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yvelaferi iciT aiv-infeqcia/Sidsi-s Sesaxeb?

aiv ­ adamianis imunodeficitis virusia, romelic 1983 wels aRmoaCines. adamianis organizmSi SeWris Semdeg aiv-i azianebs imunur sistemas, mwyobridan gamohyavs igi. Tumca aiv-infeqciis zogierTi aspeqti jerjerobiT Sewavlili ar aris, magaliTad, konkretulad rogor azianebs virusi imunur sistemas, an ratom aris zogierTi aiv-inficirebuli adamiani absoluturad janmrTeli xangrZlivi drois ganmavlobaSi. miuxedavad imisa, kacobriobis istoriaSi aiv-i erT-erTi yvelaze Rrmad Seswavlili virusia. aiv infeqcia ewodeba daavadebas virusiT inficirebis momentidan sicocxlis bolomde, xolo terminiT "Sidsi" aRiniSneba aiv infeqciis bolo stadia, rodesac pacients uviTardeba garkveuli klinikuri niSnebi da imunuri sistemis mZime dazianeba. aiv-i miekuTvneba retrovirusebis ojaxs, lentivirusebis qveojaxs, romlebic nel infeqciebs iwveven. organizmSi moxvedrisas, aiv-i moqmedebs sisxlis garkveul ujredebze ­T-limfocitebze ("helperebze"). aRniSnyuli limfocitebis zedapirze ganlagebulia TD-4 molekulebi, amitom maT agreTve T-4--limfocitebi da CD-4-limfocitebi (anu CD-4 ujredebi) ewodeba. virusis struqtura piramidulia. cximovani cxomovani molekulebis ormagi Sre zedapirze, maTgan aRmocenebuli glikoproteinebis "sokoebi", SigniT _ ribonukleinis mjavas ori jaWvi, romlebic virusis genetikuri problemis matarebelia, da cilebi _ Seqcevadi transkri ptaza, integraza da proteaza. am mwiri Semadgenlobis garda, viruss araferi ar esaWiroeba; is kvlavwarmoqmnisaTvis maspinZel ujreds iyenebs. Tlimfocitis birTvSi _ ujredSi, romelzec moqmedebs aiv-i. 100.000-jer meti genetikuri informaciaa, vidre TviT virusSi. magram ujreds ar ZaluZs masSi Sexweul virusTan brZola. viruss navsawinaaRmdego naRmis msgavsad gamosaxaven. mis zedapirze arsebuli "sokoebi" Sedgeba glikoproteinis molekulebisagan. "qudi" _3-4 glikoproteini_120-is, xolo "fexi" -3-4 glikoprotein_41-is molekulebia. aiv-i advilad inaqtivirdeba garemoSi. mSral pirobebSi virusi ramdenime saaTSi iRupeba, Tumca SesaZloa 1-3 dRe gaZlos. qsovilovan kulturaSi virusi oTaxis temperaturaze 15 dRe Zlebs, xolo 37° C-ze ­ 11 dRe. 56-60° C-ze virusi 30 wT-Si iRupeba. aiv-i advilad eqvemdebareba qimiuri saSualebebiT sterilizacias. sxvadasxva invaziuri samedicino mani pulaciebis Catarebis dros samedicino dawesebulebebSi (Seumowmebeli sisxlis da sisxlis produqtebis gadasxma, organoTa transplantacia, qirurgiuli operaciebi, stomatologiuri mani pulaciebi) da sayofacxovrebo momsaxurebis obieqtebSi (tatuireba, yuris da cxviris gaxvreta, manikuri da pedikuri da sxva) Tu ar iqna daculi samedicino iaraRebisa da sayofacxovrebo sagnebis saTanado sterilizacia, iqneba mTeli rigi infeqciebis gadacemis safrTxe. maT Soris yvelaze mniSnelovani Tavisi mimdinareobiT, simZimiT da gavrcelebiT aris aiv infeqcia/Sidsi.

aiv-infeqcia ar gadadis: · · · · saerTo moxmarebis sagnebiT (WurWeli, abazana, piradi higienis nivTebi); mwerebisa nakbeniT; xelis CamorTmeviT, daxvelebiTa da daceminebiT; kocniT da moferebiT; kriteriumebi romlis mixedviT SeiZleba aiv-infeqciaze eWvis Setana (WHO-s mixedviT): ZiriTadi: 1. sxeulis masis 10% dakargva 2. qronikuli diarea, romelic grZeldeba 1 Tveze mets; 3. gangrZlivi cxeleba (1 Tveze meti); mciredi niSnebi: 1. persistirebuli xvela (1 Tveze meti) 2. generalizirebuli qavana dermatozi; 3. morecidive sartylisebri herpesi; 4. cxvirxaxis, saylapavis kandidozi; 5. uwyvetad progresirebuli an disiminirebuli martivi herpesi; 6. generalizirebuli limfadenopaTia; im SemTxvevaSi Tu arsebobs zemoT aRniSnuli ori ZiriTadi da erTi mciredi niSnebi, imis gaTvaliswinebiT rom, imunuri sistemis daTrgunvis mniSvnelovani mizezebi ar aris (avTvisebiani simsivne, mkurnaloba 3Tveze met xans glukokortikoidebiT an/da citostatikebiT, radiaciuli dasxiveba, memkvidruli imunodeficiti)

diagnostika

Sidsis diagnostika warmoebs epidemiologiuri anamnezis aRricxvis monacemebis gaTvaliswinebiT, klinikuri simptomebis, avadmyofis imunuri statusis, agreTve sisxlSi specifiuri antisxeulebis aRmoCeniT. Sidsis diagnostikisaTvis gamoiyeneba Semdegi laboratoriuli meTodebi: · virusis gamoyofa; · aiv antisxeulebis aRmoCena; · aiv antigenebis aRmoCena; aiv antisxeulebis gamosavlenad gamoiyeneba ramodenime meTodi:

