Увеличение масштабов применения антиретровирусной

Edtkbxtybt vfcinf,jd ghbvtytybz
fynbhtnhjdbhecyjq nthfgbb d
eckjdbz[ juhfybxtyys[ htcehcjd
Herjdjlcndj gj ghbvtytyb.
vtnjljd j,otcndtyyjuj
plhfdjj[hfytybz
Htp.vt
Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz
Ltgfhnfvtyn DBX#CGBLf
Rkfcnth pljhjdmz ctvmb b j,obys
Lfyyst lkz rfnfkjuf ,b,kbjntrb DJP
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd% Herjdjlcndj gj ghbvtytyb. vtnjljd ujcelfhcndtyyjuj plhfdjj[hfytybz% htp.vt
1& Dtotcndf^ ghbvtyztvst ghjnbd DBX --nthfgtdnbxtcrjt ghbvtytybz
2& Dtotcndf^ ghbvtyztvst ghjnbd DBX --ghbvtytybt b ljpbhjdrf
3& DBX--byatrwbb --vtlbrfvtynjpyjt ktxtybt 4& Ytelfxyjt ktxtybt
5& Uheggf yfctktybz^ gjldthuf.ofzcz hbcre 6& Dphjcksq 7& Ht,tyjr
8& Herjdjlzobt ghbywbgs
ISBN 92 4 454 567 5 (NLM classification: QV 268.5)
Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz ghbdtncndetn pfghjcs yf hfphtitybt
djcghjbpdjlbnm bkb gthtdjlbnm cdjb bplfybz^ xfcnbxyj bkb gjkyjcnm.& Pfzdrb
b pfghjcs cktletn yfghfdkznm gj flhtce% jnltk bplfybq^ Dctvbhyfz jhufybpfwbz
plhfdjj[hfytybz^ CH--1211 :tytdf 27^ Idtqwfhbz& Gj ’njve flhtce vj;tn
,snm gjkextyf cfvfz gjcktlyzz byajhvfwbz j k.,s[ bpvtytybz[ d ntrcnt^
gkfyf[ gj dsgecre yjds[ bplfybq^ f nfr;t ’rptvgkzhs b gthtdjls e;t
bvt.ob[cz bplfybq&
Q Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz^ 2003 ujl
Ge,kbrfwbb Dctvbhyjq jhufybpfwbb plhfdjj[hfytybz gjkmpe.ncz pfobnjq
fdnjhcrb[ ghfd d cjjndtncndbb c gjkj;tybzvb Ghjnjrjkf 2 Dctj,otq rjydtywbb
j, fdnjhcrb[ ghfdf[& Dct ghfdf j[hfyz.ncz&
Egjnht,kztvst j,jpyfxtybz b bpkj;tybt vfnthbfkf d yfcnjzotv bplfybb
yt jpyfxftn dshf;tybz cj cnjhjys Ctrhtnfhbfnf Dctvbhyjq jhufybpfwbb
plhfdjj[hfytybz rfrjuj ,s nj yb ,skj vytybz jnyjcbntkmyj ghfdjdjuj cnfnecf
njq bkb byjq cnhfys^ nthhbnjhbb^ ujhjlf^ hfqjyf bkb b[ dkfcntq^ f nfr;t
jnyjcbntkmyj ltkbvbnfwbb b[ uhfybw&
Egjvbyfybt rjyrhtnys[ rjvgfybq bkb ghjlerwbb jghtltktyys[ ghjbpdjlbntktq
yt jpyfxftn^ xnj jyb gjllth;bdf.ncz bkb htrjvtyle.ncz Dctvbhyjq
jhufybpfwbtq plhfdjj[hfytybz gj chfdytyb. c lheubvb rjvgfybzvb bkb
ghjlerwbtq fyfkjubxyjuj [fhfrnthf^ rjnjhst yt ,skb egjvzyens& Pf
bcrk.xtybtv jib,jr b ghjgecrjd^ yfpdfybz gfntynjdfyys[ njdfhjd gbiencz c
pfukfdyjq ,erds&
Yf,hfyj b jngtxfnfyj dj Ahfywbb
Yfcnjzobq ljrevtyn edbltk cdtn njkmrj ,kfujlfhz exfcnb. d tuj gjlujnjdrt
vyjujxbcktyys[ yfwbjyfkmys[ b vt;leyfhjlys[ ’rcgthnjd^ ghbybvfdib[ exfcnbt
d rjycekmnfwbz[^ htpekmnfnjv rjnjhs[ cnfkf hfphf,jnrf lfyyjuj herjdjlcndf&
Herjdjlcndj
‘Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d
eckjdbz[ juhfybxtyys[ htcehcjd% Herjdjlcndj gj ghbvtytyb. vtnjljd
ujcelfhcndtyyjuj plhfdjj[hfytybz\
gjlujnjdktyj gjl htlfrwbtq%
l-hf Crjnnf {fvvthf (Scott Hammer)^ Rjkev,bqcrbq eybdthcbntn^
Ym.-Qjhr^ CIF^
Ukfdysq htlfrnjh* f nfr;t
l-hf Lbfys Ub,, (Diana Gibb)^ <hbnfycrbq cjdtn gj vtlbwbycrbv bccktljdfybzv^
Kjyljy^ Cjtlbytyyjt Rjhjktdcndj Dtkbrj,hbnfybb b Ctdthyjq Bhkfylbb^
htlfrnjh^ ukfdf gj gtlbfnhbb*
l-hf Lbfys {fdkbh (Diane Havlir)^ Rfkbajhybqcrbq eybdthcbntn^ Cfy-Lbtuj^ CIF^
htlfrnjh^ ukfdf gj cjgencnde.obv byatrwbzv^ cdzpfyysv c DBX*
l-hf Kbyy Vjatycjy (Lynne Mofenson)^ Yfwbjyfkmyst bycnbnens plhfdjj[hfytybz^
Yfwbjyfkmysq bycnbnen j[hfys pljhjdmz ht,tyrf b uevfybnfhyjuj hfpdbnbz^
<tntplf^ CIF htlfrnjh^ ukfdf gj djghjcfv ,thtvtyyjcnb*
l-hf Byuhbl dfy <br (Ingrid Van Beek)^ Cblytq^ Fdcnhfkbz^
htlfrnjh^ ukfdf^ rfcf.ofzcz gjnht,bntktq by]trwbjyys[ yfhrjnbrjd*
l-hf Cntafyj Dtkkf (Stefano Vella)^ Vt;leyfhjlyjt j,otcndj gj CGBLe^
Hbv^ Bnfkbz htlfrnjh^ ukfdf gj rkbybxtcrjve b kf,jhfnjhyjve vjybnjhbyue
ghbvtytybz fynbhtnhjdbhecyjq nthfgbb*
b crjjhlbybhjdfyj%
l-hjv <fpbk Dfhtklpbc (Basil Vareldzis) b l-hjv Qjc Gthhb/yc (Jos Perriëns)^
Jnltk gj DBX#CGBLe^ :tytdf
Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz dshf;ftn nfr;t jcj,e. ghbpyfntkmyjcnm
cktle.obv xktyfv Bplfntkmcrjuj rjvbntnf% Rtyytne Xt,tne^ Vfhre Ls,.ke^
Rfhkj L;frbynj^ "kkb Rfnf,hbf^ Rhbcnbyt Rfnkfvf^ L;by "kb Vfkrby^ L;tqvce
VfrBynfqhe^ Cektqvfye V~<ege^ :fre Vj[,’ne^ L;jqf Ve[thl;b^ Ghfafye
Afyegfre^ Vfehj It[nthe^ Vfhrj Fynjybj lt Fdbkf Dbnjhbf&
Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz ,kfujlfhbn nfr;t pf b[ rjvvtynfhbb
vyjujxbcktyys[ ’rcgthnjd^ drk.xfz% Cepfyye Rhje^ Rtdbyf lt Rjrf^ :fyf
"vvfye’kz^ Xfhkmpf L;bkrcf^ L;& Ujkwf^ L;ekbyf Ujklf^ Uhtuuf Ujycfkmdtcf^
Bfyf Uhe,,f^ Dbyctynf {f,bzv,tht^ {fycf {juthptqkz^ Fhfne Rjxb^ "hbrf dfy
Ghffuf^ C&C& Kb^ Gjkf Yfyyf^ Vfhrf {’hhbyunjyf^ Hj,thnf Cjkbwf^ Bd Kfrhbw^
Uf,b Dthrfenthty^ b <thyfhlf Idfhnktylthf&
DJP dshf;ftn ,kfujlfhyjcnm pf gjllth;re^ jrfpfyye. <.hj
gj bccktljdfyb. CGBLf^ Yfwbjyfkmyst bycnbnens plhfdjj[hfytybz^
CIF^ d hfphf,jnrt ’nb[ vfnthbfkjd&
CJLT:FYBT
Cjrhfotybz __________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5
Ghtlbckjdbt ________________________________________________________________________________________________________________________________________________________________________________________________________________________ 6
Ddtltybt _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 8
Wtkb ljrevtynf ___________________________________________________________________________________________________________________________________________________________________________________________________________ 10
Rjulf yfxbyfnm fynbhtnhjdbhecye. nthfgb. ______________________________________________________________________________________________ 12
Htrjvtyletvst c[tvs ktxtybz gthdjuj hzlf lkz dphjcks[ ______________________________________________ 16
Ghbxbys bpvtytybz fynbhtnhjdbhecyjq nthfgbb _________________________________________________________________________________ 19
Ds,jh c[tv fynbhtnhjdbhecyjuj ktxtybz dnjhjuj hzlf ___________________________________________________________ 20
Hfccvjnhtybt rjyrhtnys[ gjluhegg ,jkmys[ ________________________________________________________________________________________________ 22
:tyobys^ cgjcj,yst hj;fnm^ bkb ,thtvtyyst ;tyobys _______________________ 22
Ltnb _________________________________________________________________________________________________________________________________________________________________________________________________________________________ 22
<jkmyst ne,threktpjv c cjgencnde.otq DBX-byatrwbtq _____________________ 24
Gjnht,bntkb by]trwbjyys[ yfhrjnbrjd _____________________________________________________________________________________ 25
Cj,k.ltybt c[tvs fynbhtnhjdbhecyjq nthfgbb ________________________________________________________ 25
Rjynhjkm pf htpbcntynyjcnm. r ktrfhcndtyysv chtlcndfv _________________ 26
Rkbybxtcrbq b kf,jhfnjhysq vjybnjhbyu ghbvtytybz
fynbhtnhjdbhecyjq nthfgbb ___________________________________________________________________________________________________________________________________ 26
Ghbkj;tybt F% Ljpbhjdrf fynbhtnhjdbhecys[
ghtgfhfnjd lkz dphjcks[ b gjlhjcnrjd ______________________________________________________________________________________________________________________ 29
Ghbkj;tybt D% Rhfnrfz byajhvfwbz j cjcnfdt b ljpf[
ktrfhcndtyys[ chtlcnd^ ghbvtyztvs[ d gtlbfnhbb ____________________________________________________________________________ 30
Htp.vt^ fghtkm 2002 u
CJRHFOTYBZ
F<R
CGBL
FGD
FHD
FHN
d4T
ddC
LLB
LKD
"AP
BAF
DBX
BLD
KGD
GVH
YAD
YBP
NNRTI
NsRTI
NtRTI
YDG
JB
GWG
GWH
BG
HND^h
BG-HND
CRD
JR
JN
BGGG
N<
NLA
JJY
>Y"QLC
LRN
DJP
PLD
F,frfdbh
Cbylhjv ghbj,htntyyjuj bvveyjltabwbnf
Fvghtyfdbh
Fynbhtnhjdbhecysq
Fynbhtnhjdbhecyfz nthfgbz
Cnfdelby
Pfkcbnf,by
Lblfyjpby
Ltkfdbhlby
"afdbhtyp^ bvt.obq nfr;t cjrhfotybt "AD
Bvveyjathvtynysq fyfkbp (ntcn yf fynbntkf r DBX)
Dbhec bvveyjltabwbnf xtkjdtrf
Bylbyfdbh
Kjgbyfdbh
Gthtlfxf DBX jn vfnthb ht,tyre
Ytkabyfdbh
Yfwbjyfkmyst bycnbnens plhfdjj[hfytybz^ CIF
Ytyerktjpblysq byub,bnjh j,hfnyjq nhfycrhbgnfps
Ytyerktjpblysq byub,bnjh j,hfnyjq nhfycrhbgnfps
fyfkjujd yerktjpblf
Ytyerktjpblysq byub,bnjh j,hfnyjq nhfycrhbgnfps
fyfkjujd yerktjnblf
Ytdbhfgby
Cdzpfyyfz c DBX jggjhneybcnbxtcrfz byatrwbz
Gytdvjybz^ dspdyyfz Preumocyntis carinii#Gytdvjwbcnyfz
Gytdvjybz
Gjkbvthfpyfz wtgyfz htfrwbz
Byub,bnjh ghjntfps
Hbnjyfdbh
Byub,bnjh ghjntfps c bcgjkmpjdfybtv hbnjyfdbhf
Cfrbyfdbh
J,tcgtxtybt rfxtcndf
J,hfnyfz nhfycrhbgnfpf
Byatrwbz^ gthtlfdftvfz gjkjdsv gentv
Ne,threktp
