Isiqondiso samanje esivela eMnyangweni wezeMpilo waseMelika kanye nezinsizakalo zabantu
Kwakuyi-1994, ekucwaningweni kwe-ACTG 076 yomzimba, abacwaningi babonisa ngaphandle kokungabaza ukuthi ukusebenzisa imithi eyodwa ye-antiretroviral (AZT) ngesikhathi nangemva kokukhulelwa kunganciphisa ingozi yokudlulisela i-HIV kumama kuya komntwana ngokumangalisa Amaphesenti angu-67. Eminyakeni yamuva, ngokungenelela kwe- antiretroviral therapy (ART) , leso sibalo siseduze namaphesenti angu-98.
Namuhla, ukuvimbela ukudluliselwa komama kunomntwana (owaziwa ngokuthi ukuhanjiswa okuqondile) kuhlanganisa zonke izigaba zokukhulelwa, kusukela ekubelethweni kuze kube sekunakekelwa kokubeletha. Isihluthulelo sempumelelo yaso kungenelela kokuqala. Ngokunikeza i-ART isikhathi eside ngaphambi kokubeletha-kunokuba ngesikhathi sokubeletha-omama banethuba elikhulu kakhulu lokunciphisa i-HIV emazingeni angabonakali , ngaleyo ndlela ukunciphisa ingozi yokudluliselwa.
Ukunciphisa Ingozi Yokudluliswa Ngaphambi Kokubeletha
Imikhombandlela yokukhulelwa kwangaphambi kokubeletha kwe-ART ifana ncamashi nabesifazane abakhulelwe abanesandulela ngculaza njengoba bekhona kulabo abangakhulelwe, ngezinguquko ezimbalwa ngokusekelwe ekukhathazeni ngemithi ethile ye-antiretroviral.
Kulabo besifazane abazange baphathe ukwelapha ngaphambili, uMnyango wezeMpilo waseMelika kanye nezinsizakalo zabantu (DHHS) uncoma ukusebenzisa i- Retrovir (AZT, zidovudine) kanye no- Epivir (3TC, lamivudine) njengemvalela ye-ART yokuqala. Lokhu kungenxa yokuthi i- nucleoside reverse transcriptase inhibitors (i-NRTIs) efana ne-Retrovir iboniswa kangcono ukungena emkhakheni we-plaque, ukuhlinzeka umntwana ongakazalwa ukuvikelwa okukhulu kwe-HIV.
Imikhombandlela okwamanje ayincomo ukusetshenziswa kukaSustiva (efavirenz) noma izidakamizwa ezisuselwa ku-Sustiva njenge-Atripla ngenkathi ekhulelwe, nakuba lokhu kubhekwe ikakhulukazi njengendlela yokuqapha. Ngenkathi izifundo zesilwane zakuqala zibonise ngesilinganiso esiphakeme sokukhubazeka okuhlobene noSustiva, okufanayo akuzange kubonwe kubantu.
Uma ukukhulelwa kuqinisekisiwe owesifazane osevele useSustiva, kunconywa ukuthi lesi sidakamizwa sishintshwa kuphela phakathi kwamasonto ayisihlanu kuya kwayisithupha okukhulelwa. Emva kwalokho, ushintsho alubhekwa njengadingekile.
Ezinye izici zihlanganisa:
- I-Viramune (i-nevirapine) akufanele isetshenziswe kubafazi abane-CD4 count ngaphezu kwama-cell cell angu-250 / μL ngenxa yengozi eyengeziwe yokwehla kwesifo se-hepatotoxicity.
- I-Intelence (etravirine), i- Edurant (rilpivirine), i- Aptivus ( tipranavir ), i- Selzentry (maraviroc), i- Lexiva (i-fosamprenavir) ne- Fuzeon ( ifufutide ) ayitholakali okwamanje ngenxa yedatha enganele ekuphepheni nasekusebenzeni kwabo.
- I-Viracept (nelfinavir) ne- Crixivan (indinavir) ayinconywa ngenxa yamazinga aphezulu we-serum athola ngesikhathi sokukhulelwa ngaphandle uma kungekho ezinye izinketho ezitholakalayo.