· · · · ·

imunofermentuli analizi; imunoblotuni; imunoflurescencia; radioimunopreci pitacia; aglutinacia.

aiv-infeqciis mkurnalobis meTodebi

aiv-infeqciis mkurnaloba: aRadgens janmrTelobas da mravali wliT axangrZlivebs aiv-inficirebul pacientTa sicocxles. wamlebi efeqturia mxolod maTi miRebis sqemis zusti dacvis SemTxvevaSi _ gulmaviwyobasa da daudevrobas gamousworebeli ziani moaqvs. rodis Terapias? niSnaven virussawinaaRmdego

gadawyvetileba virussawinaaRmdego Terapiis dawyebis Sesaxeb, rogorc wesi, miiReba 2 analizis, CDD-4 (imunuri statusis) da virusuli datvirTvis, safuZvelze. virusuli datvirTva aCvenebs, Tu ramdenad aqtiurad vlindeba virusi sisxlSi. virusuli datvirTvis mravali meTodi arsebobs da yvela maTgani sxvadasxva Sedegs iZleva. mniSvnelovania, rom yoveli gamokvlevisas TiToeuli pacientisaTvis gamoyenebul iqnes erTi da igive meTodi. rac ufro maRalia imunuri statusi da dabalia virusuli datvirTva, miT ukeTesia. rogorc wesi, virussawinaaRmdego mkurnalobis dawyeba rekomendebulia im SemTxvevaSi, Tu: _ CD-4 500-ze naklebia, xolo virusuli datvirTva 5.000 - 10. 000-ze metia. _ virusuli datvirTvisagan damoukideblad CDD- 4 350-ze naklebia. _ simptomaturi aiv-infeqcia - momatebuli temperatura (daudgeneli mizeziT), oflianoba RamiT, wonis intensiuri kleba da sxva simptomebi. yvelaze mTavari, rac unda axsovdes pacients! mkurnalobis warmatebis erT-erT umTavres faqtors miRebis sqemis dacva warmoadgens. pacientebs uwevT dReSi 20 da meti abis miReba, mimdevrobisa da miRebis drois gaTvaliswinebiT (Wamamde, Wamis dros an Wamis Semdeg). miRebis sqema specialurad aris ise gaTvlili, rom SenarCunebuli iqnas wamlis maRali koncentracia sisxlSi, rac xels

uSlis virusis gamravlebas. preparatis miRebis gamotovebas an Sewyvetas aRniSnuli koncentraciis daqveiTeba mosdevs, es virusis gamravlebis saSualebas iZleva da rezistentobas iwvevs. rogor warmoiqmneba rezistentoba adamianis organizmSi imunodeficitis virusi mudmivad (asi aTasobiT dReSi) mravldeba. gamravlebisas xdeba Secdomebic, romelTac mutaciebi ewodeba - am SemTxvevaSi virusis asli gansxvavdeba misi `mSoblebisagan~. mutaciebi Cndeba mxolod maSin, rodesac virusi mravldeba, Tuki virusi aqtiuri ar aris, arc mutaciebi Cndeba. zogierTi mutacia warmoiqmneba virusis swored im cilebSi (Seqcevadi transkriftaza da proteaza), romlebzec aris mimarTuli virussawinaarmdego mkurnaloba. mutaciebis Sedegad am cilebis Tvisebebi icvleba da preparatebi maTze veRar moqmedebs. aRniSnul movlenas rezistentoba ewodeba. agresiuli virussawinaarmdego mkurnalobisas, rodesac mTlianad aris SeCerebuli virusis gamravleba, ar xdeba mutaciebi da rezistentobac ar warmoiqmneba. rezistentoba warmoiqmneba mxolod im SemTxvevaSi, Tuki virusi mravldeba virussawinaarmdego mkurnalobis fonze. mutant-virusebs, romlebic ar reagirebs wamlebze, uCndebaT udidesi upiratesoba da maTi raodenoba elviseburad izrdeba. virusi, romelic ar reagirebs erT preparatze, avtomaturad xdeba mdgradi sxva analogiuri wamlebis mimarTac _ am movlenas kros-rezistentoba ewodeba. amitom mkurnalobis yvelaze efeqturi sqemac ki uSedego aRmoCndeba, Tuki pacienti ar daicavs mis absolutur sizustes. im SemTxvevaSi, Tu wamlis miRebis Sualedi Zalian didia, an ukeTesi SeTvisebis mizniT uzmod misaRebad daniSnuli preparati SecdomiT miiReba Wamis Semdeg, wamlis koncetracia sisxlSi iklebs da es virusis gamravlebis saSualebas iZleva. rac ufro meti gadaxra aris daSvebuli wamlis miRebis sqemaSi _ miT ufro metia aiv-is mimarT mdgradi Stamebis ganviTarebis saSiSroeba. virussawinaarmdego Terapiis dawyebamde aucilebelia mkurnal eqimTan saubarSi yvela im sirTulis sagangebo ganxilva, rac SeiZleba wamlis miRebis sqemis dacvas daukavSirdes. unda Sedges gegma, romelic daexmareba pacients mkurnalobis moTxovnebTan misadagebuli maTi cxovrebis wesis awyobaSi. gverdiTi movlenebis warmoqmnisas saqmis kursSi unda iyos eqimi, magram araviTar SemTxvevaSi ar unda Sewydes preparatebis miReba sakuTari iniciativiT radganac virusi aRar daemorCileba wamlebs. mravali gverdiTi movlena SeiZleba moixsnas an Semsubuqdes; xandaxan erTi preparatis analogiuri moqmedebis meoreTi Secvlis saSualebac arsebobs, magram yvela es gadawyvetileba specialistma unda miiRos. didi xnis ganmavlobaSi virussawinaarmdego Terapia niSnavda mkurnalobas azT preparatiT (azidoTimidini, retroviri), romelic or-

