-
<span style="color:#b22222;"><span style="font-size:20px;"><strong>PHAN LOAI GIAI DOAN LAM SANG HIV/AIDS CHO NGUOI LON</strong></span></span><br />
<strong>VA VI THANH NIEN</strong><br />
<strong><em><u>Lam sang Giai doan I</u></em></strong><br />
- Khong co trieu chung.<br />
- Benh ly hach lympho toan than dai dang.<br />
- Hoat dong muc do 1: Khong co trieu chung, hoat dong binh thuong.<br />
<strong><em><u>Lam sang Giai doan II</u></em></strong><br />
- Sut can duoi 10% trong luong co the.<br />
- Bieu hien nhe tai da va niem mac (viem tiet ba nhon, nam hong, loet mienh tai dien, viem goc mieng).<br />
- Zona trong vong 5 nam gan day.<br />
- Nhiem trung duong ho hap tren tai phat (Viem xoang do vi khuan).<br />
- Va/hoac Hoat dong muc do 2: Co bieu hien trieu chung nhung van hoat dong binh thuong.<br />
<strong><em><u>Lam sang giai doan III</u></em></strong><br />
- Sut can tren 10% trong luong co the.<br />
- Tieu chay man tinh khong ro nguyen nhan tren 1 thang.<br />
- Sot keo dai khong ro nguyen nhan (khong lien tuc hay lien tuc) voi thoi gian tren 1 thang.<br />
- Nghiem nam Candida o mieng.<br />
- Bach san dang long o mieng.<br />
- Nhiem vi khuan nang (viem phoi, viem co mu).<br />
- Va/hoac Hoat dong Muc do 3: Nam liet giuong duoi 50% so ngay trong thang truoc do.<br />
<strong><em><u>Lam sang giai doan IV</u></em></strong><br />
- Hoi chung suy mon do HIV (sut >10% trong luong co the, cong voi tieu chay man tinh khong ro can nguyen > 1 thang, hoac met moi va sot keo dai khong ro can nguyen > 1 thang).<br />
- Viem phoi do Pneumocystis jiroveci.<br />
- Benh do toxoplasma o nao.<br />
- Benh do cryptosporidia co tieu chay, > 1 thang.<br />
- Nhiem nam cryptococcus, ngoai phoi.<br />
- Benh do cytomegalovirus o co quan khac ngoai gan, lach, hoac hach.<br />
- Nhiem virus Herpes simplex virus da va niem mac > 1 thang hoac o noi tang.<br />
- Viem nao chat trang da o tien trien.<br />
- Benh nam luu hanh o dia phuong co bieu hien lan toa toan than (nhu nam histoplasma, penicillium).<br />
- Benh nam candida thuc quan, khi quan, phe quan hoac phoi.<br />
- Nhiem cac mycobacteria khong phai lao lan toa toan than.<br />
- Nhiem khuan huyet Salmonella khong phai thuong han.<br />
- Lao ngoai phoi.<br />
- U lympho.<br />
- Sarcoma Kaposi.<br />
- Benh ly nao do HIV (Bieu hien tren lam sang bang roi loan kha nang tri thuc va/hoac roi loan chuc nang van dong anh huong den sinh hoat hang ngay, tien trien trong vai tuan hoac vai thang, ma khong co benh ly nao khac ngoai HIV la nguyen nhan gay ra cac trieu chung nay.<br />
- Va/hoac Hoat dong Muc do 4: Nam liet giuong tren 50% so ngay trong thang truoc do.<br />
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<span style="color:#b22222;"><span style="font-size:20px;"><strong>PHAN LOAI GIAI DOAN LAM SANG NHIEM HIV/AIDS O TRE EM</strong></span></span><br />
<strong><em><u>Lam sang Giai doan I</u></em></strong><br />
- Khong trieu chung.<br />
- Sung hach lympho toan than<br />
- Gan lach to<br />
<strong><em><u>Lam sang Giai doan II</u></em></strong><br />
