Yisiphi isifundo sezilwane kanye nocwaningo lwezibalo esitshela
Kube sekukhathazeka isikhathi eside ukuthi abesifazane abathwala izidakamizwa ezithile ngesikhathi sokukhulelwa bangase babhekane nobungozi bokukhubazeka kokuzalwa. Ucwaningo luvame ukuphikisana nokukhathazeka mayelana nezingozi ezingase zivele ngezinye izikhathi zingabonakali umbono wethu mayelana nokuphepha kwangempela kwezidakamizwa.
Isidakamizwa uSustiva (efavirenz) sekuyisikhathi eside sikhathazekile kakhulu ngezinkombandlela zangaphambili eziphakamisa ukuthi kufanele zigwenywe, okungenani phakathi nenyanga yokuqala, ngenxa yengozi yokuthiwa yi-teratogenicity (ukukhubazeka kokuzalwa).
Izincomo ziye zashintsha futhi manje zivumele ukusetshenziswa kwe-efavirenz ku-trimester yokuqala kufanele umama abe nomthamo wegciwane elingenakutholakali.
Ngalokho kuthiwa, iziqondiso ezifanayo zikhomba ukuthi abesifazane abangenawo abakhulelwe bokubeletha bagweme noma yiziphi izidakamizwa zokwelashwa eziqukethe i-efavirenz.
Ngakho lokhu kusho ukuthini ngempela? Ingabe iphaneli lezempilo lase-US limane libophe amabhethri abo mayelana nesidakamizwa esingase sibe yingozi noma esingenalo ukulimaza, noma kufanele sikhathazeke ngalokhu nezinye izidakamizwa?
Izifundo zezilwane Kubonisa ingozi engenzeka
Ekuhloleni ingozi yezidakamizwa ze-HIV nokukhubazeka kokuzalwa, ucwaningi lwamanje aluveli kwizifundo zabantu kepha luvela ocwaningweni lwezilwane (ngokucacile ngoba awukwazi ukubeka imfashini yomuntu emithonjeni engaba yingozi).
Ngokuqondene noSustiva, ukukhathazeka ngokuphathelene nesifo se-teratogenicity kwaphakanyiswa okokuqala lapho izinkawu ezintathu ze-cynomolgus ezivezwa kulo muthi zinezinsana ezinezinhlanzi ezincane kanye nesistimu yezinzwa zesifo sezinzwa Ngaphezu kwalokho, ukuxilongwa kwezidakamizwa kwakunezikhathi ezingu-1.3 kuphela eziphakeme kunalezo ezisetshenziselwa abantu.
Phakathi naleso sikhathi, amagundane adalulwe eSustiva abhekana nokuhlushwa kwesisu, into eyenziwa yizingane ezashona ngesikhathi sokubeletha ziphinde zabuyiselwe izingane zakuleli.
Kwakungekho ukukhubazeka kokuzalwa okubonwa onogwaja.
Izifundo zesitatimende ku-Human
Izibalo ezithathwe kuRejista Yokukhulelwa Kwe-Antiretroviral Pregnancy Registry (APR) zidwebe isithombe esithile.
Ngesikhathi i-APR iveza ukukhubazeka kokuzalwa kwabantwana abangu-18 kwabangu-766 abakwaSustiva phakathi nonyaka wokuqala, inani eliphansi leziphambeko ze-neural tube-izinhlobo ezibonwe ezifundweni zesilwane-zingabaza ngokuthi ngabe umphumela kubantu ungafana yini nezinkomo amagundane.
Ukuhlaziywa okulandelwayo kwezifundo ezingafani ezingu-19, kufaka phakathi i-APR, kusukela ngaleso sikhathi kuye kwaveza ukukhubazeka okungama-39 kwabantwana abangu-1,437 abavezwe kuSusvava. Ngokususelwa kulowo manani, izinga libonakala lingenalo umehluko kunalokho okwakubonakala kubantu base-United States jikelele.
Naphezu kwenani elincane kakhulu leziphambeko eziqinisekisiwe, izikhulu zezempilo zahlala zingenqikazi ukunikeza uSustiva izithupha.