ganizmSi aiv_is gamravlebas (replikacias) uwyobda xels. droTa ganmavlobaSi viruss warmoeqmneboda mdgradoba azT-s mimarT da mkurnaloba aRar moqmedebda. mkurnalobas, romlis drosac mxolod erTi preparati gamoiyeneba, monoTerapia ewodeba. Tanamedrove mkurnaloba kombinirebul Terapias, e.i. 2 an 3 wamlis, gamoyenebas moiTxovs. dreisaTvis azTmonoTerapia gamoiyeneba mxolod erT SemTxvevaSi, _ orsul qalebSi, axalSobilze aiv-is gadacemis Tavidan acilebis mizniT. rogor moqmdebs virussawinaaRmdego Terapia? virussawinaaRmdego wamlebi ereva aiv-is sicocxlis ciklSi, virusis gamravlebisaTvis aucilebeli cilebis (Seqcevadi transkriftazisa da proteazis) moqmedebis dablokviT. virussawinaarmdego wamlebs miekuTvneba: Seqcevadi transkriftazis nukleoziduri inhibitorebi: (lamivudini, epiviri®), (zidovudini, retroviri®), DD4T (stavudini, zeri ti)); DDC (zalcitabini, xividi®); DDI (didanozini, videqsi®). Seqcevadi transkri ptazis ara _ nukleoziduri inhibitorebi: delavirdini, nevurapini (virameni®). proteazis inhibitorebi: indinaviri (kriqsivani®; nelfinaviri (virasefti®)); rotonaviri (norviri®); sakvinaviri (inviraza®). rogorc wesi, xdeba am preparatebis Sexameba: 2 Seqcevadi transkriftazis inhibitori da 1 proteazis inhibitori.

Terapiis gverdiTi efeqtebi

nebismieri virus-sawinaaRmdego preparats SeiZleba hqondes gverdiTi moqmedeba da es marTebulia absoluturad yvela wamlis SemTxvevaSi. yvelaferi individualuria da Tuki preparatis instruqciaSi Cven gvxvdeba gverdiTi efeqtebis didi nusxa, es sulac ar niSnavs, rom aucilebelia erTerTi maTganis arseboba. zogierT adamians Terapiisas araviTari gverdiTi efeqti ar aReniSneba, zogi am moqmedebas ganicdis Serbilebuli formiT da es ar urTulebT cxovrebas, zog SemTxvevaSi ki gverdiTi efeqti SeiZleba Zalian mZime iyos.

mTavari wesi nebismieri gverdiT efeqtTan brZolis sakvanZo moments Semdegi wesi warmoadgens: winaswari codna imis Sesaxeb, Tu ra SeiZleba moxdes, da Sesabamisi moqmedebaTa gegmis arseboba ama Tu im gverdiTi efeqtis warmoqmnis SemTxvevaSi. Tu gadawyvetilia iseTi preparatis miReba, romelsac Tundac mcire albaToba gaaCnia saSiSi gverdiTi moqmedebisa, aucilebelia im simptomebis codna, romlebic yuradRebas saWiroebs. simptomebis Semcireba aseve SesaZlebelia specialuri profilaqtikuri RonisZiebebiT. wamlis miRebamde mkurnal eqimTan erTad saWiroa preparatebTan dakavSirebuli SesaZlebeli riskebis ganxilva. ras mivaqcioT yuradReba da ra gavakeToT? rodesac adamianebi iwyeben virus-sawinaaRmdego preparatebis miRebas, isini Tavdapirvelad, rogorc wesi, Tavs uaresad da ara ukeTesad grZnoben. gverdiTi movlenebis umetesoba qreba preparatebis miRebis dawyebidan 4-6 kviris Semdeg. es periodi aucilebelia imisaTvis, rom organizmis axal wamlebTan adaptireba moxdes. manmade ki adaianma SeiZleba ganicados Tavis da kunTebis tkivili, Tavbrusxveva, gulisreva. rogorc ki organizmi SeeCveva, es gverdiTi efeqtebi unda gaqres. aucilebelia arasasurveli moqmedebis warmoqmnisTanave amocnobis Seswavla. preparatebis miRebis dawyebidanve aucilebelia eqimis Setyobineba, nebismieri uCveulo reaqciis Sesaxeb. cota ram preparatebis Secvlis Sesaxeb zogjer adamianebi ganicdian Zalian seriozul gverdiT efeqtebs, ris gamoc maT surT Terapiis reJimis Secvla im SemTxvevaSic ki Tu es wamlebi kargad akontrolebs aiv-s. preparatis Secvla gverdiTi movlenebis gamo misi momavlisaTvis "Semonaxvis" saSualebasac iZleva, Tu aRmoCnda, rom mimdinare kombinaciam ar gaamarTla. miTumetes, rom pacientis mier gamocdili gverdiTi efeqtebi SeiZleba aRar ganmeordes, Tu momavalSi igive wamals daubrundeba. magram unda gvaxsovdes, rom ama Tu im preparatis miRebis Sewyveta Zalian saSiSia. aseve saSiSia wamlis dozis Semcireba eqimis nebarTvis gareSe. aman SeiZleba wamlis an am klasis sxva preparatebisadmi rezistentobis ganviTareba gamoiwvios. gverdiTi efeqtebi xSirad Cndeba virus-sawinaaRmdego Terapiis dawyebis Semdeg, magram ramdenime kviris Semdeg isini klebulobs an saerTod qreba. zogjer isini grZeldeba kombinaciis miRebis sruli periodis ganmavlobaSi. magram, am SemTxvevaSic ki SeiZleba maTi minimumamde dayvana. simptomebis arsebobis miuxedavad, mravali adamiani

