Расширение масштабов антиретровирусной терапии в условиях ограниченных ресурсов: Руководство по лечению для системы общественного здравоохранения.

PÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ: êìäéÇéÑëíÇé èé ãÖóÖçàû Ñãü ëàëíÖåõ éÅôÖëíÇÖççéÉé áÑêÄÇééïêÄçÖçàü ꉇ͈Ëfl 2003 „Ó‰‡

Всемирная организация здравоохранения Женева 2004 г

èÓ‰„ÓÚӂ͇ ̇ÒÚÓfl˘Â„Ó êÛÍÓ‚Ó‰ÒÚ‚‡ Ì ·˚· ·˚ ‚ÓÁÏÓÊÌÓÈ ·ÂÁ Û˜‡ÒÚËfl ÏÌÓ„Ëı ˝ÍÒÔÂÚÓ‚. ÇÒÂÏË̇fl Ó„‡ÌËÁ‡ˆËfl Á‰‡‚ÓÓı‡ÌÂÌËfl ‚˚‡Ê‡ÂÚ ÓÒÓ·Û˛ ÔËÁ̇ÚÂθÌÓÒÚ¸ Û˜‡ÒÚÌËÍ‡Ï ê‰‡ÍˆËÓÌÌÓ„Ó äÓÏËÚÂÚ‡ ÍÓÚÓ˚È ÔÓ‰„ÓÚÓ‚ËÎ ‰‡ÌÌ˚È ‰ÓÍÛÏÂÌÚ è‰Ò‰‡ÚÂÎÂÏ ˝ÚÓ„Ó äÓÏËÚÂÚ‡ ·˚Î ÔÓÙ. ëÍÓÚÚ ï‡ÏÏÂ ËÁ äÓÎÛÏ·ËÈÒÍÓ„Ó ÛÌË‚ÂÒËÚÂÚ‡ (縲-âÓÍ, ëòÄ) Ë Â„Ó ˜ÎÂ̇ÏË ·˚ÎË ÑË‡Ì ï‡‚ÎË (ä‡ÎËÙÓÌËÈÒÍËÈ ÛÌË‚ÂÒËÚÂÚ, ë‡Ì-î‡ÌˆËÒÍÓ, ëòÄ), ùÎËÁ äÎÂÏÂÌÚ (Çéá, ò‚ÂȈ‡Ëfl), ËÓ ë͇ÌÓ (Çéá, ò‚ÂȈ‡Ëfl), ܇Ì-ùÎÎË å‡ÎÍËÌ (ESTHER, î‡ÌˆËfl), ܇Ì-î‡ÌÒÛ‡ ÑÂÎÙ‡ÒÒË (CHU BICETRE, ANRS, è‡ËÊ, î‡ÌˆËfl), ÑÊÓÔ ã‡ÌÊ (åÂʉÛ̇Ó‰ÌÓ ÒÓÓ·˘ÂÒÚ‚Ó ÔÓ ÔÓ·ÎÂÏ‡Ï ëèàч, ò‚ˆËfl), ãˉˇ åÛÌ„ÂÂ‡ (GNP+, 섇̉‡), ãËÌÌ åÓÙÂÌÒÓÌ (燈ËÓ̇θÌ˚È ËÌÒÚËÚÛÚ Á‰‡‚ÓÓı‡ÌÂÌËfl, NICHD, ëòÄ), å‡Í ï‡ËÌ„ÚÓÌ (ÉÛÔÔ‡ Treatment Action, 縲-âÓÍ, ëòÄ), å‡ÛÓ òÂıÚÂ (î‰Â‡Î¸Ì˚È ÛÌË‚ÂÒËÚÂÚ ‚ êËÓ-‰Â-܇ÌÂÈÓ, Å‡ÁËÎËfl), ç.äÛχ‡Ò‡ÏË (YRG ñÂÌÚ ÔÓ ËÒÒΉӂ‡Ì˲ Ë ÔÓÒ‚Â˘ÂÌ˲ ÔÓ ‚ÓÔÓÒ‡Ï ëèàч, à̉Ëfl), çËÍÓÎ‡Ò ÑÛËÂ (Ç‡˜Ë ·ÂÁ „‡Ìˈ, í‡Ë·̉), è‡Ô‡ ë‡ÎËÙ ëÓÛ (ìÌË‚ÂÒËÚÂÚ Ñ‡Í‡‡, ëÂÌ„‡Î), ò‡·Ë ŇÌÛ (ëÓ‚ÂÚ ÔÓ ÍÓÌÚÓβ Á‡ ÎÂ͇ÒÚ‚ÂÌÌ˚ÏË Ò‰ÒÚ‚‡ÏË, ûÊ̇fl ÄÙË͇) Ë íÓÏ‡Ò å‡Í‡ˇ (ÅÓθÌˈ‡ ç‡Á‡ÂÚ‡, äÂÌËfl). ç‡ÒÚÓfl˘ËÈ ‰ÓÍÛÏÂÌÚ ·˚Î ÒÓÁ‰‡Ì ̇ ÓÒÌÓ‚Â ÔÓˆÂÒÒ‡ ÍÓÌÒÛθڇˆËÈ Ò Û˜ÂÚÓÏ Ëϲ˘ËıÒfl ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ̇ۘÌ˚ı ‰‡ÌÌ˚ı Ë ÒÓ‚ÂÏÂÌÌ˚ı ‚ˉӂ ΘÂÌËfl Çàó-ËÌÙÂ͈ËË. éÒÌÓ‚ÌÓÈ ‡ÍˆÂÌÚ ·˚Î Ò‰ÂÎ‡Ì Ì‡ ÛÒÎÓ‚Ëflı, ÍÓÚÓ˚ ı‡‡ÍÚÂËÁÛ˛ÚÒfl Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË. èÓÒΠÔÓ‰„ÓÚÓ‚ÍË ÔÓÂÍÚ‡ êÛÍÓ‚Ó‰ÒÚ‚‡ ꉇÍÚÓÒÍËÏ ÍÓÏËÚÂÚÓÏ ‚ ÓÍÚfl· 2003 „. ‰ÓÍÛÏÂÌÚ ·˚Π̇Ô‡‚ÎÂÌ ·ÓΠ˜ÂÏ 200 Ô‡ÚÌÂ‡Ï-ËÌÒÚËÚÛÚ‡Ï Ë Ó„‡ÌËÁ‡ˆËflÏ ‚Ó ‚ÒÂÏ ÏËÂ Ë ÒڇΠÔ‰ÏÂÚÓÏ Ó·˘ÂÒÚ‚ÂÌÌ˚ı ÍÓÌÒÛθڇˆËÈ Ò 28 ÓÍÚfl·fl ÔÓ 1 4 ÌÓfl·fl 2003 „. ̇ ‚·-Ò‡ÈÚ‡ı Çéá Ë ITAC. Çéá ‚˚‡Ê‡ÂÚ Ú‡ÍÊ ÔËÁ̇ÚÂθÌÓÒÚ¸ Á‡ Á‡Ï˜‡ÌËfl Ë ‚Í·‰: ÄÎÂÍ҇̉‡ ä‡ÎÏË (ò‚ÂȈ‡Ëfl), Ä̉˛ ïËÎÎ (ëòÄ), ÄÌ̇·ÂÎ ä‡Ì‡·ÛÒ (ëÓ‰ËÌÂÌÌÓ äÓÓ΂ÒÚ‚Ó), ùÌÚÓÌË ÄÏÓÓÒÓ (ëòÄ), ùÌÚÓÌË ï‡ËÂÒ (å‡Î‡‚Ë), ÄÚÛ ä‡ÎËÍÏ‡Ì (Å‡ÁËÎËfl), ÅÂ̇‰ 퇂ÂÌ (ëÂÌ„‡Î), Å‚ÂÎË ëÌÂÎÎ (Ä‚ÒÚ‡ÎËfl), ÅÂÒÒ åËÎÎÂ (ëòÄ), Å‡È˝Ì ùÎÂÈ (ûÊ̇fl ÄÙË͇), ä˝Ë ÑÊÂÙÙËÒ (ëòÄ), ó‡θÁ ÉËÎÍÒ (Çéá, ò‚ÂȈ‡Ëfl), äËÒ Ñ‡ÌÍÓÏ· (í‡Ë·̉), äËÒ ÉËÌ (à̉ÓÌÂÁËfl), äÎÂÏÂÌÚ å‡Î‡Û (Ä‚ÒÚ‡ÎËfl), Ñ˝‚ˉ äÓÌ (ëòÄ), чȇ̇ ÉË·· (ëÓ‰ËÌÂÌÌÓ äÓÓ΂ÒÚ‚Ó), ùχÌÛ˝Î¸ èÓÌÚ‡ÎË (àÚ‡ÎËfl), ùÏËΡ êË‚‡‰ÂÌÂÈ‡ (ëòÄ), ùËÍ Ç‡Ì è‡‡„ (ëòÄ), îËÓÌۇ· åÍÍÛ· (ä‡ÏÂÛÌ), î˝ÌÒËÒ éÌˇ̄ (Çéá, Äîêé), î‡ÌÒÛ‡ ч·Ë (î‡ÌˆËfl), É˝È ë‡ÚÚÎÂ (îËÎËÔÔËÌ˚), ÉÛË‰Ó ãÂ‚Ë (Å‡ÁËÎËfl), ïÂÎÓÈÒ‡ å‡ÍÂÒ (Å‡ÁËÎËfl), ïÂ·ÂÚ èÂÚÂÒÓÌ (Çéá, ò‚ÂȈ‡Ëfl), àÁ‡·Âθ ÜËÓ (ëÓ‰ËÌÂÌÌÓ äÓÓ΂ÒÚ‚Ó), ÑÊ˝ÈÏ ìË„ (å¸flÌχ), ÑÊÂÙÙË ëÚÛ˜Ë (ëòÄ), ÑÊÓȇ åÛÍıÂ‰ÊË (ɇËÚË), ÑÊÓÌ‡Ú‡Ì äÓÌ (ëòÄ), ÑÊÓÁ áÛÌËÌ„‡ (ëòÄ), ä‡ËÌ íËÏÏÂχÌÒ (à̉ÓÌÂÁËfl), ä‡ȇ‰Ê‡ ŇË„ (ëòÄ), äÂÈÚ ÄÎÍÓÌ (ëÓ‰ËÌÂÌÌÓ äÓÓ΂ÒÚ‚Ó), äẨÊË í‡ÏÛ‡ (Çéá, ò‚ÂȈ‡Ëfl), äÛÎ͇̇ȇ òÓÍÂԇȷÛÎÍËÚ (í‡Ë·̉), ã‡ÎË ïÓÚÂ̇¯‚ËÎË (Çéá, ÖÇêé), ãÂÓÌ ã‚ËÌ (ûÊ̇fl ÄÙË͇), å‡Òˇ чΠ (Å‡ÁËÎËfl), å‡Òˇ ê‡ıˉ (Å‡ÁËÎËfl), å‡„‡ ÇË„ÌÂÒ (ûÊ̇fl ÄÙË͇), å‡ˇ ÇË„ÌÓ (Çéá, ò‚ÂȈ‡Ëfl), å‡ËÌÂη ‰Â · ç„‡ (Å‡ÁËÎËfl), å‡Ú‡ ëÂ„Û (àÒÔ‡ÌËfl), åÓÌË͇ Å„ (Çéá, ò‚ÂȈ‡Ëfl), åÛ͇‰Ë â‡-ÑËÛÎ (ëòÄ), é·‚Ó åÛÌıÓÁ (Å‡ÁËÎËfl), èÓÎ Ñʇ„ (çÓ‚„Ëfl), èÓ· îÛ‰ÊË‚‡‡ (IUATLD, î‡ÌˆËfl), èÂÚÂ ÄÌÚÓÌ (ûÊ̇fl ÄÙË͇), èËÚÂ ÉÓ‰ÙË-îÓÒÒÂÚ (ëÓ‰ËÌÂÌÌÓ äÓÓ΂ÒÚ‚Ó), èËÂ ÄÌÊÂÎÓ íÓ‰Ó (àÚ‡ÎËfl), è‡Ù‡Ì è‡ÌÛÙ‡Í (í‡Ë·̉), êË͇‰Ó å‡ËÌÒ (Å‡ÁËÎËfl), ê˘‡‰ ã˝Ì„ (Çéá, ëÂÍÂÚ‡ˇÚ), êÓ·ËÌ ÉÂÈ (Çéá, ëÂÍÂÚ‡ˇÚ), êÓÁ‡Ì‡ ‰Âθ ŸflÌÍÓ (Å‡ÁËÎËfl), ë‡Èί ìÔ‡‰ıÛ‡È (çÂÔ‡Î), ëÚË‚ÂÌ ëÔÂÍÚÓ (ëòÄ), ëÛ‰‡¯‡Ì äÛχË (à̉Ëfl), í‡ÈÏÓ 燂‡Á (Ň̄·‰Â¯), íÛχ ÉÓÎ‰Ï˝Ì (ëòÄ), ÇËÌÒÂÌÚ ï‡·ËflÏ·Â (Çéá, ò‚ÂȈ‡Ëfl), ìËθflÏ ÅÛÏ˝Ì (ÑÂÌ‚Â, ëòÄ) Ë Ç·‰ËÏË ä¸ÂÓÁ (Å‡ÁËÎËfl) ‚ ÔÓˆÂÒÒ ӷ˘ÂÒÚ‚ÂÌÌ˚ı ÍÓÌÒÛθڇˆËÈ. àı ‚Í·‰ ·˚Î ‡ÒÒÏÓÚÂÌ ê‰‡ÍˆËÓÌÌ˚Ï ÍÓÏËÚÂÚÓÏ 26 ÓÍÚfl·fl 2003 „Ó‰‡, Ë ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ˝ÚÓ ·˚ÎÓ ÔËÁ̇ÌÓ ÌÂÓ·ıÓ‰ËÏ˚Ï, ÔÓÂÍÚ êÛÍÓ‚Ó‰ÒÚ‚‡ ·˚Î ËÁÏÂÌÂÌ Ò Û˜ÂÚÓÏ Ò‰Â·ÌÌ˚ı Á‡Ï˜‡ÌËÈ. Çéá Ú‡ÍÊ ‚˚‡Ê‡ÂÚ ÔËÁ̇ÚÂθÌÓÒÚ¸ 燈ËÓ̇θÌÓÏÛ ‡„ÂÌÚÒÚ‚Û ÔÓ Ì‡Û˜Ì˚Ï ËÒÒΉӂ‡ÌËflÏ ‰Îfl ·Ó¸·˚ ÒÓ ëèàÑÓÏ, è‡ËÊ, Á‡ Û˜‡ÒÚË ‚ ͇˜ÂÒÚ‚Â ÔËÌËχ˛˘ÂÈ ÒÚÓÓÌ˚ ‚ Á‡Ò‰‡ÌËË ê‰‡ÍˆËÓÌÌÓ„Ó ÍÓÏËÚÂÚ‡ 1 5-17 ÓÍÚfl·fl 2003 „Ó‰‡. äÓÓ‰Ë̇ˆËfl ̇ÒÚÓfl˘ÂÈ ‡·ÓÚ˚ ÓÒÛ˘ÂÒÚ‚Îfl·Ҹ å‡ÍÓ ÇËÚÓËfl Ë ÑÊÓÌÒ èÂ¸ÂÌÒ ËÁ Çéá/çíå/HIV, ÜÂÌ‚‡, ò‚ÂȈ‡Ëfl.