Ntyjajdbh lbcjghjrcbk aevfhfn
Jhufybpfwbz J,]tlbytyys[ Yfwbq
J,]tlbytyyfz ghjuhfvvf Jhufybpfwbb J,]tlbytyys[ Yfwbq
gj DBX#CGBLe
Lj,hjdjkmyjt rjycekmnbhjdfybt b ntcnbhjdfybt yf DBX
Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz
Pbljdelby^ nfr;t bpdtcnysq rfr FPN
5
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
GHTLBCKJDBT
tyt ltcznb ktn njve yfpfl e k.ltq^ ;bdeob[ c DBX#CGBLjv^ ,skj
vfkj yflt;ls& Dvtcnt c DBX-byatrwbtq yterkjyyj b ytevjkbvj
yfcnegfkj gjkyjt hfpheitybt bvveyyjq cbcntvs b cvthnm& Lkz cjnty
nsczx k.ltq^ bvt.ob[ ljcneg r hfpdbnjq cbcntvt plhfdjj[hfytybz^
gjkj;tybt rjhtyysv j,hfpjv bpvtybkjcm c gjzdktybtv d 1996 ujle
dscjrjfrnbdyjq fynbhtnhjdbhecyjq nthfgbb& {jnz b[ ghbvtytybt b yt
ghbdjlbn r bpktxtyb. jn DBX#CGBLf^ fynbhtnhjdbhecyst (FHD) ghtgfhfns htprj cyb;f.n cvthnyjcnm b pf,jktdftvjcnm^ ghjljktdf.n ;bpym b
gjdsif.n rfxtcndj ;bpyb vyjub[ k.ltq^ ;bdeob[ c DBX#CGBLjv&
V
6
Ctujlyz vs dyjdm gjljikb r nfrjve gjdjhjnyjve geyrne - yf ’njn hfp d
jnyjitybb hfpdbdf.ob[cz cnhfy& <kfujlfhz ecbkbzv cjnty frnbdbcnjd d
ytghfdbntkmcndtyys[ jhufybpfwbz[^ ghfdbntkmcndf[^ exht;ltybz[ JJY b
xfcnyjv ctrnjht wtys yf FHD-ghtgfhfns yfxfkb cyb;fnmcz^ b vs ctqxfc d
cjcnfzybb hfccvjnhtnm djpvj;yjcnm hfcibhtybz ljcnegf d eckjdbz[
juhfybxtyys[ htcehcjd&
Ghb jncencndbb xtnrjuj ujcelfhcndtyyjuj gjl[jlf d j,kfcnb plhfdjj[hfytybz^ rjnjhsq cjltqcndjdfk ,s hfwbjyfkmyjve b ,tpjgfcyjve
ghbvtytyb. ’nb[ ’aatrnbdys[ b wtyys[ vtlbrfvtynjd^ hfcibhbnm ljcneg
,eltn ytdjpvj;yj& Nfrjq gjl[jl^ cjltqcnde.obq ghbvtytyb. cnfylfhnbpbhjdfyys[ c[tv ktxtybz b eghjotyyjuj vjybnjhbyuf^ ghtlcnfdkty d
lfyys[ nt[ybxtcrb[ herjdjlzob[ ghbywbgf[^ hfphf,jnfyys[ ghb gjllth;rt Yfwbjyfkmys[ bycnbnenjd plhfdjj[hfytybz CIF& D yb[ htrjvtyljdfys cnfylfhns lkz rhegyjvfcinf,yjuj dytlhtybz FHD--ghtgfhfnjd^
bcrk.xf.obt ytghfdbkmyjt ghbvtytybt& "nj ceotcndtyyj df;yj lkz
lj,hjcjdtcnyjuj cj,k.ltybz gfwbtynfvb c[tvs ktxtybz b ghfdbkmyjuj
ghbvtytybz ntvb^ rnj dsgbcsdftn htwtgns&
Gj jwtyrfv DJP^ d 2002 ujle d gjllth;bdf.otq ;bpym FHD--nthfgbb
ye;lftncz jrjkj 6 vbkkbjyjd xtkjdtr d hfpdbdf.ob[cz cnhfyf[& Yf ltkt^ d
yfcnjzott dhtvz njkmrj 230 000 xtkjdtr bvt.n nfrjq ljcneg^ b gjkjdbyf bp
yb[ ;bden d jlyjq cnhfyt -- <hfpbkbb& Vs cxbnftv^ xnj r rjywe 2005 ujlf
cnhfys hfpdbdf.otujcz vbhf ljk;ys bvtnm djpvj;yjcnm j,tcgtxbdfnm
ljcneg r FHD--nthfgbb lkz 3 vbkkbjyjd xtkjdtr^ ghb eckjdbb^ xnj vbh ,eltn
ghjljk;fnm vt;leyfhjlyst cjukfcjdfyyst ecbkbz gj hfcibhtyb. ljcnegf
r ktxtyb. DBX b e[jle& Nfrjt ltcznbrhfnyjt edtkbxtybt bvttn pyfxtybt gj
vyjubv ghbxbyfv& Nhtv vbkkbjyfv k.ltq ,eltn ghjlktyf ;bpym^ hfcibhtybt ljcnegf r ktxtyb. ,eltn cnbvekbhjdfnm ghjabkfrnbre^ b ’nj ,eltn
bvtnm gjkj;bntkmyst gjcktlcndbz lkz cjwbfkmyj--’rjyjvbxtcrjuj hfpdbnbz^ gjcrjkmre k.lb^ ;bdeobt c DBX^ ,elen ;bnm ljkmit^ b b[ ;bpym cnfytn
,jktt ghjlernbdyjq&
Htp.vt^ fghtkm 2002 u
Yfcnjzobt herjdjlzobt ghbywbgs lf.n ifyc yflt;ls ntv^ rnj e;t
jnxfzkcz& Jyb endth;lf.n ghfdf xtkjdtrf b ljcnjbycndj k.ltq^ ;bdeob[
c DBX& Jyb ghtljcnfdkz.n djpvj;yjcnm jgthtnmcz yf cjkblfhyjcnm b
htibvjcnm ukj,fkmyjuj ldb;tybz ghjnbd DBX#CGBLf gentv ecnhfytybz
ythfdtycndf vt;le ,jufnsvb b ,tlysvb d gjkextybb vtlbwbycrjuj e[jlf&
Gj vtht gjcnegktybz yjdjq byajhvfwbb b lfyys[ jyb yf htuekzhyjq jcyjdt
,elen j,yjdkznmcz& D gthcgtrnbdt DJP ,eltn ghjljk;fnm cjnhelybxfnm cj
cdjbvb gfhnythfvb dj dctv vbht d wtkz[ lfkmytqituj hfcibhtybz ljcnegf r
e[jle b gjllth;rt lkz dct[^ rnj d ’njv ye;lftncz&
7
Njvhbc N.hvty
Bcgjkybntkmysq lbhtrnjh
Pljhjdmt ctvmb b j,obys
Dctvbhyfz jhufybpfwbz plhfdjj[hfytybz
:tytdf
Fghtkm 2003u&
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
I. Ddtltybt
tytt ltcznb ktn njve yfpfl^ rjulf tlbycndtyysq bvt.obqcz rkfcc
fynbhtnhjdbhecys[ (FHD) ghtgfhfnjd ,sk yt cgjcj,ty fltrdfnysv
j,hfpjv byub,bhjdfnm htgkbrfwb. dbhecf bvveyjltabwbnf xtkjdtrf
(DBX)^ ;bpym k.ltq c DBX#CGBLjv dj dctv vbht xfcnj cktljdfkf
ytbp,t;ysv rehcjv% gjcntgtyyjt hfpheitybt bvveyyjq cbcntvs^ ghjdtltybt ghjabkfrnbrb lkz ghtleght;ltybz jggjhneybcnbxtcrb[ byatrwbq^
hfyybq ds[jl yf gtycb.^ bcnjotybt^ xthtle.obtcz gthbjls [jhjituj b
gkj[juj cjcnjzybz pljhjdmz^ pfrfyxbdf.obtcz ytbp,t;ysv e[elitybtv^
dtleobv r gjkyjve hfpheityb. bvveyyjq cbcntvs b^ d rjytxyjv cxtnt^ r
cvthnb&
V
8
Gjzdktybt d 1996 u& yjds[ rkfccjd fynbhtnhjdbhecys[ ghtgfhfnjd b b[
rjv,bybhjdfyyjt ghbvtytybt bpvtybkb ghtlcnfdktybt k.ltq d
,jufntqib[ cnhfyf[ vbhf j DBX#CGBLt& {jnz ’nb dbls ktxtybz yt dtlen
r bpktxtyb. b cjplf.n cdjb^ yjdst ghj,ktvs lkz k.ltq^ ;bdeob[ c DBX#
CGBLjv^ jyb htprj gjybpbkb gjrfpfntkb cvthnyjcnb b pf,jktdftvjcnb^
edtkbxbkb ghjljk;bntkmyjcnm ;bpyb^ gjdscbkb rfxtcndj ;bpyb^ j;bdbkb
j,obys b gjpdjkbkb djcghbybvfnm DBX#CGBLf yt rfr xeve^ f rfr
gjllf.ottcz ktxtyb. [hjybxtcrjt pf,jktdfybt&
R cj;fktyb.^ lkz ,jkmibycndf bp 36 vbkkbjyjd k.ltq d hfpdbdf.otvcz
vbht^ ;bdeob[ d yfcnjzott dhtvz c DBX#CGBLjv^ lfyyst jgnbvbcnbxtcrbt gthcgtrnbds ybxtuj yt vtyz.n& Cjukfcyj rjycthdfnbdysv jwtyrfv
DJP^ d 2002 u& ghb,kbpbntkmyj 6 vbkkbjyjd xtkjdtr^ yf[jlzob[cz d
eckjdbz[ juhfybxtyys[ htcehcjd^ e;t d yfcnjzott dhtvz ye;lf.ncz d
gjllth;bdf.otq ;bpym fynbhtnhjdbhecyjq nthfgbb& F d htfkmyjcnb kbim
230 000 xtkjdtr bvt.n ljcneg r ktxtyb.^ b gjkjdbyf bp yb[ ;bden d jlyjq
cnhfyt - <hfpbkbb&
Gjckt ghjdtltybz Vt;leyfhjlyjq rjyathtywbb gj CGBLe d Leh,fyt d
2000 u& b Cgtwbfkmyjq ctccbb Utythfkmyjq Fccfv,ktb Jhufybpfwbb
J,]tlbytyys[ Yfwbq gj DBX#CGBLe d 2001 u& vt;leyfhjlyjt
cjj,otcndj c ytdblfyyjq hfytt htibvjcnm. yfvthtyj ecnhfybnm hfpbntkmysq rjynhfcn vt;le bvt.obvb ljcneg r ktxtyb.^ b ntvb^ rnj tuj yt
bvttn^ vt;le ,jufnsvb b ,tlysvb& Vbh ghbpyftn ytjnkj;ye. vjhfkmye.^
cjwbfkmye.^ gjkbnbxtcre. b ’rjyjvbxtcre. ytj,[jlbvjcnm crjhtqituj
htfkmyjuj hfcibhtybz ljcnegf r fynbhtnhjdbhecyjq nthfgbb lkz vyjub[
vbkkbjyjd k.ltq^ ;bdeob[ c DBX#CGBLjv^ b ghbcnegbk r vj,bkbpfwbb
‘juhjvyjuj ukj,fkmyjuj fkmzycf\ r cjplfyb. rjnjhjuj ghbpdfk Utythfkmysq ctrhtnfhm JJY Rjab Fyyfy^ lkz ljcnb;tybz wtktq^ gjcnfdktyys[
Cgtwbfkmyjq ctccbtq Utythfkmyjq Fccfv,ktb JJY&
Yfcnjzott herjdjlcndj gjlujnjdktyj d hfvrf[ Dctvbhyjq jhufybpfwbb
plhfdjj[hfytybz (DJP) gthtl ’nbvbv fkmzycjv& Lkz wtktq tuj hfphf,jnrb d
ntxtybt dctuj 2001 ujlf ghjdjlbkbcm vt;leyfhjlyst rjycekmnfnbdyst
Htp.vt^ fghtkm 2002 u
cjdtofybz^ d rjnjhs[ ghbybvfkb exfcnbt ,jktt 200 rkbybwbcnjd^ extys[^
ghtlcnfdbntktq ghfdbntkmcnd^ ghtlcnfdbntktq uhf;lfycrjuj j,otcndf b
k.ltq c DBX#CGBLjv bp ,jktt xtv 60 exfcnde.ob[ cnhfy& Htrjvtylfwbb^
drk.xtyyst d yfcnjzobq ljrevtyn^ jnhf;f.n jgnbvfkmyst ghfrnbxtcrbt
gjl[jls ^ jcyjdfyyst yf fyfkbpt ceotcnde.ob[ afrnbxtcrb[ lfyys[& D nt[
ckexfz[^ rjulf j,]tv afrnbxtcrb[ lfyys[ yt ,sk e,tlbntkmysv^ d rfxtcndt
jcyjds lkz ’nb[ htrjvtylfwbq bcgjkmpjdfkcz rjyctycec ’rcgthnjdjd& DJP
ghbpyftn^ xnj d ’njq ,scnhj hfpdbdf.otqcz j,kfcnb lfyyst htrjvtylfwbb
ytj,[jlbvj ,eltn j,yjdkznm yf htuekzhyjq jcyjdt&
{jnz yfcnjzobq ljrevtyn b zdkztncz df;ysv ifujv dgthtl^ tuj yt cktletn
‘vfubxtcrbv jhelbtv\ lkz hfcibhtybz ljcnegf r fynbhtnhjdbhecyjve
ktxtyb.& Ljcneg r ktrfhcndtyysv chtlcndfv lkz vbkkbjyjd ye;lf.ob[cz
d yb[ k.ltq vj;tn ,snm hfcibhty yt njkmrj ,kfujlfhz herjdjlcnde d
jnyjitybb hfwbjyfkmyjuj ds,jhf b ghbvtytybz fynbhtnhjdbhecys[
ktrfhcndtyys[ chtlcnd^ yj nfr;t ,kfujlfhz cjplfyb. ,jktt ghbtvktvs[
b cnf,bkmys[ eckjdbq abyfycbhjdfybz pfregjr ktrfhcndtyys[ chtlcnd b
ceotcndjdfyb. ljcnegys[^ yflkt;fobv j,hfpjv jhufybpjdfyys[ b rjvgtntynys[ cke;, plhfdjj[hfytybz& Ltqcnde.obt d hfvrf[ cbcntvs JJY b
dyt tt exfcnybrb ghjljk;f.n cgjcj,cndjdfnm jceotcndktyb. ’nb[ ghjxb[
df;ys[ ’ktvtynjd yf jcyjdt cktle.ob[v vthjghbznbq%
.
Bybwbfnbdf gj ecrjhtyb. ljcnegf^ rjnjhfz ghbdtkf r htprjve
cjrhfotyb. cnjbvjcnb fynbhtnhjdbhecys[ ktrfhcndtyys[ chtlcnd d
20 hfpdbdf.ob[cz cnhfyf[ r zydfh. 2002 u&*
.
gkfybhjdfybt bcnjxybrjd b wty yf ktrfhcndtyyst chtlcndf^ cdzpfyyst c
DBX^ jceotcndkztvjt >YBCTA^ >Y"QLC^ jhufybpfwbtq ‘Dhfxb ,tp
uhfybw\ (MSF) b DJP*
.
bccktljdfybt cntgtyb gfntynyjq pfobns ktrfhcnd^ ghbvtyztvs[ lkz
nthfgbb DBX--byatrwbb^ ghjdjlbvjt DJP b >Y"QLC*
.
edtkbxtybt abyfycjds[ b rflhjds[ htcehcjd lkz jceotcndktybz DJP
cdjtq ltzntkmyjcnb gj erhtgktyb. gjntywbfkf cbcntv plhfdjj[hfytybz
d j,kfcnb DBX#CGBLf^ drk.xfz jhufybpfwb. vt;leyfhjlyjq ctnb
exht;ltybq gj gjlujnjdrt rflhjd d j,kfcnb jrfpfybz gjvjob^
cdzpfyyjq c DBX*
.