iRebs gadawyvetilebas Terapiis gagrZelebis Sesaxeb. preparatebTan dakavSirebuli simptomTa umravlesoba waagavs im daavadebebs, romlebsac adamianebi manamdec xvdebodnen, magaliTad, hormonaluri darRvevebi, orsuloba, depresia an TviT aiv-infeqciac ki. rac ar unda awuxebdes adamians, Zalian mniSvnelovania, rom es problema eqimTan erTad iyos ganxiluli, raTa moxdes SeuZlod yofnis mizezis diagnostireba. qvemoT moyvenilia yvelaze metad gavrcelebuli gverdiTi efeqtebis aRmofxvris mokle rekomendaciebi.

qronikuli daRliloba : drodadro Cven yvela vgrZnobT daRlilobas, magram Tu daRlilobas, garemoebaTa miuxedavad, mudmivi xasiaTi aqvs, maSin es ukve samedicino problemaa, romlis ignorirebam mxolod gauareseba SeiZleba gamoiwvios. rekomendaciebi

· · · pacientma unda Seecados daiZinos da adges erTsa da imave dros _ Zilis reJimis Secvlam SeiZleba daRliloba gamoiwvios; pacienti unda Seecados ivarjiSos. es Seamcirebs stress da daexmareba, imaSi, rom Tavi ukeT igrZnos; SeiZinos meti mza produqti, rom naklebad daWirdes saWmlis mzadeba.

anemia: anemia _ es sisxlis wiTeli ujredebis dakargvaa. anemiis dros organizmis qsovilebs ar yofnis Jangbadi da es daRlilobisa da dauZlurebis grZnobas iwvevs. qalebSi anemiis simptoms SeiZleba menstrualuri cilkis darRveva warmoadgendes. anemia sicocxlisaTvis saSiSia. aiv-inficirebulTa umravlesobas ama Tu im SemTxvevaSi aqvT anemia. zogjer mizezs TviT aiv-infeqcia warmoadgens, sxva SemTxvevaSi anemia SeiZleba gamowveuli iyos virus-sawinaaRmdego preparatiT, magaliTad, retroviriT. rekomendaciebi

· · · regularulad aris asaRebi analzi hemoglobinze; Tevzi, xorci, frinvelis xorci Seicavs rkinasa da vitamis B-12-s, rac anemiis risks amcirebs; ispanaxi, salaTa, mwvane barda mdidaria folis mJaviT, rac aseve mniSvnelovania anemiis profilaqtikisaTvis;

Tavis tkivili: Tavis tkivilis mizezi is daZabulobaa, romelsac Cven ganvicdiT. magram is, SesaZloa, zogierTi wamlis, maT Soris, virussawinaaRmdego preparatebis miRebiT iyos gamowveuli. arsebobs tkivilis gamayuCebeli mravali wamali. amis garda, tkivilis Semcireba stresis moxsniTac SeiZleba.

rekomendaciebi

· · · iseT oTaxSi dasveneba, sadac bnela da simSvidea. Tvalebze civi kompresis gakeTeba, Rawvebis frTxili masaji, sasurvelia cxeli wylis abazana; Tavis tkivilis asacileblad, saWiroa maprovocirebeli mizezis dadgena. ar unda miiRos Tavis tkivilis gamomwvevi sakvebi, gansakuTrebiT kofeini (Cai, yava, koka-kola), Sokoladi, Rvino, citrusebi, sakvebi danamatebi, yveli, Zmari da xaxvi.

gulisreva da pirRebineba: zogierTi virus-sawinaaRmdego preparati iwvevs gulisrevas. Tu daiwyo pirRebineba, man qronikuli xasiaTi miiRo, saswrafod unda moxdes eqimTan mimarTva, radgan pirRebinebam, SesaZloa, preparatebis miRebaSi SeuSalos xeli. rekomendaciebi

· · racionSi Sesatania banani, brinji, vaSlis wveni, gaxuxuli puri; sawolTan unda iyos dalagebuli krekerebi an orcxobila. vidre adgeba pacienti, unda miirTvas 1-2 cali da mcire dro gaataros sawolSi. es daexmareba dilaobiT gulisrevis Tavidan acilebeSi; dasalevad pitnis, gvirilis an koWas Cai, es awynarebs kuWs; ar aris rekomendirebuli cxeli, cxare, cximiani, surnelovani sakvebi; eqimTan konsultacia, gulisrevis sawinaaRmdego preparatebis daniSvnis Sesaxeb.

· · ·

diarea: qronikuli diarea SeiZleba siTxis dakargvis mizezi gaxdes. amitom aseT SemTxvevaSi saWiroa rac SeiZleba meti siTxis miReba da srulfasovani kveba. arseboba mravali Zalian kargi diareis sawinaaRmdego preparati. Tu wamlebi iwvevs diareas, maSin eqimTan unda SeTanxmdes diareis sawinaaRmdego preparatis winaswar daniSvnis Sesaxeb.. rekomendaciebi

· racionSi unda Sediodes banani, moxarSuli brinji, vaSlis wveni, fafebi, puri (ara marcvleulis)_ es diareis sawinaaRmdego mSvenieri saSualebaa. mosaridebelia ujredisis Semcveli produqtebis miReba, magaliTad gaufcqvneli xili da bostneuli, isini arTuleben diareas; ar SeiZleba cximiani da Zalian tkbili sakvebi. misaRebad kalciumi (500mg dReSi). bevri siTxe, sicxis Tavidan asacileblad.