- Nhiem trung duong ho hap tren tai dien hoac man tinh (viem tai giua, chay mu tai, viem xoang, mac tu 2 lan tro len trong khoang thoi gian 6 thang bat ky).<br />
- Phat ban san ngua.<br />
- Herpes zoster (mac tu 1 dot tro len trong vong 6 thang).<br />
- Loet mieng tai dien (mac tu 2 dot tro len trong vong 6 thang).<br />
- Do vien loi.<br />
- Loet khoe mieng.<br />
- Sung tuyen mang tai.<br />
- Viem da tuyen ba.<br />
- Nhem vius gay u nhu o nguoi hoac virus u mem lay nang (tren 5% dien tich co the hoac gay bien dang).<br />
- Nhiem nam mong.<br />
<strong><em><u>Lam sang giai doan III:</u></em></strong><br />
<em>- </em>Suy dinh duong muc do vua* khong dap ung thich hop voi dieu tri thong thuong.<br />
- Tieu chay keo dai > 30 ngay ma khong thay can nguyen ro nguyen nhan nao khac (> 14 ngay).<br />
- Sot keo dai khong ro nguyen nhan (sot cach quang hoac lien tuc tren 1 thang).<br />
- Nhiem nam candida to mieng (ngoai giai doan chu sinh).<br />
- Bach san dang long o mieng.<br />
- Lao phoi**.<br />
- Viem phoi nang tai dien duoc cho la do vi khuan (mac tu 2 lan tro len trong vong 6 thang).<br />
- Viem loet hoai tu loi cap tinh loi/viem quanh cuong rang.<br />
- Viem phoi ke tham nhiem lympho.<br />
- Thieu mau (< 80g/L), ha bach cau trung tinh (< 1000/mm3) hoac ha tieu cau (< 30000/mm3) khong ro nguyen nhan.<br />
- Benh ly phoi man tinh lien quan den HIV, bao gom ca gian phe quan.<br />
- Benh ly co tim lien quan den HIV hoac benh ly than lien quan den HIV.<br />
<strong><em><u>Lam sang Giai doan IV</u></em></strong><br />
<em>Cac benh canh co the chan doan so bo tren co so cac dau hieu lam sang hoac cac tham do don gian:</em><br />
- Suy mon nang*** hoac suy dinh duong nang khong ro nguyen nhan khong dap ung thich hop voi dieu tri thong thuong.<br />
- Viem phoi do pneumocystis (PCP).<br />
- Nhiem trung nang tai dien duoc cho la do vi khuan (mac tu 2 dot tro len trong vong 1 nam, nhu viem mu mang phoi, viem mu co, nhiem trung xuong hoac khop, viem mang nao, nhung khong bao gom viem phoi).<br />
- Nhiem Herpes simplex moi-mieng hoac o da man tinh (keo dai tren 1 thang).<br />
- Lao ngoai phoi.<br />
- Sarcoma Kaposi.<br />
- Nhiem nam candida thuc quan.<br />
- Benh do toxoplasma he TKTU.<br />
- Benh ly nao do HIV.<br />
<em>Cac benh canh can xet nghiem khang dinh chan doan:</em><br />
- Benh do CMV (viem vong mac do CMV, hoac benh do CMV o cac co quan ngoai gan lach hoac hach lympho, khoi phat tu 1 thang tuoi).<br />
- Viem mang nao do cryptococcus (hoac benh do cryptococcus ngoai phoi).<br />
- Benh nam lan toa do loai nam lu hanh tai dia phuong (nhu benh nhiem nam histoplasma ngoai phoi, benh nhiem nam coccidio, penicillium).<br />
- Benh do cryptosporidia.<br />
- Benh do isospora.<br />
- Benh lan toa do cac loai mycobacteria khong phai lao.<br />
- Nhiem nam candida khi quan, phe quan hoac phoi.<br />
- Ro truc trang-bang quang mac phai do HIV.<br />
- U lympho o nao hoac u lympho khong phai Hodgkin te bao B.<br />
- Benh ly nao chat trang da o tien trien.<br />
<strong><em>Chan doan lam sang giai doan IV o tre < 18 thang khong co xet nghiem virus hoc</em></strong><br />