Ingozi Yokuzalwa Kwamanye Amachiza E-HIV
Ngo-2014, abacwaningi abavela eFrance Perinatal Cohort bashicilela ucwaningo olwalubheka inani lokukhubazeka lokuzalwa elibonwa ezinganeni ezivezwe ezinhlobonhlobo zezidambisigciwane ngesikhathi sokukhulelwa. Ucwaningo lwamazwe ngamazwe lwabandakanya izingane ezingu-13 124 ezizalwa abesifazane abane-HIV kusukela ngo-1986.
Imiphumela yayithakazelisayo: ngenkathi ukwanda kwezinkinga zokubeletha kwakuhlotshaniswa nemithi ethile ye-antiretroviral, njenge- Crixivan (indinavir) , isilinganiso sasingakafani nalokho okwabonwa kubantu abaningi. Ngaphezu kwalokho, akukho iphethini ecacile ngohlobo noma ubunzima bokukhubazeka kokuzalwa okungatholakala.
Phakathi naleso sikhathi, izingane ezingu-372 ezitholakala eSustiva ku-trimester yokuqala, akukho mhlangano ongatholakala phakathi kwezidakamizwa nokukhubazeka kokuzalwa.
Lokhu akusho ukuthi izidakamizwa azithwala ingozi. Abacwaningi baseFrance babone ukunyuka okuphindwe kabili kwezinhliziyo ezingenabantwana ezingenazo i- AZT (zidovudine) . Iningi lihilelekile ekutheni i-septal defect, i-defect general defect, lapho umgodi uqala khona phakathi kwamakamelo amabili aphansi enhliziyweni.
Ucwaningo oluvela eHarvard School of Public Health, olwanyatheliswa ngo-2014, luqinisekisile ukutholakala okuningi kweFrance. Lolu cwaningo olubandakanya izingane ezingu-2 580 zaseMelika ezivezwe izidambisigciwane ngesikhathi sokuqala kwe-trimester, zathola ukuthi ezimbalwa izidakamizwa futhi azikho izidakamizwa zamakilasi ezihlotshaniswa nezingozi zokukhulelwa.
Kodwa-ke, abacwaningi baseHarvard baqaphele ukuthi ingozi ephakeme yesikhumba kanye ne-musculoskeletal disorders ezinganeni ezivezwe yiRitonavir-evuselelwe i-Reyataz (atazanavir) phakathi no-trimester wokuqala. Ngesikhathi abacwaningi bephakamisa ukuthi ucwaningo oluqhubekayo lungadingeka ukuze kuhlolwe ingozi kaReyataz ekukhulelweni, besaphetha ngokuthi ingozi enkulu ihlala iphansi.
futhi waphetha ngokuthi, nakuba ucwaningo oluqhubekayo lufanelekile ekusetshenzisweni kukaReyataz ngesikhathi sokukhulelwa, "kunikezwa ingozi ephansi (congenital anomaly), izinzuzo zokusebenzisa ukwelashwa kwama-ARV ngesikhathi sokukhulelwa zisengaphezu kwezingozi ezinjalo."
> Imithombo:
> 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." Washington, DC; ibuyekeziwe ngoMashi 28, 2014.
> Ikomidi Elilawulayo Lama-Antiretroviral Pregnancy Registry. "Umbiko wesikhashana we-Regret Pregnancy Pregnancy Pregnancy Pregnancy Registry International of 1 Januwari 1989-31 Januwari 2017." UWilmington, eNyakatho Carolina; ibuyekeziwe ngoJanuwari 2017.
> Sibiude, J .; et al. "Umphakathi phakathi kokuboniswa kokubeletha ngaphambi kokubeletha kokubeletha kwe-Antiretroviral Therapy and Defects Birth: Ukuhlaziywa kwesifundo seqembu lesiFrench Perinatal (ANRS CO1 / CO11)." PLoS | Imithi. Ngo-Ephreli 29, 2014; I-DOI: 10.1371 / iphephandaba.pmed.1001635.
> Williams, uP .; Crain, M .; Yildirim, C .; et al. "Ama-anomalies angama-Congenital nase-Utero I-Antiretroviral Exposition in Virus-Immunodeficiency Virus-Eboniswa Izinsana Ezingavikelekile ." I-JAMA Pediatrics . 2014; I-DOI: 10.1001 / i-jamapediatrics.2014.