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menstrualuri ciklis darRvevebi: menstrualuri ciklis darRvevebi xSirad gvxvdeba, gansakuTrebiT susti imunuri sistemis qalebSi. es darRvevebi moicavs araregularul, mZime da mtkivneul menstruacias, an mis srul Sewyvetas. jer-jerobiT daudgenelia, iwvevs Tu ara virussawinaaRmdego preparatebi ciklis darRvevebs. rekomendaciebi

· gaTvaliswinebeli unda iyos pacientis cxovrebis wesis yvela aspeqti. maT Soris, stresebi, wonis dakleba da a.S. yvela es faqti SeiZleba faseuli informacia iyos eqimisTvis. menstrualuri tkivilebis Sesamsubuqeblad gamoiyeneba saTburi (mucelze) an cxeli abazan. nebismier SemTxvevaSi es moxsnis stress. SeiZleba msubuqi varjiSis cda: gazmoreba da gaseirneba. aman SeiZleba Seamsubuqos tkivili. oraluri kontraceptivebis (Casaxvis dawinaaRmdego abebi) zogjer gamoiyeneba imisTvis, rom "daregulirdes" ciklis darRvevebi. saWiroa eqimTan konsultacia am preparatebis miRebasTan dakavSirebiT. zogierT virus-sawinaaRmdego preparatebTan isini arian SeuTavsebelini.

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dReisaTvis arsebobs kidev bevri gaurkveveli ram gverdiTi efeqtebis sferoSi, xolo wamlebis drozirebis individualuri SerCeva jer-jerobiT SeuZlebelia. Tu avadmyofs raime gverdiTi movlenebi awuxebs, dauyovnebliv unda daukavSirdes mkurnal eqims da gaesaubros mas simptomebTan dakavSirebiT. ukidures SemTxvevaSi, preparatebis kombinaciis Secvlis an moxsnis SesaZlebloba yovelTvis arsebobs.

brZola oportunistul infeqciebTan

oportunistuli infeqciebi (opportunistic infections) - es aris pirobiTad paTogenuri mikroorganizmebi, romlebic dasustebuli imunuri sistemis mqone adamianebSi kerZod aiv-inficirebulebSi. sxvadasxva daavadebebs iwveven. Cveulebriv adamianebSi es mikroorganizmebi, rogorc wesi, daavadebas ar warmoqmnian. mravali maTgani TiTqmis yvela adamians aqvs latenturi formiT. oportunistuli infeqciebi saSiSia im

SemTxvevaSi, Tuki imunuri statusi <300. profilaqtika mdgomareobs imaSi, rom: · · gamoiricxos daavadebis gamomwveviT (baqteriebi, sokoebi, virusebi, parazitebi) dainficireba; droulad iqnes dawyebuli wamlebis miReba imisaTvis, rom daavadebis gamomwvevis aqtivoba SeCerdes manamde, vidre warmoiSveba simptomebi. oportunistuli infeqciebis zogierTi gamomwvevi adamianebis organizmSi aranairad ar mJRavndeba. da mxolod im SemTxvevaSi, Tuki imunuri statusi dabalia, isini saSiSi daavadebebis gamomwvevebi xdebian.

pnevmocisturi pnevmonia. misi gamowvevia mikroorganizmi Pneumocystis carinii, romelic garemoSi yvelgan arsebobs. pnevmocistis organizmSi moxvedris Tavidan acileba SeuZlebelia, amgvarad Tuki imunuri statusi 200-ze naklebia, am daavadebis ganviTarebis Tavidan asacileblad profilaqtikuri mizniT aucilebelia baqtrimisa an biseptolis daniSvna. toqsoplazmozi - misi gamomwvevia ujredSida paraziti Toxoplasma gondii, romelic 100-ze naklebi imunuri statusis adamianebSi iwvevs Tavis tvinis anTebas _ encefalits. toqsoplazmiT dainficireba SeiZleba moxdes naxevrad umi xorcis an katebis fekaliebTan kontaqtiT. inficirebis Semdeg toqsoplazma didxans cocxlobs adamianis organizmSi _ manamde, vidre imunuri statusis daqveiTeba miscems infeqcias saSiS daavadebaSi gadasvlis saSualebas. tuberkulozi. Tu cxovrebaSi erTxel mainc organizmSi moxvda tuberkulozis gamomwvevi mikobaqteria - Tqven xarT tuberkulozis ganviTarebis maRali riskis matarebeli, mikobaqteriebiT inficireba ganisazRvreba mantus kanis sinjiT _ aucilebelia misi Catareba regularulad, weliwadSi erTxel mainc. Tu sinji dadebiTia (papulas diametri 5 mm-ze metia), erTi wlis ganmavlobaSi unda Catardes profilaqtikuri mkurnaloba izoniazidiT. mikobaqteriebiT dainficirebisagan Tavis arideba Zalian Znelia, radganac infeqciis gadacema haer-wveTovani gziT xdeba. citomegalovirusi _ mas ZaluZs dabali imunuri statusis adamianebSi Tvalis mZime daavadebis _ retinitis _ gamowveva, romlis Sedegadac adamiani mxedvelobas kargavs. citomegalovirusi agreTve iwvevs kuW-nawlavis traqtis, nervuli sistemisa da organoTa daavadebebs. riski yvelaze maRalia, Tuki CD4<50. citomegalovirusis antisxeulze dadebiTi reaqciisa da dabali imunuri statusis SemTxvevaSi saWiroa profilaqtikuri mkurnaloba (magaliTad, gancikloviriT). citomegalovirusi arsebobs mravali adamianis organizmSi, is yvelaze xSirad sqesobrivi gziT gadaicema. Tu Tqven citomegalovirus-uaryofiTi xarT, daicaviT Tavi usafrTxo seqsis an prezervativebis gamoyenebiT. sokovani infeqciebi - maT Soris yvelaze metad gavrcelebuli kandidozebia. isini warmoiSveba aiv-infeqciis nebismier stadiaze da