Tre co huyet thanh HIV (+) va co ≥ 2 benh chi diem sau day:<br />
- Nam candida hong.<br />
- Viem phoi nang.<br />
- Suy mon/suy dinh duong nang.<br />
- Nhiem khuan huyet nang.<br />
------------------------------<br />
* Can nang rat thap so voi lua tuoi.<br />
** Lao co the xuat hien voi bat cu so TCD4 nao. Can xem xet ty le % TCD4, neu co.<br />
*** Trong luong co the rat thap hoac suy mon nang co the nhin thay hoac phu ca hai chan.
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<span style="color:#0000cd;"><strong>PHAN LOAI MIEN DICH O TRE NHIEM HIV TREN CO SO</strong><br />
<strong>SO TE BAO LYMPHO TCD4 VA TY LE LYMPHO THEO LUA TUOI</strong><br />
</span><br />
<table align="center" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td rowspan="2" style="width:248px;">
<strong>Phan loai mien dich</strong></td>
<td colspan="3" style="width:366px;">
<strong>TCD4 + (so te bao/mL va ty le te bao lympho)</strong><br />
<strong>theo tuoi</strong></td>
</tr>
<tr>
<td style="width:122px;">
<12 thang</td>
<td style="width:122px;">
1-5 nam</td>
<td style="width:122px;">
6-12 nam</td>
</tr>
<tr>
<td style="width:248px;">
Khong co bang chung cua uc che mien dich</td>
<td style="width:122px;">
<u>></u>1500 (<u>></u>25%)</td>
<td style="width:122px;">
<u>></u>1000 (<u>></u>25%)</td>
<td style="width:122px;">
<u>></u>500 (<u>></u>25%)</td>
</tr>
<tr>
<td style="width:248px;">
Uc che mien dich trung binh</td>
<td style="width:122px;">
750 - 1499<br />
(15-24%)</td>
<td style="width:122px;">
500 - 999<br />
(15-24%)</td>
<td style="width:122px;">
200 - 499<br />
(15-24%)</td>
</tr>
<tr>
<td style="width:248px;">
Uc che mien dich nghiem trong</td>
<td style="width:122px;">
<750 (<15%)</td>
<td style="width:122px;">
<500 (<15%)</td>
<td style="width:122px;">
<200 (<15%)</td>
</tr>
</tbody>
</table>
<div style="clear:both;">
</div>
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<span style="color:#0000cd;"><span style="font-size:20px;"><strong>TU VAN SONG KHOE MANH CHO NGUOI NHIEM HIV/AIDS</strong></span></span><br />
<strong><em><u>Hoat dong hang ngay:</u></em></strong><br />
<em>- </em>Giu ve sinh tot, rua tay thuong xuyen bang xa phong va nuoc.<br />
- Rua tay ky sau khi tiep xuc voi thit song, sau tiep xuc voi dat khi lam vuon, trong trot.<br />
- Tranh don rua phan meo, phan chim; tranh tiep xuc truc tiep voi phan nguoi. Tranh tiep xuc voi meo va cac loai bo sat.<br />
- Tranh boi loi trong cac ao ho, be boi, song, bien… co o nhiem phan va chat thai cua nguoi va dong vat.<br />
<strong><em><u>An uong:</u></em></strong><br />
- Uong nuoc da dun soi (trong 1 phut), hoac nuoc dong chai; nuoc lam da cung phai la nuoc da dun soi hoac dong chai.<br />
- Khong an trung, thit gia cam, cac loai thit khac, ca, do hai san.. con song hoac chua duoc nau chin ky va cac san pham sua chua duoc tiet trung.<br />
- Doi voi cac loai rau va hoa qua tuoi khong the got vo, phai rua that sach truoc khi dung.<br />
<strong><em><u>Song khoe manh:</u></em></strong><br />
- Khong hut thuoc, hoac khong bo duoc thi cung giam so thuoc hut.<br />
- Khi co quan he tinh duc phai su dung bao cao su; su dung dung cach va ngay tu dau. ap dung cac bien phap tranh thai de ngan ngua co thai ngoai y muon.<br />
- Tranh tiep xuc voi nhung nguoi co trieu chung ho va nhung nguoi bi thuy dau hoac gioi leo (zona).<br />
-
<span style="color:#0000cd;"><strong>CAC BENH NHIEM TRUNG THUONG GAP O BENH NHAN HIV</strong><br />
<strong>THEO SO TE BAO TCD4</strong><br />
</span><br />
<table align="center" border="1" cellpadding="0" cellspacing="0" style="width:768px;" width="100%">