Ukj,fkmysq ajyl gj ,jhm,t cj CGBLjv^ ne,threktpjv b vfkzhbtq^
jhufybpjdfyysq Utythfkmysv ctrhtnfhtv JJY d 2001 u& b ghtlcnfdkz.obq cj,jq pyfxbntkmyst yjdst bydtcnbwbb lkz ,jhm,s ghjnbd ’nb[
nht[ jcyjdys[ byatrwbjyys[ ,jktpytq&
9
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
II. Wtkb ljrevtynf
yfcnjzott dhtvz d eckjdbz[ juhfybxtyys[ htcehcjd vtytt 5¢
ye;lf.ob[cz d fynbhtnhjdbhecyjv ktxtybb^ vjuen gjkexbnm ljcneg
r ’nbv ktrfhcndtyysv chtlcndfv& DJP cxbnftn^ xnj^ gj vtymitq vtht^
nhtv vbkkbjyfv k.ltq^ ye;lf.obvcz d gjvjob^ cktletn ghtljcnfdbnm
djpvj;yjcnm gjkextybz ktrfhcndtyys[ chtlcnd r 2005 u& "nj zdbkjcm ,s
,jktt xtv ltcznbrhfnysv hfcibhtybtv ljcnegf&
D
10
Yfcnjzott herjdjlcndj ghtlyfpyfxtyj lkz jrfpfybz gjllth;rb b cjltqcndbz yflkt;fotve ktxtyb. b hfcibhtyb. vfcinf,jd ghbvtytybz FHN d
ghtlcnjzobt ujls gjchtlcndjv vtnjljd ujcelfhcndtyyjuj plhfdjj[hfytybz^ jcyjdysvb ghbywbgfvb rjnjhs[ zdkz.ncz%
1) edtkbxtybt vfcinf,jd ltzntkmyjcnb ghjuhfvv gj fynbhtnhjdbhecyjve
ktxtyb. lkz eljdktndjhtybz gjnht,yjcntq k.ltq c DBX#CGBLjv d
eckjdbz[ juhfybxtyys[ htcehcjd*
2) cnfylfhnbpfwbz b eghjotybt c[tv fynbhtnhjdbhecyjuj ktxtybz d wtkz[
cjltqcndbz ’aatrnbdyjve jceotcndktyb. ghjuhfvv gj ktxtyb.*
3) j,tcgtxtybt njuj^ xnj,s ghjuhfvvs gj fynbhtnhjdbhecyjve ktxtyb.
,skb jcyjdfys yf cfvs[ yflt;ys[ yfexys[ lfyys[^ c ntv xnj,s
bp,tufnm bcgjkmpjdfybz ytcnfylfhnys[ ghjnjrjkjd ktxtybz^ rjnjhst
cnfdzn gjl euhjpe htpekmnfns ktxtybz jnltkmys[ ,jkmys[ b cjplf.n
gjntywbfkmyst djpvj;yjcnb gjzdktybz htpbcntynys[ ajhv dbhecf&
{jnz tcnm jcyjdfybz yfltznmcz yf nj^ xnj yfcnjzobq ljrevtyn ,eltn
gjktpty lkz rkbybwbcnjd^ hf,jnf.ob[ d eckjdbz[ juhfybxtyys[ htcehcjd^
jy d gthde. jxthtlm ghtlyfpyfxty lkz bcgjkmpjdfybz rjycekmnfnbdysvb
cjdtnfvb gj djghjcfv ktxtybz^ herjdjlbntkzvb yfwbjyfkmys[ ghjuhfvv
gj CGBLe b lheubvb herjdjlbntkzvb dscjrjuj ehjdyz d j,kfcnb
hfphf,jnrb gjkbnbrb^ pfybvf.obvbcz djghjcfvb gkfybhjdfybz yfwbjyfkmys[ b vt;leyfhjlys[ cnhfntubq gj jrfpfyb. gjvjob k.lzv^
;bdeobv c DBX^ d eckjdbz[ juhfybxtyys[ htcehcjd& "nj herjdjlcndj
cke;bn jcyjdjq lkz ds,jhf yfb,jktt ltqcndtyys[ b jceotcndbvs[ c[tv
fynbhtnhjdbhecyjuj ktxtybz d hfvrf[ hfcibhtyys[ yfwbjyfkmys[ jndtnys[ vth yf ’gbltvb.& Lfyyfz jcyjdf yfwtktyf yf ‘ cnfylfhnbpfwb. \ b
eghjotybt fynbhtnhjdbhecyjq nthfgbb^ d pyfxbntkmyjq cntgtyb fyfkjubxyj ktxtyb. ne,threktpf d hfvrf[ yfwbjyfkmys[ ghjuhfvv gj ,jhm,t c
ne,threktpjv^ c extnjv jnyjcbntkmyjq ckj;yjcnb b cgtwbabrb ktxtybz
DBX& Gj’njve ghtlcnfdktyyst dfhbfyns ktxt,ys[ c[tv gthdjuj b dnjhjuj
hzlf exbnsdf.n gjnht,yjcnb cbcntv plhfdjj[hfytybz^ rjnjhst xfcnj
bcgsnsdf.n ytljcnfnjr d rdfkbabwbhjdfyys[ rflhf[ b j,jheljdfybb
lkz vjybnjhbyuf^ ,tp yfytctybz eoth,f rfxtcnde b htpekmnfnfv ghtlkj;tyys[ dbljd ktxtybz&
Htp.vt^ fghtkm 2002 u
Lfyyjt herjdjlcndj hfccvfnhbdftn nfrbt djghjcs^ rfr FHD nthfgbz^
jgnbvfkmyst c[tvs gthdjuj hzlf^ rhbnthbb bpvtytybz c[tvs ktxtybz b
rjv,byfwbb^ bcgjkmpetvst lkz pfvtys nthfgbb& Nfr;t jcdtoftncz djghjc
j njv^ rfrbv j,hfpjv jceotcndkznm vjybnjhbyu ’aatrnbdyjcnb ktxtybz c
extnjv vjybnjhbyuf gj,jxys[ ltqcndbq ghtgfhfnjd^ b ghtlcnfdktys
rjyrhtnyst htrjvtylfwbb gj dtltyb. cgtwbabxtcrb[ gjluhegg gfwbtynjd&
11
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
III& Rjulf yfxbyfnm fynbhtnhjdbhecye. nthfgb.
JP htrjvtyletn^ xnj,s d hfvrf[ ghjuhfvv gj fynbhtnhjdbhecyjve
ktxtyb. d eckjdbz[ juhfybxtyys[ htcehcjd DBX--byabwbhjdfyyst
gjlhjcnrb b dphjckst yfxbyfkb fynbhtnhjdbhecye. nthfgb.^ rjulf jyb
yf[jlzncz yf%
D
.
cnflbb IV DBX--byatrwbb cjukfcyj rkfccbabrfwbb DJP (rkbybxtcrfz
ajhvf CGBLf) ytpfdbcbvj jn rjkbxtcndf CD4*
.
cnflbz[ I^ II bkb III DBX--byatrwbb cjukfcyj rkfccbabrfwbb DJP c
rjkbxtcndjv CD4 vtytt 200#vv3*
.
cnflbz[ II bkb III DBX--byatrwbb cjukfcyj rkfccbabrfwbb DJP ghb
j,otv rjkbxtcndt kbvajwbnjd vtymit 1200#vv3&
12
Nfv^ ult djpvj;yj^ cnhfyfv htrjvtyletncz bcgjkmpjdfnm gjlcxtn rjkbxtcndf rktnjr CD4 d cdjb[ ghjuhfvvf[ gj fynbhtnhjdbhecyjve ktxtyb. b
hfccvjnhtnm djghjc j ghbvtytybb bvt.ob[cz d yfcnjzott dhtvz ghjcns[^
b ytljhjujcnjzob[ vtnjljkjubq gjlcxtnf CD4 lkz j,tcgtxtybz lfyyjuj
bccktljdfybz lkz gfwbtynjd& Jlyfrj d nt[ ckexfz[^ rjulf jghtltktybt
rjkbxtcndf ytljcnegyj^ cktletn ghbvtyznm gjrfpfntkm j,otuj rjkbxtcndf
kbvajwbnjd vtytt 1200# vv3 d rfxtcndt rhbnthbz lkz yfxfkf fynbhtnhjdbhecyjq nthfgbb lkz gfwbtynjd c rkbybxtcrbvb ghjzdktybzvb DBX-byatrwbb ( cnflbz II bkb III cjukfcyj rkfccbabrfwbb DJP)& {jnz j,ott
rjkbxtcndj kbvajwbnjd jnyjcbntkmyj gkj[j rjhhtkbhetn c rjkbxtcndjv
CD4^ d cjxtnfybb c jghtltktybtv rkbybxtcrjq cnflbb pf,jktdfybz lfyysq
gjrfpfntkm zdkztncz gjktpysv vfhrthjv lkz cjcnfdktybz rkbybxtcrjuj
ghjuyjpf b b ds;bdftvjcnb& Jghtltktybt dbhecyjq yfuheprb (yfghbvth^
bcgjkmpjdfybt rjkbxtcndtyyjuj jghtltktybz ehjdyz HYR DBX--1 d gkfpvt)
yt hfccvfnhbdftncz d rfxtcndt ceotcndtyyjuj eckjdbz lkz yfxfkf ghbvtytybz nthfgbb&
D jnyjitybb ltntq DJP htrjvtyletn cktle.obt rhbnthbb yfxfkf
rjv,bybhjdfyyjq FHD nthfgbb lkz DBX--gjpbnbdys[ ltntq d djphfcnt lj
18 vtczwtd% gjlndth;ltyyfz dbhecjkjubxtcrbv gentv byatrwbz (gjchtlcndjv bcgjkmpjdfybz GWH DBX bkb h24--fynbutyf DBX lbccjwbbhjdfyyjuj
bvveyyjuj rjvgktrcf^ bkb rekmnehs DBX) b gtlbfnhbxtcrfz cnflbz III
DBX--byatrwbb cjukfcyj gtlbfnhbxtcrjq rkfccbabrfwbb DJP (n&t& rkbybxtcrfz ajhvf CGBLf) bkb gtlbfnhbxtcrbt cnflbb I b II DBX--byatrwbb gj
DJP ghb ghjwtynyjv gjrfpfntkt CD4--rktnjr (CD4 )<20¢& D ckexfz[^ rjulf
jncencndetn dbhecjkjubxtcrjt gjlndth;ltybt^ rhbnthbtv yfxfkf fynbhtnhjdbhecyjq rjv,bybhjdfyyjq nthfgbb lkz DBX--gjkj;bntkmys[ ltntq
vj;tn cke;bnm III cnflbz DBX--byatrwbb cjukfcyj rkfccbabrfwbb DJP b
ghjwtynyjt cjlth;fybt CD4 <20¢& D jnyjitybb ltntq cnfhit 18 vtczwtd c
gjkj;bntkmysv htpekmnfnjv ntcnf yf fynbntkf r DBX DJP htrjvtyletn
ghbvtytybt FHN^ tckb jyb yf[jlzncz yf cnflbb III DBX--byatrwbb cjukfcyj
rkfccbabrfwbb DJP (n&t& rkbybxtcrfz ajhvf CGBLf)^ ytpfdbcbvj jn
Htp.vt^ fghtkm 2002 u
ghjwtynyjuj cjlth;fybz CD4& D jnyjitybb ltntq ,jktt cnfhituj
djphfcnf^ yf[jlzob[cz yf cnflbb I bkb II DBX--byatrwbb cjukfcyj
rkfccbabrfwbb DJP^ htrjvtyletncz ghbvtytybt FHN^ tckb ghjwtynyjt
cjlth;fybt CD4<15¢&
Nf,kbwf F& Htrjvtylfwbb gj ghbvtytyb. fynbhtnhjdbhecyjq
nthfgbb lkz ktxtybz dphjcks[ b gjlhjcnrjd c
gjlndth;ltyyjq DBX--byatrwbtq
Tckb ljcnegyj ntcnbhjdfybt yf rjkbxtcndj CD4--rktnjr%
.
.
Cnflbz IV ,jktpyb cjukfcyj rkfccbabrfwbb DJP^ ytpfdbcbvj jn
rjkbxtcndf rktnjr CD4
Cnflbz I^ II bkb IIIa cjukfcyj rkfccbabrfwbb DJP c rjkbxtcndjv rktnjr
CD4 4200#vv3 b
Tckb ytljcnegyj ntcnbhjdfybt yf cjlth;fybt CD4--rktnjr%
.
.
a
b
Cnflbz IV cjukfcyj cnfylfhnfv DJP ytpfdbcbvj jn j,otuj rjkbxtcndf
kbvajwbnjd
Cnflbz II bkb IIIa ,jktpyb cjukfcyj cnfylfhnfv DJP ghb j,otv
rjkbxtcndt kbvajwbnjd 41200#vv3 c
Ktxtybt nfr;t htrjvtyletncz lkz
,jkmys[ c ghjuhtccbhe.otq cnflbtq III
,jktpyb cjukfcyj cnfylfhnfv DJP^
drk.xfz htwblbdbhe.obq bkb gthcbcnbhe.obq rfylbljp hjnjdjq gjkjcnb b
htwblbdbhe.obt bydfpbdyst ,frnthbfkmyst byatrwbb ytpfdbcbvj jn xbckf rktnjr CD4 bkb j,otuj xbckf
kbvajwbnjd&
Njxysq ehjdtym CD4^ ghtdsif.obq 200#
vv3^ yf rjnjhjv cktletn yfxbyfnm fynbhtnhjdbhecyjt ktxtybt^ yt ,sk jghtltkty* ’nj jpyfxftn^ xnj ghb ghbyznbb
htitybz cktletn exbnsdfnm ghbcencndbt
cbvgnjvjd b crjhjcnm cjrhfotybz xbckf
rktnjr CD4 (tckb ghjdjlbncz bpvthtybt)& Ehjdtym CD4^ hfdysq 200#vv3^
cjjndtncndetn ghjwtynyjve cjlth;fyb.