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eqvemdebareba mkurnalobas. dabali imunuri statusis dros saSiSia saylapavi milis kandidozi. aranakleb saSiSia sxva sokovani infeqciac _ kriftokokuri meningiti, romelic CD4<50 dros Cndeba. orive SemTxvevaSi aucilebelia dauyovneblivi mkurnalobis dawyeba, romelic unda gagrZeldes simptomebis gaqrobis Semdegac. baqteriuli infeqciebi. aiv-infeqciis dros baqteriebiT dainficirebisas SeiZleba ganviTardes baqteriuli pnevmonia. riski izrdeba, Tu adamiani Tambaqos an narkotikebis momxmarebelia. pnevmocistuli pnevmoniis profilaqtika xels uwyobs baqteriuli pnevmoniis Tavidan acilebasac. baqteriebi, SesaZloa, kuW-nawlavis sistemis mZime daavadebebis mizezic gaxdes. herpes-virusebi. farTod gavrcelebuli infeqcia _ herpesi - dabali imunuri statusis SemTxvevaSi seriozul problemas warmoadgens. Tu Tqven ara xarT inficirebuli, Tavi aarideT infeqciebs, romlebic sqesobrivi gziT aris gadamdebi, aseve erideT adamianebs, romlebsac herpesis aqtiuri forma aqvT.

aiv/Sidsis iuridiuli aspeqtebi

aiv pozitiur adamians, iseve rogorc saqarTvelos yvela moqalaqes, icavs 1995 wels saqarTvelos parlamentis mier miRebuli kanoni "adamianis imunodeficitis virusiT infeqcia/Sidsis profilaqtikis Sesaxeb", romelic ganixilavs aiv infeqciasTan dakavSirebul yvela aspekts. kerZod, dauSvebelia aiv inficirebulis nebismieri uflebis Selaxva da kanonieri interesebis SesRudva mxolod maTi daavadebis gamo. jandacvis organoebi da dawesebulebebi, medicinis yvela muSaki valdebulia gauwios samedicino daxmareba aiv pozitiurs. misi saTanado daxmarebis gareSe datoveba kanoniT isjeba. samedicino personali da sxva pirebi, romlebmac dakisrebuli movaleobis Sesrulebisas Seityves moqalaqeTa aiv inficirebaze samedicino Semowmebis monacemebi da Sedegebi, valdebulni arian saidumlod Seinaxon isini. amasTanave, aiv inficirebuli valdebulia daicvas yvela wesi, rom ar gaavrcelos es daavadeba. man unda gaafrTxilos samedicino personali, sqesobrivi partniori da a. S. Tavisi aiv statusis Sesaxeb. meore pirisaTvis aiv infeqciis ganzrax gadacemis safrTxis Seqmna an misi

dainficireba isjeba sisxlis samarTlis kodeqsis mixedviT. kerZoT, regulirdeba saqarTvelos kanonis Semdegi muxlebiT: Tavi V, muxli 9. aiv inficirebulTa movaleobani. aiv daavadebuli piri valdebulia daicvas am infeqciis gavrcelebis Tavidan acilebis RonisZiebani. aiv daavadebuli yvela piri samedicino daxmarebisTvis mimarTvis SemTxvevaSi valdebulia gaafrTxilos samedicino dawesebuleba an calkeuli medicines muSaki, rom igi inficirebulia adamianis imunodeficitis virusiT. Tavi V, muxli 12. medicinis muSakTa movaleobani. janmrTelobis dacvis organoebi da dawesebulebebi, medicines yvela muSaki valdebulia aiv daavadebuls gauwion samedicino daxmareba. janmrTelobis dacvis organoebi da dawesebulebebi, medicines muSakebi valdebuli arian aiv infeqciaze/Sidsze moqalaqeTa gamokvlevisas, agretve sxva samedicino moni pulaciebis dros daicvan aiv infeqciis/Sidsis gavrcelebis sawinaaRmdego epidemreJimis moTxovnebi da uzrunvelYon rogorc pacientTa, aseve samedicino personalis usafrTxoeba. medicinis muSakebi da sxva pirini, romlebmac dakisrebuli movaleobis Sesrulebisas Seityves moqalaqeTa aiv infeqciebze/Sidsze samedicino Semowmebis monacemebi da maTi Sedegebi, valdebulni arian saidumlod Seinaxon es monacemebi. zemoaRniSnuli movaleobis Seusrulebloba iwvevs samarTlis pasuxismgeblobas moqmedi kanonmdeblobis Sesabamisad.

