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Наказ №887 «Про затвердження змін до Клінічного протоколу антиретровірусної терапії ВІЛ-інфекції у дорослих та підлітків»

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Наказ МОЗ України №887 від 22.12.2015 року «Про затвердження змін до Клінічного протоколу антиретровірусної терапії ВІЛ-інфекції у дорослих та підлітків»

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Наказ №887 «Про затвердження змін до Клінічного протоколу антиретровірусної терапії ВІЛ-інфекції у дорослих та підлітків»

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  4. 4. penxceimsi Heramsnnx acninxizz po3Bim<y pezncrenmocri B1JI'ra Bl" B (All); — nauiemn 3 Ba)KKHMId HCl3p0Jl0I'lHHHMld a6o Hefipoxorn maunmn nopyuienmmn; — nauiemu is 3JI05IKlCHHMH BUI- accouiosaimmu noaoynsopenmmm; - l'laI. Il€HTl/ I 3 BHCOKI/ [M accouioaarmmn Ta e BN1- 3 KlJIbKlC'I'1< . . Hepeirrn i pu3m<i ' mis Wpena; Hauieum, mci I‘IO‘lI/ lHa}0'1‘b APT, noammi npnfimam _penapa, pO3yMl'I'H ii’ MO>KJIHBlCTb He-ofixinuicr , 3a>Knm3ic'rz. np| nxmrsHoc'ri. o Bmismu Ta ycynyru no notiancy niicynaumz (nonaroic l, nonarox 2) Binnoeinno no pei<oMe " - , policy on collab rative TB/ l-fl V activities: Guidelines for national programmes and other stakehold Section C.5, page 29): Hpn rm»t6oi<ii7i imyuocynpecii (CD4 TB/ BUI cm'n’po3not1aTn APT '~{€p€3 2 'rH>i<H nixyaamm». 5) Hinnyi-ucr 5.2.1. «Flepesam i pusnxu noviancy APT y 6e3ci4MnToM1mx nauieirris 3 KlJIbKlCTl nimcboumis 6inLu1e 500 KJ1l'I‘HH/ MKII -I]lM(l)0l1H’I‘lB< 50 Kn/ Mxn) nauici Tam 3 i nicnsz notiarxy npo'rHTy6ep‘i<yn a>K6HH$l iMynHoi' CHCT6MH; — ’3HH>K€Hl-I51 pH3m<y BIJ1— " acoumoaannx yCl<JIa11HCHb, x ' npn KlIlbKOC'I‘l CD4-niMd>oun' ' Hexon>i<KiHcbi<oi' nirmjoomn, capxowi Kanouii, acouifioisaimx 3 naninomaaipycom monmm, J1 nopytueub Kornimmmx (by: -umifi;
  5. 5. — 31111>1<e1-11151 pnauxy Heonoprynicrnqimx CTaI-ITB, 13 TOM)’ tmcni cepue13o- cynnnnux 3ax1aop1o13aH1>, 3ax13op1o13aH1. 