebSi, romelTac aqvT cirozi HBV mkurnalobis sakiTxi unda
gadawydes HBV DNA-s dabali maCveneblis dros. (HBV DNA>200IU/ml). aseT
avadmyofebSi interferoni ukunaCvenebia.
fulminanturi mwvave B hepatitis mkurnaloba HIV koinfeqciiT
avadmyofebSi
Cveulebriv mwvave B hepatiti SemTxvevaTa maRal procentSi mTavrdeba
gamojanmrTelebiT da amitom mkurnalobas ar saWiroebs.
fulminanturi mwvave B hepatitis SemTxvevaSi lamivudiniT mkurnaloba
unda iqnas ganxiluli, miuxedavad aiv-is mimarT rezistentobis
ganviTarebis riskisa.
tenofoviris da adefoviris daniSvnisgan Tavi unda iqnas Sekavebuli am
medikamentebis gamoxatuli nefrotoqsiurobis gamo.
6. reabilitacia da dakvirveba
HBV mkurnalobis efeqturoba HBeAg (+) pozitiur avadmyofebSi fasdeba anti-HBe-is myari serokonversiiT, xolo HBeAg (-) negatiur avadmyofebSi
ALT-s myari normalizebiT da HBV dnm-is myari supresiiT(<2000 IU/ml).
nukleotidis da nukleozidis analogebiT mkunalobis SemTxvevaSi
sawyisi pasuxi mkurnalobaze ganisazRvreba rogorc HBV dnm-is 1 log10-iT
SemcirebiT 1-3 Tvis ganmavlobaSi. amis Semdeg HBV dnm-s gansazRvra unda xdebodes yoves 3 TveSi erTjer. mkurnaloba efeqturia Tu HBV dnm aragansazRvradia.
rac Seexeba mkurnalobis Sewyvetis sakiTxs (nukleozidis da nkleotidis
analogebiT mkurnalobisas) jer-jerobiT amis Taobaze azrTa
sxvadasxvaobaa. mkurnaloba sasurvelia gagrZeldes rac SeiZleba
didxans, radganac Sewyvetam SesaZloa gamoiwvios RviZlis fataluri
daavadeba.
7. gaidlaini romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
64
infeqcia/SidsiT avadmyofebSi C hepatitis virusiT ko-infeqciis marTva
(protokoli)
1. daavadebis /nozologiis/sindromis mokle ganmarteba
C hepatiti adamianis C hepatitis virusiT gamowveuli infeqciuri
daavadebaa. aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis
virusiT gamowveul infeqciur daavadebas. orive paTogeniT erTdroulad
daavadebisas saubaria aiv infeqcia/Sidsis da C hepatitis virusiT
koinfeqciaze.
2. kriteriumebi
a) damadasturebeli – aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is da/an aiv provirusis dnm-is aRmoCena
sisxlSi polimerizaciis jaWvuri reaqciis meTodiT; C hepatitis virusiT
daavadebis damadasturebeli kriteriumebia: C hepatitis virusis
sawinaaRmdego antisxeulebis arseboba sisxlis SratSi imunofermentuli
analizis meTodiT da/an C hepatitis virusis rnm-is aRmoCena sisxlSi
polimerizaciis jaWvuri reaqciis meTodiT..
b) gamomricxavi – aiv infeqcia/Sidsis gamomricxavi kriteriumebia: Aaiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli analizis
meTodiT, aiv rnm-is da/an aiv provirus dnm-is ararseboba sisxlSi
polimerizaciis jaWvuri reaqciis meTodiT. C hepatitis virusiT
infeqciis gamomricxavi kriteriumebia: C hepatitis virusis sawinaaRmdego antisxeulebis ararseboba, da/an C hepatitis virusis rnm-is ararseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT.