eTikuri problemebi

aiv-inficirebul pacientebTan urTierTobis dros saWiroa garkveuli eTikuri normebis dacva. Sids-is problemebze saubrisas Cven viyenebT gamoTqmebs, romlebsic asaxavs Cvens codnasa da warmodgenebs epidemiis Sesaxeb, aseve damokidebulebas inficirebuli adamianebis mimarT.imisaTvis rom warsuls Cabardes diskriminacia, ucodinaroba da isteria, sazogadoebaSi TandaTanobiT rom Camoyalibdes saRi da humanuri damokidebuleba Sids-is problemis sxvadasxva aspeqtebis mimarT, Cveni saubari zusti da diskrimanaciis cru rwmenebisagan Tavisufali unda iyos. Sids-is problemaze saubrisas daSvebuli arakoreqtuloba badebs cru warmodgenebsa da miTebs, rac xels uSlis adamianebs marTebuli gadawyvetilebebis miRebaSi, zogierT SemTxvevaSi ki gadadis diskriminaciasa da adamianebis tragediaSi. qvemoT moyvanilia arasasurveli gamoTqmebi, romlebic ufro Tanamedrove da SesatyvisiT unda Seicvalos. nu SegawuxebT is garemoeba, rom zogierTi maTgani SeuCvevlad JRers: axali ideebi da movlenebi asaxvisaTvis axal gamoTqmebsa da sityvebs saWiroebs. `XX saukunis Wiri~. es moZvelebuli Jurnalisturi Stampi gaCnda epidemiis aRmocenebisTanave, jer kidev maSin, rodesac adamianebisaTvis ar iyo cnobili am saSiSi daavadebis mizezebisa da gavrcelebis gzebis Sesaxeb, da samwuxarod, dRemde gvxvdeba sxvadasxva publikaciebSi. WirTan Sedareba aRzevebs Sids-is fobias, isteriasa da infeqciisadmi Suasakunovan SiSs, Sedegad ki _ xels uwyobs diskriminaciasa da aivinficirebulTa izolacias. `Sids-is msxverplni~. sityva `msxverpli~ saSiSroebis winaSe pasiurobasa da ususurobas gulisxmobs. aiv-inficirebulTa da Sids-ianTa umravlesoba aqtiurad ibrZvis sicocxlisaTvis, janmrTelobisaTvis, adamianis uflebebisaTvis da xels uwyobs sxvebs infeqciis Tavidan acilebaSi. swored maTi Zalisxmevis Sedegad aris miRweuli uzarmazari warmatebebi aiv/Sids-is mkurnalobasa da profilaqtikaSi. `Sids-is udanaSaulo msxverplni~. ase uwodeben bavSvebs, romelTa inficireba samedicino dawesebulebebSi moxda da ratomRac usityvod igulisxmeba, rom adamianebi, romelTa inficireba sqesobrivi gziT an narkotikebis moxmarebis dros moxda, `damnaSaveni~ arian. Sids-i ar aris danaSauli, es daavadebaa. aramarto Sids-i, aramed sxva mravali daavadebac SeiZleba iyos gamowveuli adamianis sarisko qceviT, magram aravis ar mouva azrad isaubros kibos, hi pertoniisa an diabetis `udanaSaulo msxverplebze~. an gamoarkvios ramdenad `damnaSavea~ adamiani am daavadebebis arsebobaSi.

`Sids-iT inficireba~. cxadia, rom SesaZlebelia mxolod aiv-inficireba, es infeqcia ki droTa ganmavlobaSi SeiZleba gadavides Sids-is stadiaSi. mkurnalobis Tanamedrove meTodebi mimarTulia imaze, rom ar iqnes daSvebuli aiv-infeqciis gadasvla Sids-Si. `aiv-inficirebulebi~, `pacientebi~, `Sids-iT daavadebulebebi~. SeecadeT Tavi aaridoT iseT gamoTqmebs, romlebic adamianebs infeqciisa an daavadebis WrilSi ganixilavs. sityva `pacienti~ misaRebia mxolod klinikur aspeqtSi _ saxlSi an samsaxurSi adamiani aRar aris pacienti. gamoTqma `Sids-iT daavadebuli~ SeiZleba gamoyenebul iqns mxolod im adamianis mimarT, romelic namdvilad aris avad. msoflioSi miRebulia terminebi `aiv-dadebiTebs~ (anu isini, vinc aiv-infeqciis analizze dadebiTi pasuxi miiRo), `adamianebi, romlebic cxovroben aiv/Sids-iT~ an `aiv/Sids-iani adamianebi~. fraza `adamianebi, romlebsac Seexo Sidsis epidemia~ ixmareba rogorc aiv-dadebiTi statusis mqone adamianebis mimarT, ise maTi axloblebis mimarT, aiv-statusis miuxedavad. `riskis jgufebi~. es aris moZvelebuli, uwignuri da xSirad diskriminaciuli gamoTqma, romelic saerTod aRar ixmareba sazogadoebaSi. risks gansazRvravs adamianis individualuri qceva da ara misi ama Tu im jgufisadmi kuTvnileba. sazogadoebis zogierTi wevri SeiZleba ufro mgrZnobiare iyos aiv-is mimarT, radganac zogierTi faqtoris (siRaribe, diskriminacia, uufleboba) gamo ver uzrunvelyofs sakuTari Tavis usafrTxoebas da sarisko situaciebis Tavidan acilebas. am SemTxvevaSi ufro misaRebia gamoTqma `mowyvladi jgufi~. profilaqtikuri programebi iqmneba miznobrivi jgufebisaTvis. `saSiSi daavadeba~. daavadeba ki ar aris saSiSi, saSiSia umecreba, diskriminacia, realuri profilaqtikisa da efeqturi mkurnalobis xelmiuwvdomloba. SiSi - cudi mrCevelia. is axSobs gonebasa da nebisyofas swored maSin, rodesac aucilebelia naTeli azrovneba da gabeduli qmedebebi.

aiv infeqcia da stresi

stresi da depresia somaturi daavadebis 50-70%-is erT-erT gamomwvevi faqtoria: fsiqonervoimunologiur sferoSi Catarebulma gamokvlevebma cxadyo, rom stresi da depresia aqveiTebs imunitets,rac Tavis mxriv xels uwyobs aiv-infeqciis progresirebas. cxovelebze Catarebulma eqspreimentebma gviCvena, rom Zlieri eleqtroSoki (stresis gamomwvevi erT-erTi faqtori) xels uSlis organzmSi limfocitebis warmoqmnas, rac aqveiTebs daavadebasTan brZolis unars.