<tbody>
<tr>
<td style="width:222px;">
TCD4 > 500 te bao/mm3</td>
<td style="width:515px;">
Hoi chung nhiem retrovirus cap<br />
Cac benh nhiem trung thuong gap trong cong dong<br />
Viem am dao do Candida<br />
Benh ly hach keo dai toan than<br />
Viem mang nao nuoc trong do HIV<br />
Nhiem Salmonella<br />
Giang mai<br />
Viem noi tam mac (dac biet o nguoi tiem chich, do tu cau)</td>
</tr>
<tr>
<td style="width:222px;">
500-200 te bao/mm3</td>
<td style="width:515px;">
Viem phoi do phe cau va cac vi khuan khac<br />
Lao phoi<br />
Zona (Herpes zoster)<br />
Benh nhiem nam hong-thuc quan<br />
Tieu chay cap tinh do Cryptosporidia<br />
Sarcoma Kaposi<br />
Bach san dang long o mieng*<br />
U mach truc khuan (<em>Bartonella henselae </em>hoac <em>B.quintana)</em><br />
Sot do HIV<br />
Ung thu trong bieu mo co tu cung va ung thu co tu cung*<br />
Viem phoi ke xam nhiem te bao lympho*</td>
</tr>
<tr>
<td style="width:222px;">
< 200 te bao/mm3</td>
<td style="width:515px;">
Viem phoi do <em>P.jiroveci</em><br />
Benh nhiem nam Hisstoplasma lan toa<br />
Benh nhiem nam Coccidioido lan toa<br />
Lao ke/ngoai phoi<br />
Benh ly nao chat trang da o tien trien*<br />
U lympho non-Hodgkin*<br />
Nhiem Nocardia<br />
Suy mon</td>
</tr>
<tr>
<td style="width:222px;">
< 100 te bao/mm3</td>
<td style="width:515px;">
Nhiem Herpes simplex lan toa<br />
Nhiem Toxoplasma<br />
Nhiem Cryptococcosis<br />
Tieu chay man tinh do Cryptosporidia<br />
Tieu chay man tinh do Microsporidia<br />
Viem thuc quan do Candida<br />
Nhiem Leishmania noi tang</td>
</tr>
<tr>
<td style="width:222px;">
< 50 te bao/mm3</td>
<td style="width:515px;">
Nhiem <em>Penicillium marneffei </em>lan toa<br />
Nhiem phuc hop Mycobacterium avium va cac mycobacteria khac lan toa (<em>M.kansasii, M.haemophilum, M.fortuitum, v.v.</em>)<br />
Nhiem Cytomegalovirus lan toa<br />
U lympho He Than kinh Trung uong*</td>
</tr>
</tbody>
</table>
<div style="clear:both;">
</div>
# O moi giai doan suy giam mien dich se xuat hien nhung benh nhiem trung co hoi nhat dinh <strong><em><u>cong </u></em></strong><strong><em><u>voi</u></em></strong>nhung benh cua nhung giai doan mien dich truoc do.<br />
* Nhung benh u nay co lien quan den nhiem mot so loai virus nhu Epstain-Barr, virus Herpes-8, virus JC…<br />
<div>
</div>
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<span style="font-size: 20px;"><span style="color: rgb(0, 0, 205);"><strong>AC DUNG PHU CUA CAC THUOC DUNG DE DIEU TRI</strong><br />
<strong>VA DU PHONG NHIEM TRUNG CO HOI</strong></span></span><br />
<br />
<table align="center" border="1" cellpadding="0" cellspacing="0" style="width: 768px;" width="100%">
<tbody>
<tr>
<td style="width: 161px;">
<strong>Tac dung phu</strong></td>
<td style="width: 576px;">
<strong>Thuoc</strong></td>
</tr>
<tr>
<td style="width: 161px;">
Suy tuy</td>
<td style="width: 576px;">
Cidofovir, dapsone, ganciclovir, pyrimethamine, rifabutin, sulfadiazine, TMP-SMX<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Tieu chay</td>
<td style="width: 576px;">
Atovaquone, clindamycin<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Nhiem doc gan</td>
<td style="width: 576px;">
Clarithromycin, fluconazole, isoniazid, itraconazole, ketonazole, pyrazinamide, rifabutin, rifampin, TMP-SMX<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Nhiem doc than</td>
<td style="width: 576px;">
Amphotericin B, cidofovir, foscarnet, pentamidine, acyclovir lieu cao<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Anh huong den mat</td>