Ukunciphisa Ingozi Yokudluliswa Ngesikhathi Kulethwa
Ekuqalisweni komsebenzi, abesifazane abane-ART kumele baqhubeke nokuphuza imishanguzo yabo isikhathi eside ngangokunokwenzeka. Kodwa-ke, uma owesifazane oletha ngesikhathi sokusebenza, ngubani oqinisekisa ukuthi unegciwane lesandulela ngculazi kodwa engatholakali ukwelapha okulwa negciwane lesandulela ngculaza noma unomthamo wegciwane elingaphezu kuka-400 amakhophi / μL, i-zidovudine engenalutho izophathwa ngokuqhubekayo kulo lonke i-labor .
Ngokusho kwe-US Centers for Disease Control and Prevention (CDC), cishe amaphesenti angu-30 abesifazane ase-US awahlolwe i-HIV ngesikhathi sokukhulelwa. Ukwengeza, amaphesenti angu-15 alabo abanegciwane lesandulela ngculazi athola ukunakekelwa kokubeletha okungekho, noma amaphesenti angama-20 aqala ukunakekelwa kuze kube sekupheleni kwesithathu.
Uma kungekho ukwelashwa ngezidambisigciwane, ingozi yokudlulisa okulinganiselwa ukuthi iphakathi kwamaphesenti angu-25 namaphesenti angu-30.
Izincomo Zokuthumela Izindlela
Ubufakazi buveze ukuthi isigaba sokulinda esilungiselelwe sibeka ingozi ephansi kakhulu yokudlulisa ukudlula ukulethwa kwesisu.
Ngokwenza i-cearean ngaphambi kokuqala komsebenzi (kanye nokwahlukana kwamakhanda amniotic), usana olusanda kuzalwa alukwazi ukuthola igciwane-ikakhulukazi ezimweni lapho umama engakwazi ukufeza ukucindezelwa kwegciwane.
I-DHHS incoma ukuthi ukulethwa kwezidakamizwa kuhlelwe emavikini angu-38 wokukhulelwa uma umama
- akatholanga i-ART ngenkathi ekhulelwe, noma
- unomthamo wegciwane elingaphezu kuka-1 000 amakhophi / μL emavikini angu-36 wokukhulelwa.
Ngokuphambene nalokho, ukubelethwa kwesisu kungenziwa kubomama abaye bathola umthamo wegciwane elingenakulinganiswa emavikini angu-36 wokukhulelwa. Ingozi yokudluliselwa kwalaba omama ngokuvamile ingaphansi kwamaphesenti angu-1.
Uma kwenzeka owesifazane eveza ngemuva kokuqhekeka kwembulane futhi nomthamo wegciwane elingaphezu kuka-1 000 amakhophi / μL, i-zidovudine engenayo isetshenziswa ngokuvamile, ngezinye izikhathi isebenzisa i-oxytocin ukusheshisa ukulethwa kwezidingo.
Izincomo zangaphambi kokuzalwa
Uma sekulethwa, isiraphu ye-Retrovir kumele ihanjiswe kusana olusanda kuzalwa phakathi kwamahora ayisithupha kuya kwangu-12 okuzalwa, eqhubeka njalo ngemva kwamahora angu-12 emavikini ayisithupha alandelayo. Umthamo uzohlala ulungiswa njengoba usana lukhula. Ukumiswa kwe-Viramune ngomlomo kungase kukhishwe futhi lapho umama engazange athole i-ART ngenkathi ekhulelwe.
Isivivinyo se- HIV PCR esifanele kufanele sihlelelwe isana ngezinsuku ezingu-14-21, inyanga eyodwa kuya kwezinyanga ezimbili, nezinyanga ezine kuya kwezinyanga eziyisithupha. Izivivinyo ze-PCR ezihambisana nokutholakala kwegciwane lesandulela ngculazi ezinganeni zezingane zingaphambene ne- ELISA ejwayelekile, ehlolwa ngama- antibodies e-HIV . Njengoba amasosha omzimba ikakhulukazi "athola ifa" kusukela kumama, ukutholakala kwabo akukwazi ukunquma ukuthi isifo senzekile emntwaneni.