1mpo1<, neL1i111<1z1, He aconifio annx 3i 3HTrT)KeHH5T p143m<y nepenalii BUT Bin i11q1i1<oBa11o'1' oco611, 1110 Mac no311’r111sm1i1 nnmna Ha rpomancbxe 3110p0B’;1. lTo're11ui1"1Hi p113m<14 paHHb0T‘O noqaricy ni yuanwi: — p03BHTOK Ta cymauix I'TO5l‘-IHHX peaKui171 i 'ro1<cw111oc'ri y 3lFa’5I3Ky 3 npm‘/1oMoM APB—npenapaTiB Ta inumx 11eo6xinHix nixapcmcnx 3aco6i13; — pozizmoic pe3ncTe1m-1oc'ri BUT no a1m1pe1‘po13ipyc111»1x . r1i1<apcb1<11 3aco6i13 y 3B’>131<y 3 HCTTOBHOTO cynpecieio Bipycy, [no npH311onM'rb no 3M€HT1TCHlT}T)l(BTp’cT’T‘T-T) Tepaneimmuoro B116opy y Ma1716y'rHboMy; — Meiituxm r1poMi>1<o1< '~T. '.TCy TIJUI nauiema, 11106 ni311aT1»1c11_npo BUT T8 —- nepenqacne 3ac'rocyr121Hm1 1111<y13a1-um no po3po61c14 Ta ITOC'[‘>'T'Ty no ecl)e1<'r11BHi1u11x, Me11u.1 'ro1<c1«1l11mx Ta/ a6o Kpaluc 131113t1eH1«1x 1<0M6i11a11iT’1 APB- TTPCTTBPETTTB; _ nepenatia pe311cTe'r11oro Bipycy Bin nauiemita, y mcnx He ITlI1TpTdMyC'l‘b >1 noena aipycna cynpecin». 2. ITyH1<T l 1.2 po3niny T 1 imicnacm y Ta1<i1Z pena1<L1ii': «11.2. }T1<u1o TTp0'I‘5TT‘OM 13ariTHocTi >1<i111<a oTpnMyBa.11a APT 3 MCTOK) pimemni npo npono13>1<e1111s1 APT Mae Bpaxosyisam ITO'1‘0‘THHT7T 11o1<a311111< Kl T: KOCTl CD4-niMtj1ou11TiB Ta iioro n1«111aMi1<y, BH BUT, a Ta1<o>1< 6a>1<a11m1 na ie1m<n npono11>1<y1saT11 APT Ta y3ron>1<y1saT11cs1 3 no1<a3a1111$1M11 no APT. }l1<1uo np111”111;11‘o piiuemui Luono np1m11HeI11151 APT, yci npenapam CXCMH Bl11MlT-TIOTO'T'bC}T on11o, t1ac11o. Cnin 3ay3a>1<1«m«1, TLLO Ol'TTPTMaJIbHOTO crparerieio nnsi 36epe>1<eHH;1 3nopoB’s1 >1<i1H1<11 Ta npo<biI1a1<1:111<1»1 nepenaqi BUT, c 6e3nepep1311e npono13>1<eHH;1 APT nicmi TTOJTOFlB Ta 13 T'lO11aJIT: l1TOMy, He3ane>1<Ho Bin 1<i. r11.1<oc‘ri CD4-J1iM<l, >ou11Ti13 11a notizmcy APT». ‘ 3. T) Y po3ni11i X11 2163111111 nisa, Tpn, L1o'r1»1p11 y ninn_v111<1‘i 12.6.1 ny111<'1‘y 12.6 11111<n21c'm y '1‘a1<i1“4 pena1<11ii': «YciM nauieHTaM, >11<i 0£l, lTO‘T£1CHO l'T0'I‘pe6yTOTb i APT, i ni1<yBaH1u1 r'e11a'r Ty B, cnin np1»1311at1aTn Tenocponipy nmonpoxcnn 13 cnonyqenni 3 namiaynpmoill ITauiemaM 3a HEIHBI-TOCTl no1<a3aHb no ni1<y13aHH;1 renarm-y B cal; TTpPT3Ha'-Ta'I‘PT APT, Hc3ane>1n1o Bin l<lT1bKOCTl CD4-JllM(bOL1HTlB, i3 131<J110t1e1111;1lM no cxeM11 npenaparin 3 non13i1"1H_o1o a1<1‘m111icT1o npoT1«1.BT‘B Ta BUT. Y ne511<1»1x minanicax 3 MBTOTO ni1<y1sam«1s1 BFB-iHd>e1<L1ii' 3acToco13yem. c;1 CTl€Lll»T(l)l‘{Ha Tepanisi i3 Bm<op14cTa11H;1M Ten6i13ynn11y a6o ane(T1o13ipy 011H0‘TaQHO 3 11ane>1<11o1o cxeMo1o APT. E11Te1<a13ip cnin 13m<op11cTo5yna'r11 nmue y noennaniii i3