<td style="width: 576px;">
Cidofovir, ethambutol, rifabutin<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Viem tuy</td>
<td style="width: 576px;">
Pentamidine, TMP-SMX<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Viem than kinh ngoai vi</td>
<td style="width: 576px;">
Isoniazid<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Nhiem doc than kinh</td>
<td style="width: 576px;">
Acyclovir (lieu cao), quinolones<br />
</td>
</tr>
<tr>
<td style="width: 161px;">
Man ngua da</td>
<td style="width: 576px;">
Atovaquone, dapsone, pyrimethamine, sulfadiazine, TMP-SMX, ribavirin<br />
</td>
</tr>
</tbody>
</table>
<br />
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<b style="color: rgb(17, 17, 17); font-family: sans-serif, Helvetica, Arial; font-size: 12px; text-align: center; background-color: rgb(226, 237, 205);"><span style="color:#0000cd;"><span style="font-size: 10pt; font-family: arial;"><span style="font-size:22px;">CAC THUOC <span style="text-transform: uppercase;">ARV</span> CHO TRE EM</span></span></span></b><br />
<br />
<br />
<div>
<table border="0" cellpadding="0" cellspacing="0" style="width:768px;" width="100%">
<tbody>
<tr>
<td style="width:108px;">
<strong>Ten thuoc</strong></td>
<td style="width:141px;">
<strong>Dang thuoc</strong></td>
<td style="width:257px;">
<strong>Lieu luong va cach su dung</strong></td>
<td style="width:201px;">
<strong>Ghi chu</strong></td>
</tr>
<tr>
<td colspan="4" style="width:753px;">
<strong><em>1. Cac thuoc Nucleozid uc che men sao chep nguoc (NRTI)</em></strong></td>
</tr>
<tr>
<td style="width:108px;height:105px;">
Zidovudine (ZDV)</td>
<td style="width:141px;height:105px;">
Siro 10mg/ml<br />
<br />
Vien nang: (co the boc roi va pha bot thuoc voi nuoc hoac thuc an) 100mg, 250mg<br />
<br />
Vien: 300mg (co the chia nho va tan thanh bot)</td>
<td style="width:257px;height:105px;">
Tre duoi 4 tuan tuoi : 4mg/kg/lieu x 2 lan/ngay<br />
<br />
Tre tu 4 tuan tuoi toi duoi 13 tuoi: 180mg/m2/lieu x 2 lan/ngay<br />
<br />
Lieu cao nhat<br />
<br />
symbol 179 \f "Symbol" \s 9³ 13 tuoi: 300mg/lieu x 2 lan/ngay</td>
<td style="width:201px;height:105px;">
- Khong ket hop voi d4T<br />
<br />
- Bao quan o lo mau<br />
<br />
- Co the dung cung thuc an</td>
</tr>
<tr>
<td style="width:108px;height:96px;">
Lamivudine (3TC)</td>
<td style="width:141px;height:96px;">
Siro 10mg/ml<br />
<br />
Vien 150mg</td>
<td style="width:257px;height:96px;">
Tre duoi 1 thang : 2mg/kg/lieu x 2 lan/ngay<br />
<br />
Tre tren 1 thang va tre lon < 60kg : 4mg/kg/lieu x 2 lan/ngay<br />
<br />
Lieu toi da : 150mg x 2 lan/ngay cho tre > 60kg</td>
<td style="width:201px;height:96px;">
- Co the dung cung thuc an<br />
<br />
- Bao quan thuoc dang siro o nhiet do phong va su dung trong vong 1 thang sau khi mo nap.</td>
</tr>
<tr>
<td style="width:108px;">
Vien ket hop ZDV va 3TC</td>
<td style="width:141px;">
Khong co dang siro<br />
<br />
Vien: 300mg ZDV + 150mg 3TC</td>
<td style="width:257px;">
Tre > 13 tuoi hoac > 60kg: 1 vien x 2 lan/ngay</td>
<td style="width:201px;">
</td>
</tr>
<tr>
<td style="width:108px;height:138px;">
Stavudine (d4T)</td>
<td style="width:141px;height:138px;">
Dung dich uong 1mg/kg<br />
<br />
Vien nang 15mg, 20mg,<br />
<br />
30mg, 40mg</td>
<td style="width:257px;height:138px;">
- Tre < 30kg: 1mg/kg x 2 lan/ngay<br />
<br />
- 30 - 60kg: 30mg x 2 lan/ngay<br />
<br />
Lieu toi da cho tre ³ 60kg: 40mg x 2 lan/ngay</td>
<td style="width:201px;height:138px;">
Khong ket hop voi AZT<br />
<br />