é„·‚ÎÂÌË ëÔËÒÓÍ ÒÓÍ‡˘ÂÌËÈ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. II. ǂ‰ÂÌË . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ñÂÎË ‰ÓÍÛÏÂÌÚ‡. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 7 9 1 1 2 1 24

III. äÓ„‰‡ ÒΉÛÂÚ Ì‡˜Ë̇ڸ ÄêÇ ÚÂ‡Ô˲ Û ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV. êÂÍÓÏẨÛÂÏ˚ ÒıÂÏ˚ ÄêÇ-ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ ‰Îfl ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V. é·ÓÒÌÓ‚‡ÌËfl ‰Îfl ÍÓÂ͈ËË Äêí Û ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚. . . . . VI. äÎËÌ˘ÂÒÍËÈ Ë Î‡·Ó‡ÚÓÌ˚È ÏÓÌËÚÓËÌ„ . . . . . . . . . . . . . . . . . . . .

VII. Ç˚·Ó ÒıÂÏ ÄêÇ-ÚÂ‡ÔËË ‚ ÒÎÛ˜‡Â ̽ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl ÍÓÏ·Ë̇ˆËflÏË ÔÂ‚Ó„Ó fl‰‡ ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚. . . . . . . . . . . 27 VIII. èÓ·ÎÂÏ˚, ͇҇˛˘ËÂÒfl ÍÓÌÍÂÚÌ˚ı ͇Ú„ÓËÈ Ô‡ˆËÂÌÚÓ‚ . . . . . . . 29 A. ÜÂÌ˘ËÌ˚, ÒÔÓÒÓ·Ì˚Â Í ‰ÂÚÓÓʉÂÌ˲, ËÎË ·ÂÂÏÂÌÌ˚Â. . . . B. ÑÂÚË. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1 C. ã˛‰Ë, ·ÓθÌ˚ ÚÛ·ÂÍÛÎÂÁÓÏ, Ò ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ Çàó-ËÌÙÂ͈ËÂÈ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 D. èÓÚ·ËÚÂÎË ËÌ˙Â͈ËÓÌÌ˚ı ̇ÍÓÚËÍÓ‚ . . . . . . . . . . . . . . . . . . . . 43 IX. ëӷβ‰ÂÌË ÂÊËχ ‡ÌÚËÂÚÓ‚ËÛÒÌÓÈ ÚÂ‡ÔËË . . . . . . . . . . . . . 44 X. ùÔˉ̇‰ÁÓ Á‡ ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï . . 46 XI. Ç˚‚Ó‰˚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 èËÎÓÊÂÌË A. ÑÓÁËӂ͇ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ ‰Îfl ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 èËÎÓÊÂÌË B. ëËÒÚÂχ Ô‰ˇÚ˘ÂÒÍÓÈ Í·ÒÒËÙË͇ˆËË Í‡Ú„ÓËÈ ‚ËÛÒ‡ ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ˜ÂÎÓ‚Â͇ ̇ ÓÒÌÓ‚Â ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ CD4+ T Ë Ëı ÔÓˆÂÌÚÌÓ„Ó ÒÓ‰ÂʇÌËfl Ò Û˜ÂÚÓÏ ‚ÓÁ‡ÒÚ‡ . . . . . . . . . . 49 èËÎÓÊÂÌË C. ë‚Ӊ͇ ‰‡ÌÌ˚ı ÔÓ Ô‰ˇÚ˘ÂÒÍËÏ ÙÓÏ‡Ï Ë ‰ÓÁ‡Ï ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 èËÎÓÊÂÌË D. äÓÏ·Ë̇ˆËË ÄêÇ-ÔÂÔ‡‡ÚÓ‚ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁ‡ı ÔÓ ÒÓÒÚÓflÌ˲ ̇ 1 ‰Â͇·fl 2003 „. . . . . . . . . . . . . . . . . . . . . . . . . 60 èËÎÓÊÂÌË E. ëËÒÚÂχ ÓÔ‰ÂÎÂÌËfl ÒÚ‡‰ËÈ Çàó-ËÌÙÂ͈ËË Ë Á‡·Ó΂‡ÌËfl Û ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚ ÔÓ Í·ÒÒËÙË͇ˆËË Çéá. . . . . èËÎÓÊÂÌË F. ëËÒÚÂχ ÓÔ‰ÂÎÂÌËfl ÒÚ‡‰ËÈ Çàó-ËÌÙÂ͈ËË Ë Á‡·Ó΂‡ÌËfl Û ‰ÂÚÂÈ ÔÓ Í·ÒÒËÙË͇ˆËË Çéá . . . . . . . . . . . . . . . . . . . . . . 6 1 62

ÅË·ÎËÓ„‡ÙËfl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

ëÔËÒÓÍ ÒÓÍ‡˘ÂÌËÈ ÄÇë – ÄÅä ‡·‡Í‡‚Ë ACTG – Éäàë „ÛÔÔ‡ ‰Îfl ÍÎËÌ˘Â-

ÒÍÓ„Ó ËÁÛ˜ÂÌËfl ëèàч AIDS – ëèàÑ ÒË̉ÓÏ ÔËÓ·ÂÚÂÌÌÓ„Ó ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ALT – ÄíÄ ‡ÏËÌÓÚ‡ÌÒÙÂ‡Á‡ ‡Î‡ÌË̇ ART – Äêí ‡ÌÚËÂÚÓ‚ËÛÒ̇fl ÚÂ‡ÔËfl ÄRV – ÄêÇ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚È ATV – Äáç ‡Ú‡Á‡Ì‡‚Ë bid – ‰‰ ‰‚‡ ‡Á‡ ‚ ‰Â̸ CD4 T-ÎËÏÙÓˆËÚ CD4+ CNS – ñçë ˆÂÌÚ‡Î¸Ì‡fl ÌÂ‚̇fl ÒËÒÚÂχ d4T ÒÚ‡‚Û‰ËÌ DART – êÄêíÄ ‡Á‡·ÓÚ͇ ‡ÌÚËÂÚÓ‚ËÛÒÌÓÈ ÚÂ‡ÔËË ‚ ÄÙËÍ ddI ‰Ë‰‡Ìo‡ÁËÌ DOT – Ñéíë ÚÂ‡ÔËfl ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ„Ó Ì‡·Î˛‰ÂÌËfl EFV – ùîñ ˝Ù‡‚ËÂ̈ ENF (T-20) – ˝ÌÙÛ‚ÚÚˉ ùîí FBC: èÄä FDC – îÑ

ÔÓÎÌ˚È ‡Ì‡ÎËÁ ÍÓ‚Ë ÙËÍÒËÓ‚‡Ì̇fl ‰ÓÁËӂ͇ FTC – ùíñ ˝ÏÚˈËÚ‡·ËÌ GI – Éà „‡ÒÚÓËÌÚÂÒÚË̇θÌ˚È HAART – ‚˚ÒÓÍÓ‡ÍÚ˂̇fl ÇÄÄêí ‡ÌÚËÂÚÓ‚ËÛÒ̇fl ÚÂ‡ÔËfl Hgb „ÂÏÓ„ÎÓ·ËÌ HIV – Çàó ‚ËÛÒ ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ˜ÂÎÓ‚Â͇ HIVab – Çàó‡Ú ‡ÌÚËÚ· ‚ËÛÒ‡ ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ˜ÂÎÓ‚Â͇ IDU – èàç ÔÓÚ·ËÚÂθ ËÌ˙Â͈ËÓÌÌ˚ı ̇ÍÓÚËÍÓ‚ IDV – àÑÇ Ë̉Ë̇‚Ë LPV – ãèÇ ÎÓÔË̇‚Ë MTCT – èåê ÔÂ‰‡˜‡ ÓÚ Ï‡ÚÂË ·ÂÌÍÛ (Çàó)

ÏÛÚ‡ˆËfl ‡Ì‡ÎÓ„‡ ÌÛÍÎÂÓÁˉ‡ NFV – çîÇ ÌÂθÙË̇‚Ë NGO – çèé ÌÂÔ‡‚ËÚÂθÒÚ‚ÂÌÌ˚ Ó„‡ÌËÁ‡ˆËË NNRTI – ÌÂÌÛÍÎÂÓÁˉÌ˚È ççàéí ËÌ„Ë·ËÚÓ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ NsRTI – çÁàéí ÌÛÍÎÂÓÁˉÌ˚È ËÌ„Ë·ËÚÓ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ NtRTI – çÚàéí ÌÛÍÎÂÓÚˉÌ˚È ‡Ì‡ÎÓ„ ËÌ„Ë·ËÚÓ‡ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ NVP – çÇè Ì‚Ë‡ÔËÌ PCR – èñê ÔÓÎËÏÂ̇fl ˆÂÔ̇fl ‡͈Ëfl PI – àè ËÌ„Ë·ËÚÓ ÔÓÚ‡Á˚ qd – ‰ ‡Á ‚ ‰Â̸ RT – éí Ó·‡Ú̇fl Ú‡ÌÒÍËÔÚ‡Á‡ RTI – àéí ËÌ„Ë·ËÚÓ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ RTV – êíç ËÚÓ̇‚Ë RTV-PI – ËÌ„Ë·ËÚÓ ÔÓÚ‡Á˚ ̇ êíç-àè ÓÒÌÓ‚Â ËÚÓ̇‚Ë‡ sgc Ïfl„͇fl „Â΂‡fl ͇ÔÒÛ· SQV – ëäÇ Ò‡ÍË̇‚Ë TB – íÅ ÚÛ·ÂÍÛÎÂÁ TDF – íÑî ÚÂÌÓÙÓ‚Ë‰ËÁÓÔÓÍÒË· ÙÛχ‡Ú TLC – éäã Ó·˘Â ÍÓ΢ÂÒÚ‚Ó ÎËÏÙÓˆËÚÓ‚ UN – ééç é„‡ÌËÁ‡ˆËfl é·˙‰ËÌÂÌÌ˚ı 燈ËÈ UNAIDS – é·˙‰ËÌÂÌ̇fl ûçùâÑë ÔÓ„‡Ïχ ééç ÔÓ Çàó/ëèàÑÛ WBC – äÅä ÍÓ΢ÂÒÚ‚Ó ·ÂÎ˚ı ÍÓ‚flÌ˚ı ÚÂΈ WHO – Çéá ÇÒÂÏË̇fl Ó„‡ÌËÁ‡ˆËfl Á‰‡‚ÓÓı‡ÌÂÌËfl ZDV – áÑÇ ÁˉӂۉËÌ (Ú‡ÍÊ ËÁ‚ÂÒÚÂÌ Í‡Í Äáí) /r – / ËÚÓ̇‚Ë ‚ χÎ˚ı ‰ÓÁ‡ı NAM – åÄç

4

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

I. ÇÇÖÑÖçàÖ

é

Ô‰ÂÎÂÌË ‰ÂÈÒÚ‚ÂÌÌ˚ı ‚ˉӂ ‡ÌÚËÂÚÓ‚ËÛÒÌÓÈ ÚÂ‡ÔËË (Äêí) ‚ 1 996 „. ·˚ÎÓ Ì‡ÒÚÓfl˘ÂÈ ‚ÓβˆËÂÈ ‰Îfl ·ÓθÌ˚ı Ò Çàó/ëèàÑÓÏ ‚ ÔÓÏ˚¯ÎÂÌÌÓ ‡Á‚ËÚ˚ı ÒÚ‡Ì‡ı ÏË‡. ïÓÚfl ˝ÚÓÚ ‚ˉ ΘÂÌËfl Ì fl‚ÎflÂÚÒfl ԇ̇ˆÂÂÈ Ë ÒÓÁ‰‡ÂÚ ÌÓ‚˚ ÔÓ·ÎÂÏ˚ ‚ ÓÚÌÓ¯ÂÌËË ÔÓ·Ó˜ÌÓ„Ó ‰ÂÈÒÚ‚Ëfl Ë ÂÁËÒÚÂÌÚÌÓÒÚË Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï, ÓÌ ÒÔÓÒÓ·ÒÚ‚Ó‚‡Î Á̇˜ËÚÂθÌÓÏÛ ÒÓÍ‡˘ÂÌ˲ ÔÓ͇Á‡ÚÂÎÂÈ Á‡·Ó΂‡ÂÏÓÒÚË Ë ÒÏÂÚÌÓÒÚË Ë ÛÎÛ˜¯ËΠ͇˜ÂÒÚ‚Ó ÊËÁÌË Î˛‰ÂÈ Ò Çàó/ëèàÑÓÏ, ‚ÓÁӉ˂ ̇‰ÂÊ‰Û ‚ Ó·˘ÂÒÚ‚Â. ÅÓΠÚÓ„Ó, Çàó/ëèàÑ ‡ÒÒχÚË‚‡ÂÚÒfl ÚÂÔÂ¸ Í‡Í ÔÓ‰‰‡˛˘ÂÂÒfl ΘÂÌ˲ ıÓÌ˘ÂÒÍÓ Á‡·Ó΂‡ÌËÂ, ‡ ̠̘ÚÓ Ò‡‚ÌËÏÓÂ Ò ˝ÔˉÂÏËÂÈ ˜ÛÏ˚1.