  6. 6. 1<oM6iHoBaHo1o APT, ocxinsxu Monorepanix iuaunxo 3)’MOBJT10€ poaamtax Myrauii Ml84V, Lno 'ra1<o>1< 3)’MOBJlT0€ p€3PTCTCHTHlC'I‘I> no naMi13ynHHy Ta eM'I’pHLT Ta6i11y». ' 2). A63anH nsa, Tpn, tiompn y ninnymcri 12.6.2. nyH1<ry 12.6 1T11<. r1acT1»1 y 'ra1(111 penaxuu: «YciM rIaui€H'raM 3 K0-iHcbe1<ui€1o BFC/ BUT APT Mae np1«1311a11f1T11cs1 npu xinmcocri CD4-J1iM¢1o1111TiB <S00 1<.11i'r11H/ M1<11, He3a. r1e>1<Ho Bin I-Ta51BHOC'T‘l CHMTTTOMTB. ,T_Ioni111.H11M e pe1<oMe11ny1aaTH no11a1‘o1< APT nauie11'raM 3 1<o-l11(11e1<11ic1o BFC/ BUT 171 npn 1<inm<ocTi CD4—11iMcpo1111ri13 >500 KITTTHH/ MKJT. ITp11 x o11it1HoMy rer1aT11T1 C, 3a T-TEISTBHOCTT BinnoBinH11x no1<a3aH1., cnin npononnrn 1<oll16iHo12aHy npoT1«11aipycHy Tepani1o Bl"C-iHq)e1<11i'1' i3 3acTocy13aH1151M npenaparia neri 1,o13aHoro iHTepd1epo11y y noenHaHHi 3 p116a13ipnHoM a6o 1<oM6iHo13aHy l'Tp0THT_3lpyCHll/ repaniio BT‘C-i11d)e1<ui'1' i3 3ac1‘ocy13a111111M npoTH11ipyc111-1x 11per1z1pa"ri13 nps1Mo'1' 111'! ’ (TTTTJL). Izinnoninuo no 1<niHiHH11x pc1<oMeHnaui1"1 mono 11i1<y11a11m1 Bl“Cii111]>c1<11i‘1I E(lJC1"T‘T4BHlCTb npoT11nipyc11oi' T€p£11TlT XT'C i3 3aCTOCyBaHH}IM n enapa'ri13 nerinsoaanoro iHTepcpepo11y y noenHa11Hi 3 pn6a13ip1411oM y x13op11x Ha BUT- iHq)e1<ui1o OTITHIOGTBCST y 14-73%, 3a11e>1<Ho Bin reHorHny Ta BH BFC, ecpe THBHTCTL 1'TBT i3 3acTocyBaHH51M TTITII e 31-Ta‘-THO BHUTOIO. T7TMo3ipHic'r1. nocs1rHe111 :1 yciiixy J1i1<y13a11H;1 Bipycnoro rena1‘11"ry C c 13Hu1o1o npu 1311u1oMy no1<a3H111<y 1flJTbKOC'l'l CD4-. r1iM<11on1»1'ri13. ; BHacnino1< 133aeMoni'1' 3 p116aBipHHoM, np11 o11Ho=1ac11oMy up 11eneH11i 11i1<y13aHH>1 BT’C-iHq>e1<11i'1' i3 11111<op11c'ra11H;1M cr1eu11q)iI111o'1' 1<oM6iHo13aHo’ 'repanii' cnin yTp1«1My13a'r11c51 Bin npH3HaqeHHs1 AZT (p03BHTOK a11eMii'), ddT Ta d-1'1" (.11a1<Tau1«1no3). € nani mono a111‘aroHi3My p116a11ip1111y Ta ABC 13 3111 >1<e111111M etl)e1<T111311ocTi APT. Flpn FTBT nipycnoro renaT111'y C i3 sacrocyaanmfim FTITII 1-1eo6xin11o apaxo3y13aT11 11i1<apc1.1<i 133acMonii’ 3 npenaparaism APT». T111pe1<1‘opTIenap1‘aMe1n'y _, ' ’ _. " 5 rpoMancb1coro3nopoB‘n -* ' C. ()d'ra1u1<o 1 l