3. simptomebi da niSnebi
a) damadasturebeli - aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia, igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SesaZloa gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (1 Tvis ganmavlobaSi sxeulis wonis 10% an meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi; C hepatiti mwvave stadiaze ZiriTadad usimptomod
mimdinareobs, mxolod SemTxvevaTa 25%-Si SeasaZloa gamovlindes
simptomebi: siyviTle, saerTo sisuste, Sardis gamuqeba, ganavlis
gaRiaveba, zogjer sxeulis temperatutis momateba, diskomforti muclis
RruSi, gulisrevis SegrZneba, Rebineba da sxva intoqsikaciis movlenebi.
daavadeba SemTxvevaTa 80%-Si qronikul mimdinareobas Rebulobs da
qronikuli C hepatiti praqtikulad xasiaTdeba usimptomo mimdinareobiT,
SesaZlebelia gamoxatuli iyos mxolod zogadi saerTo sisuste. aqedan
gamomdinare C hepatitic miekuTvneba laboratiriulad dasiagnostiko
daavadebebs.
65
b) gamomricxavi - aiv infeqcia/Sidsis gamomricxavi simptomebi da niSnebi ar arsebobs, aiv inficirebuls wlebis ganmavlobaSi SesaZloa simptomebi
ar aReniSnebodes; C hepatitis virusiT infeqciis simptomebi da niSnebi
aseve ar arsebobs da avadmyofs wlebis ganmavlobaSi SesaZloa ar
aReniSnebodes araviTari simptomi.
4. diagnostikur-laboratoriuli testebi.
yvela HIV dadebiT avadmyofs udna Cautardes gamokvleva anti-HCV antisxeulebze(AII). Anti-HCV (+) pozitiuri Sedegis SemTxvevaSi unda
Catardes HCV RNA-s gansazRvra. yvela avadmyofs, romelsac aqvs HCV RNA (+) pozitiuri unda Catardes Semdegi gamokvlevebi:
1. ΗCV genotipis gansazRvra . 2. HCV virusuli datvirTvis gansazRvra. 3. sisxlis saerTo analizi, ALT, AST, G-GT, kreatinini. 4. RviZlis ultrabgeriTi gamokvleva.
5. RviZlis biofsia an fibrozis arainvaziuri markerebis
gansazRvra RviZlis daavadebis simZimis Sesafaseblad
6 CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra,
aiv virusuli datvirTvis gansazRvra.
5. mkurnaloba
HCV infeqciis samkurnalod HCV/HIV ko-infeqciiT avadmyofbSi gamoiyeneba
kombinirebuli antivirusuli mkurnaloba pegilirebuli alfa
interferoniT da ribaviriniT.
mwvave C hepatitis mkurnalobis sakiTxi ko_infeqciiT avadmyofebSi jer-
jerobiT sabolood gadaWrili ar aris.
qronikuli C hepatitis mkurnaloba: Tu qronikuli C hepatitis diagnozi ganisazRvra aiv infeqciis adreul stadiaze (manamde, sanam avadmyofs ar
Wirdeba HAART mkurnaloba) HCV infeqciis mkurnaloba dawyebul unda
iqnas. (AIII).
Tu ko-infeqciT avadmyofebs aqvT Rrma imunodeficiti, jer dawyebul
unda iqnas HAART da HCV mkurnalobis sakiTxi ganxilul unda iqnas
mxolod CD4 ujredebis raodenobis momatebis Semdeg. (AII).
HCV infeqciis mkurnalobis rejimi HIV koinfeqciiT avadmyofebSi
interferoni:
- PEG-IFN alpha 2α- 180 mkg 1 Xjer kviraSi an PEG-IFN alpha 2b 1.5 mkg/kg kviraSi erTxel.
ribavirini - HCV 1 da HCV 4 genotipiT avadmyofebisTvis maRali virusuli
datvirTviT ribavirini 1000-1200 mg dReSi 1-jer (mkurnalobis
dawyeba) (BIII)
66
- yvela sxva SemTxvevaSi (maT Soris HCV 1 da HCV 4 genotipiT
avadmyofebisTvis dabali virusuli datvirTviT) ribavirini 800 mg dReSi 1-jer (AII).
HIV/HCV ko-infeqciiT avadmyofebSi, genotipisgan damoukideblad
mkurnalobis xangrZlivoba Seadgens 48 kviras (BI).