CD4 - jrjkj 15¢&
c
J,ott xbckj kbvajwbnjd d rjkbxtcndt
41200#vv3 vj;tn ,snm bcgjkmpjdfyj
dvtcnj xbckf rktnjr CD4^ d nt[ ckexfz[^
rjulf gjcktlytt bccktljdfybt ytljcnegyj b ceotcnde.n cbvgnjvs^ cdzpfyyst c DBX (bkb cbvgnjvs
ghjuhtccbhjdfybz DBX--byatrwbb)&
Jghtltktybt j,otuj xbckf kbvajwbnjd
bvttn vtymitt pyfxtybt lkz
,tccbvgnjvys[ gfwbtynjd& Nfrbv
j,hfpjv^ ghb jncencndbb ntcnbhjdfybz
yf rktnrb CD4 yt cktletn yfxbyfnm
ktxtybt ,tccbvgnjvys[ DBX--byabwbhjdfyys[ ,jkmys[ (cnflbz I cjukfcyj
cnfylfhnfv DJP)^ gjnjve xnj d yfcnjzott dhtvz yt ceotcndetn lheub[ yflt;ys[ fkmnthyfnbdys[ vfhrthjd d
eckjdbz[ xhtpdsxfqyj juhfybxtyys[
htcehcjd&
13
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
Nf,kbwf D% Htrjvtylfwbb gj ghbvtytyb. fynbhtnhjdbhecyjq
nthfgbb lkz ktxtybz ltntq uhelyjuj b hfyytuj djphfcnf
Ntcnbhjdfybt yf cj- Djphfcn
lth;fybt CD4
Lbfuyjcnbxtcrjt
ntcnbhjdfybt yf DBX
<18
vtczwtd
Gjpbnbdysq dbhecjkjubxtcrbq ntcn yf DBX1
Gtlbfnhbxtcrfz cnflbz III
cjukfcyj rkfccbabrfwbb DJP
(CGBL) ytpfdbcbvj jn
ghjwtynyjuj cjlth;fybz
rktnjr CD42
. Gtlbfnhbxtcrfz cnflbz I
,jktpyb (,tccbvgnjvyjq) bkb
cnflbz II ,jktpyb cjukfcyj
cnfylfhnfv DJP c ghjwtynysv
cjlth;fybtv CD4 <20¢3
. Gtlbfnhbxtcrfz cnflbz III
Dbhecjkjubxtcrjt ntcnbhjdfybt yf DBX yt
,jktpyb (CGBL) cjukfcyj
ghjdjlbncz^ yj ht,tyjr cnfylfhnfv DJP c ghjwtynzdkztncz DBX-cthjgjpb- ysv cjlth;fybtv
nbdysv bkb hj;lty DBX- rktnjr CD4 <20¢
byabwbhjdfyyjq
vfnthm. (Ghbvtxfybt%
ntcn yf fynbntkf r DBX
ytj,[jlbvj gjdnjhbnm d
djphfcnt 18 vtczwtd lkz
gjkextybz njxyjuj
lbfuyjpf DBX-byatrwbb)
. Gtlbfnhbxtcrfz cnflbz III
518 vtc- Gjpbnbdysq cthjkjubzwtd
xtcrbq ntcn yf fynbntkf r ,jktpyb (CGBL) cjukfcyj
DBX
cnfylfhnfv DJP ytpfdbcbvj
jn ghjwtynyjuj cjlth;fybz
rktnjr CD42
. Gtlbfnhbxtcrfz cnflbz I
,jktpyb (,tccbvgnjvyjq) bkb
cnflbb II ,jktpyb cjukfcyj
cnfylfhnfv DJP c ghjwtynysv
cjlth;fybtv CD4 <15¢3
. Gtlbfnhbxtcrfz cnflbz III
Gjpbnbdysq dbhecjkjTckb yt ghjdjlbncz <18
vtczwtd ubxtcrbq ntcn yf DBX
ntcnbhjdfybt yf
cjukfcyj cnfylfhnfv DJP2
cjlth;fybt CD4
4
. Ktxtybt yt htrjvtyletncz
Dbhecjkjubxtcrjt ntcnbhjdfybt yf DBX yt
ghjdjlbncz^ yj ht,tyjr
zdkztncz DBX-cthjgjpbnbdysv bkb hj;lty
DBX-byabwbhjdyfyjq
vfnthm.
. Gtlbfnhbxtcrfz cnflbz III
518
Gjpbnbdysq ntcn yf
vtczwtd fynbntkf r DBX
,jktpyb cjukfcyj cnfylfhnfv
DJP2
Tckb ghjdjlbncz
ntcnbhjdfybt yf
cjlth;fybt CD4
14
Htrjvtylfwbb gj
ktxtyb.
.
Htp.vt^ fghtkm 2002 u
1
Ntcns yf GWH LYR DBX bkb GWH HYR
DBX bkb h24 fynbuty lbccjwbbhjdfyyjuj
bvveyyjuj rjvgktrcf bkb rekmnehs DBX&
2
Vj;yj nfr;t hfccvjnhtnm djghjc j
yfxfkt FHN lkz ktxtybz ltntq^ yf[jlzob[cz yf ghjuhtccbhe.otq gtlbfnhbxtcrjq cnflbb II ,jktpyb cjukfcyj
cnfylfhnfv DJP^ drk.xf.otq nfrbt
cbvgnjvs^ rfr nz;tkfz ajhvf htwblbdbhe.otuj bkb gthcbcnbhe.otuj rfylbljpf hjnjdjq gjkjcnb gjckt ytjyfnfkmyjuj gthbjlf^ gjnthz vfccs ntkf^
ntvgthfnehf bkb htwblbdbhe.obt
nz;tkst ajhvs ,frnthbfkmys[
byatrwbq^ ytpfdbcbvj jn rjkbxtcndf
CD4&
3
Ehjdtym evtymitybz ghjwtynyjuj
cjlth;fybz CD4 (tckb ghjdjlbncz
bpvthtybt) cktletn exbnsdfnm ghb
ghbyznbb htitybz&
4
Vyjubt rkbybxtcrbt cbvgnjvs^ yf,k.lftvst yf gtlbfnhbxtcrjq cnflbb II b III
,jktpyb cjukfcyj rkfccbabrfwbb DJP^
yt zdkz.ncz cgtwbabxysvb lkz DBX-byatrwbb b d pyfxbntkmyjq cntgtyb
xfcnbxyj cjdgflf.n c cbvgnjvfvb^ rjnjhst yf,k.lf.ncz e ltntq ,tp DBX-byatrwbb d eckjdbz[ juhfybxtyys[
htcehcjd cbcntvs plhfdjj[hfytybz* nfrbv j,hfpjv^ ghb jncencndbb dbhecjkjubxtcrjuj ntcnbhjdfybz b ntcnf yf rktnrb
CD4 d wtkjv yt cktletn hfccvfnhbdfnm
djghjc j ghbvtytybb FHN lkz ktxtybz
DBX--byabwbhjdfyys[ ltntq d djphfcnt
418 vtczwtd^ ytp
fdbcbvj jn bvt.ob[cz cbvgnjvjd&
15
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
IV& Htrjvtyletvst c[tvs ktxtybz gthdjuj
hzlf lkz dphjcks[
nhfyfv htrjvtyletncz bcgjkmpjdfnm vtnjls j,otcndtyyjuj plhfdjj[hfytybz lkz cjltqcndbz edtkbxtyb. vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd& "nj jpyfxftn^
xnj cktletn hfphf,jnfnm ghjuhfvvs gj fynbhtnhjdbhecyjve ktxtyb.^ b
cjplfnm tlbyst cnfylfhns tuj ghbvtytybz& D xfcnyjcnb^ cnhfyfv ghtlkfuftncz ds,hfnm tlbycndtyye. ktxt,ye. c[tve gthdjuj hzlf b juhfybxtyyjt
xbckj ktxt,ys[ c[tv dnjhjuj hzlf lkz ibhjrjvfcinf,yjuj bcgjkmpjdfybz
c extnjv njuj^ xnj jnltkmyst kbwf^ rjnjhst yt vjuen gthtyjcbnm c[tvs
ktxtybz gthdjuj b dnjhjuj hzlf bkb lkz rjnjhs[ ’nb c[tvs jrfpsdf.ncz
yt’aatrnbdysvb^ ,elen yfghfdkznmcz r cgtwbfkbcnfv lkz ghjdtltybz
bylbdblefkmyjuj ktxtybz&
C
16
Ghb ds,jht c[tv fynbhtnhjdbhecyjuj ktxtybz rfr yf ehjdyt ghjuhfvvs^ nfr
b yf ehjdyt jnltkmys[ ,jkmys[^ cktletn exbnsdfnm frnbdyjcnm^ [fhfrnth
gj,jxys[ ltqcndbq^ djpvj;yjcnb lkz cj[hfytybz ,eleob[ dfhbfynjd
ktxtybz^ ghtlgjkfuftvjt cj,k.ltybt ,jkmysvb ktxt,yjq c[tvs^
cjgencnde.obt eckjdbz (yfghbvth^ cjgencnde.obt byatrwbb^ yfheitybz
j,vtyf dtotcnd)^ ,thtvtyyjcnm bkb hbcr tt gjzdktybz^ bcgjkmpjdfybt
cjgencnde.ob[ ktrfhcndtyys[ chtlcnd (n&t& gjntywbfkmyjt dpfbvjltqcndbt
ktrfhcndtyys[ chtlcnd)^ djpvj;yjcnb gthdbxyjuj byabwbhjdfybz htpbcntynysvb ajhvfvb dbhecf^ f nfr;t cnjbvjcnm b ljcnegyjcnm ktxtybz& D
xbckj ljgjkybntkmys[ hfccvfnhbdftvs[ afrnjhjd^ cdzpfyys[ c eckjdbzvb
juhfybxtyys[ htcehcjd^ vj;tn d[jlbnm ljcneg kbim r juhfybxtyyjve xbcke
fynbhtnhjdbhecys[ ghtgfhfnjd^ juhfybxtyyfz byahfcnernehf cke;, plhfdjj[hfytybz^ ytj,[jlbvjcnm gjcnfdjr ktrfhcndtyys[ chtlcnd d ctkmcrbt
hfqjys^ dscjrfz pf,jktdftvjcnm ne,threktpjv b utgfnbnjv D b#bkb C^ f
nfr;t ghbcencndbt hfpkbxys[ uhegg b gjlnbgjd DBX--byatrwbb&
C extnjv dct[ hfccvjnhtyys[ afrnjhjd^ pf bcrk.xtybtv cnjbvjcnb
ktrfhcndtyys[ chtlcnd^ ghtlgjxnbntkmyst ktxt,yst c[tvs fynbhtnhjdbhecyjq nthfgbb gthdjuj hzlf lkz dphjcks[ b gjlhjcnrjd gthtxbcktys d
Nf,kbwt C& Dct ktxt,yst c[tvs drk.xf.n ldf yerktjpblys[ byub,bnjhf
j,hfnyjq nhfycrhbgnfps^ f nfr;t cbkmyj ltqcnde.ott nhtnmt ktrfhcndtyyjt
chtlcndj^ bcgjkmpetvjt lkz tuj ljgjkytybz& Pbljdelby (PLD)#kfvbdelby
(3NC) ghtlcnfdkty d rfxtcndt yfxfkmyjq htrjvtylfwbb d jnyjitybb
ldjqyjuj yerktjpblyjuj rjvgjytynf^ bc[jlz bp ’aatrnbdyjcnb^ njrcbxyjcnb^ rkbybxtcrjuj jgsnf b yfkbxbz PLD#3NC d rfxtcndt abrcbhjdfyyjq
rjv,bybhjdfyyjq ljps& PLD#3NC vj;yj pfvtybnm lheubvb ldjqysvb
rjv,byfwbzvb yerktjpblys[ rjvgjytynjd^ drk.xfz cnfdelby (d4T)#3NC^
d4N#lblfyjpby (LLB) b PLD#LLB d pfdbcbvjcnb jn cgtwbabrb cnhfys&
Jlyfrj ybrjulf yt cktletn bcgjkmpjdfnm dvtcnt PLD#d4T d cdzpb c
gjlndth;ltyysv fynjujybpvjv vt;le ’nbvb ldevz ktrfhcndtyysvb
chtlcndfvb&
Htp.vt^ fghtkm 2002 u
Cktletn jnvtnbnm^ xnj ,jkmit yt htrjvtyle.ncz kbim jlyb ldjqyst
yerktjpblyst c[tvs vtlbrfvtynjpyjuj ktxtybz (,bnthfgbz -- ghbv& gthtdjlxbrf)^ gjcrjkmre jyb fltrdfnysv j,hfpjv yt gjlfdkz.n htgkbrfwb.
DBX--byatrwbb b j,sxyj dtlen r ,scnhjve gjzdktyb. htpbcntywbb&
Nf,kbwf C& Htrjvtyletvst rjv,bybhjdfyyst ktxt,yst c[tvs fynbhtnhjdbhecyjq nthfgbb gthdjuj hzlf lkz dphjcks[ b gjlhjcnrjd c ljrevtynfkmyj gjlndth;ltyyjq DBX-byatrwbtq
Ktxt,yst c[tvsa
Ckexfb ,thtvtyyjcnb
Jcyjdyst dbls njrcbxyjcnb
PLD#3NC#"AP bkb
PLD#PNC#YDG
Dvtcnj "AP bpgjkmpjdfnm
YDG lkz ,thtvtyys[
;tyoby bkb ;tyoby^ lkz
rjnjhs[ ytdjpvj;yj
j,tcgtxbnm ’aatrnbdye.
rjynhfwtgwb.