  7. 7. Hon 1'01: 1 KJITHl'~1HOT‘O nporo ony aimiperposipycnoi "repanii BUT-iHd)e1<ui'1' y no ocnnx Ta ninnirxis (posni 5) Ta6n11L1;12. «I'To1<a3a1111>1 no not1aT1<y APT y I'Tal.1l€H'I‘lB 3 xpo11iHHo1p BUT- lH(‘lDeKL1l€TO 1 0 6ynb-511<e CHT11- (AI); 0 6ynL-s11<e BUT-acoui1?1o13aHe 3ax13op1o13a11H11 a6o c1'a11 (AT); T 0 KUTLKTCTB CD4-JTlM(T)0L11rT'I‘lB M61-11.116 350 KITTTHH/ MTU1 (AT), He3aJ1e>1<11o 13in Ha5TBHOC’l‘l c11MnToMiB; 0 l<U1T>KlCTb CD4-J1lM(l)OL1Td’I‘lB 350-500 KJTTTHH/ MKJ1 (ATI), 11e3ane>1<Ho Bin Ha$1BHOC'I‘l CPTMTTTOMTB; o BaT‘lTHlCTB, He3a. r1e>1<11o Bin Bipyconorittnux, lMyHOJ'TOT‘l‘-THHX a6o 1(JTlHl‘1T1HX T10T<a3HHKlB, 3 Merozo nponenennn npoq11J1a1<r111<11 nepenatn Cm o3noqHHaT“ am- BUT Bin Marepi no n11'r11HH (nam — TTTTBMTI) ‘ (AT) Ta 36epe>1<eHH51 3nopo11’51 >1<i1-1101; o BUT-aco11i1‘»’1o13aHa Hetpponarisfl (AT), np11 6ynL- >11<1«1x paHHix o3Ha1<ax H1»1p1<o13oi'n11cq1y111<ni'1', He3ane>1<11o Bin 1<inm<oc'ri CD4~JTlM(l)OT.1PTTlT3; 0 na11ie1m1 3 1<o-iH(l)e1<uie1o B1313/BUT, 11e3z1J1e '11o 11in KUTBKOCTT CD4-niM(l>ou1«11"i13, ix 321c'roc))’l3aHH51M J1i1<apcb1<11x 3aco6iB 3 nonaiiinoio a1<Tn1aHicT1o nporn BUT Ta BF B (AT1); o na11ic1m1 3 1<o—i1~1(pe1<11ic1o BFC/ BUT, He3ane>1<Ho Bin 11211111110011 u11po3y nel1iH1<11, >11<i or HM TOTI: ni1< Bax-111:1 131 more renam iunmcaropiie 3axBop1o13aHHs1 . ' nepeaaxmo nnn xaopmx acppo—aMepm<aucbxoro noxonmeuun: 21 Cnocrepiraevbcn L1.J8M, [1Ke 3poc1"rm>1 plans: xpeammny; 3), Heqaporwma nport. -m~, pm (>3 r/ no6y); 4). Bviauauanbnvui pieeub BH BIT y nna:1M1. Taxom xapancrepui: HopMan1=Hm'1 apreplanbnmi mcx, 36in1:u1eHi rinepexorermi rm K1/I, aincyrnicm nepmtbepmunmx Haépnxio (ne3aa>1<a1o~m Ha rinoanbéyminemiio); niana cranin B111-1'H¢>e ui'1'i mannxe nporpecyeanrm no TepMiHanbHo1' cranir 1mp1<o13o‘1‘ Henocramocn npornrom 1-4 MlC. ). . -1. mnoai 1<ni111~1Hi npomam: uJK<1> < 60 Mn/ xa. npomrom 6inuu1e 3 MlC. , nporeinypin > 1,5 r/ n‘6y,