HCV infeqciis mkurnalobis algoriTmi HCV/HIV koinfeqciiT
avadmyofebSi
HCV/HIV koinfeqcia
CD4+ <200/mm3
HCV RNA (+) dadebiTi
HCV 1an 4 genotipi virusuli datvirTva
(>800, 000 IU/ml)
HCV 1 genotipi virsuli datvirTva
(<800, 000 IU/ml)
HCV 2,3 genotipi virusuli datvirTva
maRali/dabali
HAARTCD4+ >200/mm3
( 200-350 mm3)
HCV mkurnaloba
HCV mkurnalboba
naCvenebia
daavadebis simZimis Sefaseba:
RviZlis biofsia, fibro testi
da sxva,
msubuqi daavadeba
F0-F1 saSualo simZimis da
mZime
F2-F4
dakvirveba dinamikaSi
mkurnalobis
xangrZlivoba
48 kvira
67
pegilirebuli interferonis da ribavirinis dozis cvlilebebi
mkurnalobis dros ganviTarebuli hematologiuri cvlilebebis dros
medikamentebis dozis cvlilebebi
ribavirinis Semcireba 600 mg -mde
ribavirin
is
Sewyveta
PEG-IFN-is Semcireba
70%,50%, 25%-iT
PEG-IFN Sewyveta
kombinirebuli
mkurnalobis
Sewyveta
neitrofilebi <750/mm3 <500/mm3
Trombocitebi 25 000– 50 000/mm3 <25 000/mm3
hemoglobini
(gulis daavadebis
gareSe)
8.5–10.0 g/dl <8.5 g/dl
gulis stabiluri
daavadeba
≥2 g/dl –iT
daqveiTeba
nebismieri
4 kviris
ganmavl-Si
<12 g/dl
HIV ko infeqciiT avadmyofebSi HCV mkurnalobis ukuCvenebebi:
• orsuloba;
• kardiopaTia, rogoricaa gulis ukmarisoba da iSemiuri daavadeba;
• fsiqiuri sferos darRvevebi;
• alkoholis aqtiuri moxmareba (>50 g/dRe); • dekompensirebuli cirozi (Child-Pugh C).
HCV infeqciis mkurnalobis dros ganviTarebuli gverdiTi movlenebis
marTva
avadmyofebSiPPEG-INF + ribavirinis kombinaciiT mkurnalobisas
ganviTarebuli gverdiTi movlenebis marTvisTvis rekomendebulia
Semdegi saSualebebi.
mmeenneejjmmeennttii ggvveerrddiiTTii mmoovvlleenneebbii
paracetamoli
(SesaZlebelia kombinacia
anTebis sawinaaRmnego
arasteroidebTan)
eriTropoetini
zrdis faqtori
antidepresantebi
gripismagvari sindromisTvis (AII).
mZime anemiis SemTxevaSi (BI).
mZime neitropeniis SemTxvevaSi (CIII).
klinikurad gamoxatuli depresiis SemTxvevaSi(ΑΙΙ)
68
mmeenneejjmmeennttii ggvveerrddiiTTii mmoovvlleenneebbii
(seleqtiuri serotoninis
ukumitacebis inhibitori)
Tireoiduli hormoni
β-blokatorebi
hipoTireozis dros (AII).
hiperTireozis dros (CIII).
Tanmxlebi antiretrovirusuli medikamentebis
gamoyeneba.
PEG- intrferoniT da ribaviriniT kombinirebuli mkurnalobis dros
cirozian avadmyofebSi didanozini (ddI) ukunaCvenebia (EI) da aseve
sasurvelia ar iqnas gamoyenebuli RviZlis naklebad mZime dazianebis
dros. (EII).
PEG- intrferoniT da ribaviriniT kombinirebuli mkurnalobis dros
stavudini (d4T) gansakuTrebiT didanozinTan (ddI) kombinaciaSi ar unda iqnas gamoyenebuli, radgan am dros izrdeba laqtat acidozis
ganviTarebis riski. (EII).
aseve HCV –s kombinirebuli antivirusuli mkurnalobis dros HIV ko-infeqciiT avadmyofebSi zidovudinis gamoyenebisgan Tavi unda iqnas
Sekavebuli, radgan zidovudini zrdis anemiis da neitropeniis
ganviTarebis risks (DII).