ä ÒÓʇÎÂÌ˲, ·Óθ¯‡fl ˜‡ÒÚ¸ ËÁ 40 ÏËÎÎËÓÌÓ‚ ˜ÂÎÓ‚ÂÍ, ÊË‚Û˘Ëı ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl Ò Çàó/ëèàÑÓÏ, ÊË‚ÛÚ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı Ë Ì ‡Á‰ÂÎfl˛Ú ˝ÚÓ„Ó ÓÔÚËÏËÒÚ˘ÌÓ„Ó ÔÓ„ÌÓÁ‡2. èÓ Ò‡Ï˚Ï ÍÓÌÒÂ‚‡ÚË‚Ì˚Ï ‡Ò˜ÂÚ‡Ï Çéá, Í ÍÓÌˆÛ 2003 „. ÔË·ÎËÁËÚÂθÌÓ 6 ÏËÎÎËÓÌÓ‚ ˜ÂÎÓ‚ÂÍ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÌÛʉ‡ÎËÒ¸ ‚ Äêí ‰Îfl ÒÓı‡ÌÂÌËfl ÊËÁÌË. é‰Ì‡ÍÓ Î˯¸ ÓÍÓÎÓ 400 000 ˜ÂÎÓ‚ÂÍ ÔÓÎÛ˜‡ÎË ÌÂÓ·ıÓ‰ËÏӠΘÂÌËÂ, Ô˘ÂÏ Ó‰Ì‡ ÚÂÚ¸ ËÁ ÌËı ÔÓÊË‚‡ÂÚ ‚ Å‡ÁËÎËË. ç‡ ÒÂÒÒËË É ÂÌÂ‡Î¸ÌÓÈ ÄÒ҇ϷÎÂË ééç ÔÓ Çàó/ëèàÑÛ 22 ÒÂÌÚfl·fl 2003 „. Çéá Á‡fl‚Ë· Ó ÚÓÏ, ˜ÚÓ ÓÚÒÛÚÒÚ‚Ë ‰ÓÒÚÛÔ‡ Í Î˜ÂÌ˲ Çàó-ËÌÙÂ͈ËË ÒÓÁ‰‡ÂÚ ˜ÂÁ‚˚˜‡ÈÌÛ˛ ÒËÚÛ‡ˆË˛ ‚ „ÎÓ·‡Î¸ÌÓÏ Á‰‡‚ÓÓı‡ÌÂÌËË. Çéá Ó·‡˘‡ÂÚÒfl Ò ÔËÁ˚‚ÓÏ Í ÔËÌflÚ˲ ·ÂÒÔˆ‰ÂÌÚÌ˚ı ÏÂ ‰Îfl ÚÓ„Ó, ˜ÚÓ·˚ 3 ÏËÎÎËÓ̇ ˜ÂÎÓ‚ÂÍ, ÌÛʉ‡˛˘ËıÒfl ‚ Äêí, ÔÓÎÛ˜ËÎË ‰ÓÒÚÛÔ Í ÌÂÈ Í ÍÓÌˆÛ 2005 „Ó‰‡. ÑÎfl ‰ÓÒÚËÊÂÌËfl ˝ÚÓÈ ˆÂÎË Çéá ̇ÏÂÂ̇ ÒÓÁ‰‡Ú¸ ÒÚ‡Ú„˘ÂÒÍÛ˛ ÒÚÛÍÚÛÛ, ÓÔË‡˛˘Û˛Òfl ̇: ◗ É ÎÓ·‡Î¸ÌÓ ÛÍÓ‚Ó‰ÒÚ‚Ó, ÒËθÌÓ ԇÚÌÂÒÚ‚Ó Ë ÔÓÔ‡„‡Ì‰Û; ◗ çÂÁ‡Ï‰ÎËÚÂθÌÛ˛ Ë ÛÒÚÓÈ˜Ë‚Û˛ ÔÓ‰‰ÂÊÍÛ ÒÚ‡Ì‡Ï; ◗ ìÔÓ˘ÂÌÌÛ˛ Òڇ̉‡ÚËÁËÓ‚‡ÌÌÛ˛ ÏÂÚÓ‰ËÍÛ ‰Îfl Ó·ÂÒÔ˜ÂÌËfl Äêí; ◗ ùÙÙÂÍÚË‚Ì˚Â Ë Ì‡‰ÂÊÌ˚ ÔÓÒÚ‡‚ÍË ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ë ‰Ë‡„ÌÓÒÚ˘ÂÒÍËı Ò‰ÒÚ‚; ◗ Å˚ÒÚÓ ‚˚fl‚ÎÂÌËÂ Ë ËÒÔÓθÁÓ‚‡ÌË ÌÓ‚˚ı ‰‡ÌÌ˚ı Ë ÛÒÔ¯Ì˚ı ÔÓ‰ıÓ‰Ó‚. ç‡ÒÚÓfl˘Â ӷÌÓ‚ÎÂÌÌÓÂ Ë ÛÔÓ˘ÂÌÌÓ ÛÍÓ‚Ó‰ÒÚ‚Ó fl‚ÎflÂÚÒfl ÓÒÌÓ‚ÓÈ Ô·̇ Çéá «3 Í 5» Ë fl‚ÎflÂÚÒfl ·ÓΠ‰ËÂÍÚË‚Ì˚Ï, ˜ÂÏ Â„Ó ‡ÌÌËÈ ‚‡ˇÌÚ ‚ ÓÚÌÓ¯ÂÌËË Í ÚÂ‡ÔËË ÔÂ‚Ó„Ó Ë ‚ÚÓÓ„Ó fl‰‡. éÌÓ Û˜ËÚ˚‚‡ÂÚ Ì ÚÓθÍÓ Ù‡ÍÚ˘ÂÒÍË ‰‡ÌÌ˚Â, ÒÓ·‡ÌÌ˚ ‚ ÂÁÛθڇÚ ÍÎËÌ˘ÂÒÍËı ËÒÔ˚Ú‡ÌËÈ Ë Ì‡·Î˛‰ÂÌËÈ ‚ ÓÚÌÓ¯ÂÌËË ˝ÙÙÂÍÚË‚ÌÓÒÚË Ë ÔÓ·Ó˜ÌÓ„Ó ‰ÂÈÒÚ‚Ëfl ‡ÒÒχÚË‚‡ÂÏ˚ı ÂÊËÏÓ‚ ΘÂÌËfl, ÌÓ Ë ÓÔ˚Ú, ̇ÍÓÔÎÂÌÌ˚È ÔÓ„‡ÏχÏË Äêí ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚, ‡ Ú‡ÍÊ ‚ÓÔÓÒ Ó ÒÚÓËÏÓÒÚË Ë Ì‡Î˘ËË ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ ‚ Ú‡ÍËı ÛÒÎÓ‚Ëflı. ç‡ ÓÒÌÓ‚Â ˝ÚÓ„Ó ÔÓ‰ıÓ‰‡ Çéá ÒÚÂ-

5

ÏËÚÒfl Ó͇Á‡Ú¸ ÒÓ‰ÂÈÒÚ‚Ë ÒÚ‡Ì‡Ï Ë „ËÓÌ‡Ï ‚ Ó·ÂÒÔ˜ÂÌËË ˝ÙÙÂÍÚË‚ÌÓ„Ó ‡ÌÚËÂÚÓ‚ËÛÒÌÓ„Ó Î˜ÂÌËfl ‰Îfl ÏËÎÎËÓÌÓ‚ β‰ÂÈ, ÍÓÚÓ˚Ï ÌÂÁ‡Ï‰ÎËÚÂθÌÓ Ú·ÛÂÚÒfl Ú‡ÍӠΘÂÌËÂ. ç‡ÒÚÓfl˘ËÈ ‰ÓÍÛÏÂÌÚ, ‡ÒÒχÚË‚‡˛˘ËÈ ÂÍÓÏẨ‡ˆËË ‚ ÓÚÌÓ¯ÂÌËË Î˜ÂÌËfl Ë ÏÓÌËÚÓËÌ„‡ Äêí, ‰ÓÎÊÂÌ ÒÚ‡Ú¸ Ó‰ÌÓÈ ËÁ ÒÓÒÚ‡‚Îfl˛˘Ëı ÍÓÏÔÎÂÍÒÌÓÈ ÏÂÚÓ‰ËÍË Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë Ì‡ ÛÓ‚Ì ÒÚ‡Ì, ‚Íβ˜‡fl ÔÓÙË·ÍÚËÍÛ Ë Î˜ÂÌË ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍËı ËÌÙÂ͈ËÈ, ÔÓ„‡ÏÏ˚ ÔËÚ‡ÌËfl Ë ÔÒËıÓÎӄ˘ÂÒÍÓÈ ÔÓ‰‰ÂÊÍË ‰Îfl ËÌÙˈËÓ‚‡ÌÌ˚ı Îˈ. ã˜ÂÌË Çàó-ËÌÙÂ͈ËË Ì‡ ÓÒÌÓ‚Â Û͇Á‡ÌÌÓ„Ó ÛÍÓ‚Ó‰ÒÚ‚‡ ÒÚ‡ÌÂÚ ‰ÓÔÓÎÌÂÌËÂÏ Í ¯ËÓÍÓÏÛ ‰Ë‡Ô‡ÁÓÌÛ ÛÒËÎËÈ ÔÓ ÔÓÙË·ÍÚËÍ Çàó-ËÌÙÂ͈ËË ‰Îfl ÚÂı, ÍÚÓ Ì fl‚ÎflÂÚÒfl ÔÓ͇ ËÌÙˈËÓ‚‡ÌÌ˚Ï, ̇ ÛÓ‚Ì ÒÚ‡Ì. èË ÔÓ‰„ÓÚÓ‚Í ‰‡ÌÌÓ„Ó ËÁ‰‡ÌËfl ·˚ÎË Û˜ÚÂÌ˚ ÒÎÂ‰Û˛˘Ë ‰ÓÒÚËÊÂÌËfl ‚ ӷ·ÒÚË Äêí: ◗ ‰‡ÌÌ˚ ÍÎËÌ˘ÂÒÍËı ËÒÒΉӂ‡ÌËÈ, ‚Íβ˜‡fl ̉ÓÒÚ‡ÚÓ˜ÌÛ˛ ‚ËÛÒÓÎӄ˘ÂÒÍÛ˛ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ÚÓÈÌÓ„Ó ÒÓ˜ÂÚ‡ÌËfl ÌÛÍÎÂÓÁˉӂ, áÑÇ/3íë/‡·‡Í‡‚Ë (ÄÅä) ‚ Ò‡‚ÌÂÌËË Ò ÚÂ‡ÔËÂÈ, ÓÒÌÓ‚‡ÌÌÓÈ Ì‡ ÒÓ˜ÂÚ‡ÌËË ÚÂı ËÎË ˜ÂÚ˚Âı ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ ̇ ÓÒÌÓ‚Â ˝Ù‡‚ËÂ̈‡; ◗ ̇΢ˠÌÛÍÎÂÓÚˉÌÓ„Ó ‡Ì‡ÎÓ„‡ ÚÂÌÓÙÓ‚Ë‰ËÁÓÔÓÍÒË· ÙÛχ‡Ú‡ (íÑî); ◗ ÒÓÓ·‡ÊÂÌËfl, Ò‚flÁ‡ÌÌ˚Â Ò ÚÓÍÒ˘ÌÓÒÚ¸˛ ‰‚ÓÈÌÓÈ ÌÛÍÎÂÓÁˉÌÓÈ ÒÓÒÚ‡‚Îfl˛˘ÂÈ ÒÚ‡‚Û‰Ë̇ (d4í)/‰Ë‰‡ÌÓÁË̇ (ddl); ◗ Û‚Â΢ÂÌË ÔËÁ̇ÌËfl ÒÚÂÔÂÌË ÍÓÒÒ-ÂÁËÒÚÂÌÚÌÓÒÚË ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ ÒÂ‰Ë ÌÛÍÎÂÓÁˉӂ Ë ‡Ì‡ÎÓ„Ó‚ ÌÛÍÎÂÓÚˉ‡; ◗ ÔËÌflÚË ÌÓ‚˚ı ‡Ì‡ÎÓ„Ó‚ ÌÛÍÎÂÓÁˉ‡, ˝ÏÚˈËÚ‡·Ë̇ (ùíñ), ËÌ„Ë·ËÚÓ‡ ÔÓÚ‡Á˚, ‡Ú‡Á‡Ì‡‚Ë‡ (Äáç), ËÌ„Ë·ËÚÓ‡ ÒÓ‰ËÌÂÌËfl ˝ÌÙÛ‚ËÚˉ‡ (ùîí, T-20) Ë ‚ÓÁ‡ÒÚ‡˛˘Û˛ ‰ÓÒÚÛÔÌÓÒÚ¸, ‡ Ú‡ÍÊ ÍÎËÌ˘ÂÒÍËÈ ÓÔ˚Ú, ̇ÍÓÔÎÂÌÌ˚È ‚ ÓÚÌÓ¯ÂÌËË ÌÂÔ‡ÚÂÌÚÓ‚‡ÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ Äêí (Ú.Ì. ÔÂÔ‡‡ÚÓ‚-„ÂÌÂËÍÓ‚), ÓÒÓ·ÂÌÌÓ ‚ ÒÓ˜ÂÚ‡ÌËflı ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁ˚ Ë ‚ ·ÎËÒÚÂÌ˚ı ÛÔ‡Íӂ͇ı (ùîí ‰‡Î ̠·Û‰ÂÚ ‡ÒÒχÚË‚‡Ú¸Òfl ‚ ̇ÒÚÓfl˘ÂÏ ‰ÓÍÛÏÂÌÚ ‚ Ò‚flÁË Ò Ú·ӂ‡ÌËÂÏ Ó Â„Ó Ô‡ÂÌÚÂ‡Î¸ÌÓÏ ËÒÔÓθÁÓ‚‡ÌËË Ë Ò Û˜ÂÚÓÏ ÒÚÓËÏÓÒÚË ÔÂÔ‡‡Ú‡, ˜ÚÓ ‰Â·ÂÚ Â„Ó Ï‡ÎÓÔË„Ó‰Ì˚Ï ‰Îfl ËÒÔÓθÁÓ‚‡ÌËfl ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚). ì͇Á‡ÌÌÓ êÛÍÓ‚Ó‰ÒÚ‚Ó ÔÓ Î˜ÂÌ˲ ÒÓÒÚ‡‚ÎflÂÚ ˜‡ÒÚ¸ Ó·flÁ‡ÚÂθÒÚ‚ Çéá ‚ ÓÚÌÓ¯ÂÌËË Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë Îˈ‡Ï, ÊË‚Û˘ËÏ Ò Çàó/ëèàÑÓÏ. èÂ‚˚È ‚‡ˇÌÚ Û͇Á‡ÌÌ˚ı ÂÍÓÏẨ‡ˆËÈ ·˚Î ÓÔÛ·ÎËÍÓ‚‡Ì ‚ ‡ÔÂΠ2002 „. Ë ÒڇΠÓÚ‡ÊÂÌËÂÏ ÎÛ˜¯ÂÈ Ô‡ÍÚËÍË ‚ ÚÓ ‚ÂÏfl ̇ ÓÒÌÓ‚Â Ù‡ÍÚ˘ÂÒÍËı ‰‡ÌÌ˚ı. ë Û˜ÂÚÓÏ ·˚ÒÚÓ„Ó ‡Á‚ËÚËfl ‰‡ÌÓÈ Ó·Î‡ÒÚË Çéá ‚ Ò‡ÏÓÏ Ì‡˜‡Î ÔÓˆÂÒÒ‡ Û͇Á‡Î‡ ̇ ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ „ÛÎflÌÓ„Ó Ó·ÌÓ‚ÎÂÌËfl ÂÍÓÏẨ‡ˆËÈ. ç‡ÒÚÓfl˘Â ӷÌÓ‚ÎÂÌÌÓ ËÁ‰‡ÌË ·˚ÎÓ ÔÓ‰„ÓÚÓ‚ÎÂÌÓ ‚ ÂÁÛθڇÚ ÔÓÎÛ˜ÂÌËfl ÌÓ‚˚ı ̇ۘÌ˚ı ‰‡ÌÌ˚ı Ë ‡Ò¯ËÂÌËfl χүڇ·Ó‚ ËÒÔÓθÁÓ‚‡ÌËfl Äêí ‚Ó ÏÌÓ„Ëı ÒÚ‡Ì‡ı.