Fytvbz^ cdzpfyyfz c PLD
Cbvgnjvs yfheitybz wtynhfkmyjq ythdyjq cbcntvs^ dspdfyyst
"AP
Djpvj;yfz nthfnjutyyjcnm "AP
Utgfnjnjrcbxyjcnm b cbkmyfz
csgm^ dspdfyyst YDG
PLD#3NC#F<R
Juhfybxtyyst lfyyst gj
,tpjgfcyjcnb F<R
Fytvbz^ cdzpfyyfz c PLD
Ubgthxedcndbntkmyjcnm ( ,jktt
njxysq nthvby)
Fkkthubz yf F<R
b
PLD#3NC#BG-HND
bkb PLD#PNC#YAD
Juhfybxtyyst lfyyst gj
,tpjgfcyjcnb KGD#hnd
Fytvbz^ cdzpfyyfz c PLD
YAD% yfb,jktt
e,tlbntkmyst lfyyst gj
,tpjgfcyjcnb
Ytahjkbnbfp^ cdzpfyysq c BLD
Lbfhtz^ dspdfyyfz YAD
Gj,jxyjt djpltqcndbt yf j,vty
dtotcnd^ cdzpfyyjt c BG
Ghtbveotcndf bcgjkmpjdfybz rjv,byfwbb bp lde[ ytyerktjpblys[ fyfkjujd byub,bnjhjd j,hfnyjq nhfycrhbgnfps d cjxtnfybb c jlybv ytyerktjpbla
PLD#3NC ghtlcnfdkty d rfxtcndt yfxfkmyjq htrjvtylfwbb d jnyjitybb
ldjqyjuj yerktjpblyjuj rjvgjytynf c
extnjv ’aatrnbdyjcnb^ njrcbxyjcnb^
rkbybxtcrjuj jgsnf b yfkbxbz abrcbhjdfyyjq rjv,byfwbb cjcnfdf ljps&
Lheubt ldjqyst rjvgjytyns NsRTI
drk.xfz d4T/3TC^ d4T#LLB b PLD# LLB^
vj;yj pfvtybnm d pfdbcbvjcnb jn
ds,jhf rjyrhtnys[ cnhfy& Ybrjulf yt
cktletn bcgjkmpjdfnm dvtcnt PLD# d4T d
cdzpb c gjlndth;ltyysv fynfujybpvjv&
b
BG--HND drk.xftn BLD#hnd^ KGD#hnd b
CRD#hnd &
17
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
18
ysv byub,bnjhjv pfrk.xf.tncz d njv^ xnj ’nb ktrfhcndtyyst chtlcndf
ibhjrj hfcghjcnhfytys gj ljcnegysv wtyfv b c ghbtvktvsv rjkbxtcndjv
nf,ktnjr& Jcyjdysvb ytljcnfnrfvb zdkz.ncz hfpdbnbt htpbcntynyjcnb r
ktrfhcndtyysv chtlcndfv^ gjntywbfkmyfz utgfnjnjrcbxyjcnm ytdbhfgbyf
(YDG)^ f nfr;t ytj,[jlbvjcnm hfphf,jnrb jnltkmys[ ktxt,ys[ c[tv lkz
ve;xby b ;tyoby d cdzpb c djpvj;ysv nthfnjutybxtcrbv djpltqcndbtv
’afdbhtypf ("AP)^ rjnjhjt bcrk.xftn tuj ghbvtytybt lkz ,thtvtyys[
;tyoby bkb ;tyoby ltnjhjlyjuj djphfcnf^ gjldthuf.ob[cz hbcre
yt;tkfntkmyjq ,thtvtyyjcnb& Cnhfys cj pyfxbntkmyjq hfcghjcnhfytyyjcnm. dbhecf DBX--2^ f nfr;t dbhecf DBX--1 Uheggs J vjuen hfccvjnhtnm
djghjc j, juhfybxtybb ghbvtytybz ktxt,ys[ c[tv^ cjlth;fob[ ytyerktjpbls^ njkmrj lkz ,jkmys[ c gjlndth;ltyyjq byatrwbtq DBX--1^ gjcrjkmre
dbhec DBX--2^ f nfr;t dbhec DBX--1 Uheggs J gj ghbhjlt htpbcntynyst r
’njve rkfcce ktrfhcndtyys[ chtlcnd&
Ktxt,yfz c[tvf PLD#3NC#f,frfdbh (F<R) zdkztncz yfb,jktt ghbtvktvjq
rfr lkz ,jkmys[ nfr b lkz ghjuhfvvs d wtkjv (ldt nf,ktnrb d ltym b
jncencndbt pyfxbntkmyjuj dpfbvjltqcndbz ktrfhcndtyys[ chtlcnd)& D xbckj
tt jcyjdys[ ytljcnfnrjd d[jlbn ytrjnjhfz ytjghtltktyyjcnm d jnyjitybb
njuj^ ltqcndetn kb jyf d nt[ ckexfz[^ rjulf dbhecyfz yfuheprf jxtym dscjrf e
,jkmys[ c ghjuhtccbhe.otq ajhvjq ,jktpyb^ ytedthtyyjcnm d njv^ xnj ’nb
ktrfhcndtyyst chtlcndf -- jcj,tyyj F<R -- ,elen ljcnegys gj ghbtvktvsv
wtyfv^ f nfr;t djpvj;yjt ghjdjwbhjdfybt ktnfkmys[ htfrwbq
ubgthxedcndbntkmyjcnb^ rjnjhst ytdjpvj;yj jghtltkbnm d eckjdbz[ ytpyfxbntkmys[ htcehcjd& Ceotcnde.n jnyjcbntkmyj juhfybxtyyst lfyyst gj
’aatrnbdyjcnb lheub[ djpvj;ys[ nhjqys[ rjv,byfwbq yerktjpblys[
byub,bnjhjd j,hfnyjq nhfycrhbgnfps (NsRTI)& "nj pfcnfdkztn DJP
djplth;fnmcz jn htrjvtylfwbb b[ ghbvtytybz d yfcnjzott dhtvz&
Ghtbveotcndjv ktxt,ys[ c[tv c bcgjkmpjfdfybtv 2 yerktjpblys[
byub,bnjhjd j,hfnyjq nhfycrhbgnfps b byub,bnjhf ghjntfps (BG)
zdkztncz gjlndth;ltyyfz dscjrfz frnbdyjcnm d cyb;tybb dbhecyjq yfuheprb& Ytljcnfnrfvb zdkz.ncz ,jkmijt rjkbxtcndj nf,ktnjr^ pyfxbntkmyjt
dpfbvjltqcndbt c lheubvb ktrfhcndtyysvb chtlcndfvb^ rjnjhjt bcrk.xftn
bkb jckj;yztn b[ bcgjkmpjdfybt dj dhtvz ktxtybz ne,threktpf c ghbvtytybtv hbafvgbwbyf^ d ckexft yfheitybz j,vtyf dtotcnd^ f nfr;t ghbvtytybt
ht;bvjd c bcgjkmpjdfybtv hbnjyfdbhf nht,etn yfkbxbz bkb ytj,[jlbvjcnb
aeyrwbjybhjdfybz [jkjljdjq wtgb lkz ktxt,ys[ c[tv c gjdsityysv
cjlth;fybtv hbnjyfdbhf&
Htp.vt^ fghtkm 2002 u
V& Ghbxbys bpvtytybz fynbhtnhjdbhecyjq
nthfgbb
HN vj;tn gjnht,jdfnm bpvtytybz kb,j d cdzpb c yt’aatrnbdyjcnm.
ghjdjlbvjuj ktxtybz^ kb,j d cdzpb c njrcbxyjcnm.& Yt’aatrnbdyjcnm
ktxtybz vj;yj jghtltkbnm rkbybxtcrbv gentv^ bvveyjkjubxtcrbv gentv
gjchtlcndjv bpvthtybz rjkbxtcndf CD4 b#bkb dbhecjkjubxtcrbv gentv
gjchtlcndjv bpvthtybz dbhecyjq yfuheprb& Jlyfrj^ gjcrjkmre gjcktlybq
cgjcj, j,sxyj yt ghbvtyztncz d eckjdbz[ juhfybxtyys[ htcehcjd^ htrjvtyletncz^ xnj,s d ghjuhfvvf[^ jceotcndkztvs[ d nfrb[ eckjdbz[^
ukfdysv j,hfpjv bcgjkmpjdfkbcm rkbybxtcrbt rhbnthbb b^ gj djpvj;yjcnb^
rhbnthbb^ cdzpfyyst c rjkbxtcndjv CD4 lkz jghtltktybz ’aatrnbdyjcnb
ghjdjlbvjq nthfgbb&
F
Njrcbxyjcnm cdzpfyf c ytcgjcj,yjcnm. gthtyjcbnm gj,jxyst ltqcndbz
vtlbrfvtynjpyjuj ktxtybz b cj pyfxbntkmysv yfheitybtv aeyrwbb
jhufyjd^ rjnjhjt vj;tn gjzdbnmcz d htpekmnfnt ’njuj& Vj;yj jceotcndkznm
vjybnjhbyu rkbybxtcrbv gentv yf jcyjdt ;fkj, ,jkmys[ b abpbxtcrb[
j,cktljdfybq^ f nfr;t vj;tn bcgjkmpjdfnmcz juhfybxtyyjt xbckj
kf,jhfnjhys[ ntcnjd^ d pfdbcbvjcnb jn ghbvtyztvjq rjyrhtnyjq
rjv,bybhjdfyyjq ktxt,yjq c[tvs&
Tckb gjnht,etncz dytcnb bpvtytybz d ktxt,ye. c[tve d cdzpb c ytelfxysv
ktxtybtv^ ytj,[jlbvj ,eltn ghbvtybnm yjde. ktxt,ye. c[tve dnjhjuj
hzlf& Tckb ’nj cdzpfyj c njrcbxyjcnm.^ nj vj;yj kb,j yfpyfxbnm
cjdthityyj yjde. ktxt,ye. c[tve dnjhjuj hzlf^ kb,j (d njv ckexft^ rjulf
njrcbxyjcnm cdzpfyf c ytrjnjhsv ktrfhcndtyysv chtlcndjv d ktxt,yjq
c[tvt^ rjnjhjt vj;yj jghtltkbnm) ’nj dspsdf.ott yfheitybt ktrfhcndtyyjt chtlcndj vj;yj pfvtybnm lheubv ktrfhcndtyysv chtlcndjv^ rjnjhjt
yt j,kflftn fyfkjubxysv gj,jxysv ltqcndbtv&
19
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
VI& Ds,jh c[tv fynbhtnhjdbhecyjuj ktxtybz
dnjhjuj hzlf
ckexft ytelfxyjuj ktxtybz DJP htrjvtyletn pfvtybnm dc. c[tve
ktxtybz gthdjuj hzlf yf rjv,bybhjdfyye. c[tve ktxtybz dnjhjuj
hzlf& D yjdjq ktxt,yjq c[tvt dnjhjuj hzlf ytj,[jlbvj ,eltn bcgjkmpjdfnm
ktrfhcndtyyst chtlcndf^ rjnjhst cj[hfyz.n frnbdyjcnm d jnyjitybb
infvvf dbhecf e ,jkmys[ b d bltfkmyjv ckexft drk.xf.n yt vtytt nht[
yjds[ ktrfhcndtyys[ chtlcndf^ ghbxtv^ gj rhfqytq vtht^ jlyj bp yb[ bp
yjdjuj rkfccf^ c ntv xnj,s gjdscbnm dthjznyjcnm ecgtiyjuj ktxtybz b
cdtcnb r vbybveve hbcr gthtrhtcnyjq htpbcntynyjcnb&
D
20
D Nf,kbwt D gthtxbcktys ktxt,yst c[tvs dnjhjuj hzlf^ rjnjhst vj;yj
hfccvjnhtnm d jnyjitybb gjlhjcnrjd b dphjcks[ lkz rf;ljq bp ktxt,ys[
c[tv gthdjuj hzlf^ jghtltktyys[ d nf,kbwt C& Ghbtvktvsv ldjqysv
yerktjpblysv rjvgjytynjv^ rjnjhsq zdkztncz fkmnthyfnbdjq PLD#3NC^
zdkztncz d4T#LLB& Rhjvt njuj^ PLD#LLB vj;tn pfvtybnm d4T#3NC b
yfj,jhjn c ghtleght;ltybtv j njv^ xnj gthtrhtcnyfz htpbcntywbz yerktjpblys[ fyfkjujd dspsdftn djphfcnf.oe. j,tcgjrjtyyjcnm&
D nt[ ckexfz[^ rjulf bcgjkmpjdfkcz PLD#3NC d ktxt,yjq c[tvt gthdjuj hzlf^
gthtrhtcnyfz htpbcntynyjcnm r yerktjpble vj;tn gjcnfdbnm gjl euhjpe
frnbdyjcnm d4N#LLB d ktxt,yjq c[tvt dnjhjuj hzlf^ jcj,tyyj ghb yfkbxbb
lkbntkmyjq dbhecjkjubxtcrjq yt’aatrnbdyjcnb ghjdjlbvjuj ktxtybz (jncencndbt ’aatrnbdyjuj gjlfdktybz dbhecyjq yfuheprb -- ghbv& Htl&)&
Gjcrjkmre dthjznyjcnm gthtrhtcnyjq htpbcntynyjcnb ytcrjkmrj
evtymiftncz ghb gtht[jlt r F<R#LLB gj chfdytyb. c gtht[jljv r d4N#
LLB^ gthdsq vj;yj nfr;t hfccvfnhbdfnm d rfxtcndt yerktjpblyjq jcyjds
lkz ktxt,yjq c[tvs dnjhjuj hzlf d njv ckexft^ tckb ktxt,yfz c[tvf gthdjuj
hzlf yt drk.xfkf F<R& Jlyfrj dscjrbq ehjdtym htpbcntynyjcnb r PLD#3NC
dspsdftn evtymitybt xedcndbntkmyjcnb r F<R&
Ghb eckjdbb evtymitybz gjntywbfkf gjxnb k.,juj yerktjpblyjuj rjvgjytynf dnjhjuj hzlf^ rjvgjytyn BG--HND [bylbyfdbh (BLD#hnd)^ kjgbyfdbh
(KGD#hnd)^ cfrbyfdbh (CRD#hnd)] zdkztncz ,jktt ghtlgjxnbntkmysv gj
chfdytyb. c ytkabyfdbhjv (YAD) d ktxt,ys[ c[tvf[ dnjhjuj hzlf c extnjv
b[ frnbdyjcnb& YAD vj;yj hfccvfnhbdfnm d rfxtcndt fkmnthyfnbds lkz
rjvgjytynf BG^ tckb jncencnde.n BG c bcgjkmpjdfybtv HND bkb tckb
ceotcnde.n rkbybxtcrbt ghjnbdjgjrfpfybz lkz tuj ghbvtytybz&
Htp.vt^ fghtkm 2002 u
Nf,kbwf D& Htrjvtyletvst ktxt,yst c[tvs dnjhjuj hzlf lkz
dphjcks[ b gjlhjcnrjd
Ktxt,yst c[tvs
gthdjuj hzlf
Ktxt,ysq c[tvs dnjhjuj Fkmnthyfnbdyst ktxt,yst
hylf d ckexft ytelfxyjuj c[tvs dnjhjuj hzlf d
ckexft ytelfxyjuj ktxtybz
ktxtybz
PLD#3NC#"AP bkb PLD#
3NC#YDG
d4T#LLY + BG-HND1
F<R#LLB + BG-HND
F<R#LLB + YAD bkb
d4N#LLB + YAD
2
PLD#3NC#F<R
NNRTI + KGD#h c bkb ,tp
d4N bkb LLB
d4N#LLB + BG-HND
PLD#3NC#BG-HND bkb
PLD#3NC#YAD
- d4N#LLB + NNRTI2
F<R#LLB + NNRTI2
1
BG-HND vj;tn ghtlcnfdkznm cj,jq BLD#hnd^ KGD#hnd bkb CRD#hnd
2
NNRTI vj;tn ,snm "AP bkb YDG
21
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
VII& Hfccvjnhtybt rjyrhtnys[ gjluhegg
,jkmys[
F& :tyobys^ cgjcj,yst hj;fnm^ bkb ,thtvtyyst ;tyobys
22
DJP htrjvtyletn ghbvtytybt PLD^ 3NC^ YDG^ YAD b CRD d cjxtnfybb c
ybprjq ljpjq hbnjyfdbhf^ gjcrjkmre jyb yfb,jktt ibhjrj ghbvtyz.ncz ghb
fynbhtnhjdbhecyjv ktxtybb ,thtvtyys[ ;tyoby& Yt htrjvtyletncz ghbvtyznm "AP lkz ktxtybz ;tyoby^ rjnjhst vjuen pf,thtvtytnm^ d cdzpb c tuj
gjntywbfkmysv nthfnjutybxtcrbv djpltqcndbtv yf gkjl d ntxtybt gthdjuj
nht[vtczxyjuj gthbjlf &
Ds,jh FHN lkz ;tyoby^ cgjcj,ys[ ,thtvtytnm^ vj;tn drk.xfnm hfccvjnhtybt djpvj;yjcnb gjkextybz fynbhtnhjdbhecys[ ghtgfhfnjd d yfxfkt
gthdjuj nht[vtczxyjuj gthbjlf lj jghtltktybz ,thtvtyyjcnb b d ntxtybb
yfxfkmyjuj gthbjlf hfpdbnbz jhufyjd gkjlf& :tyobys^ r rjnjhsv
ghbvtyztncz FHN^ ljk;ys bvtnm ljcneg r ’aatrnbdysv b yflkt;fobv
vtnjlfv rjynhfwtgwbb lkz evtymitybz dthjznyjcnb yt;tkfntkmyjq
,thtvtyyjcnb& Df;yj jnvtnbnm^ xnj ytrjnjhst fynbhtnhjdbhecyst ghtgfhfns (NNRTI^ YDG b "AP b dct BG c ghbvtytybtv HND) vjuen
evtymifnm rjywtynhfwb. jhfkmys[ rjynhfwtgnbdjd d rhjdb^ b
ytj,[jlbvj ghbvtytybt ljgjkybntkmyjq bkb fkmnthyfnbdyjq rjynhfwtgwbb lkz bp,t;fybz ,thtvtyyjcnb e ;tyoby^ ghbybvf.ob[ ’nb ktrfhcndtyyst chtlcndf&
Lkz ,thtvtyys[ ;tyoby ;tkfntkmyj ghbcnegbnm r FHN gjckt gthdjuj
nht[vtczxyjuj gthbjlf^ [jnz lkz nz;tkj ,jkmys[ ,thtvtyys[ ;tyoby
ghtbveotcndf crjhtqituj ghbvtytybz nthfgbb gthtdtibdftn k.,jq
gjntywbfkmysq hbcr lkz gkjlf& Rhjvt njuj^ ldjqyjt cjxtnfybt d4N#
LLB d rfxtcndt yerktjpblyjuj rjvgjytynf nhb--nthfgbb cktletn bcgjkmpjdfnm dj dhtvz ,thtvtyyjcnb kbim d nt[ ckexfz[^ rjulf jncencnde.n
lheubt fkmnthyfnbds^ d cdzpb c gjntywbfkmysv gjdsityysv hbcrjv
vjkjxyjuj fwbljpf e ,thtvtyys[ ;tyoby^ dspdfyyjuj ’njq rjv,byfwbtq&
D& Ltnb
Juhfybxtyyst bccktljdfybz gjcktlcndbq ghbvtytybz FHN lkz pljhjdmz
ltntq gjrfpsdf.n^ xnj ghbvtytybt hfpkbxys[ nthfgtdnbxtcrb[ c[tv FHD
lf.n c[jlyst ekexitybz cehhjufnys[ gjrfpfntktq -- nj tcnm^ gjrfpfntktq
dbhecjkjubxtcrjuj b bvveyjkjubxtcrjuj cjcnjzybz&
<jkmibycndj fynbhtnhjdbhecys[ ghtgfhfnjd^ bvt.ob[cz lkz dphjcks[^
nfr;t bvt.ncz d gtlbfnhbxtcrb[ ajhvf[ c hfcxtnjv ljps yf tlbybwe
gkjoflb gjdth[yjcnb ntkf bkb tlbybwe vfccs& Dfhbfyns ktxtybz gthdjuj
hzlf lkz ltntq drk.xf.n PLD#3NC b#bkb ytyerktjpbl (YDG bkb "AP) bkb
F<R& Cktletn gjvybnm^ xnj "AP ytkmpz ghbvtyznm lkz ktxtybz ltntq d
Htp.vt^ fghtkm 2002 u
djphfcnt lj nht[ ktn d cdzpb c jncencndbtv yflt;yjq byajhvfwbb d
jnyjitybb ljpbhjdrb& Jlyfrj "AP ,eltn ghtlgjxnbntkmysv ytyerktjpbljv lkz ltntq^ ghbybvf.ob[ hbafvgbwby^ d njv ckexft^ tckb fynbhtnhjdbhecyjt ktxtybt ytj,[jlbvj yfxfnm lj pfdthitybz ghjnbdjne,threktpyjq
nthfgbb& Nthfgbz dnjhjuj hzlf lkz ltntq^ d ckexft ytelfxyjq ktxt,yjq
c[tvs gthdjuj hzlf^ ,eltn drk.xfnm bpvtytybt yerktjpblyjuj rjvgjytynf
(yfghbvth^ gtht[jl jn PLD+3NC r d4T+LLB) b byub,bnjh ghjntfps&
Bcgjkmpjdfybt lheub[ byub,bnjhjd ghjntfps^ rhjvt KGD#hnd b YAD^
zdkztncz ghj,ktvfnbxysv d jnyjitybb ltntq d cdzpb c jncencndbtv
gjl[jlzob[ ltncrb[ ljpbhjdjr BLD b CRD&
23
Nf,kbwf T& Htrjvtyletvst c[tvs fynbhtnhjdbhecyjuj ktxtybz
gthdjuj hzlf lkz ltntq1
Ktxt,yst c[tvs
2
PLD#3NC + F<R
PLD#3NC2 + NNRTI
Pfvtxfybz
Zdkztncz ghtlgjxnbntkmyjq^ tckb ghbvtyztncz
cjgencnde.ofz ghjnbdjne,threktpyfz nthfgbz
Ds,jh NNRTI%
tckb djphfcn <3 ktn bkb vfccf ntkf <10 ru^ ghbvtyznm YDG
. tckb djphfcn 53 ktn bkb vfccf ntkf 510 ru^ ghbvtyznm YDG
bkb "AD
.