Uma ukuhlolwa kwezinsana kungakapheli inyanga eyodwa kuya kwezinyanga ezimbili, i-PCR yesibili izokwenziwa okungenani inyanga kamuva. Umphumela wesibili ongalungile uzosebenza njengobufakazi bokuthi isifo asizange senzeke.
Ngakolunye uhlangothi, usana lutholakala ukuthi lunesandulela ngculaza ngemva kokuhlolwa kokuhlolwa kwe-PCR emihle. Uma kwenzeka ingane inesandulela ngculaza, i-ART izobekwa ngokushesha kanye ne-Bactrim prophylaxis (esetshenziselwa ukuvimbela ukuthuthukiswa kwe-pneumonia ye-PCP).
Ukubeletha Noma Ukunceliswa?
Impendulo emide nesikhashana ukuthi omama abane-HIV e-US kufanele bagweme ukuncelisa ukubelesa ngisho noma bekwazi ukulondoloza ukucindezelwa okuphelele kwegciwane. Emazweni athuthukile afana ne-US, lapho ukondla usana luphephile futhi selutholakala kalula, ukuncelisa ubisi kubangela ingozi ekhunjelwayo engaphezu kwamanani ayo okubambisana (isib. Ukubeletha komama, isisombululo somzimba sangasese, njll)
Ngenkathi ucwaningo olwenziwe ekusetshenzisweni kwezidambisigciwane ngesikhathi sokuncelisa kokubeletha lungakapheli, izifundo eziningi e-Afrika zibonise izinga lokudlulisela noma yikuphi phakathi kwamaphesenti angu-2,8 kuya ku-5.9% emva kwezinyanga eziyisithupha zokuncelisa.
I-pre-chewing (noma pre-mastication) yokudla kwezinsana nayo ayinconywa ngabazali noma abaqaphi abane-HIV. Ngenkathi sekukhona izimbalwa ezimbalwa eziqinisekisiwe zokudluliselwa nge-pre-mastication, kukhona okungenzeka ngenxa yezinsini eziphuma igazi kanye nezilonda ezingabuka ekuhlanzeni kwamazinyo amancane, kanye nokusikeka nokuqeda okwenzeka phakathi nesikhathi.
> Imithombo:
> Connor, E .; Ukuphanga, R .; I-Gelber, R .; et al. "Ukunciphisa Ukudluliswa Kwasemantwaneni Kwabantwana Bokuzalwa Kwamantombazane Uhlobo Loku-1 Nge-Zidovudine Treatment. I-Pediatric AIDS Clinical Trials Group I-Protocol 076 Study Group." I-New England Journal of Medicine. NgoNovemba 3, 1994; 331 (18): 1173-1180.
> Dominquez, K .; Rakhmanina, N .; U-Juliano, u-A. "et al." Ukubheka njengendlela yomzila wokudlulisa i-HIV: I-case-Control kanye nokuphenya ngezigaba. "I- Journal of Acquired Immune Deficiency Syndrome .
> Funda, J. neNewell, M. "Ukusebenza nokuphepha kwe-Caesarean Delivery for Prevention of Transmission of Mother to Child-HIV (1)." I-Cochrane Database yezibuyekezo ezihleliwe. Okthoba 9, 2005; (4): i-CD005479.
> Amasevisi aseMelika okuLawula nokuVimbela (CDC). "I-HIV Phakathi Kwabesifazane Abakhulelwe, Izinsana Nezingane." I-Atlanta, Georgia.
> UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). "Izincomo zokusetshenziswa kwezidakamizwa zokulwa negciwane lesandulela ngculaza abakhulelwe abanegciwane lesandulela ngculazi nengculazi abakhulelweyo ngenxa yokugula komama kanye nokunciphisa ukunciphisa ukuhanjiswa kwe-HIV e-United States." I-Rockville, e-Maryland. Ukubuyekezwa okukhishwe ngomhla kaMeyi 21, 2013.