Ukutheleleka kwe-fungal okuqhubekayo kuqhubeka kube yisisusa esikhulu sokugula nokufa kubantu abane-HIV, kanti izifo ezingenasici noma eziyinkimbinkimbi zivame ukuphawula. Phakathi kwezifo ezithathelwanayo ezifakwe emangcwabeni ngokuvamile ezihlotshaniswa ne- HIV :
- I- candidiasis ye- oral and esophageal (thrush)
- I-Cryptococcosis (kufaka phakathi i-cryptococcal meningitis)
- Histoplasmosis
- I-Coccidioidomycosis (I-Valley Fever)
Ezinye izifo ezithathelwanayo (kufaka phakathi i-aspergillosis, i-penicillosis, ne-blastomycosis) ziye zaphawulwa, ikakhulukazi kubantu abanezibalo ze- CD4 ngezansi 250 amaseli / mL.
Kunezinhlobo zamaseli ezivame ukusetshenziselwa ukuphatha izifo ezithinta i-HIV. Lezi zidakamizwa zihlukaniswe ngendlela ethile yezenzo, futhi zingahle zihlukaniswe zibe ngamaqembu amane ajwayelekile:
I-Polyene Antifungals
Ama-antifungals e-Polyene asebenza ngokuphula ukwethembeka kwesibani sefayalini, okuyinto ekugcineni eholela ekufeni kweseli. Ama-antifungals e-polyene ejwayelekile kakhulu asetshenziselwa i-HIV yilezi:
- I-Amphotericin B : Ngokuvamile ehlotshaniswa nokwelashwa kwe-systemic (umzimba wonke) izifo ezinjenge-fungal ezifana ne-cryptococcal meningitis. Uma i-intravenously iphathwe, i-amphotericin B iyaziwa ngokuba nemiphumela emibi kakhulu, ngokuvamile ephendula ngokuphawulekayo ngemuva kokukhipha (isib. Ukushisa, ukukhuza, ukukhwabanisa, ukuhlanza, ukuhlushwa ikhanda, nobuhlungu bomzimba). Ngakho-ke, ukuphathwa okunamandla kwe-amphotericin B kuboniswa ngokujwayelekile kwiziguli ezikhukhumezekile noma ezigula kakhulu. Amalungiselelo omlomo atholakalayo asetshenziselwa ukwelapha i-candidiasis, ephephile ukusetshenziswa nokusetshenziswa kwezidakamizwa eziphansi.
- I-Nystatin : iphathwe ngomlomo noma ngokwezihloko ukuze i-candidiasis yomlomo, i-esophageal, ne-vaginal ingenasiphelo. I-Nystatin ingasetshenziselwa ukwelashwa kwe-prophylactic (okuvimbelayo) ezigulini ezinegciwane lesandulela ngculazi ezineengozi enkulu yokutheleleka kwefungal (isibalo se-CD4 sama cell 100 / mL noma ngaphansi). I-Nystatin iyatholakala njengamaphilisi, umlomo womlomo, ama-pastilles, ama-powders, ama-creams namafutha.
II. Azole Antifungals
I-Azole antitifungals iphazamisa ukuhlanganiswa kwama-enzyme adingekayo ukuze kugcinwe ubuqotho bendwangu yesifungo, ngaleyo ndlela igweme ikhono lekhunta lokukhula. Imiphumela emibi evamile ihlanganisa ukuqhuma, ukukhanda ikhanda, isizungu, isicanucanu, ukuhlanza, isifo sohudo, izimpande zesisu, kanye ne-enzyme yesibindi ephakeme.
- I-Diflucan (fluconazole) : Ngokungangabazeki enye yezinambuzane ezinqunyelwe kakhulu emhlabeni wonke, i-Diflucan isetshenziselwa ukwelashwa okungenangqondo kanye nezifo ezithinta izifungulu, kuhlanganise ne-candidiasis, cryptococcosis, i-histoplasmosis, ne-coccidioidomycosis. I-Diflucan iyatholakala kwifomu yethebhulethi, njenge-powder yokumiswa ngomlomo, noma njengesixazululo esiyinyumba sokusetshenziswa komzimba.