1
Rjyrhtnyst cnhfys c extnjv cdjb[
gjpbwbq b ds,jhf ljk;ys jghtltkbnm^
rfre. ktxt,ye. c[tve bkb c[tvs cktletn ghbvtyznm&
2
PLD#3NC zdkztncz ghtlgjxnbntkmyjq
ldjqyjq c[tvjq lkz ltntq^ gjcrjkmre
jyf cdzpfyf c yfb,jkmibv rkbybxtcrbv
jgsnjv& Lheubvb rjv,byfwbzvb yerktjpblys[ rjvgjytynjd vjuen ,snm%
PLD#LLB^ d4N#3NC^ d4N#LLB b LLB#3TC&
Ybrjulf yt cktletn dvtcnt ghbvtyznm
PLD#d4N d cdzpb c gjlndth;ltyysv
fynfujybpvjv&
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
Nf,kbwf F
24
1
Htrjvtyletvst c[tvs fynbhtnhjdbhecyjuj ktxtybz
dnjhjuj hzlf lkz ltntq
Ktxt,yst c[tvs gthdjuj hzlf
Ktxt,yst c[tvs dnjhjuj hzlf
PLD#3NC#F<R
d4T#LLB#KGD#hnd1 bkb
d4T#LLB#YAD bkb
d4T#LLB#NNRTI2
PLD#3NC# NNRTI2
d4T#LLB#KGD#hnd1 bkb
d4T#LLB#YAD
Lkz ltntq^ rjnjhst vjuen ukjnfnm rfgceks b lkz rjnjhs[ ceotcnde.obt d
yfcnjzott dhtvz cjcnfds rfgcek gjpdjkz.n hfccxbnfnm ljpbhjdre c yflkt;fobv extnjv vfccs bkb gjdth[yjcnb
ntkf^ ljgjkybntkmyst dfhbfyns lkz
pfvtys KGD#hnd drk.xf.n CRD#hnd b
BLD#hnd&
2
Ds,jh NNRTI% tckb djphfcn <3 ktn bkb
vfccf ntkf <10 ru^ ghbvtyznm YDG* tckb
djphfcn 53 ktn bkb vfccf ntkf 510 ru^
ghbvtyznm YDG bkb "AD&
C& <jkmyst ne,threktpjv c cjgencnde.otq DBX--byatrwbtq
DJP htrjvtyletn k.lzv c N<#DBX pfdthifnm ghjnbdjne,threktpye.
nthfgb. lj yfxfkf fynbhtnhjdbhecyjuj ktxtybz^ tckb jncencndetn dscjrbq
hbcr ghjuhtccbhjdfybz DBX--byatrwbb b cvthnb dj dhtvz gthbjlf ktxtybz
N< (n&t& rjkbxtcndj CD4 <200#vv3 bkb ceotcndetn lbcctvbybhjdfyysq
N<)& D nt[ ckexfz[^ rjulf xtkjdtre ytj,[jlbvj jlyjdhtvtyyjt ktxtybt N< b
DBX--byatrwbb^ dfhbfyns ktxtybz gthdjuj hzlf drk.xf.n PLD#3NC bkb
d4T#3NC gk.c ytyerktjpbl bkb F<R& D rfxtcndt ytyerktjpblyjuj rjvgjytynf ghtlgjxnybntkmyj bcgjkmpjdfnm "AP ^ gjcrjkmre tuj gjntywbfkmyfz
cgjcj,yjcnm j,jcnhznm utgfnjnjrcbxyjcnm ktxtybz ne,threktpf zdkztncz
vtymit^ xtv gjntywbfkmyfz cgjcj,yjcnm YDG& Jlyfrj vj;tn gjnht,jdfnmcz edtkbxtybt tuj ljpbhjdrb lj 800 vu d ltym& Pf bcrk.xtybtv
CRD#hnd yt htrjvtyletncz ghbvtytybt byub,bnjhjd ghjntfps dj dhtvz
ktxtybz N< hbafvgbwbyjv d cdzpb c b[ dpfbvjltqcndbtv c gjcktlybv
ktrfhcndtyysv chtlcndjv&
Htp.vt^ fghtkm 2002 u
Nf,kbwf G& Fynbhtnhjdbhecyfz nthfgbz lkz k.ltq c cjgencnde.otq
byatrwbtq ne,threktpf
Cbnefwbz
Htrjvtylfwbb
Ne,threktp kturb[ b rjkbxtcndj
CD4 <50#vv3 bkb dytktujxysq
ne,threktp
Yfxfnm ghjnbdjne,threktpye. nthfgb.& Yfxfnm
jlye bp cktle.ob[ c[tv FHN^ rfr njkmrj jghtltktyf gthtyjcbvjcnm ghjnbdjne,threktpyjq nthfgbb%
PLD#3NC#F<R
PLD#3NC#"AP
PLD#3NC#CRD#hnd
PLD#3NC#YDG
Ne,threktp kturb[ b rjkbxtcndj
CD4 cjcnfdkztn 50-200#vv3
bkb j,ott xbckj kbvajwbnjd
41200#vv3
Yfxfnm ghjnbdjne,threktpye. nthfgb.& Yfxfnm
jlye bp cktle.ob[ ktxt,ys[ c[tv gjckt pfdthitybz lde[vtczxyjuj rehcf ghjnbdjne,threktpyjq
nthfgbb%
PLD#3NC#F<R
PLD#3NC#"AP
PLD#3NC#CRD#h
PLD#3NC#YDG
Ne,threktp kturb[ b rjkbxtcndj
CD4 >200#vv3 bkb j,ott xbckj
kbvajwbnjd >1200#vv3
Ktxbnm N<& Tckb djpvj;yj^ ghjdjlbnm vjybnjhbyu
rjkbxtcndf CD4& Yfxfnm FHN d cjjndtncndbb c
nf,kbwfvb F b D gjckt pfdthitybz ktxtybz N<&
D& Gjnht,bntkb by]trwbjyys[ yfhrjnbrjd
Gjnht,bntkzv by]trwbjyys[ yfhrjnbrjd^ rjnjhsv ghtlgbcfyf FHN^
cktletn j,tcgtxbnm ljcneg r ’njq nthfgbb lkz cgfctybz ;bpyb& Afrnjhs^
nht,e.obt jcj,juj hfccvjnhtybz lkz ’njq uheggs yfctktybz^ drk.xf.n
cjdvtcnbvjcnm ljcnfnjxyj [fjnbxyjuj j,hfpf ;bpyb c eckjdbzvb cnhjujuj
cj,k.ltybz ghbtvf ktrfhcndtyys[ chtlcnd^ f nfr;t gjntywbfkmyjt dpfbvjltqcndbt fynbhtnhjdbhecys[ ktrfhcndtyys[ chtlcnd c nfrbvb dtotcndfvb^
rfr vtnfljy& Gjjohztncz hfphf,jnrf ghjuhfvv^ rjnjhst cjdvtof.n
ktxtybt yfhrjvfybb b DBX& D ’nb[ eckjdbz[ vj;yj jceotcndkznm nfrbt
gjl[jls^ rfr nthfgbz gjl ytgjchtlcndtyysv yf,k.ltybtv& C[tvs^ ghtlecvfnhbdf.obt jlyjrhfnysq ghbtv ghtgfhfnjd d ltym^ e;t bpexf.ncz b
vjuen ,snm ghtlkj;tys rfr jlby bp gjl[rjljd&
F& Cj,k.ltybt c[tvs fynbhtnhjdbhecyjq nthfgbb
DJP htrjvtyletn hfphf,jnfnm yjdfnjhcrbt gjl[jls r ,jktt cnhjujve
cj,k.ltyb. c[tvs FHN d cdzpb c gj;bpytyysv [fhfrnthjv ’njuj ktxtybz&
Cnhfntubb gj ,jktt cnhjujve cj,k.ltyb. c[tvs drk.xf.n cdtltybt r
vbybveve rjkbxtcndf nf,ktnjr b xfcnjns jghtltktybz ljp gjchtlcndjv
ghtlgjxnbntkmyjuj ghbvtytybz rjv,bybhjdfyys[ nf,ktnjr yf jcyjdt
jlyjhfpjdjuj bkb lde[hfpjdjuj t;tlytdyjuj ghbtvf& D yfcnjzott dhtvz d
25
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
26
ghjlf;t bvttncz hzl ghtgfhfnjd c abrcbhjdfyysv cjxtnfybtv ljp^
cjlth;fob[ ldf bkb nhb fynbhtnhjdbhecys[ ktrfhcndtyys[ chtlcndf^
rjnjhst vj;yj ghbvtyznm ldf hfpf d ltym& Jlyfrj^ [jnz d yfcnjzott dhtvz
,sk endth;lty hzl fynbhtnhjdbhecys[ ghtgfhfnjd lkz jlyjhfpjdjuj
t;tlytdyjuj ghbtvf^ jnyjcbntkmyj ytvyjubt ktxt,yst c[tvs c jlyjhfpjdsv t;tlytdysv ghbtvjv nht[ bkb xtnsht[ ktrfhcndtyys[ chtlcnd frnbdyj
ghjdthz.ncz d rkbybxtcrb[ bcgsnfybz[& Lheubt gjl[jls^ rjnjhst vjuen
cgjcj,cndjdfnm cj,k.ltyb. ht;bvf^ drk.xf.n% j,tcgtxtybt gjvjom.
xktyjd ctvmb bkb j,obys lkz jrfpfybz gjllth;rb ,jkmysv d ghbtvt b[
ktrfhcndtyys[ chtlcnd yf htuekzhyjq b cdjtdhtvtyyjq jcyjdt* ibhjrjt
rjycekmnbhjdfybt b ghjcdtotybt ,jkmys[* b nthfgbz gjl ytgjchtlcndtyysv
yf,k.ltybtv& Ytj,[jlbvj exbnsdfnm gcb[jcjwbfkmyst ghj,ktvs^
rjnjhst vjuen nfr;t cgjcj,cndjdfnm e[elityb. cj,k.ltybz ht;bvf
nthfgbb^ jcj,tyyj gjnht,bntkzvb by]trwbjyys[ yfhrjnbrjd b lheubvb
ezpdbvsvb uheggfvb yfctktybz&
G& Rjynhjkm pf htpbcntynyjcnm. r ktrfhcndtyysv chtlcndfv
DJP htrjvtyletn cnhfyfv^ gkfybhe.obv ghbvtytybt ghjuhfvv FHN^
nfr;t jlyjdhtvtyyj ghbvtyznm cbcntve rjynhjkmyjuj yflpjhf pf htpbcntynyjcnm. DBX r ktrfhcndtyysv chtlcndfv& "nj gjpdjkbn cnhfyfv
dszdkznm gjntywbfkmye. htpbcntynyjcnm r ktrfhcndtyysv chtlcndfv yf
ehjdyt yfctktybz b cjjndtncnde.obv j,hfpjv vtyznm htrjvtyletvst
c[tvs ktxtybz& Lkz jrfpfybz gjvjob ujcelfhcndfv--xktyfv d ’njq j,kfcnb^
DJP d cjnhelybxtcndt c gfhnythcrbvb jhufybpfwbzvb cjplftn Ukj,fkmye.
ctnm rjynhjkz pf htpbcntynyjcnm. DBX r ktrfhcndtyysv chtlcndfv&
Y& Rkbybxtcrbq b kf,jhfnjhysq vjybnjhbyu ghbvtytybz fynbhtnhjdbhecyjq nthfgbb
DJP ^ d eckjdbz[ juhfybxtyys[ htcehcjd^ htrjvtyletn lj yfxfkf ghbvtytybz
FHN ghjdtltybt jcyjdyjq rkbybxtcrjq jwtyrb^ rjnjhfz drk.xftn ljrevtynfwb. ghjikjq bcnjhbb ,jktpyb^ dszdktybt ceotcnde.ob[ d yfcnjzott
dhtvz b ceotcndjdfdib[ d ghjikjv pf,jktdfybq^ cdzpfyys[ c DBX^
jghtltktybt cjgencnde.ob[ vtlbwbycrb[ cjcnjzybq^ rjnjhst vjuen
jrfpfnm dkbzybt yf ds,jh nthfgbb (nfrb[ rfr N< bkb ,thtvtyyjcnm)^ f nfr;t
ceotcnde.ob[ cbvgnjvjd b abpbxtcrb[ ghbpyfrjd&
C wtkm. cjltqcndbz edtkbxtyb. vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjuj ktxtybz d eckjdbz[ juhfybxtyys[ htcehcjd DJP ghjdtkf uhflfwb.
cnfylfhnjd rkbybrj--kf,jhfnjhyjuj vjybnjhbyuf^ d pfdbcbvjcnb jn ljcnegyjcnb gj xtnshtv rfntujhbzv%
.
f,cjk.nysq ytj,[jlbvsq vbybvev ntcnjd*
.
jcyjdyst htrjvtyletvst ntcns*
Htp.vt^ fghtkm 2002 u
.