Bao quan siro trong tu lanh; co the su dung trong vong 30 ngay. Can lac deu truoc khi uong. Dung trong chai bang thuy tinh.<br />
<br />
Co the mo vien nang va pha voi mot luong nho thuc an hoac nuoc.</td>
</tr>
<tr>
<td style="width:108px;height:63px;">
<br clear="all" />
Vien ket hop lieu co dinh d4T va 3TC</td>
<td style="width:141px;height:63px;">
Khong co dang siro<br />
<br />
Vien:30mg d4T+150mg3TC<br />
<br />
Vien: 40mgd4t+150mg3TC</td>
<td style="width:257px;height:63px;">
Danh cho tre lon<br />
<br />
Lieu toi da: 30-60kg – 1 vien 30mg d4T x 2 lan/ngay<br />
<br />
>60kg - 1 vien 40mg d4T x 2 lan/ngay</td>
<td style="width:201px;height:63px;">
Khong chia nho vien thuoc</td>
</tr>
<tr>
<td style="width:108px;height:128px;">
Didanosine (ddI)</td>
<td style="width:141px;height:128px;">
Dung dich hoac bot cho tre<br />
<br />
em 10mg/ml<br />
<br />
Vien co the nhai duoc 25, 50, 100, 150 va 200mg<br />
<br />
Vien boc: 125, 200, 250, 400 mg</td>
<td style="width:257px;height:128px;">
Tre 2 tuan den 3 thang tuoi: 50mg/m2/lieu x 2 lan/ngay<br />
<br />
Tu 3 thang - 13 tuoi : 90-120mg/m2/lieu x 2 lan/ngay<br />
<br />
Toi da: 200mg/lieu x 2 lan/ngay (cho tre > 60kg)</td>
<td style="width:201px;height:128px;">
Giu dang thuoc dung dich trong tu lanh; co the giu trong 30 ngay. Lac deu truoc khi su dung.<br />
<br />
Uong luc doi (30 phut truoc hoac 2 gio sau khi an)<br />
<br />
Dang vien boc co the mo va tron voi mot luong nho thuc an</td>
</tr>
<tr>
<td style="width:108px;height:63px;">
Abacavir (ABC)</td>
<td style="width:141px;height:63px;">
Siro 20mg/ml<br />
<br />
Vien: 300mg</td>
<td style="width:257px;height:63px;">
Tre < 16 tuoi hoac < 37,5kg: 8mg/kg/lieu x 2 lan/ngay<br />
<br />
Tre > 16 tuoi hoac > 37,5kg: 300 mg/lieu x 2 lan/ngay</td>
<td rowspan="2" style="width:201px;height:63px;">
Co the giam vien ABC va tron voi mot luong nho nuoc hoac thuc an va dung ngay.<br />
<br />
Can thong bao truoc ve su qua man cam truoc khi dung ABC. Neu benh nhan bi di ung, phai dung han ABC.</td>
</tr>
<tr>
<td style="width:108px;height:63px;">
Vien ket hop san lieu co dinh ZDV + 3TC + ABC</td>
<td style="width:141px;height:63px;">
Vien chua 300mg ZDV +<br />
<br />
150mg 3TC + 300mg ABC</td>
<td style="width:257px;height:63px;">
Tre tren 40kg: 1 vien x 2 lan/ngay</td>
</tr>
<tr>
<td colspan="4" style="width:753px;">
<strong><em>2. Thuoc uc che men sao chep nguoc Non-nucleoside (NNRTI)</em></strong></td>
</tr>
<tr>
<td style="width:108px;height:169px;">
Nevirapine (NVP)</td>
<td style="width:141px;height:169px;">
Siro10mg/ml<br />
<br />
Vien: 200mg (co the chia nho hoac giam nat)</td>
<td style="width:257px;height:169px;">
- Tre tu 15 - 30 ngay tuoi: 5mg/kg/ngay trong 2 tuan sau do 120mg/m2 x 2 lan/ngay trong 2 tuan, sau do 200 mg/m2 x 2 lan/ngay<br />
<br />
- Tre tren 30 ngay den 13 tuoi: 120mg/m2 x 1 lan/ngay trong 2 tuan sau do 120-200mg/m2 x 2 lan/ngay<br />
<br />
- Lieu toi da 200mg/ngay trong 2 tuan, sau do 200mg/lieu x 2 lan/ngay</td>
<td style="width:201px;height:169px;">
Tranh dung voi rifamycin<br />
<br />
Bao quan o nhiet do phong. Lac truoc khi dung.<br />
<br />
Can bao truoc cho cha me tre ve tac dung phu gay phat ban cua thuoc</td>
</tr>
<tr>
<td style="width:108px;height:96px;">
Efavirenz (EFZ)</td>
<td style="width:141px;height:96px;">
Siro 30mg/ml<br />
<br />
Vien nang (co the be va chia nho lieu) 50, 100 va 200mg</td>
<td style="width:257px;height:96px;">
- Lieu toi da: 600mg mot lan/ngay<br />
<br />
Ttre tren 3 tuoi: vien nang hoac nhu dich<br />
<br />
10 - 15kg : 200mg (270mg = 9ml)/ngay<br />