6

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

II. ñÖãà ÑéäìåÖçíÄ

Ç

̇ÒÚÓfl˘Â ‚ÂÏfl ÏÂÌ 5% β‰ÂÈ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı, ÌÛʉ‡˛˘ËıÒfl ‚ Äêí, ËÏÂ˛Ú ‰ÓÒÚÛÔ Í ÌÂÓ·ıÓ‰ËÏ˚Ï ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡Ú‡Ï. Çéá ÔÓ·„‡ÂÚ, ˜ÚÓ ÔÓ Í‡ÈÌÂÈ ÏÂ 3 ÏËÎÎËÓ̇ ˜ÂÎÓ‚ÂÍ, ÌÛʉ‡˛˘ËıÒfl ‚ ÔÓÏÓ˘Ë, ‰ÓÎÊÌ˚ ËÏÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ÔÓÎÛ˜ËÚ¸ ÌÂÓ·ıÓ‰ËÏ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ Ò‰ÒÚ‚‡ Í 2005 „Ó‰Û. ùÚÓ ÓÁ̇˜‡ÎÓ ·˚ Ô‡ÍÚ˘ÂÒÍË ‰ÂÒflÚËÍ‡ÚÌÓ ۂÂ΢ÂÌË ‰ÓÒÚÛÔ‡. ç‡ÒÚÓfl˘Â ÛÍÓ‚Ó‰ÒÚ‚Ó ÔÓ Î˜ÂÌ˲ Ô‰̇Á̇˜ÂÌÓ ‰Îfl ÒÓ‰ÂÈÒÚ‚Ëfl ‰ÓÎÊÌÓÏÛ ‚‚‰ÂÌ˲ Ë ‡Ò¯ËÂÌ˲ Äêí ‚ Ô‰ÒÚÓfl˘Ë „Ó‰˚ Á‡ Ò˜ÂÚ ÓÔ‰ÂÎÂÌËfl ÔÓ‰ıÓ‰‡ Ó·˘ÂÒÚ‚ÂÌÌÓ„Ó Á‰‡‚ÓÓı‡ÌÂÌËfl ‰Îfl ‰ÓÒÚËÊÂÌËfl Û͇Á‡ÌÌ˚ı ˆÂÎÂÈ. éÒÌÓ‚Ì˚ÏË ÛÒÎÓ‚ËflÏË Ú‡ÍÓ„Ó ÔÓ‰ıÓ‰‡ fl‚Îfl˛ÚÒfl ÒÎÂ‰Û˛˘ËÂ: 1) ê‡Ò¯ËÂÌË χүڇ·Ó‚ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ı ÔÓ„‡ÏÏ Î˜ÂÌËfl ‰Îfl Ó·ÂÒÔ˜ÂÌËfl ‚ÒÂÓ·˘Â„Ó ‰ÓÒÚÛÔ‡ ËÎË, ËÌ˚ÏË ÒÎÓ‚‡ÏË, ‚ÒÂı Îˈ, ÍÓÚÓ˚ ÌÛʉ‡˛ÚÒfl ‚ ΘÂÌËË, ÔÓ Ï‰ˈËÌÒÍËÏ ÔÓ͇Á‡ÌËflÏ Ë ÍÓÚÓ˚ ‰ÓÎÊÌ˚ ËÏÂÚ¸ Í ÌÂÏÛ ‰ÓÒÚÛÔ. ëڇ̉‡ÚËÁ‡ˆËfl Ë ÛÔÓ˘ÂÌË ÍÛÒÓ‚ ΘÂÌËfl Äêí ‰Îfl Ó͇Á‡ÌËfl ÒÓ‰ÂÈÒÚ‚Ëfl ˝ÙÙÂÍÚË‚ÌÓÏÛ ÓÒÛ˘ÂÒÚ‚ÎÂÌ˲ ÔÓ„‡ÏÏ Î˜ÂÌËfl ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚. é·ÂÒÔ˜ÂÌË ÚÓ„Ó, ˜ÚÓ·˚ ÔÓ„‡ÏÏ˚ ΘÂÌËfl Äêí ËÒıÓ‰ËÎË ËÁ ̇ۘÌ˚ı ‰‡ÌÌ˚ı, Ò ÚÂÏ ˜ÚÓ·˚ ËÁ·Âʇڸ ËÒÔÓθÁÓ‚‡ÌËfl ÌÂÒÓÓÚ‚ÂÚÒÚ‚Û˛˘Ëı Òڇ̉‡ÚÓ‚ ‚ ÔÓÚÓÍÓ·ı, ÍÓÚÓ˚ ÒÚ‡‚flÚ ÔÓ‰ Û„ÓÁÛ ÂÁÛθڇÚ˚ ΘÂÌËfl ÓÚ‰ÂθÌ˚ı ·ÓθÌ˚ı Ë ÒÓÁ‰‡˛Ú ÛÒÎÓ‚Ëfl ‰Îfl ‚ÓÁÌËÍÌÓ‚ÂÌËfl ‚ËÛÒ‡, ÂÁËÒÚÂÌÚÌÓ„Ó Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï. ÇÏÂÒÚÂ Ò ÚÂÏ, ˜ÂÁ‚˚˜‡ÈÌÓ ‚‡ÊÌÓ Ú‡ÍÊ ‡ÒÒÏÓÚÂÚ¸ Ë ‚ÓÔÓÒ Ó ‡ÎËflı ‚ ÓÚÌÓ¯ÂÌËË Ì‡Î˘Ëfl ͇‰Ó‚˚ı ÂÒÛÒÓ‚, ËÌÙ‡ÒÚÛÍÚÛ ÒËÒÚÂÏ˚ Á‰‡‚ÓÓı‡ÌÂÌËfl Ë ÒӈˇθÌÓ-˝ÍÓÌÓÏ˘ÂÒÍËı ÛÒÎÓ‚ËÈ ‰Îfl ÔÓ‰„ÓÚÓ‚ÍË ˜ÂÚÍËı Ë ‡ÎËÒÚ˘ÂÒÍËı ÂÍÓÏẨ‡ˆËÈ.

2)

3)

Ç˚‡Ê‡fl ̇‰ÂÊ‰Û Ì‡ ÚÓ, ˜ÚÓ Ì‡ÒÚÓfl˘ËÈ ‰ÓÍÛÏÂÌÚ Ó͇ÊÂÚÒfl ÔÓÎÂÁÌ˚Ï ‰Îfl ÍÎËÌˈËÒÚÓ‚, ‡·ÓÚ‡˛˘Ëı ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚, ÓÌ Ô‰̇Á̇˜ÂÌ ÔÂʉ ‚ÒÂ„Ó ‰Îfl ËÒÔÓθÁÓ‚‡ÌËfl ÍÓÌÒÛθڇÚË‚Ì˚ÏË ÒÓ‚ÂÚ‡ÏË ÔÓ Î˜ÂÌ˲, ̇ˆËÓ̇θÌ˚ÏË ÛÍÓ‚Ó‰ËÚÂÎflÏË ÔÓ„‡ÏÏ ÔÓ ëèàÑÛ Ë ‰Û„ËÏË Îˈ‡ÏË, ÓÔ‰ÂÎfl˛˘ËÏË ÔÓÎËÚËÍÛ, ÍÓÚÓ˚ ÔËÌËχ˛Ú Û˜‡ÒÚË ‚ Ô·ÌËÓ‚‡ÌËË Ì‡ˆËÓ̇θÌ˚ı Ë ÏÂʉÛ̇Ó‰Ì˚ı ÒÚ‡Ú„ËÈ ÔÓ ·Ó¸·Â Ò Çàó-ËÌÙÂ͈ËÂÈ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı. êÛÍÓ‚Ó‰ÒÚ‚Ó ÔÓ Î˜ÂÌ˲ Ô‰ÒÚ‡‚ÎflÂÚ ÒÓ·ÓÈ ÓÔ‰ÂÎÂÌÌÛ˛ ‡ÏÓ˜ÌÛ˛ ÒÚÛÍÚÛÛ ‰Îfl ÓÚ·Ó‡ ̇˷ÓΠ˝ÙÙÂÍÚË‚Ì˚ı Ë ÓÒÛ˘ÂÒÚ‚ËÏ˚ı ÒıÂÏ ÄêÇ-ΘÂÌËfl ‚ ͇˜ÂÒÚ‚Â ÒÓÒÚ‡‚Îfl˛˘Ëı ‡Ò¯ËÂÌÌÓÈ Ì‡ˆËÓ̇θÌÓÈ ÔÓ„‡ÏÏ˚ ‰ÂÈÒÚ‚ËÈ ÔÓ Ó͇Á‡Ì˲ ÔÓÏÓ˘Ë Çàó-ËÌÙˈËÓ‚‡ÌÌ˚Ï Îˈ‡Ï. ì͇Á‡Ì̇fl ÒÚÛÍÚÛ‡ ÒÚ‡‚ËÚ Ò‚ÓÂÈ ˆÂθ˛ Òڇ̉‡ÚËÁ‡ˆË˛ Ë ÛÔÓ˘ÂÌË ‡ÌÚËÂÚÓ‚ËÛÒÌÓÈ ÚÂ‡ÔËË, ‡ Ú‡ÍʠΘÂÌË ÚÛ·ÂÍÛÎÂÁ‡ (íÅ) ‚ ̇ˆËÓ̇θÌ˚ı ÔÓ„‡Ïχı ÔÓ ·Ó¸·Â Ò íÅ, ÓÚϘ‡fl Ó‰ÌÓ‚ÂÏÂÌÌÓ Á̇˜ËÚÂθÌÛ˛ ÒÎÓÊÌÓÒÚ¸ ΘÂÌËfl Çàó-ËÌÙÂ͈ËË. Ç ÒÓÓÚ‚ÂÚÒÚ‚ËË Ò ˝ÚËÏ ‚‡ˇÌÚ˚ ‰Îfl ÚÂ‡ÔËË ÔÂ‚Ó„Ó Ë ‚ÚÓÓ„Ó fl‰‡ Ô‰ÒÚ‡‚Îfl˛ÚÒfl ‚ ̇ÒÚÓfl˘ÂÏ ‰ÓÍÛÏÂÌÚÂ

7

Ò Û˜ÂÚÓÏ ÌÂÓ·ıÓ‰ËÏÓÒÚË ÛÍÂÔÎÂÌËfl ÒËÒÚÂÏ Á‰‡‚ÓÓı‡ÌÂÌËfl, ÍÓÚÓ˚ Á‡˜‡ÒÚÛ˛ Ì ӷ·‰‡˛Ú ÌÂÓ·ıÓ‰ËÏ˚ÏË Í‡‰Ó‚˚ÏË ÂÒÛÒ‡ÏË Ë ÛÒÎÓ‚ËflÏË ‰Îfl ÏÓÌËÚÓËÌ„‡, Ò ˆÂθ˛ χÍÒËχθÌÓ„Ó ÛÎÛ˜¯ÂÌËfl Í‡Í Í‡˜ÂÒÚ‚‡, Ú‡Í Ë ÂÁÛθڇÚÓ‚ Ô‰·„‡ÂÏ˚ı ‚ˉӂ ΘÂÌËfl. Ç ÛÍÓ‚Ó‰ÒÚ‚Â ‡ÒÒχÚË‚‡ÂÚÒfl ‚ÓÔÓÒ Ó ÚÓÏ, ÍÓ„‰‡ ÒΉÛÂÚ Ì‡˜Ë̇ڸ ÄêÇΘÂÌËÂ, ͇ÍË ÍÛÒ˚ ‰ÓÎÊÌ˚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì˚ Ë Í‡ÍË ‰ÓÎÊÌ˚ ·˚Ú¸ Ô˘ËÌ˚ ‰Îfl ËÁÏÂÌÂÌËfl Äêí Ë ÍÛÒÓ‚, ÍÓÚÓ˚ ‰ÓÎÊÌ˚ ·˚Ú¸ ÔÓ‰ÓÎÊÂÌ˚ ‚ ÒÎÛ˜‡Â ͇ÍËı-ÎË·Ó ËÁÏÂÌÂÌËÈ ‚ Ò‡ÏÓÏ Î˜ÂÌËË. Ç ÌÂÏ Ú‡ÍÊ ‡ÒÒχÚË‚‡ÂÚÒfl ‚ÓÔÓÒ Ó ÚÓÏ, Í‡Í ÓÒÛ˘ÂÒÚ‚ÎflÚ¸ ÏÓÌËÚÓËÌ„ ΘÂÌËfl Ò ÓÒÓ·˚Ï ‡ÍˆÂÌÚÓÏ Ì‡ ‚ÓÔÓÒ˚ ÔÓ·Ó˜ÌÓ„Ó ‰ÂÈÒÚ‚Ëfl Äêí Ë Ì‡Á̇˜‡ÂÏ˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÍÛÒÓ‚ Ò ‚Íβ˜ÂÌËÂÏ ÒÔˆˇθÌ˚ı ÂÍÓÏẨ‡ˆËÈ ‰Îfl ÓÚ‰ÂθÌ˚ı „ÛÔÔ ·ÓθÌ˚ı.

8

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

III. äéÉÑÄ ëãÖÑìÖí çÄóàçÄíú ÄêÇ íÖêÄèàû ì Çáêéëãõï à èéÑêéëíäéÇ

Ç

éá ÂÍÓÏẨÛÂÚ, ˜ÚÓ·˚ ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚ Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ ‚ÁÓÒÎ˚Â Ë ÔÓ‰ÓÒÚÍË Ì‡˜Ë̇ÎË ÍÛÒ ÄêÇ-ÚÂ‡ÔËË Ò ÏÓÏÂÌÚ‡ ÔÓ‰Ú‚ÂʉÂÌËfl ̇΢Ëfl ËÌÙÂ͈ËË, ‡ Ú‡ÍÊÂ Ò ‰ÓÎÊÌ˚Ï Û˜ÂÚÓÏ Ó‰ÌÓ„Ó ËÁ Ù‡ÍÚÓÓ‚, Û͇Á˚‚‡ÂÏ˚ı ÌËÊÂ. ◗ äÎËÌ˘ÂÒÍË ÔÓ‰‚ËÌÛÚ˚ ÒÚ‡‰ËË Çàó-Á‡·Ó΂‡ÌËfl: ◗ ëÚ‡‰Ëfl IV Çàó-Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ ëD4; ◗ ëÚ‡‰Ëfl III Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá Ò Û˜ÂÚÓÏ Ì‡Î˘Ëfl ÍÎÂÚÓÍ ëD4 <350/ÏÏ3 ‰Îfl ÒÓ‰ÂÈÒÚ‚Ëfl ‚ ÔËÌflÚËË ¯ÂÌËfl. ◗ CÚ‡‰Ëfl I ËÎË II Çàó-Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá ÔË ÍÓ΢ÂÒÚ‚Â ÍÎÂÚÓÍ ëD4 <200/ÏÏ3 (퇷Îˈ‡ Ä).