;tkfntkmyst ntcns* b
.
ytj,zpfntkmyst (ds,jhjxyst) ntcns&
F,cjk.nyst vbybvfkmyst ntcns zdkz.ncz ytj,[jlbvsvb ghtldfhbntkmysvb eckjdbzvb lkz drk.xtybz fynbhtnhjdbhecyjq nthfgbb d yfwbjyfkmye. ghjuhfvve& Jcyjdyst htrjvtyletvst ntcns ibhjrj bcgjkmpe.ncz d
rkbybxtcrb[ eckjdbz[ b ytj,[jlbvs lkz j,tcgtxtybz ’aatrnbdyjuj vjybnjhbyuf ,jkmibycndf c[tv fynbhtnhjdbhecyjuj ktxtybz& D cdtnt
ytjnkj;yjcnb jrfpfybz ;bpytyyj df;yjq cnjkm vyjubv vbkkbjyfv
k.ltq gjvjob DJP yfvthtdftncz cdtcnb r vbybveve ghtgzncndbz lkz tt
jrfpfybz& D rfxtcndt nfrjds[^ jncencndbt jcyjdys[ htrjvtyletvs[
kf,jhfnjhys[ ntcnjd yt ljk;yj ,snm ghtgzncndbtv lkz njuj^ xnj,s yfxfnm
ktxtybt^ [jnz b[ ytj,[jlbvj jceotcndkznm nfv^ ult bvt.ncz cjjndtncnde.obt htcehcs& :tkfntkmyst ntcns cltkf.n ujhfplj ,jktt ’aatrnbdysv
vjybnjhbyu b jwtyre ’aatrnbdyjcnb ghjuhfvv^ f ds,jhjxyst ntcns vj;yj
bcgjkmpjdfnm d eckjdbz[ ljcnegyjcnb pyfxbntkmys[ htcehcjd&
F,cjk.nyst vbybvfkmyst kf,jhfnjhyst ntcns^ rjnjhst ytj,[jlbvj
ghjdtcnb lj yfxfkf FHN^ drk.xf.n ntcn yf fynbntkf r DBX b jghtltktybt
ehjdyz utvjukj,byf bkb utvfnjrhbnf& Jcyjdyfz ghbxbyf pfrk.xftncz d njv^
xnj ytj,[jlbvj bvtnm ljrfpfntkmcndj yfkbxbz DBX--byatrwbb e gfwbtynf
lj yfxfkf ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d gthdsq hfp^ f crhbybyu
lkz dszdktybz fytvbb zdkztncz ceotcndtyysv lj yfxfkf ghbvtytybz
ktxt,ys[ c[tv^ cjlth;fob[ pbljdelby&
Jcyjdyjt htrjvtyljdfyyjt ntcnbhjdfybt ljk;yj drk.xfnm jghtltktybt
rjkbxtcndf ktqrjwbnjd b tuj rjkt,fybz (c ntv xnj,s gjpdjkbnm ghjdtcnb
jwtyre gj,jxyjuj djpltqcndbz yf ytqnhjgtyb. b gjlcxtn j,otuj xbckf
kbvajwbnjd)^ ehjdyz csdjhjnjxyjuj fkfybyf bkb fcgfhnfn fvbyjnhfyathfps lkz jwtyrb djpvj;yjcnb ceotcndjdfybz cjgencnde.otq byatrwbb
utgfnbnf b lkz vjybnjhbyuf utgfnjnjrcbxyjcnb^ csdjhjnjxyjuj rhtfnbybyf
b #bkb fpjnf vjxtdbys rhjdb lkz jwtyrb jcyjdyjq gjxtxyjq aeyrwbb^
csdjhjnjxyjq uk.rjps b ntcnjd yf ,thtvtyyjcnm lkz ;tyoby& {jnz ’nb
ntcns yt zdkz.ncz f,cjk.nyj ytj,[jlbvsvb^ jyb jxtym htrjvtyle.ncz lkz
njuj^ xnj,s bvtnm djpvj;yjcnm ghjdjlbnm vjybnjhbyu ,tpjgfcyjuj
ghbvtytybz ’nb[ dtotcnd b ghbybvfnm j,jcyjdfyyst htitybz j pfvtyt
ktxt,ys[ c[tv& Jghtltktybt rjkbxtcndf rktnjr CD4 d yfcnjzott dhtvz yt
hfccvfnhbdftncz d rfxtcndt jcyjdyjuj htrjvtyletvjuj ntcnf& Jlyfrj
dshf;ftncz yflt;lf yf nj^ xnj c dytlhtybtv ghjcns[ b vtytt ljhjujcnjzob[ vtnjljd jghtltktybz rjkbxtcndf rktnjr CD4^ ’njn ntcn cnfytn ,jktt
ibhjrj ljcnegysv& DJP htrjvtyletn cxbnfnm tuj ghbjhbntnysv^ gjnjve
xnj rjkbxtcndj rktnjr CD4 zdkztncz yfbkexibv gjrfpfntktv bvveyyjq
htfrwbb yf ktxtybt&
:tkfntkmyst ntcns drk.xf.n ntcnbhjdfybt yf ,bkbhe,by^ fvbkfpe b
csdjhjnjxyst kbgbls^ f nfr;t yf xbckj rktnjr CD4& "nb ntcns^ [jnz b yt
zdkz.ncz ceotcndtyysvb^ ,tpeckjdyj^ ghtljcnfdkz.n pyfxbntkmye. byajhvfwb.^ rjnjhfz vj;tn jrfpfnmcz gjktpyjq ghb vjybnjhbyut ghbvtytybz fynbhtnhjdbhecyjuj ktxtybz d eckjdbz[ juhfybxtyys[ htcehcjd&
27
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
Ntcnbhjdfybt yf dbhecye. yfuhepre d yfcnjzott dhtvz cxbnftncz
ytj,zpfntkmysvb bp--pf pfnhelytybq^ cdzpfyys[ c htcehcfvb& Rkbybxtcrbq
vjybnjhbyu bvttn ceotcndtyyjt pyfxtybt lkz j,tcgtxtybz ,tpjgfcyjcnb b
’aatrnbdyjcnb fynbhtnhjdbhecyjq nthfgbb& {jnz kf,jhfnjhysq vjybnjhbyu juhfybxty^ nofntkmysq rkbybxtcrbq vjybnjhbyu ghbj,htnftn tot
,jkmitt pyfxtybt&
28
DJP nfr;t hfcghtltkbkf kf,jhfnjhyst ntcns gj rfntujhbzv d cjjndtncndbb
c ehjdyzvb cke;, plhfdjj[hfytybz^ d rjnjhs[ jyb vjuen ,snm bcgjkmpjdfys& Ghjcnst jgthfnbdyst lbfuyjcnbxtcrbt ntcns DBX b jnghfdrf ghj,
lkz ntcnbhjdfybz yf CD4 ljk;ys jceotcndkznmcz yf ehjdyt gthdbxyjq
vtlbrj--cfybnfhyjq gjvjob b yf hfqjyyjv ehjdyt& Exht;ltybz yf
hfqjyyjv ehjdyt ljk;ys nfr;t hfcgjkfufnm djpvj;yjcnzvb lkz ntcnbhjdfybz ,thtvtyyjcnb^ ghjdtltybz ntcnjd gj jghtltktyb. ehjdyz utvjukj,byf^ aeyrwbb gtxtyb^ rhtfnbybyf b ehjdyz cf[fhf& Rhjvt
dsiterfpfyys[ ntcnjd^ exht;ltybz gthbathbqyjuj ehjdyz ljk;ys hfcgjkfufnm djpvj;yjcnzvb lkz ghjdtltybz ntcnjd gj jghtltktyb. rjkbxtcndf
rktnjr CD4&
Tckb gjpdjkz.n htcehcs^ nj ntcnbhjdfybt yf dbhecye. yfuhepre b
bccktljdfybt htpbcntywbb dbhecjd cktletn jceotcndkznm yf wtynhfkmyjv
ehjdyt&
Htp.vt^ fghtkm 2002 u
Ghbkj;tybt F& Ljpbhjdrb fynbhtnhjdbhecys[ ghtgfhfnjd lkz
dphjcks[ b gjlhjcnrjd1
Rkfcc ktrfhcndtyys[ chtlcnd#
ktrfhcndtyyjt chtlcndj
Ljpf
Yerktjpblysq fyfkju byub,bnjhjd j,hfnyjq nhfycrhbgnfps
Pbljdelby (PLD)
300 vu ldf hfpf d ltym
Cnfdelby (d4N)
40 vu ldf hfpf d ltym (30 vu ldf hfpf d ltym^
tckb vfccf ntkf <60 ru)
Kfvbdelby (3NC)
150 vu ldf hfpf d ltym
Lblfyjpby (LLB)
400 vu jlby hfp d ltym(250 vu jlby hfp d ltym^
tckb vfccf ntkf <60 ru)
F,frfdbh (F<R)
300 vu ldf hfpf d ltym
Yerktjnblyst byub,bnjhs j,hfnyjq nhfycrhbgnfps
Ntyjajdbh (NLA)
300 vu jlby hfp d ltym
Ytyerktjpblyst fyfkjub byub,bnjhjd j,hfnyjq nhfycrhbgnfps
"afdbhtyp ("AP)
600 vu jlby hfp d ltym
Ytdbhfgby (YDG)
1
2
200 vu jlby hfp d ltym d ntxtybt 14 lytq^
pfntv
200 vu ldf hfpf d ltym
Byub,bnjhs ghjntfps
Ytkabyfdbh (YAD)
1250 vu ldf hfpf d ltym
Bylbyfdbh#hbnjyfdbh (BLD#hnd)
800 vu#100 vu ldf hfpf d ltym2^ 4
Kjgbyfdbh#hbnjyfdbh (KGD#hnd)
400 vu#100 vu ldf hfpf d ltym
(533 vu#133 vu ldf hfpf d ltym^ rjulf
ghbybvftncz d cjxtnfybb c "AP bkb YDG)
Cfrbyfdbh#hbnjyfdbh (CRD#hnd)
1000 vu#100 vu ldf hfpf d ltym3^ 4
"nb ljpbhjdrb bvt.n hfcghjcnhfytyyjt
rkbybxtcrjt ghbvtytybt& Ljpbhjdrb^
erfpfyyst d ’njq nf,kbwt^ ,skb
ds,hfys yf jcyjdt yfbkexib[
bvt.ob[cz rkbybxtcrb[ lfyys[&
Ghtlgjxnbntkmytq bcgjkmpjdfnm ljpbhjdrb^ rjnjhst vj;yj ghbybvfnm jlby
bkb ldf hfpf d ltym d wtkz[ ,jktt
cnhjujuj cj,k.ltybz c[tvs nthfgbb&
Gthtxbcktyyst ljps zdkz.ncz ljpfvb
lkz gfwbtynjd c yjhvfkmyjq aeyrwbtq
gjxtr b gtxtyb& Cktletn exbnsdfnm
cgtwbfkmye. byajhvfwb. j ghtgfhfnt
ghb rjhhtrnbhjdrt ljps^ rjnjhfz vj;tn
,snm cdzpfyf c yfheitybtv aeyrwbb
gjxtr bkb gtxtyb bkb c djpvj;ysv
dpfbvjltqcndbtv c lheubvb ktrfhcndtyysvb chtlcndfvb^ ghbtv rjnjhs[ cdzpfy
bkb yt cdzpfy c DBX&
"nf c[tvf ghbtvf ktrfhcndtyyjuj
chtlcndf ibhjrj bcgjkmpetncz d rkbyb-
xtcrjq ghfrnbrt& Lheubt c[tvs ghbtvf
BLD#hnd^ rjnjhst rjkt,k.ncz jn 800 vu#
200 vu ldf hfpf d ltym lj 400 vu#100 vu
ldf hfpf d ltym nfr;t bcgjkmpe.ncz d
rkbybxtcrjq ghfrnbrt&
3
Vjuen bcgjkmpjdfnmcz rfr rfgceks c
ndthlsv utktv^ nfr b rfgceks c vzurbv
utktv d nt[ ckexfz[^ rjulf CRD ghbybvftncz d cjxtnfybb c HND&
4
Erfpsdftncz rjhhtrnbhjdrf c[tvs ghbtvf ktrfhcndtyyjuj chtlcndf d ckexft tuj
cjxtnfybz c ytyerktjpblysv byub,bnjhjv j,hfnyjq ghjntfps^ yj d yfcnjzott dhtvz ytdjpvj;yj ghtlcnfdbnm
jabwbfkmye. htrjvtylfwb.& Htrjvtyletncz kbim edtkbxbnm rjvgjytyn HND
lj 200 vu^ rjulf jy ghbybvftncz d
cjxtnfybb c "AP bkb YDG& Nht,e.ncz
ljgjkybntkmyst lfyyst j dpfbvjltqcndbb ktrfhcndtyys[ chtlcnd&
29
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
Ghbkj;tybt D& Rhfnrfz byajhvfwbz j cjcnfdt b ljpf[
ktrfhcndtyys[ chtlcnd^ ghbvtyztvs[ d gtlbfnhbb
Yfbvtyjdfybt ktrfhcndtyyjuj chtlcndf
Cjcnfd
Bvt.obtcz
lfyyst j
afhvfrjrbytnbrt
Yerktjpblst byub,bnjhs j,hfnyjq nhfycrhbgnfps
Pbljdelby (PLD)
Cbhjg% 10 vu#vk
Rfgceks% 100 vu* 250 vu
Nf,ktnrb% 300 vu
Dct djphfcns
Kfvbdelby (3NC)
Gthjhfkmysq hfcndjh%
10vu#vk
Nf,ktnrb% 150 vu
Dct djphfcns
Abrcbhjdfyyfz
rjv,bybhjdfyyfz ljpf
PLD b 3NC
Jncencndetn d ;blrjv dblt
Nf,ktnrb% 300 vu PLD b 150 vu 3NC
Gjlhjcnrb b
dphjckst
Lblfyjpby (LLB^
lbltjrcbbyjpby)
Jhfkmyfz cecgtypbz ltncrjuj gjhjirf#djls Dct djphfcns
10 vu#vk& Dj vyjub[ cnhfyf[ nht,etncz