<br />
15 - 20kg : 250mg (300mg = 10ml)/ngay<br />
<br />
20 - 25kg : 300mg (360mg = 12ml)/ngay<br />
<br />
25 - 33kg : 350mg (450mg = 15ml)/ngay<br />
<br />
33 - 40kg : 400mg (510mg = 17ml)/ngay<br />
<br />
</td>
<td style="width:201px;height:96px;">
Thuong thay chong mat, co nhung giac mo khung khiep. <br />
<br />
Khong dung cho tre < 3 tuoi<br />
<br />
Tot nhat cho uong luc di ngu</td>
</tr>
<tr>
<td colspan="4" style="width:753px;">
<strong><em>3. Cac thuoc uc che Protease (PI)</em></strong></td>
</tr>
<tr>
<td style="width:108px;height:108px;">
Nelfinavir (NFV)</td>
<td style="width:141px;height:108px;">
Bot hoa nuoc 200mg/5ml<br />
<br />
(50mg trong 1,25ml)<br />
<br />
Vien 250mg - co the be ra<br />
<br />
pha voi nuoc hoac tron voi thuc an</td>
<td style="width:257px;height:108px;">
- Duoi 1 tuoi : 50mg/kg x 3 lan/ngay<br />
<br />
&n bsp; hoac 75mg/kg x 2 lan/ngay<br />
<br />
- Tu 1 den 13 tuoi: 55 - 60mg/kg x 2 lan/ngay</td>
<td style="width:201px;height:108px;">
- Tre duoi 1 tuoi can dung lieu cao hon.<br />
<br />
- Khong uong voi cac chat chua (co vi dang)<br />
<br />
- Vien thuoc be de chia lieu. Dung trong bua an</td>
</tr>
<tr>
<td style="width:108px;height:185px;">
Lopinavir/Ritonavir<br />
<br />
&n bsp; (LPV/r)</td>
<td style="width:141px;height:185px;">
Siro: LPV 80mg/ml<br />
<br />
+ RTV 20mg/ml<br />
<br />
Vien nang: LPV 133,3mg RTV 33,3mg (khong duoc be hoac chia nho vien thuoc)</td>
<td style="width:257px;height:185px;">
- 6 thang - 13 tuoi: LPV 225mg/m2 + RTV 57,5mg/m2 x 2 lan/ngay hoac tinh lieu theo can nang<br />
<br />
- Tu 7 - 15kg: LPV 12mg/kg + RTV 3mg/kg x 2 lan/ngay<br />
<br />
- Tu 15 - 40 kg: LPV 10mg/kg + TTV 25mg/kg x 2 lan/ngay<br />
<br />
- Lieu toi da:<br />
<br />
Tre > 40kg: LPV 400mg RTV 100mg (3 vien nang hoac 5ml) x 2 lan/ngay</td>
<td style="width:201px;height:185px;">
Nhu dich va vien nang can duoc bao quan trong tu lanh. Co the giu o nhiet do < 25oC toi 2 thang. Neu nhiet do > 25oC, thuoc nhanh hong hon.<br />
<br />
Dung trong bua an<br />
<br />
Tuong tac voi nhieu thuoc</td>
</tr>
</tbody>
</table>
<div style="clear:both;">
</div>
</div>
<br />
-
<span style="color:#0000cd;"><span style="font-size:22px;"><strong>TUONG TAC CUA CAC THUOC ARV</strong></span></span><br />
<br />
<table align="center" border="1" cellpadding="0" cellspacing="0" style="width:768px;" width="100%">
<tbody>
<tr>
<td style="width:110px;">
<strong>Thuoc khang retrovirus</strong></td>
<td style="width:100px;">
<strong>Cac thuoc tuong tac</strong></td>
<td style="width:268px;">
<strong>Co che/Tac dung</strong></td>
<td style="width:229px;">
<strong>Khuyen nghi</strong></td>
</tr>
<tr>
<td style="width:110px;">
LPV/r</td>
<td style="width:100px;">
Clarithromycin</td>
<td style="width:268px;">
uc che chuyen hoa - nong do clarithromycin tang</td>
<td style="width:229px;">
Chi dieu chinh lieu clarithromycin khi co suy than.</td>
</tr>
<tr>
<td style="width:110px;">
EFV, NVP</td>
<td style="width:100px;">
Clarithromycin</td>
<td style="width:268px;">
Kich thich chuyen hoa - giam nong do clarithromycin</td>
<td style="width:229px;">
Hieu qua dieu tri va du phong MAC co the bi giam, can theo doi sat.</td>
</tr>
<tr>
<td style="width:110px;">
EFV</td>
<td style="width:100px;">
Rifabutin</td>
<td style="width:268px;">
Kich thich chuyen hoa, giam dang ke nong do rifabutin/ Muc efavirenz co the giam</td>
<td style="width:229px;">
Tang lieu rifabutin len 450-600 mg hang ngay hoac 600 mg hai lan trong 1 tuan.<br />
Khong can thiet thay doi lieu efavirenz.</td>
</tr>
<tr>