PI –s gamoyeneba amcirebs myari virusuli pasuxis(SVR) ganviTarebis
albaTobas HIV/HCV ko-infeqciiT avadmyofebSi, Tumca jer-jerobiT
kategoriuli uaryofiTi rekomendaciebi PI –s gamoyenebis mimarT ar aris.
NVP (nevirapini) sifrTxiliT unda iqnas gamoyenebuli (AII).
6. reabilitacia da dakvirveba
HCV antivirusul mkurnalobaze myofi avadmyofebis
monitoringi, mkurnalobis tolerantobis da mkurnalobis
efeqturobis Sefasebis mizniT
maCveneblebi 1,2
4
8
12
16
20
24
28
32
34
36
48
72
mkurnalobis
tolerantoba
sisxlis
saerTo
Trombocite
bi
X
X X X X X X X X X X X X
CD4 X X X X X X X X X
TSH X X X
69
HCV RNA raodenobri
vi (VL)
X
mkurnalobis
efeqturoba
HCV RNA Tvisobrivi
X
X X
antivirusuli mkurnalobis dawyebidan 12 kviraze, Tu HCV virusuli
datvirTva gaxda aragansazRvradi an Semcirda sul cota 2 log10-iT, es
niSnavs, rom mkurnalobaze adreuli virusuli pasuxi (EVR) miRebulia da mkurnaloba unda gagrZeldes.
Tu HCV virusuli datvirTva ar Semcirda sul cota 2 log10-iT,
mkurnaloba unda Sewydes, radgan aseT SemTxvevaSi myari virusuli
pasuxis(SVR) ar miReba mosalodnelia daaxloebiT 99-100%-Si. (AII). zemoT aRniSnuli vrceldeba HCV nebismieri genotipiT avadmyofze.
amis Semdeg mkurnalobis dawyebidan 24 kviraze rekomendebulia HCV RNA –is (Tvisobrivi) gansazRvra da im avadmyofebSi, romlebic am
etapze rCebian HCV RNA (+) pozitiuri, mkurnaloba unda Sewydes.
(radgan aseT SemTxvevaSi myari virusuli pasuxis(SVR) ar miiReba
mosalodnelia daaxloebiT 99-100%-Si.)
mkurnalobis dawyebidan 48 kviraze unda ganisazRvros HCV RNA
(Tvisobrivi) da miRebuli Sedegi daafiqsirebs mkurnalobis bolo
pasuxs. (EOT) mkurnalobis damTavrebidan 6 Tvis Semdeg kvlav unda ganisazRvros
HCV RNA (Tvisobrivi). negatiuri HCV RNA mianiSnebs myari virusuli
pasuxis (SVR) miRebaze, ris Semdegac daavadebis recidivis ganviTareba
Zalian iSviaTia.
Semdgomi gamokvleva SesaZloa Catardes 12-24 Tvis Semdeg mkurnalobis
damTavrebidan.
7. gaidlaini romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.
70
aiv infeqcia/Sidsis da tuberkulozis koinfeqciis marTva
(protokoli)
1. daavadebis /nozologiis/sindromis mokle ganmarteba
aiv infeqcia/Sidsi ewodeba adamianis imunodeficitis virusiT
gamowveul infeqciur daavadebas. tuberkulozis gamomwvevia
tuberkulozis mikobaqteria. orive paTogeniT erTdroulad daavadebisas
saubaria aiv infeqcia/Sidsis da tuberkuloziT koinfeqciaze.