  8. 8. Ta >11<HM ni1<y1zaHHs1 aipycnoro r‘enaT11Ty C e 11enocTynH11M, He3ane>1<11o BT11 KlITbKOCTl CD4- niM(poLu«1TiB (BTT); 0 nanicmn 3 13a>1<1<11M11 He13po. r1ori111111M11 a6o He171po1<or11i"r11B1111M11 nopy111e11Hs1M11 (AT), He3aJT6)KHO sin KUILKOCTT CD4-nimdaoumia; 0 nauieum i3 niMcboMo1o Xon>1<1<iHa, acoui171o13aH11M 3 nan11noMa-13ipyco1v1 Ta He BUT- acoui1‘&o13aH11M1«1 BITOHTCTCHHMH 11o13oyT13opeHH;1M11, 11e3a11e>1<11o nin T(lJTI>1(OCTlCD4~. ITlM(TJOTII/ TTTB; 0 flaul€HTH 3 13Hco1<HM p1131«11<oM nepenaqn BUT 13Hacnino1< oco61111uoc'rc1”1 >1<11'1‘1‘s1: mci nepe6y13a1oTs 13 cepon11c1<opnaH'rH11x napax (on11H 3 napT11epi13 e i11(bi1<o13aHHM BUT, 21 npyr111‘«i -111), 3 MCTOTO 3H1»1>1<eH11s1 pn3H1<y nepenaqn BUT npn rerepoceiccyanbmix 1<o11"ra1<Tax (AT), He3ane>1<11o Bin KUTBKOCTT CD4-. r1iM(11ou11TiB; 0 nauicH'1‘11 3 iHLu11x rpyn p113H1<y nepenaqi BUT AIII). 1
  9. 9. T10 a1‘o1< 2 K1111-1iH11oro npo1'o1<o11y aHTP1p6TpOBlpyCT1 1' repanii BUT-iHq1e1<ui'1'yn ocnHx Ta ninniT1<i13 (po3n IT 5) Ta6n11ui 2. TTo1<a3aHH;1 no no'-1aT1<y APT y T'TaT. Tl€H'I‘lB 3 XpOHl‘1HO1O BUT-' iH e1<nie1o T‘TagieHT1»1 3 Pe1<oMeHny13aTH T‘TpTd3Ha'~TeHH}1 APT y Hacrynimx 1s11n n1<a-1;. T”. l KiIIbKiCTIO 0 13Hco1<e B1-T BUT (>100 000 l<OITlT7T/ MIT); . CD4- _ 0 1u13Hn1<e 3lT1d)T(CHH$T KUTLKOCTT CD4-T1lM(l)OTTH'1‘lB (Hl1 120 £1M¢9_lL'L7;| L3 1<11iTHH/ M1<n Ha pix), 1110 f1l11TT3ep11‘/ TCCHO nHoMa . __5lm>_II1_. €__50__0 nocnin>1<eHHs1M11 3 l1T'1‘CpBEUTOM y 14-28 1116; 1 _. _______K“lT”“/ MK“ 0 , nix 1‘1211.1ic111'a nonan 50 p01<i11 (BITT); ,1 l lflflL_"—l‘C-l—'E 0 H£! }TBHlC'T‘b (l1a1<Topi13 pH31»11<y He ac0L1i1”1o13aH11x 3 BUT Elflllflrléfilll 3axnop1o13aH1= (i1ueMiHHa x13opo6a cepnn B aHaMHe3li a6o 1‘9fl’i9l—"~Y——3- B14co1<111i 1<apnioBac1<ym1pHH171 pH3H1< (> 20% y 11ac'ryn11i ' 3a3Ha'-TCHHX 10 po1<iH), 311o>11<ic11i 11o11oy1‘13ope111-111). BHTTTCTC me 1113 APT cnin po3r1oHH11a1‘H 'ra1<o>1< y BClX nauieuria 3 'KTHT3H1dM ’T‘y6€pKyJTbO30M, He3aJ1e>1<Ho 13in KUTbl<0C'I‘l CD4-J1lMLl)0I. ITr1'T‘lB, nicnn no¢11r11eHHs1 3a110BlJTbHOT [T€peHOCHMOCTl ec11e1<TH13Ho'1‘ nporm‘y6ep1<yn1.o3Ho'1’Tepanii. O11'1‘HMa. r1bHH171 Hac r1oL1z1'1‘1<y APT y 6e3cHMm'oM1-111x 1131116111111 3 K CD4-I1lM(lJ01J,1r1TlB 13141116 500 KI1l'l‘HH/ MKJT 0CTaT0‘1HO He 8143118’-TCHO. n1.1<ic'1‘1o 4..

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