<td style="width:110px;">
ddI</td>
<td style="width:100px;">
Gancyclovir</td>
<td style="width:268px;">
Muc ddI tang gan 100%</td>
<td style="width:229px;">
Theo doi tac dung phu lien quan den ddI</td>
</tr>
<tr>
<td style="width:110px;">
LPV/r</td>
<td style="width:100px;">
Ketoconazole</td>
<td style="width:268px;">
uc che chuyen hoa, nong do ketoconazole tang</td>
<td style="width:229px;">
Su dung than trong voi lieu ketoconazole > 200 mg/ngay</td>
</tr>
<tr>
<td style="width:110px;">
ddI</td>
<td style="width:100px;">
Khang sinh quinolone</td>
<td style="width:268px;">
Su ion duong hoa lam giam dang ke nong do cac thuoc quinolone</td>
<td style="width:229px;">
Su dung cac thuoc co dien tich duong it nhat 2 gio sau khi uong quinolone. </td>
</tr>
<tr>
<td style="width:110px;">
DLV</td>
<td style="width:100px;">
Rifabutin</td>
<td style="width:268px;">
Kich thich chuyen hoa, giam dang ke nong do delavirdine</td>
<td style="width:229px;">
Tranh su dung dong thoi hai loai thuoc nay</td>
</tr>
<tr>
<td style="width:110px;">
RTV, LPV/r, SQV/r, IDV, NFV, APV</td>
<td style="width:100px;">
Rifabutin</td>
<td style="width:268px;">
uc che chuyen hoa, tang dang ke nong do rifabutin/ Kich thich chuyen hoa, nong do saquinavir co the giam</td>
<td style="width:229px;">
Giam rifabutin xuong 150 mg cach ngay hoac 3 lan mot tuan.<br />
Can nhac tang lieu indinavir len 1000mg 8 gio mot lan neu day la thuoc PI duy nhat; khong thay doi lieu cua cac thuoc PI khac</td>
</tr>
<tr>
<td style="width:110px;">
NVP, APV, DLV, IDV, LPV/r, NFV, SQV</td>
<td style="width:100px;">
Rifamycin</td>
<td style="width:268px;">
Kich thich chuyen hoa, giam dang ke nong do NVP, cac thuoc uc che protease hoac nong do delavirdine</td>
<td style="width:229px;">
Tranh su dung dong thoi cac thuoc nay</td>
</tr>
<tr>
<td style="width:110px;">
EFV, RTV, SQV/r, NVP</td>
<td style="width:100px;">
Rifamycin</td>
<td style="width:268px;">
Kich thich chuyen hoa, giam muc cac thuoc uc che protease hoac nevirapine</td>
<td style="width:229px;">
Co the dung ket hop.<br />
Can nhac tang lieu efavirenz len 800mg/ngay khi su dung voi rifamycin.</td>
</tr>
<tr>
<td style="width:110px;">
d4T, NVP, EFV, RTV, SQV, NFV, LPV</td>
<td style="width:100px;">
Methadone</td>
<td style="width:268px;">
Giam nong do methadone</td>
<td style="width:229px;">
Chu y hoi chung cai nghien; co the phai tang lieu methadone</td>
</tr>
<tr>
<td style="width:110px;">
IDV, ATV</td>
<td style="width:100px;">
Cac thuoc tranh thai Norethindrone, Ethinyl estradiol</td>
<td style="width:268px;">
Tang nong do cac thuoc tranh thai</td>
<td style="width:229px;">
Khong can dieu chinh lieu cac thuoc tranh thai</td>
</tr>
<tr>
<td style="width:110px;">
NVP, RTV, NFV, APV, LPV</td>
<td style="width:100px;">
Ethyl estradiol</td>
<td style="width:268px;">
Giam dang ke nong do Ethyl estradiol</td>
<td style="width:229px;">
Su dung bien phap tranh thai thay the hoac ho tro.</td>
</tr>
<tr>
<td style="width:110px;">
ddI</td>
<td style="width:100px;">
TDF</td>
<td style="width:268px;">
Nong do ddI tang</td>
<td style="width:229px;">
Giam lieu ddI xuong 250mg moi ngay</td>
</tr>
<tr>
<td style="width:110px;">
IDV, SQV va mot so thuoc ARV khac</td>
<td style="width:100px;">
Carbamazepine Phenobarbitol, Phenytoin</td>
<td style="width:268px;">
Giam nong do IDV, SQV va mot so thuoc ARV khac</td>
<td style="width:229px;">
Than trong khi dung dong thoi, xem xet dung thuoc ARV thay the; theo doi tac dung cua cac thuoc chong co giat.</td>
</tr>
</tbody>
</table>
<div style="clear:both;">
</div>
<br />