é·ÓÒÌÓ‚‡ÌËÂÏ ‰Îfl ˝ÚËı ÂÍÓÏẨ‡ˆËÈ ÒÎÛÊËÚ ÒÎÂ‰Û˛˘ÂÂ. ã˜ÂÌË ·ÓθÌ˚ı ̇ ÒÚ‡‰ËË IV ·ÓÎÂÁÌË ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (ÍÎËÌ˘ÂÒÍË ÙÓÏ˚ ëèàч) Ì ‰ÓÎÊÌÓ ÒÚ‡‚ËÚ¸Òfl ‚ Á‡‚ËÒËÏÓÒÚ¸ ÓÚ ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ ëD4. ÇÏÂÒÚÂ Ò ÚÂÏ, ÔÓ ‚ÓÁÏÓÊÌÓÒÚË ˝ÚÓÚ ÚÂÒÚ ÏÓÊÂÚ Ó͇Á‡Ú¸Òfl ÔÓÎÂÁÌ˚Ï ‰Îfl ‡ÒÔ‰ÂÎÂÌËfl ·ÓθÌ˚ı ÔÓ Í‡Ú„ÓËflÏ Ì‡ ÒÚ‡‰ËË III Á‡·Ó΂‡ÌËfl ‚ ÓÚÌÓ¯ÂÌËË ÌÂÓ·ıÓ‰ËÏÓÒÚË ÌÂÁ‡Ï‰ÎËÚÂθÌÓ Ì‡Á̇˜ËÚ¸ ÍÛÒ Î˜ÂÌËfl. í‡Í, ̇ÔËÏÂ, ΄ӘÌ˚È íÅ ÏÓÊÂÚ ËÏÂÚ¸ ÏÂÒÚÓ ÔË Î˛·ÓÏ ÍÓ΢ÂÒÚ‚Â ÍÎÂÚÓÍ ëD4, Ë ÔË ÒÓı‡ÌÂÌËË ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ ëD4 (̇ÔËÏÂ, >350/ÏÏ3) Ô‰ÒÚ‡‚ÎflÂÚÒfl ‡ÁÛÏÌ˚Ï ÓÚÎÓÊËÚ¸ ̇˜‡ÎÓ ÚÂ‡ÔËË Ë ÔÓ‰ÓÎÊËÚ¸ ̇·Î˛‰ÂÌË Á‡ ·ÓθÌ˚Ï. ÑÎfl ÒÚ‡‰ËË III Á‡·Ó΂‡ÌËfl ·˚Î ‚˚·‡Ì «ÔÓÓ„», ÒÓÒÚ‡‚Îfl˛˘ËÈ 350/ÏÏ3, ‚ ͇˜ÂÒÚ‚Â ÛÓ‚Ìfl, ÌËÊ ÍÓÚÓÓ„Ó ËÏÏÛÌÓ‰ÂÙˈËÚ fl‚ÎflÂÚÒfl Ә‚ˉÌ˚Ï, Ë Ú‡ÍË ·ÓθÌ˚ ‰ÓÎÊÌ˚ ÔÓÎÛ˜‡Ú¸ ΘÂÌË ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ Ëı ÍÎËÌ˘ÂÒÍÓ ÒÓÒÚÓflÌË Ô‰ÔÓ·„‡ÂÚ ·˚ÒÚÓ ÛıÛ‰¯ÂÌË ÍÎËÌ˘ÂÒÍËı ÒËÏÔÚÓÏÓ‚. ìÓ‚Â̸, ÒÓÒÚ‡‚Îfl˛˘ËÈ 350/ÏÏ3, Ú‡ÍÊ ÒÓÓÚ‚ÂÚÒÚ‚ÛÂÚ ‰Û„ËÏ ÛÍÓ‚Ó‰fl˘ËÏ ‰ÓÍÛÏÂÌÚ‡Ï3 4, Òӄ·ÒÓ‚‡ÌÌ˚Ï Ì‡ ÓÒÌÓ‚Â ÍÓÌÒÂÌÒÛÒ‡. ÑÎfl ·ÓθÌ˚ı ̇ ÒÚ‡‰ËË I ËÎË II Á‡·Ó΂‡ÌËfl, ÍÓ„‰‡ ÍÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ ëD4 ÒÓÒÚ‡‚ÎflÂÚ <200/ÏÏ3, ˝ÚÓ fl‚ÎflÂÚÒfl ÔÓ͇Á‡ÚÂÎÂÏ ‰Îfl ̇˜‡Î‡ ΘÂÌËfl. Ç ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ÍÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ ëD4 Ì ÏÓÊÂÚ ·˚Ú¸ ÓÔ‰ÂÎÂÌÓ, ‡ Ó·˘Â ÍÓ΢ÂÒÚ‚Ó ÎËÏÙÓˆËÚÓ‚ ‚ ÍÓ‚Ë ÒÓÒÚ‡‚ÎflÂÚ 1 200/ÏÏ3 ËÎË ÌËÊ ˝ÚÓ„Ó ÔÓ͇Á‡ÚÂÎfl, ÚÓ Â„Ó ÏÓÊÌÓ ËÒÔÓθÁÓ‚‡Ú¸ ‚ ͇˜ÂÒÚ‚Â Á‡ÏÂÌfl˛˘Â„Ó ÔÓ͇Á‡ÚÂÎfl ‰Îfl ̇˜‡Î‡ ΘÂÌËfl ‚ ÒÎÛ˜‡Â ÒËÏÔÚÓχÚ˘ÂÒÍÓÈ Çàó-ËÌÙÂ͈ËË. ïÓÚfl Ó·˘Â ÍÓ΢ÂÒÚ‚Ó ÎËÏÙÓˆËÚÓ‚ Ì ‚Á‡ËÏÓÒ‚flÁ‡ÌÓ ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ Ò ÍÓ΢ÂÒÚ‚ÓÏ ëD4 ÍÎÂÚÓÍ Û Îˈ Ò ·ÂÒÒËÏÔÚÓÏÌ˚ÏË ÔÓfl‚ÎÂÌËflÏË ÔË ÒÓ˜ÂÚ‡ÌËË Ò ÍÎËÌ˘ÂÒÍËÏË Ì‡·Î˛‰ÂÌËflÏË, ÓÌÓ ‚Ò Ê fl‚ÎflÂÚÒfl Ó‰ÌËÏ ËÁ ÔÓ͇Á‡ÚÂÎÂÈ ‰Îfl ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘Â„Ó ÔÓ„ÌÓÁ‡ Ë ‚˚ÊË‚‡ÌËfl ·ÓθÌÓ„Ó5-10. éˆÂÌ͇ ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË (Ò Û˜ÂÚÓÏ ÛÓ‚ÌÂÈ Ô·ÁÏ˚ Çàó-1 êçä) Ì Ú·ÛÂÚÒfl ‰Îfl ̇˜‡Î‡

9

ÍÛÒ‡ ΘÂÌËfl. ë Û˜ÂÚÓÏ ÚÛ‰ÌÓÒÚÂÈ Ë ÒÚÓËÏÓÒÚË ÓÔ‰ÂÎÂÌËfl ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË Çéá ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl Ì ÂÍÓÏẨÛÂÚ Â ‚ ͇˜ÂÒÚ‚Â Ó·˚˜ÌÓ„Ó Ò‰ÒÚ‚‡ ‰Îfl ÓˆÂÌÍË ‚ ÔËÌflÚËË ¯ÂÌËfl Ó ÚÓÏ, ÍÓ„‰‡ ÒΉÛÂÚ Ì‡˜Ë̇ڸ ÚÂ‡Ô˲ Ò Û˜ÂÚÓÏ ÓÒÚÓÈ ÌÂı‚‡ÚÍË ÂÒÛÒÓ‚. ÇÏÂÒÚÂ Ò ÚÂÏ, ‚˚‡Ê‡ÂÚÒfl ̇‰Âʉ‡, ˜ÚÓ ·Óθ¯‡fl ‰ÓÒÚÛÔÌÓÒÚ¸ ÏÂÚÓ‰Ó‚ ‰Îfl ÓÔ‰ÂÎÂÌËfl ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË, ÍÓÚÓ˚ ÔÓfl‚flÚÒfl ÒÓ ‚ÂÏÂÌÂÏ, ÔÓÁ‚ÓÎËÚ ¯Ë ËÒÔÓθÁÓ‚‡Ú¸ Ò‚flÁ‡ÌÌ˚Â Ò ˝ÚËÏ ·ÓΠÒÎÓÊÌ˚ ÏÂÚÓ‰˚ ÏÓÌËÚÓËÌ„‡. ëΉÛÂÚ ÓÚÏÂÚËÚ¸, ˜ÚÓ ‡Á‡·ÓÚ‡Ì̇fl Çéá ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ÒËÒÚÂχ ‰Îfl ÓÔ‰ÂÎÂÌËfl ÒÚ‡‰ËÈ Á‡·Ó΂‡ÌËfl ‚ ÓÚÌÓ¯ÂÌËË Çàó-ËÌÙÂ͈ËË Û ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚ ·˚· ÒÓÁ‰‡Ì‡ ÌÂÒÍÓθÍÓ ÎÂÚ ÚÓÏÛ Ì‡Á‡‰ Ë ‚ Ò‚flÁË Ò ˝ÚËÏ fl‚ÎflÂÚÒfl Ó„‡Ì˘ÂÌÌÓÈ. ë Û˜ÂÚÓÏ ˝ÚÓ„Ó ÏÓÊÂÚ ÔÓ̇‰Ó·ËÚ¸Òfl ‡‰‡ÔÚ‡ˆËfl ÛÓ‚ÌÂÈ Ì‡ˆËÓ̇θÌ˚ı ÔÓ„‡ÏÏ. ÇÏÂÒÚÂ Ò ÚÂÏ, ˝Ú‡ ÒËÒÚÂχ ÔÓ-ÔÂÊÌÂÏÛ ÓÒÚ‡ÂÚÒfl ÔÓÎÂÁÌ˚Ï ËÌÒÚÛÏÂÌÚÓÏ ‰Îfl ÒÓ‰ÂÈÒÚ‚Ëfl ‚ ÓÔ‰ÂÎÂÌËË Ô‡‡ÏÂÚÓ‚ ̇˜‡Î¸Ì˚ı ÍÛÒÓ‚ ÚÂ‡ÔËË ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚ Ë Ú‡ÍËÏ ËÏÂÌÌÓ Ó·‡ÁÓÏ ËÒÔÓθÁÛÂÚÒfl ‚ ̇ÒÚÓfl˘ÂÏ ËÁ‰‡ÌËË.

íÄÅãàñÄ Ä. êÖäéåÖçÑÄñàà Ñãü çÄóÄãÄ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà ì Çáêéëãõï à èéÑêéëíäéÇ èêà çÄãàóàà èéÑíÇÖêÜÑÖççéâ Çàó-àçîÖäñàà èË Ì‡Î˘ËË ÚÂÒÚ‡ ̇ ÒÓ‰ÂʇÌË ÍÎÂÚÓÍ ëD4 ÂÍÓÏẨÛÂÚÒfl Ó·ÂÒÔ˜ËÚ¸ ÔÓ‰Ú‚ÂʉÂÌË ÓÒÌÓ‚Ì˚ı ÔÓ‰Ò˜ÂÚÓ‚ ÍÎÂÚÓÍ ëD4 Ë Ô‰ÎÓÊËÚ¸ ÍÛÒ Äêí ‰Îfl ·ÓθÌ˚ı Ò: ◗ ÒÚ‡‰ËÂÈ IV Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ ëD4 ◗ ÒÚ‡‰ËÂÈ III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (Ò Û˜ÂÚÓÏ, ÌÓ Ì ӄ‡Ì˘˂‡flÒ¸ ÒËÏÔÚÓχÏË Ò‚flÁ‡ÌÌÓ„Ó Ò Çàó-ËÌÙÂ͈ËÂÈ ËÒÚÓ˘ÂÌËfl, ıÓÌ˘ÂÒÍÓÈ ‰Ë‡ÂÂÈ ÌÂËÁ‚ÂÒÚÌÓÈ ˝ÚËÓÎÓ„ËË, ÔÓ‰ÓÎÊËÚÂθÌ˚Ï ÔÓ‚˚¯ÂÌËÂÏ ÚÂÏÔÂ‡ÚÛ˚ ÌÂËÁ‚ÂÒÚÌÓÈ ˝ÚËÓÎÓ„ËË, ΄ӘÌ˚Ï íÅ, ıÓÌ˘ÂÒÍËÏË ·‡ÍÚÂˇθÌ˚ÏË ËÌÙÂ͈ËflÏË ËÎË ıÓÌ˘ÂÒÍËÏ/ÔÂÒËÒÚÂÌÚÌ˚Ï Í‡Ì‰Ë‰ÓÁÓÏ ÒÎËÁËÒÚÓÈ) Ò ÚÂÏ ˜ÚÓ·˚ Û˜ÂÒÚ¸ ̇΢ˠÍÎÂÚÓÍ ëD4, ÒÓÒÚ‡‚Îfl˛˘Ëı <350/ÏÏ3 ‰Îfl ÒÓ‰ÂÈÒÚ‚Ëfl ‚ ÔËÌflÚËË ¯ÂÌËfl‡ ◗ ÒÚ‡‰ËflÏË I ËÎË II Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá ÔË Ì‡Î˘ËË ÍÎÂÚÓÍ ëD4 ≤ 200/ÏÏ3 b èË ÓÚÒÛÚÒÚ‚ËË ‰‡ÌÌ˚ı ÚÂÒÚ‡ ̇ ÍÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ ëD4 ÂÍÓÏẨÛÂÚÒfl Ô‰ÓÒÚ‡‚ËÚ¸ Äêí ÒÎÂ‰Û˛˘ËÏ ·ÓθÌ˚Ï; ◗ ç‡ıÓ‰fl˘ËÏÒfl ̇ ÒÚ‡‰ËË IV Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá ÌÂÁ‡‚ËÒËÏÓ ÓÚ Ó·˘Â„Ó ÍÓ΢ÂÒÚ‚‡ ÎËÏÙÓˆËÚÓ‚ ◗ ç‡ ÒÚ‡‰ËË III Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (Ò Û˜ÂÚÓÏ, ÌÓ Ì ӄ‡Ì˘˂‡flÒ¸ ÒËÏÔÚÓχÏË Ò‚flÁ‡ÌÌÓ„Ó Ò Çàó-ËÌÙÂ͈ËÂÈ ËÒÚÓ˘ÂÌËfl, ıÓÌ˘ÂÒÍÓÈ ‰Ë‡ÂÂÈ ÌÂËÁ‚ÂÒÚÌÓÈ ˝ÚËÓÎÓ„ËË, ÔÓ‰ÓÎÊËÚÂθÌ˚Ï ÔÓ‚˚¯ÂÌËÂÏ ÚÂÏÔÂ‡ÚÛ˚ ÌÂËÁ‚ÂÒÚÌÓÈ ˝ÚËÓÎÓ„ËË, ΄ӘÌ˚Ï íÅ, ıÓÌ˘ÂÒÍËÏË ·‡ÍÚÂˇθÌ˚ÏË ËÌÙÂ͈ËflÏË ËÎË ıÓÌ˘ÂÒÍËÏ/ÔÂÒËÒÚÂÌÚÌ˚Ï Í‡Ì‰Ë‰ÓÁÓÏ ÒÎËÁËÒÚÓÈ) ÌÂÁ‡‚ËÒËÏÓ ÓÚ Ó·˘Â„Ó ÔÓ͇Á‡ÚÂÎfl ÎËÏÙÓˆËÚÓ‚Ò ◗ ç‡ ÒÚ‡‰ËË II Á‡·Ó΂‡ÌËfl ÔÓ Í·ÒÒËÙË͇ˆËË Çéá c Ó·˘ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ÎËÏÙÓˆËÚÓ‚, ÒÓÒÚ‡‚Îfl˛˘ËÏ ≤1200/ÏÏ3 d

10

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

‡ èË ÓÔ‰ÂÎÂÌËË ÌÂÓ·ıÓ‰ËÏÓÒÚË Ôӂ‰ÂÌËfl ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓÈ ÚÂ‡ÔËË Ê·ÚÂθÌÓ ÔÓ‚ÂÒÚË ÔÓ‰Ò˜ÂÚ ÍÎÂÚÓÍ ëD4. í‡Í, ̇ÔËÏÂ, ΄ӘÌ˚È íÅ ÏÓÊÂÚ ËÏÂÚ¸ ÏÂÒÚÓ ÔË Î˛·ÓÏ ÛÓ‚Ì ÍÎÂÚÓÍ ëD4, ‡ ‰Û„Ë ÔËÁ̇ÍË ÏÓ„ÛÚ Ó·˙flÒÌflÚ¸Òfl Ú‡ÍÊ Ì ÓÚÌÓÒfl˘ËÏËÒfl Í Çàó ˝ÚËÓÎÓ„ËflÏË (̇ÔËÏÂ, ıÓÌ˘ÂÒÍÓÈ ‰Ë‡ÂÂÈ, ÔÓ‰ÓÎÊËÚÂθÌ˚Ï ÔÓ‚˚¯ÂÌËÂÏ ÚÂÏÔÂ‡ÚÛ˚).

‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚ ̇ ÒÚ‡‰ËË III Á‡·Ó΂‡ÌËfl ÍÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ ëD4 Ô‚˚¯‡ÂÚ 200, ÌÂÍÓÚÓ˚ ËÁ ÌËı ÏÓ„ÛÚ ÔÓÎÛ˜‡Ú¸ ‡ÌÚËÂÚÓ‚ËÛÒÌӠΘÂÌË ‰Ó ‰ÓÒÚËÊÂÌËfl ÔÓÓ„Ó‚ÓÈ ‚Â΢ËÌ˚ ëD4 <200. Ç ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ÍÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ ëD4 Ì ÏÓÊÂÚ ·˚Ú¸ ÓÔ‰ÂÎÂÌÓ, ‡ÌÌ ̇˜‡ÎÓ ÍÛÒ‡ Äêí Û Ú‡ÍËı ·ÓθÌ˚ı Ì ‰ÓÎÊÌÓ ‡ÒÒχÚË‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ÓÒÓ·ÓÈ ÔÓ·ÎÂÏ˚. d 鷢 ÍÓ΢ÂÒÚ‚Ó ÎËÏÙÓˆËÚÓ‚, ÒÓÒÚ‡‚Îfl˛˘Â ≤1200/ÏÏ3, ÏÓÊÂÚ Á‡ÏÂÌflÚ¸ ÔÓ‰Ò˜ÂÚ˚ ÍÎÂÚÓÍ ëD4 ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ҉·ڸ ˝ÚÓ Ì‚ÓÁÏÓÊÌÓ Ë ÍÓ„‰‡ ӷ̇ÛÊË‚‡˛ÚÒfl ÒËÏÔÚÓÏ˚, Ò‚flÁ‡ÌÌ˚Â Ò Çàó-ËÌÙÂ͈ËÂÈ. é‰Ì‡ÍÓ ˝ÚÓ„Ó Ì ÒΉÛÂÚ ‰Â·ڸ ‚ ÒÎÛ˜‡Â ·ÂÒÒËÏÔÚÓÏÌ˚ı ·ÓθÌ˚ı. í‡ÍËÏ Ó·‡ÁÓÏ, ÔË ÓÚÒÛÚÒÚ‚ËË ‰‡ÌÌ˚ı ‚ ÓÚÌÓ¯ÂÌËË ÍÎÂÚÓÍ ëD4 ·ÂÒÒËÏÔÚÓÏÌ˚ Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ ·ÓθÌ˚ ( ÒÚ‡‰Ëfl I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá) Ì ‰ÓÎÊÌ˚ ÔÓıÓ‰ËÚ¸ ÍÛÒ˚ ΘÂÌËfl, ÔÓÒÍÓθÍÛ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl Ì ÒÛ˘ÂÒÚ‚ÛÂÚ ‰Û„Ëı ̇‰ÂÊÌ˚ı χÍÂÓ‚ ‚ ÛÒÎÓ‚Ëflı Í‡ÈÌ ӄ‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚.

b ìÓ‚Â̸ ÒÓ‰ÂʇÌËfl ÍÎÂÚÓÍ ëD4, Ô‚˚¯‡˛˘ËÈ 200/ÏÏ3, ÔË ÍÓÚÓÓÏ ÒΉÛÂÚ Ì‡˜Ë̇ڸ ‡ÌÚËÂÚÓ‚ËÛÒÌӠΘÂÌËÂ, Ì ·˚Î ÛÒÚ‡ÌÓ‚ÎÂÌ.

Ò êÂÍÓÏẨ‡ˆËfl Ó Ì‡˜‡Î Äêí Û ‚ÒÂı ·ÓθÌ˚ı, ̇ıÓ‰fl˘ËıÒfl ̇ ÒÚ‡‰ËË III Á‡·Ó΂‡ÌËfl, ·ÂÁ Û˜ÂÚ‡ Ó·˘Â„Ó ÍÓ΢ÂÒÚ‚‡ ÎËÏÙÓˆËÚÓ‚ ҂ˉÂÚÂθÒÚ‚ÛÂÚ Ó Â‰ËÌÓÏ ÏÌÂÌËË ˝ÍÒÔÂÚÓ‚. éÌÓ Û˜ËÚ˚‚‡ÂÚ ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ ̇΢Ëfl Ô‡ÍÚ˘ÂÒÍÓÈ ÂÍÓÏẨ‡ˆËË, ÍÓÚÓ‡fl ÔÓÁ‚ÓÎflÂÚ ÍÎËÌ˘ÂÒÍËÏ ÒÎÛÊ·‡Ï Ë ÔÓ„‡ÏÏ‡Ï ÔÓ íÅ ‚ ÛÒÎÓ‚Ëflı Í‡ÈÌ ӄ‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚ Ó·ÂÒÔ˜ËÚ¸ ‰ÓÒÚÛÔ Í Äêí ‰Îfl ·ÓθÌ˚ı. èÓÒÍÓθÍÛ Û ÌÂÍÓÚÓ˚ı

IV. êÖäéåÖçÑìÖåõÖ ëïÖåõ ÄêÇ-íÖêÄèàà èÖêÇéÉé êüÑÄ Ñãü Çáêéëãõï à èéÑêéëíäéÇ Ú‡Ì‡Ï ÂÍÓÏẨÛÂÚÒfl ËÒÔÓθÁÓ‚‡Ú¸ ÔÓ‰ıÓ‰˚ Ó·˘ÂÒÚ‚ÂÌÌÓ„Ó Á‰‡‚ÓÓı‡ÌÂÌËfl ‰Îfl ÒÓ‰ÂÈÒÚ‚Ëfl ‡Ò¯ËÂÌËfl ÄêÇ ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚, Í‡Í ˝ÚÓ ÓÔ‰ÂÎÂÌÓ ‚ Ô·Ì Çéá «3 Í 5». ùÚÓ ÓÁ̇˜‡ÂÚ, ˜ÚÓ ‰ÓÎÊÌ˚ ·˚Ú¸ ÒÓÁ‰‡Ì˚ ÔÓ„‡ÏÏ˚ Äêí, ÍÓÚÓ˚ ӷÂÒÔ˜‡Ú Óı‚‡Ú Í‡Í ÏÓÊÌÓ ·Óθ¯Â„Ó ˜ËÒ· β‰ÂÈ, ÍÓÚÓ˚ ÌÛʉ‡˛ÚÒfl ‚ Ú‡ÍËı ÍÛÒ‡ı ΘÂÌËfl, ˜ÚÓ Ô‰ÔÓ·„‡ÂÚ Òڇ̉‡ÚËÁ‡ˆË˛ ÍÛÒ‡ Äêí. ëÚ‡Ì‡Ï ÓÒÓ·Ó ÂÍÓÏẨÛÂÚÒfl ‚˚·Ë‡Ú¸ ÒıÂÏ˚ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ Ë ÓÔ‰ÂÎÂÌÌÓ ˜ËÒÎÓ ÚÂ‡ÔËË ‚ÚÓÓ„Ó fl‰‡, ˜ÚÓ ÒÎÛÊËÚ ÔËÁ̇ÌËÂÏ ÚÓ„Ó Ù‡ÍÚ‡, ˜ÚÓ Î˛‰Ë, ÍÓÚÓ˚ Ì ÏÓ„ÛÚ ÔÂÂÌÓÒËÚ¸ ÚÂ‡Ô˲ ÔÂ‚Ó„Ó fl‰‡ Ë ÚÂ‡Ô˲ ‚ÚÓÓ„Ó fl‰‡, ·Û‰ÛÚ Ì‡Ô‡‚ÎflÚ¸Òfl ‰Îfl ÔÓÎÛ˜ÂÌËfl Ë̉˂ˉۇÎËÁËÓ‚‡ÌÌÓÈ ÔÓÏÓ˘Ë Í ‚‡˜‡Ï-ÒÔˆˇÎËÒÚ‡Ï. àÒÔÓθÁÓ‚‡ÌË Òڇ̉‡ÚÌ˚ı ÍÛÒÓ‚ ÚÂ‡ÔËË ‚ ͇˜ÂÒÚ‚Â ‚‡ÊÌÂȯÂÈ ÒÓÒÚ‡‚Îfl˛˘ÂÈ Ô·̇ «3 Í 5» ·Û‰ÂÚ ÒÓ‰ÂÈÒÚ‚Ó‚‡Ú¸ ÛÒËÎËflÏ Çéá ÔÓ Ó͇Á‡Ì˲ „ÓÒÛ‰‡ÒÚ‚‡Ï-˜ÎÂÌ‡Ï ÔÓÏÓ˘Ë ‚ ‰ÓÒÚËÊÂÌËË ÔÓÒÚ‡‚ÎÂÌÌÓÈ ˆÂÎË. àÏÂÌÌÓ Ú‡ÍÓ‚ ÔÓ‰ıÓ‰, ÔËÌflÚ˚È ‰Îfl ÓÔ‰ÂÎÂÌËfl ÍÛÒ‡ ÄêÇ ‚ ̇ÒÚÓfl˘ÂÏ ‰ÓÍÛÏÂÌÚÂ.

ë

ëÂ‰Ë Ù‡ÍÚÓÓ‚, ÍÓÚÓ˚ÏË ‰ÓÎÊÂÌ ÓÔ‰ÂÎflÚ¸Òfl ‚˚·Ó ÒıÂÏ Äêí, Í‡Í Ì‡ ÛÓ‚Ì ÔÓ„‡ÏÏ, Ú‡Í Ë Ì‡ ÛÓ‚Ì ÓÚ‰ÂθÌÓ„Ó ·ÓθÌÓ„Ó, ÌÂÓ·ıÓ‰ËÏÓ Û͇Á‡Ú¸ ÒÎÂ‰Û˛˘ËÂ:

11

◗ ÒË· ‚ÓÁ‰ÂÈÒÚ‚Ëfl; ◗ ı‡‡ÍÚÂ ÔÓ·Ó˜ÌÓ„Ó ‰ÂÈÒÚ‚Ëfl; ◗ Ú·ӂ‡ÌËfl Í Î‡·Ó‡ÚÓÌÓÏÛ ÏÓÌËÚÓËÌ„Û; ◗ ÔÓÚÂ̈ˇΠ‰Îfl ÔÓ‰‰ÂʇÌËfl ËÁ·‡ÌÌ˚ı ÍÛÒÓ‚ ΘÂÌËfl ‚ ·Û‰Û˘ÂÏ; ◗ Ô‰ÔÓ·„‡ÂÏÓ ÒΉӂ‡ÌË ̇Á̇˜ÂÌÌÓÏÛ ÍÛÒÛ Î˜ÂÌËfl ÒÓ ÒÚÓÓÌ˚ ·ÓθÌÓ„Ó; ◗ ‰Û„Ë ӷÒÚÓflÚÂθÒÚ‚‡ (̇ÔËÏÂ, ÒÓÔÛÚÒÚ‚Û˛˘Ë ËÌÙÂ͈ËË, ÏÂÚ‡·Ó΢ÂÒÍË ̇Û¯ÂÌËfl); ◗ ̇΢ˠ·ÂÂÏÂÌÌÓÒÚË ËÎË ÒÛ˘ÂÒÚ‚Û˛˘ËÈ ‚ Ò‚flÁË Ò ˝ÚËÏ ËÒÍ; ◗ ËÒÔÓθÁÓ‚‡ÌË ‰Û„Ëı ωË͇ÏÂÌÚÓÁÌ˚ı Ò‰ÒÚ‚ (Ú.Â. ‚ÓÁÏÓÊÌÓ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ë ‡Á΢Ì˚ı ÎÂ͇ÒÚ‚); ◗ ‚ÓÁÏÓÊÌÓÒÚ¸ ËÌÙˈËÓ‚‡ÌËfl ¯Ú‡ÏÏÓÏ ‚ËÛÒ‡, ÏÂÌ ÔÓ‰‚ÂÊÂÌÌÓ„Ó ‚ÓÁ‰ÂÈÒڂ˲ Ó‰ÌÓ„Ó ËÎË ·Óθ¯Â„Ó ˜ËÒ· ÄêÇ ÔÂÔ‡‡ÚÓ‚, ‚Íβ˜‡fl ÚÓ, ˜ÚÓ Ò‚flÁ‡ÌÓ Ò ‡Ì ËÒÔÓθÁÓ‚‡ÌÌ˚ÏË ÍÛÒ‡ÏË ÄêÇ, ÍÓÚÓ˚ Ô‰·„‡ÎËÒ¸ ‰Îfl ÔÓÙË·ÍÚËÍË ËÎË Î˜ÂÌËfl; ◗ Ë, ˜ÚÓ Ó˜Â̸ ‚‡ÊÌÓ, ̇΢ËÂ Ë ÒÚÓËÏÓÒÚ¸ ΘÂÌËfl. àÒÔÓθÁÓ‚‡ÌË ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ı ÔÂÔ‡‡ÚÓ‚ ‚˚ÒÓÍÓ„Ó Í‡˜ÂÒÚ‚‡‡ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁËӂ͇ı (îÑ)b ËÎË ‚ ·ÎËÒÚÂÌ˚ı ÛÔ‡Íӂ͇ıc fl‚ÎflÂÚÒfl ¢ ӉÌËÏ ‚‡ÊÌ˚Ï Ù‡ÍÚÓÓÏ, ÔÓÒÍÓθÍÛ ˝ÚÓ ÒÓ‰ÂÈÒÚ‚ÛÂÚ ÎÛ˜¯ÂÏÛ ‚˚ÔÓÎÌÂÌ˲ ÒıÂÏ˚ ΘÂÌËfl Ë ‚ Ò‚Ó˛ Ó˜Â‰¸ ÔÂÔflÚÒÚ‚ÛÂÚ ‚ÓÁÌËÍÌÓ‚ÂÌ˲ ÂÁËÒÚÂÌÚÌÓÒÚË Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï. ùÚÓ Ú‡ÍÊ ÒÓ‰ÂÈÒÚ‚ÛÂÚ ı‡ÌÂÌ˲ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ı ÔÂÔ‡‡ÚÓ‚ Ë Ëı ‡ÒÔ‰ÂÎÂÌ˲. ÑÓÔÓÎÌËÚÂθÌ˚ ÒÓÓ·‡ÊÂÌËfl, ‚‡ÊÌ˚ ‰Îfl ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì, ‚Íβ˜‡˛Ú ‰ÓÒÚÛÔ Í Ó„‡Ì˘ÂÌÌÓÏÛ ˜ËÒÎÛ ÄêÇ-ÔÂÔ‡‡ÚÓ‚, Ó„‡Ì˘ÂÌÌ˚ ‚ÓÁÏÓÊÌÓÒÚË ËÌÙ‡ÒÚÛÍÚÛ˚ Á‰‡‚ÓÓı‡ÌÂÌËfl (‚Íβ˜‡fl ͇‰Ó‚˚ ÂÒÛÒ˚), ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ ÔÓÒÚ‡‚ÍË ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ ‚ ÒÂθÒÍË ‡ÈÓÌ˚, ‚˚ÒÓÍÛ˛ ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚ¸ íÅ Ë „ÂÔ‡ÚËÚ‡ Ç Ë/ËÎË ë ‚ „ÛÔÔ‡ı ̇ÒÂÎÂÌËfl, ‡ Ú‡ÍÊ ̇΢ˠ‡Á΢Ì˚ı ÚËÔÓ‚ „ÛÔÔ Ë ÔÓ‰‚ˉӂ Çàó-ËÌÙÂ͈ËË. _______________________ ‡ ãÂ͇ÒÚ‚ÂÌÌ˚ ÔÂÔ‡‡Ú˚ Ò Û‰ÓÒÚÓ‚ÂÂÌËÂÏ Í‡˜ÂÒÚ‚‡ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁËӂ͇ı (îÑ) ‚ ̇ÒÚÓfl˘ÂÏ ‰ÓÍÛÏÂÌÚ ‚Íβ˜‡˛Ú ÓÚ‰ÂθÌ˚ ÔÓ‰ÛÍÚ˚, ÍÓÚÓ˚Â, Í‡Í Ô‰ÔÓ·„‡ÂÚÒfl, ÒÓÓÚ‚ÂÚÒÚ‚Û˛Ú ËÎË ‰‡Ê Ô‚ÓÒıÓ‰flÚ ÏÂʉÛ̇Ó‰Ì˚ Òڇ̉‡Ú˚ ‚ ÓÚÌÓ¯ÂÌËË Í‡˜ÂÒÚ‚‡, ·ÂÁÓÔ‡ÒÌÓÒÚË Ë ˝ÙÙÂÍÚË‚ÌÓÒÚË. Ç ÒÎÛ˜‡Â ÒÓ˜ÂÚ‡ÌËfl ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚, ÍÓÏÔÓÌÂÌÚ˚ ÍÓÚÓ˚ı ÔÓÒÚÛÔ‡˛Ú ÓÚ ‡Á΢Ì˚ı ÔÓËÁ‚Ó‰ËÚÂÎÂÈ, ÏÂʉÛ̇Ó‰Ì˚ Òڇ̉‡Ú˚ Ô‰ÔÓ·„‡˛Ú ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ Ôӂ‰ÂÌËfl ÍÎËÌ˘ÂÒÍËı ËÒÒΉӂ‡ÌËÈ ·Ëӽ͂˂‡ÎÂÌÚÌÓÒÚË ‰Îfl ÓÔ‰ÂÎÂÌËfl ÚÂ‡Ô‚Ú˘ÂÒÍÓÈ ‚Á‡ËÏÓÁ‡ÏÂÌflÂÏÓÒÚË ÍÓÏÔÓÌÂÌÚÓ‚. ë ‡·ÓÚ‡ÏË Çéá ÔÓ Ô‰‚‡-