- I-Nizoral (ketoconazole) : I-Nizoral yiyona imithi yokuqala ye-azole antifungal, kodwa isetshenziselwa ezinye izazi ezingenayo ubuthi obuncane nokubambelela okukhulu. Itholakala kwifomu yethebhulethi, kanye nasezicelo ezihlukahlukene zezobuciko ezisetshenziselwa ukusetshenziswa kwezifo ezithathelwanayo, kufaka phakathi i-candidiasis.
- I-Sporanox (itraconazole) : Ngokujwayelekile isetshenziselwa ukutheleleka kwesistimu (njenge-candidiasis noma i-cryptococcosis) uma ezinye izici eziphilayo zingasebenzi noma zingalungile. I-Sporanox itholakala kwifomu ye-capsule noma njengesisombululo somlomo (kubhekwa njengokwedlula ngokubambelela nokuhlaziywa kwemvelo). Ukulungiswa kwe-intravenous akusatholakali e-US Ngenxa yokungena kwayo okuphansi ku-cerebrospinal fluid, i-Sporanox ngokuvamile isetshenziswa kuphela emgqeni wesibili uma ukwelapha i-cryptococcal meningitis.
Amanye ama-azol asetshenziselwa ukwelashwa kwezifo ezithathelanayo ezifayilini yi-VFend (voriconazole) ne-Posanol (posaconazole).
III. Antimetabolite Antifungal
Kunomuthi owodwa kuphela we-antimetabolite (i-Ancobon) owaziwa ukuthi unempahla ye-antifungal, ewufeza ngokuphazamisa kokubili i-RNA ne-DNA synthesis.
- I-Ancobon (flucytosine) : Isetshenziselwa ukwelapha amacala amakhulu kakhulu e-candidiasis kanye ne-cryptococcosis, i-Ancobon ihlale iphathwa nge-fluconazole kanye / noma i-amphotericin B njengoba ukuthuthukiswa kokumelana kuvamile uma kusetshenziselwa yedwa. Ukuhlanganiswa kwe-amphotericin B no-Ancobon kuboniswe ukuthi kulungile ekwelapheni kwe-cryptococcal meningitis. I-Ancobon iyatholakala kwifomu ye-capsule. Imiphumela emibi ingabandakanya ukubekezelelana kwamathumbu kanye nokucindezelwa komnyoba we-bone (kubandakanya i-anemia). I-Rash, ikhanda lokukhanda, ukudideka, i-hallucination, i-sedation, nokusebenza okuphakeme kwesibindi kuye kwabikwa.
IV. Echinocandins
Iklasi elisha lama-antifungals elibizwa nge-echinocandins nalo lisetshenziswa ekunakekeleni i-candidiasis ne-aspergillosis. I-Echinocandins isebenza ngokuvimbela ukuhlanganiswa kwe-polysaccharides ethile emdongeni wamaseli wefungal. Ngokuvamile, i-echinocandini inikeza ubuthi obuphansi kanye nokusebenzisana okuncane kwezidakamizwa, nakuba okwamanje ngokuvamile kunqunywe ezigulini ezingavumelani nezinye izidakamizwa zendabuko. Zonke lezi zintathu zilawulwa ngaphakathi, ngokuphepha okufanayo, ukusebenza kahle nokubekezela.
- I-Eraxis (i-anidulafungin)
- I-cancidas (caspofungin)
- I-Mycamine (micafungin)
Imithombo:
I-Marty, F. ne-Mylonakis, E. "Ukusetshenziswa okusetshenzisiwe kokutheleleka nge-HIV." I-Expert Opinion Pharmacotherapy. February, 2002; 3 (2): 91-102.
Mei, H .; I-kok, i-L .; Shariff, M .; et al. Ukusetshenziswa Kwe-Antitifungal for Infection Opportunistic In HIV Abagulayo: Ukuqhathaniswa kohlelo lokuPhepha nokuPhepha. " Ingculazi ye-WebmedCentral. 2011; 2 (12): WMC002674.
Izikhungo Zempilo Zikazwelonke (NIH). "Imihlahlandlela Yokuvimbela Nokunakekelwa Kwezifo Ezingavamile Ezinganeni Ezikhulelwe Ne-Adolescent". I-Bethesda, e-Maryland; ibuyekezwe ngo-Septhemba 27, 2013.