ghbujnjdktybt c bcgjkmpjdfybtv ljgjkybntkmyjuj fynfwblyjuj chtlcndf&
:tdfntkmyst nf,ktnrb%
25 vu* 50 vu* 100 vu*
150 vu* 200 vu
Gjrhsnst ’ynthjcjk.,bkmyjq
j,jkjxrjq uhfyeks d rfgcekf[% 125 vu*
200 vu* 250 vu* 400 vu
Cnfdelby (d4N)
Gthjhfkmysq hfcndjh%
1vu#vk
Rfgceks% 15 vu^ 20 vu^ 30 vu^
40 vu
30
Dct djphfcns
Htp.vt^ fghtkm 2002 u
Djphfcn (VFCCF NTKF)^ LJPF'
B XFCNJNF ghbtvf
Lheubt pfvtxfybz
<4 ytltkb% 4 vu#ru#ldf hfpf d ltym
jn 4 ytltkm lj 13 ktn% 180 vu# v2#ldf hfpf d ltym
Vfrcbvfkmyfz ljpf%
513 ktn% 300 vu#ldf hfpf d ltym
<jkmijt rjkbxtcndj cbhjgf yt jxtym
[jhjij gthtyjcbncz ltnmvb ,jktt
cnfhituj djphfcnf&
Nht,etn [hfytybz d cntrkzyys[
cjcelf[ d ntvyjv vtcnt&
Vj;yj ghbybvfnm dvtcnt c gbotq&
Ljps 600vu#v 2 #ldf hfpf d ltym^
ytj,[jlbvst lkz ’ywtafkjgfnbb&
Yt ghbybvfnm dvtcnt c d4N (fynfujybcnbxtcrjt fynbhtnhjdbhecyjt ltqcndbt)&
<30 lytq% 2vu#ru#ldf hfpf d ltym
530 lytq bkb vfccf ntkf <60 ru%
4 vu#ru# ldf hfpf d ltym
Vfrcbvfkmyfz ljpf%
vfccf ntkf >60 ru%
150 vu#ldf hfpf d ltym
{jhjij gthtyjcbncz
Vj;yj ghbybvfnm dvtcnt c gbotq
{hfybnm hfcndjh ghb rjvyfnyjq
ntvgthfneht (bcgjkmpjdfnm d ntxtybt
jlyjuj vtczwf gjckt dcrhsnbz)
Vfrcbvfkmyfz ljpf%
>13 ktn bkb vfccf ntkf >60 ru%
1 nf,ktnrf ldf hfpf d ltym
Nf,ktnrb ytkmpz lhj,bnm
<3 vtczwf% (50 vu#v2#ldf hfpf d ltym
jn 3 vtczwtd lj <13 ktn% 90vu#v2#ldf hfpf d
ltym bkb 240 vu#v2#jlby hfp d ltym
Vfrcbvfkmyfz ljpf%
513 ktn bkb vfccf ntkf >60 ru%
200 vu#ldf hfpf d ltym bkb
400 vu#jlby hfp d ltym
<30 ru% 1vu#ru#ldf hfpf d ltym
Jn 30 lj 60 ru% 30 vu#ldf hfpf d ltym
Vfrcbvfkmyfz ljpf%
>60 ru% 40 vu#ldf hfpf d ltym
Cecgtypb. [hfybnm d ghj[kflyjv
vtcnt* cj[hfyztn cdjqcndf d ntxtybt
30 lytq* ytj,[jlbvj [jhjij
dcnhz[yenm&
D bltfkmyjv ckexft ghbybvfnm xthtp
xfc bkb ldf xfcf gjckt tls* vj;tn
bvtnm vtymitt pyfxtybt lkz ltntq&
Gjrhsnst ’ynthjcjk.,bkmyjq j,jkjxrjq
uhfyeks d rfgcekf[ vj;yj jnrhsnm b
dscsgfnm yf yt,jkmibt recjxrb gbob&
<jkmijq j,]tv hfcndjhf&
Hfcndjh [hfybnm d ghj[kflyjv vtcnt%
cj[hfyztn cdjqcndf d ntxtybt 30 lytq%
ytj,[jlbvj [jhjij dcnhz[yenm&
Ytj,[jlbvj [hfybnm d cntrkzyys[
,enskjxrf[&
Jnrhsnst rfgceks b gthtvtifyyst c
yt,jkmibvb recjxrfvb gbob [jhjij
gthtyjczncz (cj[hfyztn cdjqcndf d
hfcndjht d ntxtybt 24 xfcjd ghb [hfytybb d [jkjlbkybrt)&
Yt ghbybvfnm dvtcnt c FPN (fynfujybcnbxtcrjt fynbhtnhjdbhecyjt ltqcndbt)
31
Edtkbxtybt vfcinf,jd ghbvtytybz fynbhtnhjdbhecyjq nthfgbb d eckjdbz[ juhfybxtyys[ htcehcjd
F,frfdbh (F<R)
Gthjhfkmysq hfcndjh% 20 vu#vk
Nf,ktnrb% 300 vu
Cnfhit 3 vtczwtd
Abrcbhjdfyyfz
rjv,bybhjdfyyfz ljpf
PLD + 3NC + F<R
Jncencndetn d ;blrjv dblt
Nf,ktnrb% PLD 300 vu +
3NC 150 vu + F<R 300 vu
Gjlhjcnrb b
dphjckst
32
Ytyerktjpbnyst byub,bnjhs j,hfnyjq nhfycrhbgnfps
Ytdbhfgby (YDG)
Gthjhfkmyfz cecgtypbz% 10 vu#vk
Nf,ktnrb% 200 vu
"afdbhtyp ("AP)
Cbhjg% 30 vu#vk
Dct djphfcns
Kbim lkz
ltntq cnfhit
(Ghbvtxfybt% cbhjg
3 ktn
nht,etn ,jktt dscjrb[ ljp gj chfdytyb.
c rfgcekfvb^ cv& c[tve ghbtvf ktrfhcndtyys[ chtlcnd)
Rfgceks% 50 vu^ 100 vu^ 200 vu^ 600vu
Htp.vt^ fghtkm 2002 u
<16 ktn bkb vfccf ntkf 437^5 ru% 8 vu#ru#ldf
hfpf d ltym
Vfrcbvfkmyfz ljpf%
>16 ktn bkb vfccf ntkf >37^5 ru%
300 vu#ldf hfpf d ltym
Cbhjg [jhjij gthtyjcbncz^ f nf,ktnrb
vj;yj lhj,bnm&
Vj;yj ghbybvfnm dvtcnt c gbotq&
YTJ<{JLBVJ GHTLEGHTLBNM
HJLBNTKTQ J< FKKTHUBXTCRJQ
HTFRWBB&
D ckexft fkkthubxtcrjq htfrwbb
cktletn ghtrhfnbnm gjcnjzyysq
ghbtv F<R&
Vfrcbvfkmyfz ljpf%
>40 ru% 1 nf,ktnrf ldf hfpf d ltym
Nf,ktnrb ytkmpz lhj,bnm&
YTJ<{JLBVJ GHTLEGHTLBNM
HJLBNTKTQ J< FKKTHUBXTCRJQ
HTFRWBB&
D ckexft fkkthubxtcrjq htfrwbb
cktletn ghtrhfnbnm gjcnjzyysq ghbtv
f,frfdbhf&
15-30 lytq% 5 vu#ru#jlby hfp d ltym d ntxtybt
2 ytltkm^ pfntv 120vu#v2#ldf hfpf d ltym
d ntxtybt 2 ytltkm^ pfntv 200vu#v2#ldf hfpf
d ltym
>30 lytq lj 13 ktn% 120vu#v2#ldf hfpf d ltym
d ntxtybt 2 ytltkm^ pfntv 200vu#v2#ldf hfpf
d ltym
Vfrcbvfkmyfz ljpf%
>13 ktn% 200vu#jlby hfp d ltym d ntxtybt
gthds[ 2 ytltkm^ pfntv 200vu#ldf hfpf d ltym
Rfgcekf (;blrjcnm) - ljpf lkz ltntq >3 ktn% jn
10 lj 15 ru% 200 vu (270 vu = 9vk) jlby hfp d ltym
Jn 15 lj <20 ru% 250 vu (300 vu = 10 vk) jlby hfp
d ltym
Jn 20 lj <25 ru% 300 vu (360 vu = 12 vk) jlby hfp
d ltym
Jn 25 lj <33 ru% 350 vu (450 vu = 15 vk) jlby hfp
d ltym
Jn 33 lj <40 ru% 400 vu (510 vu = 17 vk) jlby hfp
d ltym
Vfrcbvfkmyfz ljpf%
540 ru% 600 vu jlby hfp d ltym
Tckb jlyjdhtvtyyj ghbybvftncz hbafvgbwby^ edtkbxbnm ljpe YDG
ghb,kbpbntkmyj yf 30¢ bkb ghtrhfnbnm
ghbvtytybt (cv& Hfpltk j ne,threktpt)&
Cecgtypb. [hfybnm ghb rjvyfnyjq
ntvgthfneht* ytj,[jlbvj [jhjij
dcnhz[yenm&
Vj;yj ghbybvfnm dvtcnt c gbotq&
YTJ<{JLBVJ GHTLEGHTLBNM
HJLBNTKTQ J DJPVJ:YJCNB GJZDKTYBZ CSGB& Yt edtkbxbdfnm ljpe d
ckexft gjzdktybz csgb (d ckexft
ytpyfxbntkmyjq#chtlytq cntgtyb csgb
ghjljk;fnm ghbtv ktrfhcndtyyjuj
ch tlc nd f* rj u lf c sg m bcx tp y t n ^
djpj,yjdbnm ljpbhjdre c yfxfkf edtkbxtybz ljps* d ckexft cbkmyjq csgb ghtrhfnbnm ghbtv ktrfhcndtyyjuj chtlcndf)&
Dp fbvj ltqcndbt ktr fhcndtyys[
chtlcnd&
Rfgceks vj;yj jnrhsnm b lj,fdbnm d
gboe^ yj jyf ,eltn bvtnm jxtym ujhmrbq
drec* b[ vj;yj^ jlyfrj^ cvtifnm cj ckfljcnzvb bkb l;tvjv lkz bpvtytybz drecf&
Vj;yj ghbybvfnm dvtcnt c gbotq (yj
bp,tufnm ghbtvf gjckt jxtym ;bhyjq
gbob^ rjnjhfz edtkbxbdftn f,cjh,wb.
yf 50¢)&
Kexit dctuj ghbybvfnm gthtl cyjv^
jcj,tyyj gthdst 2 ytltkb lkz cjrhfotybz gj,jxyjuj djpltqcndbz yf
wtynhfkmye. ythdye. cbcntve&
Dp fbvj ltqcndbt ktr fhcndtyys[
chtlcnd&
33
Byub,bnjhs ghjntfps
34
'
Dct djphfcns&
Jlyfrj d cdzpb
cj pyfxbntkmysv
afhvfrjrbytnbxtcrbv rjkt,fybtv e ltntq^
nht,etncz lfdfnm
jxtym dscjrbt
ljps uhelysv
ltnzv <1 ujlf
Ytkabyfdbh (YAD)
Gjhjijr lkz gthjhfkmyjq cecgtypbb (gthtvtifnm c ;blrjcnm.)% 200 vu yf xfqye.
kj;re (50 vu yf 1^25 vk)% 5 vk
Nf,ktnrb 250 vu (nf,ktnrb vj;yj hfpltkznm
yf ldt xfcnb^ lhj,bnm b lj,fdkznm d gboe b
hfcndjhznm d djlt)
Kjgbyfdbh#hbnjyfdbh^
(KGD#h)
Gthjhfkmysq hfcndjh% 80 vu#vk kjgbyfdbhf 6 vtczwtd bkb
cnfhit
+ 20 vu#vk hbnjyfdbhf
Rfgceks% 133^3 vu kjgbyfdbhf + 33^3 vu
hbnjyfdbhf
Bpvthznm gjchtlcndjv hfcxtnf gkjoflb gjdth[yjcnb ntkf% rdflhfnysq rjhtym
dtkbxbys (hjcn d cv yf vfcce ntkf d ru^ hfpltktyye. yf 3600)
<1 ujlf% 40-50 vu#ru#nhb hfpf d ltym
bkb 65-75 vu#ru ldf hfpf d ltym
>1 ujlf lj <13 ktn % 55-65 vu#ru#ldf hfpf d ltym
Vfrcbvfkmyfz ljpf%
513 ktn% 1250 vu#ldf hfpf d ltym
>6 vtczwtd lj 13 ktn% 225 vu#v2
KGD#57^5 vu#v2 hbnjyfdbhf ldf hfpf d ltym
bkb ljpbhjdrf d pfdbcbvjcnb jn vfccs ntkf%
7-15 ru% 12 vu#ru KGD#3 vu#ru hbnjyfdbh#ldf
hfpf d ltym
15-40 ru% 10 vu#ru kjgbyfdbhf#5 vu#ru hbnjyfdbhf
ldf hfpf d ltym
Gjhjijr ckflrbq^ ckturf ujhmrjdfnsq^
yj ndthlsq b nhelyjhfcndjhbvsq*
ytgjchtlcndtyyj gthtl ghbtvjv
ytj,[jlbvj hfpvtifnm d djlt^ vjkjrt^
ltncrjq cvtcb^ ltcthnt b n&l& yt
ghbvtyznm rbckjnye. gboe bkb cjr
(edtkbxbdftn ujhmrbq drec)&
D cdzpb c nhelyjcnzvb^ cdzpfyysvb
c ghbvtytybtv gjhjirf kexit bcgjkmpjdfnm hfplhj,ktyyst nf,ktnrb
(lf;t lkz uhelys[ ltntq)^ tckb vj;yj
gjlj,hfnm cjjndtncnde.oe. ljpe&
Gjhjijr b nf,ktnrb vj;yj [hfybnm ghb
rjvyfnyjq ntvgthfneht&
Ghbybvfnm c gbotq&
Dp fbvj ltqcndbt ktr fhcndtyys[
chtlcnd (d vtymitq cntgtyb xtv byub,bnjhs ghjntfps^ cjlth;fobt hbnjyfdbh)&
Gthjhfkmysq hfcndjh b rfgceks ghtlgjxnbntkmyj [hfybnm d ghj[kflyjv
vtcnt* jlyfrj b[ vj;yj [hfybnm ghb
rjvyfnyjq ntvgthfneht lj 25o C d
ntxtybt 2 vtczwtd
:blrbq cjcnfd bvttn vtymibq j,]tv^
yj ,jktt ujhmrbq drec
Kexit [hfybnm d ghj[kflyjv vtcnt
Rfgceks ,jkmijuj hfpvthf
Ghbybvfnm dvtcnt c gbotq
Dp fbvj ltqcndbt ktr fhcndtyys[
chtlcnd
35