ËÚÂθÌÓÏÛ Û‰ÓÒÚÓ‚ÂÂÌ˲ ͇˜ÂÒÚ‚‡ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ı ÔÂÔ‡‡ÚÓ‚ ÏÓÊÌÓ ÓÁ̇ÍÓÏËÚ¸Òfl ̇ Ò‡ÈÚÂ: http://www.who.int/ medicines/organization/qsm/activites/pilotroc/proc.shml. b îËÍÒËÓ‚‡ÌÌ˚ ‰ÓÁËÓ‚ÍË ÓÒÌÓ‚‡Ì˚ ̇ ÔË̈ËÔ ‚Íβ˜ÂÌËfl ‰‚Ûı ËÎË ·Óθ¯Â„Ó ˜ËÒ· ‡ÍÚË‚Ì˚ı Ù‡χÍÓÎӄ˘ÂÒÍËı ÒÛ·Òڇ̈ËÈ ‚ Ó‰ÌÛ Ú‡·ÎÂÚÍÛ-͇ÔÒÛÎÛ, ÔËββ ËÎË ‡ÒÚ‚Ó.

c ÅÎËÒÚÂ̇fl ÛÔ‡Íӂ͇ Ô‰ÒÚ‡‚ÎflÂÚ ÒÓ·ÓÈ Ô·ÒÚËÍÓ‚Û˛ ËÎË ‡Î˛ÏËÌËÂ‚Û˛ Ô·ÒÚËÌÍÛ, ÒÓ‰Âʇ˘Û˛ ‰‚ ËÎË ·Óθ¯Â ÍÓ΢ÂÒÚ‚Ó ÔËβθ, ͇ÔÒÛÎ ËÎË Ú‡·ÎÂÚÓÍ.

12

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

è‰˚‰Û˘‡fl ‚ÂÒËfl (‡ÔÂθ 2002 „.) ̇ÒÚÓfl˘Â„Ó ÛÍÓ‚Ó‰ÒÚ‚‡ ÔÓ Î˜ÂÌ˲ ÂÍÓÏẨӂ‡ÎÓ ÒÚ‡Ì‡Ï ÔÓ‚ÂÒÚË ‚˚·Ó ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ Ë ÓÔ‰ÂÎflÎÓ ‚ˉ˚ ÒıÂÏ Î˜ÂÌËfl, ‚Íβ˜‡‚¯ËÂ, ‚ ͇˜ÂÒÚ‚Â ‚ÓÁÏÓÊÌÓ„Ó ‚˚·Ó‡, ‰‚‡ ÌÛÍÎÂÓÁˉ‡, ‡ Ú‡ÍÊ ÎË·Ó ÌÂÌÛÍÎÂÓÁˉ, ÎË·Ó ‡·‡Í‡‚Ë, ÎË·Ó ËÌ„Ë·ËÚÓ ÔÓÚ‡Á˚. èÓÒΠÓÔÛ·ÎËÍÓ‚‡ÌËfl ˝ÚÓ„Ó ÛÍÓ‚Ó‰ÒÚ‚‡ ÏÌÓ„Ë ÒÚ‡Ì˚ ̇˜‡ÎË ÍÛÒ˚ ÄêÇ-ΘÂÌËfl Ë ‚˚·‡ÎË ÒıÂÏ˚ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ Ò Û˜ÂÚÓÏ ÚÓ„Ó, Í‡Í Û͇Á‡ÌÌ˚ ‚˚¯Â Ù‡ÍÚÓ˚ ÏÓ„ÎË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ó‚‡Ú¸ ‚ ‡Á΢Ì˚ı ÛÒÎÓ‚Ëflı. ÅÓθ¯ËÌÒÚ‚Ó ÔÓ„‡ÏÏ Î˜ÂÌËfl ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ‚˚ÒÚÛÔ‡˛Ú Á‡ ÒıÂÏÛ ÚÂ‡ÔËË, ÒÓÒÚÓfl˘Û˛ ËÁ ‰‚Ûı ÌÛÍÎÂÓÁˉӂ Ë ÌÂÌÛÍÎÂÓÁˉÌÓ„Ó ËÌ„Ë·ËÚÓ‡ éí. íÓÈÌ˚ ÌÛÍÎÂÓÁˉÌ˚ ÒıÂÏ˚ ΘÂÌËfl, ‚Íβ˜‡fl ‡·‡Í‡‚Ë, Ô‡ÍÚ˘ÂÒÍË ÌËÍÓ„‰‡ Ì ËÁ·Ë‡˛ÚÒfl Ò Û˜ÂÚÓÏ Ëı ÒÚÓËÏÓÒÚË Ë „ËÔÂ˜Û‚ÒÚ‚ËÚÂθÌ˚ı ‡͈ËÈ; ÒıÂÏ˚ ΘÂÌËfl, ‚Íβ˜‡˛˘Ë ËÌ„Ë·ËÚÓ ÔÓÚ‡Á˚, Ú‡ÍÊ ÒÚ‡ÎË ÏÂÌ Ê·ÚÂθÌ˚Ï ‚˚·ÓÓÏ ‚ ÓÒÌÓ‚ÌÓÏ ÔÓÚÓÏÛ, ˜ÚÓ ÓÌË ÒÚÓflÚ Ó˜Â̸ ‰ÓÓ„Ó, ‰‡ÊÂ Ò Û˜ÂÚÓÏ ËÏ‚¯Â„Ó ÏÂÒÚÓ ÒÌËÊÂÌËfl ˆÂÌ. ÑÛ„ËÏË ÔÂÔflÚÒÚ‚ËflÏË fl‚Îfl˛ÚÒfl ‰ÓÒÚ‡ÚÓ˜ÌÓ ÒÎÓÊÌ˚ ‡Ò˜ÂÚ˚ ‰ÓÁ˚, ÔÓ·Ó˜ÌÓ ‚ÓÁ‰ÂÈÒÚ‚Ë ˝ÚËı ÔÂÔ‡‡ÚÓ‚ Ë ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ ̇΢Ëfl ·ÓΠÒÎÓÊÌÓÈ Ï‡ÚÂˇθÌÓÚÂıÌ˘ÂÒÍÓÈ ·‡Á˚ (‚Íβ˜‡fl ıÓÎÓ‰ËθÌ˚ ÛÒÚ‡ÌÓ‚ÍË). ꉇ͈ËÓÌÌ˚È ÍÓÏËÚÂÚ ‡ÒÒÏÓÚÂÎ ÒıÂÏ˚ ΘÂÌËfl, Ì ÓÒÌÓ‚‡ÌÌ˚ ̇ ÌÛÍÎÂÓÁˉ‡ı, Ë Û˜ÂÎ ÍÎËÌ˘ÂÒÍËÈ ÓÔ˚Ú ‚ ÓÚÌÓ¯ÂÌËË ˝ÙÙÂÍÚË‚ÌÓÒÚË Ë ÚÓÍÒ˘ÌÓÒÚË ÌÛÍÎÂÓÁˉÌÓ„Ó ËÌ„Ë·ËÚÓ‡ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ (çàéí), ‡ Ú‡ÍÊ ÌÂÌÛÍÎÂÓÁˉÌÓ„Ó ËÌ„Ë·ËÚÓ‡ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚(ççàéí), ̇΢ˠÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁËÓ‚ÓÍ (èËÎÓÊÂÌË D), ÓÚÒÛÚÒÚ‚Ë Ú·ӂ‡ÌËÈ ‚ ÓÚÌÓ¯ÂÌËË ıÓÎÓ‰ËθÌÓÈ ÛÒÚ‡ÌÓ‚ÍË, ̇΢ˠÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ Ë ÒÚÓËÏÓÒÚË. ç‡ ˝ÚÓÈ ÓÒÌÓ‚Â äÓÏËÚÂÚ Ô˯ÂÎ Í ‚˚‚Ó‰Û Ó ÚÓÏ, ˜ÚÓ ÔÂ‚˚ ˜ÂÚ˚ ÒıÂÏ˚ ÄêÇ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡, Ô‰ÒÚ‡‚ÎÂÌÌ˚ ‚ 퇷Îˈ Ç, ÏÓ„ÛÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì˚ ‰Îfl ‚ÁÓÒÎ˚ı Ë ÔÓ‰ÓÒÚÍÓ‚. ùÚË ÒıÂÏ˚ ΘÂÌËfl ÒÓÒÚÓflÚ ËÁ ‡Ì‡ÎÓ„‡ ÚËÏˉË̇ çàéí, Ú.Â. ÒÚ‡‚Û‰Ë̇ (d4í) ËÎË ÁˉӂۉË̇ (áÑÇ), ÚˇˆËÚˉË̇ (çàéí), Ú.Â. ·ÏË‚Û‰Ë̇ (3íë) Ë ççàéí, Ú. Â. Ì‚Ë‡ÔË̇ (çÇè) ËÎË ˝Ù‡‚ËÂ̈‡ (ùîñ). Ç˚·Ó ÏÂÊ‰Û d4í Ë áÑÇ ‰ÓÎÊÂÌ ÓÒÛ˘ÂÒÚ‚ÎflÚ¸Òfl ̇ ÛÓ‚Ì ÒÚ‡Ì Ò Û˜ÂÚÓÏ ÏÂÒÚÌ˚ı ÛÒÎÓ‚ËÈ, ÌÓ ÂÍÓÏẨÛÂÚÒfl Ó·ÂÒÔ˜ËÚ¸ ̇΢ˠÚÓ„Ó Ë ‰Û„Ó„Ó ÔÂÔ‡‡Ú‡. d4í ‚ ̇˜‡Î ӷ˚˜ÌÓ ÔÂÂÌÓÒËÚÒfl ÎÛ˜¯Â ˜ÂÏ áÑÇ Ë Ì Ú·ÛÂÚ ÏÓÌËÚÓËÌ„‡ „ÂÏÓ„ÎÓ·Ë̇. ÇÏÂÒÚÂ Ò ÚÂÏ, ÒÂ‰Ë çàéí ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ÓÌ ‚Ó ‚Ò ·Óθ¯ÂÈ ÒÚÂÔÂÌË ‡ÒÒÓˆËËÛÂÚÒfl Ò ÎËÔÓ‡ÚÓÙËÂÈ Ë ‰Û„ËÏË ÏÂÚ‡·Ó΢ÂÒÍËÏË Ì‡Û¯ÂÌËflÏË, ‚Íβ˜‡fl ·ÍÚ‡ˆËÓÌÌ˚È ‡ˆË‰ÓÁ, ÓÒÓ·ÂÌÌÓ ÔË ÒÓ˜ÂÚ‡ÌËË Ò ‰Ë‰‡ÌÓÁËÌÓÏ (ddl). éÌ ÏÓÊÂÚ Ú‡ÍÊ ‚˚Á˚‚‡Ú¸ ÔÂËÙÂ˘ÂÒÍÛ˛ ÌÂÈÓÔ‡Ú˲ Ë Ô‡ÌÍ‡ÚËÚ. áÑÇ Ú‡ÍÊ ·˚Î ÓÚϘÂÌ ‚ ÏÂÚ‡·Ó΢ÂÒÍËı ÓÒÎÓÊÌÂÌËflı ÍÛÒ‡ ÚÂ‡ÔËË, ÌÓ ‚ ÏÂ̸¯ÂÈ ÒÚÂÔÂÌË, ˜ÂÏ d4í. Ç Ì‡˜‡Î ҂flÁ‡ÌÌ˚Â Ò ÎÂ͇ÒÚ‚‡ÏË ÔÓ·Ó˜Ì˚ ‰ÂÈÒÚ‚Ëfl („ÓÎӂ̇fl ·Óθ, ÚÓ¯ÌÓÚ‡) fl‚Îfl˛ÚÒfl ·ÓΠ˜‡ÒÚ˚ÏË ÔË ËÒÔÓθÁÓ‚‡ÌËË áÑÇ, Ë ˝ÚÓÚ ÔÂÔ‡‡Ú ÏÓÊÂÚ ‚˚Á˚‚‡Ú¸ ÚflÊÂÎÛ˛ ‡ÌÂÏ˲ Ë ÌÂÈÚÓÔÂÌ˲, ÍÓÚÓ˚ ÚÂ·Û˛Ú Ó·ÂÒÔ˜ËÚ¸ ÏÓÌËÚÓËÌ„ „ÂÏÓ„ÎÓ·Ë̇ ‰Ó ̇˜‡Î‡ Ë ‚Ó ‚ÂÏfl ΘÂÌËfl áÑÇ. d4í ÏÓÊÂÚ ·˚Ú¸ Á‡ÏÂÌÂÌ Ì‡ áÑÇ ‚ ÒÎÛ˜‡Â ÌÂÔÂÂÌÓÒËÏÓÒÚË ÔÓÒΉÌÂ„Ó Ë Ì‡Ó·ÓÓÚ (Á‡ ËÒÍβ˜ÂÌËÂÏ ÔÓ‰ÓÁÂÌËfl ̇ ·ÍÚ‡ˆËÓÌÌ˚È ‡ˆË‰ÓÁ, ‚ ÒÎÛ˜‡Â ÍÓÚÓÓ„Ó ÌË Ó‰ÌÓ ËÁ ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ Ì ‰ÓÎÊÌÓ Ì‡Á̇˜‡Ú¸Òfl). ÇÏÂÒÚÂ Ò ÚÂÏ, ÒÚÂÏÎÂÌË ҂ÂÒÚË Í ÏËÌËÏÛÏÛ ÌÂÓ·ıÓ‰ËÏ˚È Î‡·Ó‡ÚÓÌ˚È ÏÓÌËÚÓËÌ„ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ÓÚ‰‡ÂÚ Ô‰ÔÓ˜ÚÂÌË d4í Í‡Í ÌÛÍÎÂÓÁË‰Û ‰Îfl ·Óθ¯ÂÈ ˜‡ÒÚË ·ÓθÌ˚ı ‚ ÔÓ„‡Ïχı Äêí ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚, „‰Â ÌÂÓ·ıÓ‰Ëχ ·˚ÒÚ‡fl ËÌÚÂÌÒËÙË͇ˆËfl ÍÛÒ‡.