2. kriteriumebi
a) damadasturebeli – aiv infeqcia/Sidsis damadasturebeli
kriteriumebia: aiv antisxeulebis arseboba sisxlis SratSi
imunoblotingis meTodiT, aiv rnm-is raodenobrivad da/an aiv provirusis
dnm-is Tvisobrivad aRmoCena sisxlSi polimerizaciis jaWvuri reaqciis
meTodiT; tuberkuloziT daavadebis damadasturebeli kriteriumia:
avadmyofis biologiur masalaSi (maT Soris naxvelis nacxSi) mJavagamZle
baqteriebis (mgb) arseboba, biologiur masalaSi kulturaluri meTodiT
tuberkulozis mikobaqteriis aRmoCena.
b) gamomricxavi – aiv infeqcia/Sidsis gamomricxavi kriteriumebia: Aaiv
antisxeulebis ararseboba sisxlis SratSi imunofermentuli meTodiT,
raodenobrivad aiv rnm-is da/an Tvisobrivad aiv provirus dnm-is
ararseboba sisxlSi polimerizaciis jaWvuri reaqciis meTodiT;
tuberkulozis gamomricxavi kriteriumebia: tuberkulozis
damaxasiaTebeli klinikuri niSnebisa da simptomebis ararseboba,
biologiur masalaSi (maT Soris naxvelis nacxSi) baqterioskopiiT mgb-
sa da kulturaluri gamokvleviT tub.mikobaqteriis ararseboba.
3. simptomebi da niSnebi
a) damadasturebeli - aiv infeqcia/Sidss paTognomuri klinikuri niSnebi
ar gaaCnia, igi miekuTvneba laboratoriulad sadiagnozo daavadebebs.
simptomebidan SesaZloa gamovyoT: gaxangrZlivebuli cxeleba,
gaxangrZlivebuli faRaraTi, limfadenopaTia, aramotivirebuli
profuzuli oflianoba, Zlieri saerTo sisuste, aramotivirebuli wonaSi
kleba (1 Tvis ganmavlobaSi sxeulis wonis 10% an meti), sxvadasxva
gamonayari kansa da lorwovanze, kandidozuri ezofagiti, cns-is
atipiuri dazianebebi; tuberkulozis damadasturebel simptomebs
miekuTvneba: zogadi niSnebi: subfebriliteti, Ramis oflianoba, advilad
daRla, saerTo sisuste, Sromis unaris daqveiTeba, taqikardia.
tuberkulozis filtvis formis dros zogad simptomatikas emateba: 2
kviris an meti xangrZlivobis xveleba (produqtiuli, mSrali an
sisxliani), haeris ukmarisoba, usiamovno SegrZneba an tkivili
gulmkerdSi; tuberkulozis filtvgareSe formebis dros ki zogado
intoqsikaciis niSnebs emateba ama Tu im organos dazianebisaTvis
damaxasiaTebeli lokaluri simptomatika.
71
b) gamomricxavi - aiv infeqcia/Sidsis gamomricxavi simptomebi da niSnebi
ar arsebobs, aiv inficirebuls wlebis ganmavlobaSi SesaZloa simptomebi
ar aReniSnebodes; tuberkulozis gamomricxavi niSnebi da simptobebia
Civilebis ararseboba, kontaqtis ararseboba aqtiuri tuberkuloziT
daavadebulTan;
mdgomareobebi dakavSirebuli aqtiur tuberkulozTan bavSvebSi
tuberkulozi saeWvoa, rodesac adgili aqvs:
• anamnezSi kontaqts filtvis tuberkulozis dadasturebul
SemTxvevasTan
• wiTelas gadatanis Semdeg imunosupresiul mdgomareobas
• wonaSi klebas, xvelas, paTologiur auskultaciur monacemebs
filtvebSi, romelic ar daeqvemdebara farTo speqtris
antibiortikoTerapias
• zedapiruli limfuri kvanZebis umtkivneulo SeSupebas
tuberkulozi savaraudoa, roca adgili aqvs saeWvo tuberkulozis
SemTxevevas da erT-erT niSans qvemoT CamoTvlilTagan
• tuberkulozis kanis testi 5 mm-ze meti induraciiT
• Sesabamisi cvlilebebi gulmkerdis rentgenogramaze
• Sesabamisi histologiuri cvlilebebi biofsiur masalaSi
• dadebiTi Sedegi antituberkulozur mkurnalobaze
tuberkulozi dadasturebulia, roca
• tuberkulozis mikobaqteria identificirebulia biologiur
sekretebSi an qsovilebSi
• naxvelis nacxis samjeradi pirdapiri mikroskopiiT minimum or
preparatSi aRmoCenilia mJavagamZle mikobaqteria
4. diagnostikur-laboratoriuli testebi da specialistTa konsultaciebi
CD3, CD4, CD8 limfocitebis absoluturi ricxvis gansazRvra, aiv
virusuli datvirTvis gansazRvra, sisxlis saerTo analizi, RviZlis
funqciuri sinjebi, Tirkmlis funqciuri sinjebi, virusuli hepatitis
markerebis gansazRvra, naxvelis nacxis gamokvleva mgb-ze, gul-mkerdis
rentgenologiuri gamokvleva, muclis Rrus eqoskopia; eqim-
infeqcionistis konsultacia, eqim-fTiziatris konsultacia;
5. mkurnaloba
tuberkulozis mkurnaloba aiv inficirebul pacientebSi unda daiwyos
aqtiuri tuberkulozis diagnozis dadasturebidan rac SeiZleba male.