aiv-infeqciis diagnozs SeuZlia gamoiwvios stresi an/da depresia, da aRZras adamianSi sruliad bunebrivi SiSi sakuTari janmrTelobis gamo. stresi/depresia ki Tavis mxriv, rogorc imunitetis damTrgunveli, iwvevs aiv-inficirebulis zogadi mdgomareobis gauaresebas. vinaidan cnobilia, rom aiv-infeqcia pirvel rigSi imunitetis daTrgunvas niSnavs da swored misTvis damaxasiaTebel simptomebSi gamoixateba, inficirebuli adamiani da misi axloblebi am simptomebs mxolod aiv-s miaweren da ar iTvaliswineben stresis an/da depresiis faqtors. amiT isini xels uwyoben infeqciis progresirebas. am situaciaSi mniSvnelovani xdeba ori garemoebas: 1. aiv-infeqcias specialuri mkurnaloba sWirdeba, romelic inficirebulma adamianma gare samyarodan unda miiRos; 2. stresTan/depresiasTan SebrZoleba pacientis ZalaSia da mxolod misi Sinagani resursebis mobilizacias moiTxovs. imunitetis daqveiTebis Semdeg zogad simptomebSi gamoixateba: · qronikuli daRliloba · akviatebuli fiqri aiv-iT inficirebis faqtze; · uxasiaToba; · uimedoba; · martoobis SegrZneba; · gare samyarosadmi gulgriloba; · sasowarkveTa; depresiaSi myofi inficirebuli adamiani obieqturad cudad grZnobs Tavs. am SemTxvevaSi mas uCndeba survili mkurnal eqmis mimarTos. ojaxis wevrebi, naTesavebi da axloblebic igives urCeven. eqimi ki xedavs ra stresis gavlenas, pacients urCevs mimarTos fsiqoTerapevts da stress/depresias SeebrZolos. adamianSi dabneuloba matulobs, veRar acnobierebs marTla avadaa Tu eCveneba. aiv-pozitiur statuss bevri adamiani, maT Soris zogierTi eqimic, aigivebs SidsiT daavadebasTan. aseTi damokidebuleba metwilad informaciis simwiriTa da sazogadoebaSi aiv/Sidsis problemaze damokidebuli araswori SexedulebiTaa gamowveuli. es ganapirobebs imas, rom sazogadoebis umetesi nawili (inficireuli adamianis ojaxis wevrebis da axloblebis, maTi TanamSromlebis, mezoblebis, zogierTi samedicino muSakebis CaTvliT) winaswarganwyobilia janmrTelobis daqveiTebis yoveli axali niSani aiv-s miaweros. maT aviwydebaT, rom arainficirebuli adamianebic iseve avadmyofoben gri piT, iRlebian zedmeti fizikuri an gonebrivi datvirTvis gamo, civdebian, roogrc inficirebulebi. Tu, magaliTad, inficirebuli adamiani dRis ganmavlobaSi swavlobs, RamiT muSaobs da Tanac xmaurian raionSi cxovrobs, amasTan, mkurnalobis fonze mainc qronikul daRlilobas uCivis, es ukanaskneli ufro misi cxovrebis reJimiT aris gamowveuli, vidre aiv-iT. aseT situaciaSi xom nebismieri adamiani igives igrZnobda. Tu aiv-inficirebuli adamiani gamudmebiT Tavis pozitiur statusze fiqrobs da garSemomyofnic sul amaze esaubrebian, gareT ar gadis, aranair dadebiT STabeWdilebas ar Rebulobs da araferi ar ainteresebs, gana es virusis bralia?

bevri arainficirebuli adamiani SeiZleba aRmoCndes aseT mdgomareobaSi sxvadasxva mizezebis gamo (umuSevroba, imedis gabilweba, uiRblo siyvaruli da mravali sxva).

rogor unda ebrZolo stress da depresias?

pirvel rigSi, pacientma unda scnos da gaiazros maTi arseboba, Seiswavlos maTi niSnebi, gaiTvaliswinos maTi uaryofiTi gavlena; gaxsovdeT, rom problemis mizezis amocnoba, misi daZlevis winapirobaa! agreTve pacientma unda eZebos dadebiTi emociebis wyaroebi: sayvareli wigni, kargi kinokomedia, mxiaruli megobrebi, saintereso saqme, axali profesiis SeZena (kompiuteri, ucxo ena, Zerwva, keramika, kerva Tu qsova), anda ubralod, parkSi gaseirneba, gaWirvebulis daxmareba, da mravali, mravali sxva. sworad SerCeuli mkurnalobis warmateba aris Tavad avadmyofis xelSi!

kveba aiv-infeqciis dros

mravali daavadebis SemTxvevaSi eqimebi niSnaven dietas, radganac cnobilia, rom kveba _ pirveli wamalia. es marTebulia aivinfeqciis SemTxvevaSic. dietis princi pebi Zalian martivia: meti kaloria! meti cila! saWiro ar aris Cveuli racionis radikaluri Secvla kaloriebis misaRebad: · pacientma unda miiRos yvelaferi is, rac yovelTvis, magram meti raodenobiT; · kveba ara 2-3-jer, aramed 5-6-jer dReSi, cot-cota. · yvela SesaZlebel SemTxvevaSi sakvebs unda daematos karaqi, araJani, maionezi gaxexili yveli; · wylis nacvlad wvenebi an rZe. · dabalkaloriuli da cxim gamoclili sakvebi ar aris rekomendirebuli; · tkbileuli, Sokoladi, naRebis nayini.

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