Izikhombandlela Zaphakamisa i-CD4 Ukuqapha Kungase Kukhetheke
Ngempumelelo yokwanda kwe- antiretroviral yesimanje (i-ART) , ukugcizelela akufanele kubekwe ekusebenziseni izibalo ze-CD4 njengesilinganiso sempumelelo ye-ART. Ngokwemihlahlandlela ekhishwe uMnyango wezeMpilo kanye noHulumeni be-US (DHHS) ngoMeyi 1, 2014, imithwalo yegciwane kufanele igcine isetshenziselwa ukunquma lokhu.
Nakuba lokhu kungase kubonakale kushintshile kwabanye, kuvuma amaqiniso amabili abalulekile:
- Ukuthi impendulo ye-immunological yesiguli nge-ART (njengoba ilinganiselwe ukubalwa kwe-CD4) ingaba yinto eguquguqukayo kakhulu ngisho nalapho ibhekene nokucindezelwa okuqhubekayo kwegciwane.
- Ukuqapha kwe-CD4 akubambi kakhulu ukuthi i-ART iphethwe kanjani kwiziguli zokwelapha.
Ngaphambi kwesigaba semithi yesandulela- ngculaza esisha , kwakungavamile ukuba odokotela abathile bashintshe i-ART ngokusekelwe kuphela ekuhlulekeni kwesiguli ukufeza ukuvuselelwa kwamagciwane. Lokhu kuvame ukuholela ekuqedeni ukwelashwa ngaphambi kwesikhathi, kaningi naphezu kokulawulwa kwe-virologic (njengoba kulinganiswa umthamo wegciwane) futhi kaningi iminyaka ngaphambi kokuba kwenziwe izinguquko ezinjalo.
Ekukhipheni imikhombandlela ebuyekeziwe, i-DHHS yaphetha ngokuthi "impendulo engafanele ye-CD4 esigulini esinokucindezelwa kwegciwane ayiyona into ebonisa ukuguqula umbuso we-antiretroviral." Iphinde yavuma ukuthi ikhono lokubuyisela impendulo yomzimba yesiguli ngculazi kaningi lihlanjululwa yizici ezidlula ngaphezu kokufinyelela kwezidakamizwa-kuhlanganise nesibalo esincane se-CD4 ekuqaleni kokulashwa, ubudala obudala noma umlando wezifo ezihambisana ne-HIV.
Ezigulini ezinalezi zinkinga, ukuguqula ama-ART okusekelwe ku-CD4 count kungase kube nenhlekelele engaphezu kokuhle, okwandisa ingozi yokumelana nezidakamizwa ngokushintsha imigomo noma ekuqaleni noma kaningi kakhulu.
Ukuphindaphinda kwe-CD4 Count Monitoring
Ngokusho kwe-DHHS, inani le-CD4 yesiguli kufanele lisetshenziselwe enye yezinhloso ezintathu eziyinhloko:
- Ukusiza ukuthola ukuthi uzoqala nini i-ART kumuntu one-HIV
- Ukuqondisa lapho ukuqala noma ukumisa ukwelashwa kwe-prophylactic ukuvimbela kangcono ukuthuthukiswa kwezifo ezithathelanayo (OIs)
- Ukuhlola ukuthi isifo se-ART sokuzivikela nge-ART sanele yini (sichazwa ngokuthi ukwanda kwe-CD4 count by 50-150 amaseli ngonyaka wokuqala wezokwelapha, ngokunyuka okufanayo njalo ngonyaka kuze kube khona isimo esifanele)
Ukuze iziguli ezitholakale zitholakale zingakafiki ku-ART, ukuhlolwa kwe-CD4 kufanele kwenziwe ngesikhathi sokungena ekunakekeleni bese kuthi emva kwezinyanga ezintathu kuya kwezi-6-6.
Kulabo abagulayo abane-ART, ukuhlolwa kwe-CD4 kufanele kuphindwe emva kwezinyanga ezintathu emva kokuqala ukwelashwa bese kuthi emva kwezinyanga ezintathu kuya kwezi-6-6.
Okokugcina, kulabo abaye begciwane lesandulela ngculazi okungenani iminyaka emibili futhi bebephethe imithwalo engavamile engavamile, kunconywa ukuba
- Ukuqapha kwe-CD4 kwenziwa njalo ezinyangeni ezingu-12 kulabo abanezibalo ze-CD4 phakathi kuka-300 no-500 amaseli / mL, futhi;
- Ukuqapha kwe-CD4 kubhekwa njengokhetho kulabo abanezibalo ze-CD4 ezingaphezu kwamangqamuzana angu-500 / ml.
Ngakolunye uhlangothi, ukuqapha i-CD4 kufanele kubuyele ezigulini ezine-rebro viologic; ukugula okuhlobene ne-HIV; noma yisiphi esinye isimo noma ukwelashwa okungase kunciphise inani le-CD4 yomuntu.
Ukuqapha ezinye i-lymphocyte subsets (isb., I-CD8, i-CD19) ayisekho ukunconywa ngoba ukuhlolwa kokubili kuyabiza futhi akunikezeli inani langempela lomtholampilo.
Ukuvama kwe-Monitoring Load Monitoring
Kulezi ziguli ezisanda kutholakala ukuthi une-HIV, ukuhlolwa kwe-viral load kufanele kwenziwe ngesikhathi sokungena ekunakekeleni. Uma kubonakala ukuthi i-ART ingahle ihlehliswe, ukuphinda ukuhlolwa kungabhekwa njengokuzikhethela kwezinye izimo.
Kulabo abagulayo abane-ART kuboniswa, ukuhlolwa komthamo wegciwane kufanele kwenziwe ngaphambi kokuqala ukwelashwa (ukuhlinzeka ngesisekelo sokuqala sokukala ukubhekana nokwelapha). Kumele kuphindwephindwe ngamasonto amabili kuya ku-4 ngemuva kokuqaliswa kwe-ART kanye namaviki amane kuya kwangu-8 emva kwalokho kuze kube yilapho umthamo wesandulela ngculazi ususwe ngokuphelele.
Kulabo abagulayo abangenakutholakali ukutholakala negciwane lesandulela ngculaza, ukuhlolwa kufanele kuphindwe njalo ezinyangeni ezintathu kuya kwezingu-4. Uma ukucindezelwa kwegciwane kuqhubeka okungenani iminyaka emibili, ukuhlolwa kungadluliselwa njalo ezinyangeni eziyisithupha.
Imithombo:
UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). " Imihlahlandlela yokusetshenziswa kwama-Antiretroviral Agents ku-HIV-1-Adult Adult and Adolescents." Bethesda, Maryland.