72
aqtiuri tuberkulozis mkurnalobisTvis rekomendirebuli reJimebi aiv
inficirebul pacientebSi
tuberkulozis SemTxvevis tipi tuberkulozis mkurnalobis
reJimebi1
intensiuri faza2 gagrZelebis
faza
axali tbB pacienti HRZE 2 Tvis
ganmavlobaSi 3
HR 4 Tvis
ganmavlobaSi
adre tb-namkurnalebi pacienti, maT
Soris
• relafsi
• mkurnaloba misi Sewyvetis
Semdeg
• sxva SemTxveva
• uSedego mkurnaloba 4
HRZES 2 Tvis
ganmavlobaSi
an
HRZE 1 Tvis
ganmavlobaSi
HRE 5 Tvis
ganmavlobaSi
qronikuli (zedamxedvelobis qveS
Catarebuli ganmeorebiTi mkurnalobis
Semdeg naxveli isev mgb pozitiuria)
mrtb (aRiniSneba rezistentoba minimum H da R)
specialuri reJimi
H –izoniazidi, R – rifampicini, Z – pirazinamidi, E – etambutoli, S- streptomicini.
1 – aiv inficirebuli pacientebisaTvis aqtiuri tuberkuloziT mkurnalobis
yoveldRiuri reJimia rekomendirebuli;
2 - rekomendebulia mkurnaloba uSualo zedamxedvelobis qveS Catarebuli
qimioTerapiis mTeli kursis ganmavlobaSi.
3 – streptomicini SesaZloa gamoyenebul iqnes etambutolis nacvlad. tuberkulozuri
meningitisas etambutoli unda Seicvalos streptomiciniT.
4- yvela SemTxvevaSi unda Catardes wamlebis mimarT mikroorganizmis mgrZnobelobis
Seswavla mkurnalobis reJimis individualuri wesiT SesarCevad.
tuberkulozis mkurnalobisTvis aiv inficirebul bavSvebSi
rekomendirebulia igive reJimebi, rac mozrdilebSi. preparatebis
dozireba xdeba sxeulis masis Sesabamisad.
73
pirveli rigis antituberkulozuri medikamentebis rekomendebuli dozebi
medikamentebi dRiuri dozebi 1
(Cveuli doza an
zRvruli)
kviraSi samjer
miRebisTvis
gaTvaliswinebuli
dozebi
(Cveuli doza an
zRvruli)
izoniazidi 5 mg/kg
(Cveulebriv 300 mg)
10 mg/kg
(Cveulebriv 900 mg)
rifampicini 10 mg/kg
(450 mg TuU <50 kg
600 mg Tu >50 kg)
10 mg/kg
(450 mg TuU <50 kg
600 mg Tu >50 kg)
pirazinamidi 25 mg/kg
(20-30 mg/kg)
35 mg/kg
(30-40 mg/kg)
etambutoli 15 mg/kg
(15-20 mg/kg)
30 mg/kg
(20-35 mg/kg)
streptomicini 15 mg/kg
(12-18 mg/kg)
15 mg/kg
(12-18 mg/kg)
1. rodesac rifampicini gamoiyeneba antiretrovirusul
medikamentebTan erTad, rekomendebulia yoveldRiuri reJimiT
mkurnaloba
rekomendebuli pirveli rigis mmaaaarrTT reJimi tb
pacientebisaTvis, romlebsac eZlevaT rifampicini1
maarT arv preparatebis
kombinacia
sasurvelia
2 nrti
(nukleoziduri revers
transkriftazas inhibitori)
++
1 aannttrrii (aranukleoziduri
revers trankriftazas
inhibitori)
ZDV (an TDF)+ 3TC (an FTC) + EFV 2
alternatiuli
3 nnrrttii ZDV+ 3TC + ABC(an TDF)
1 – dozireba ix me-2 damatebaSi
2 - rekomendebulia efavirenzis dozireba 600 mg/dR gansakuTrebiT <60 kg
wonis pacientebSi. dozis gazrda 800 mg/ dReSi saWiroa >60kg
pacientebSi, Tumca es debuleba saWiroebs Semdgom kvlevas.
nevirapini SesaZloa gamoyenebul iqnas (200 mg erTxel 2 kviris
ganmavlobaSi, Semdeg 200 mg orjer), RviZlis funqciuri testebis da
wamlis toqsiurobis kontroliT.
74
rekomendebuli meore rigis mmaaaarrTT reJimi tb pacientebisaTvis
maarT arv preparatebis
kombinacia
sasurvelia
2 nnrrttii
++
2 ppii (maT Soris erTi
bustirebuli)
ABC+ ddI + LPV/r +RTV an
TDF+ ddI + LPV/r +RTV
alternatiuli
2 nnrrttii
++
2 ppii
ABC+ ddI + SQV +RTV an
TDF+ ddI + SQV +RTV
rekomendebuli tb reJimebi Tirkmlis daavadebis mqone pacientebisTvis 1
intensiuri faza gagrZelebis faza
SerCevis preparati HRZ 2 Tve HR 4 Tve
alternatiuli HRZE 2 Tve HR 4 Tve
1. zemoT aRniSnuli rekomendaciebi unda iqnes gaTvaliswinebuli,
rodesac kreatininis done miaRwevs 130-160 mkm/l.
rekomendebuli tb reJimebi pacientebSi RviZlis daavadebebiT 1
intensiuri faza gagrZelebis faza
SerCevis preparati SHRE 2 Tve HR 6 Tve
I alternativa SHE 2 Tve HE 10 Tve
II alternativa RE 9 Tve
1. RviZlis daavadebad iwodeba mdgomareoba, rodesac
alaninaminotransferaza samjer aRemateba normis maCvenebels an Tu
saxezea qronikuli hepatiti an cirozi.
75
6. reabilitacia da dakvirveba
arv da tb mkurnalobaze myofi pacientebis monitoringi
Sefaseba kvira Tve
0 2 4 8 3 4 5 6 7 8 9 10 11 12
tb/ aiv daavadebebis istoria X X
fizikaluri gamokvleva X X X X X X X
komorbiduli daavadebebi X X X X
ginekologiuri gamokvleva X X X X X
rutinuli laboratoriuli
testebi:
• sisxlis saerTo analizi
• RviZlis funqciuri sinjebi
(alt, ast, bilirubinebi)
• kreatinini
• Sardovana
X X X X
CD4 ujredebi X X X X
virusuli datvirTva X X X X
gul-mkerdis rentgenologiuri
gamokvleva
X X
orsulobis testi X X
naxvelis-nacxis gamokvleva 1 X X X X X X
mkurnalobis reJimis dacvis
Sefaseba (orive daavadebis: tb da
aiv infeqciis)
X X X X X X X X X X X X X X
7. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli _
`aiv infeqcia/SidsiT avadmyofTa mkurnaloba da movla~.
8. adamianuri da materialur-teqnikuri resursi _ eqimi-
infeqcionisti, eqimi-epidemiologi, eqimi-laboranti, virusologiuri,
imunologiuri, klinikuri bioqimiis da molekuluri medicinis
laboratoriebi.