13

áÑÇ fl‚ÎflÂÚÒfl ÒËθÌ˚Ï çàéí, ÔÓ‰ÂÏÓÌÒÚËÓ‚‡‚¯ËÏ ÓÚ΢ÌÛ˛ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸, ·ÂÁÓÔ‡ÒÌÓÒÚ¸ Ë ÔÂÂÌÓÒËÏÓÒÚ¸. éÌ ÏÓÊÂÚ Ì‡Á̇˜‡Ú¸Òfl Ó‰ËÌ ËÎË ‰‚‡ ‡Á‡ ‚ ‰Â̸ Ë ·˚Î ‚Íβ˜ÂÌ ‚ fl‰ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁËÓ‚ÓÍ. ùÏÚˈËÚ‡·ËÌ (ùíñ) fl‚ÎflÂÚÒfl ÔÓÎÛ˜ÂÌÌ˚Ï Ì‰‡‚ÌÓ ‡Ì‡ÎÓ„ÓÏ ÌÛÍÎÂÓÁˉ‡, ÍÓÚÓ˚È ÒÚÛÍÚÛÌÓ ‚Á‡ËÏÓÒ‚flÁ‡Ì Ò 3íë, ËÏÂÂÚ Ó·˘ËÈ Ò ÌËÏ ÔÓÙËθ ÂÁËÒÚÂÌÚÌÓÒÚË Ë ÏÓÊÂÚ Ì‡Á̇˜‡Ú¸Òfl Ó‰ËÌ ‡Á ‚ ‰Â̸11. Ç Ì‡ÒÚÓfl˘Â ‚ÂÏfl ÔÓ‚Ó‰ËÚÒfl Â„Ó ËÒÔ˚Ú‡ÌË ‚ ͇˜ÂÒÚ‚Â ÔÓ‰ÛÍÚ‡ ‰Îfl ‡ÒÙ‡ÒÓ‚ÍË Ò ÙÛχ‡ÚÓÏ ÚÂÌÓÙÓ‚Ë‰ËÁÓÔÓÍÒË· (íÑî). ì˜ËÚ˚‚‡fl, ˜ÚÓ ÌÂÍÓÚÓ˚ ÒÚ‡Ì˚ ‡Á¯ËÎË ÔËÏÂÌÂÌË ùíñ Ò‡‚ÌËÚÂθÌÓ Ì‰‡‚ÌÓ, ÓÌ Ì ‚Íβ˜‡ÂÚÒfl ‚ ÂÍÓÏẨӂ‡ÌÌ˚È ÔÂ˜Â̸ ÒıÂÏ ÔÂ‚Ó„Ó fl‰‡, ÌÓ ˝ÚÓ ÏÓÊÂÚ ·˚Ú¸ ËÁÏÂÌÂÌÓ ÔÓ ÏÂ ̇ÍÓÔÎÂÌËfl ÌÂÓ·ıÓ‰ËÏÓ„Ó ÓÔ˚Ú‡ Ò ‰‡ÌÌ˚Ï ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚ÓÏ Ò Û˜ÂÚÓÏ Â„Ó Ì‡Î˘Ëfl Ë ÒÚÓËÏÓÒÚË. Ñ‚ÓÈÌÓÈ ÍÓÏÔÓÌÂÌÚ ÌÛÍÎÂÓÁˉ‡ d4í/ddl ·ÓΠ̠ÂÍÓÏẨÛÂÚÒfl ‰Îfl ÒıÂÏ ÔÂ‚Ó„Ó fl‰‡ Ò Û˜ÂÚÓÏ ÔÓÙËÎfl Â„Ó ÚÓÍÒ˘ÌÓÒÚË, ÓÒÓ·ÂÌÌÓ ‰Îfl ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ12. éÒÓ·Ó ÓÚϘ‡ÂÚÒfl Ú‡ÍÊ ÚÓ, ˜ÚÓ áÑÇ Ë d4í ÌËÍÓ„‰‡ Ì ‰ÓÎÊÌ˚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚ÏÂÒÚÂ Ò Û˜ÂÚÓÏ Ëı ÌÂÒÓ‚ÏÂÒÚËÏÓÒÚË13. íÑî ËÏÂÂÚ ‰ÎËÚÂθÌ˚È ÔÂËÓ‰ ‚ÌÛÚËÍÎÂÚÓ˜ÌÓ„Ó ÔÓÎÛ‡ÒÔ‡‰‡ Ë Ò Û˜ÂÚÓÏ ˝ÚÓ„Ó ÏÓÊÂÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ÒÓÒÚ‡‚Îfl˛˘ÂÈ ‚ ÒıÂÏ ÔËÂχ Ó‰ËÌ ‡Á ‚ ‰Â̸ ÎÂ͇ÒÚ‚‡, ÒÓÒÚÓfl¯Â„Ó ËÁ ÚÂı ˜‡ÒÚÂÈ. . Å˚ÎÓ ÓÚϘÂÌÓ, ˜ÚÓ íÑî fl‚ÎflÂÚÒfl ˝ÙÙÂÍÚË‚Ì˚Ï ÍÓÏÔÓÌÂÌÚÓÏ ÒıÂÏ ÔÂ‚Ó„Ó fl‰‡ ‚ ÒÓ˜ÂÚ‡ÌËË Ò 3íë Ë ˝Ù‡‚ËÂ̈ÂÏ (ùîñ)14, 15. é·˚˜ÌÓ ÓÌ ıÓÓ¯Ó ÔÂÂÌÓÒËÚÒfl, ıÓÚfl Ë ·˚ÎË ÓÚϘÂÌ˚ ÒÎÛ˜‡Ë ‚ÓÁÌËÍÌÓ‚ÂÌËfl ÔӘ˜ÌÓÈ Ì‰ÓÒÚ‡ÚÓ˜ÌÓÒÚË Û ·ÓθÌ˚ı, ÔËÌËχ˛˘Ëı íÑî16-18. ÇÏÂÒÚÂ Ò ÚÂÏ Ì‡ÍÓÔÎÂÌÌ˚È ‚ ÏË ÓÔ˚Ú ÔÓ ËÒÔÓθÁÓ‚‡Ì˲ ˝ÚÓ„Ó ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó ÔÂÔ‡‡Ú‡ fl‚ÎflÂÚÒfl ‰ÓÒÚ‡ÚÓ˜ÌÓ Ó„‡Ì˘ÂÌÌ˚Ï. äÓÏ ÚÓ„Ó, Â„Ó Ó„‡Ì˘ÂÌ̇fl ‰ÓÒÚÛÔÌÓÒÚ¸ Ë ÓÚÌÓÒËÚÂθÌÓ ‚˚ÒÓ͇fl ÒÚÓËÏÓÒÚ¸ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı Ú‡ÍÊ ‚˚ÒÚÛÔ‡˛Ú ‚ ͇˜ÂÒÚ‚Â Á̇˜ËÚÂθÌ˚ı Ù‡ÍÚÓÓ‚. Ç ˝ÚÓÈ Ò‚flÁË ‰Îfl ̇ÒÚÓfl˘Â„Ó ÛÍÓ‚Ó‰ÒÚ‚‡ ÔÓ Î˜ÂÌ˲ ‡ÒÒÏÓÚÂÌË ‚ÓÔÓÒ‡ Ó Â„Ó ËÒÔÓθÁÓ‚‡ÌËË ·Û‰ÂÚ Ó„‡Ì˘˂‡Ú¸Òfl ÒıÂχÏË Î˜ÂÌËfl ‚ÚÓÓ„Ó fl‰‡. èÓÒΠÚÓ„Ó Í‡Í ·Û‰ÂÚ ÛÚÓ˜ÌÂÌ ‚ÓÔÓÒ Ó Ì‡Î˘ËË Ë ÒÚÓËÏÓÒÚË ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚, ·Û‰ÂÚ ‡ÒÒÏÓÚÂÌ ‚ÓÔÓÒ Ó ‚Íβ˜ÂÌËË íÑî ‚ ÂÍÓÏẨÛÂÏ˚ Çéá ÒıÂÏ˚ ΘÂÌËfl ÔÂ‚Ó„Ó fl‰‡ ÇÓ ‚ÒÂÏ ÏË ÒıÂÏ˚ ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ ̇ ççàéí, fl‚Îfl˛ÚÒfl ̇˷ÓΠ˜‡ÒÚÓ Ì‡Á̇˜‡ÂÏ˚ÏË ÒÓ˜ÂÚ‡ÌËflÏË ‰Îfl ̇˜‡Î‡ ÍÛÒ‡ ΘÂÌËfl. éÌË fl‚Îfl˛ÚÒfl ‰ÓÒÚ‡ÚÓ˜ÌÓ ˝ÙÙÂÍÚË‚Ì˚ÏË, ÓÚÌÓÒËÚÂθÌÓ ÔÓÒÚ˚ÏË, ÌÓ Ì‰ÓÒÚ‡ÚÓ˜ÌÓ ‡ÍÚË‚Ì˚ÏË ‚ ÓÚÌÓ¯ÂÌËË Çàó-2 Ë „ÛÔÔ˚ 0 Çàó-1. ùîñ Ë çÇè ÓÚÌÓÒflÚÒfl Í „ÛÔÔ ÒËθÌÓ ‰ÂÈÒÚ‚Û˛˘Ëı ççàéí, fl‚Îfl˛˘ËıÒfl Ó˜Â̸ ˝ÙÙÂÍÚË‚Ì˚ÏË ÔË Ì‡Á̇˜ÂÌËË ‚ ÍÓÏ·Ë̇ÚÓÌ˚ı ÒıÂχı. ÇÏÂÒÚÂ Ò ÚÂÏ, ‡Á΢ˠ‚ ÔÓÙËΠÚÓÍÒ˘ÌÓÒÚË, ‡ Ú‡ÍÊ ‚ÓÁÏÓÊÌÓÒÚ¸ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ò ‰Û„ËÏË ÍÛÒ‡ÏË Ë ÒÚÓËÏÓÒÚ¸ ÏÓ„ÛÚ ·˚Ú¸ ÓÒÌÓ‚‡ÌËÂÏ Í‡Í ‰Îfl ÔÓÁËÚË‚Ì˚ı, Ú‡Í Ë Ì„‡ÚË‚Ì˚ı ÂÍÓÏẨ‡ˆËÈ ÔÓ Ëı ËÒÔÓθÁÓ‚‡Ì˲14, 19-25. çÇè ˜‡˘Â ‚˚Á˚‚‡ÂÚ Ò˚Ô¸, ÍÓÚÓ‡fl ÏÓÊÂÚ ·˚Ú¸ Ó˜Â̸ ÒÂ¸ÂÁÌÓÈ Ë Û„Óʇڸ ÊËÁÌË Ë Ó·Î‡‰‡ÂÚ Ì‡Ë·Óθ¯ÂÈ Û„ÓÁÓÈ „ÂÔ‡ÚÓÚÓÍÒ˘ÌÓÒÚË, ÍÓÚÓ‡fl Ú‡ÍÊ ÏÓÊÂÚ ÒÚ‡Ú¸ Û„Óʇ˛˘ÂÈ ‰Îfl ÊËÁÌË. ùÚÓ ‰Â·ÂÚ ˝ÚÓÚ ÔÂÔ‡‡Ú ÏÂÌ ÔË„Ó‰Ì˚Ï ‰Îfl ΘÂÌËfl ·ÓθÌ˚ı, ÍÓÚÓ˚ ÔÓÎÛ˜‡˛Ú ‰Û„Ë „ÂÔ‡ÚÓÚÓÍÒ˘ÂÒÍË Ò‰ÒÚ‚‡, ËÎË ÎÂ͇ÒÚ‚ÂÌÌ˚ ÔÂÔ‡‡Ú˚, Ú‡ÍËÂ, ÍÓÚÓ˚ ÏÓ„ÛÚ ÔË‚Ó‰ËÚ¸ Í Ò˚ÔË ËÎË Í ÚÓÏÛ Ë ‰Û„ÓÏÛ, Í‡Í Ì‡ÔËÏÂ ËÙ‡ÏÔˈËÌ. éÒÌÓ‚Ì˚ ÚÓÍÒ˘ÂÒÍË ͇˜ÂÒÚ‚‡ ùîñ Ò‚flÁ‡Ì˚ Ò ˆÂÌÚ‡Î¸ÌÓÈ ÌÂ‚ÌÓÈ ÒËÒÚÂÏÓÈ (ñçë), ÚÂ‡ÚÓ„ÂÌÌÓÒÚ¸˛ Ë Ò˚Ô¸˛. (ë˚Ô¸ „Ó‡Á‰Ó ˜‡˘Â ÔÓfl‚ÎflÂÚÒfl Û ‰ÂÚÂÈ, ˜ÂÏ Û ‚ÁÓÒÎ˚ı, ÌÓ ‚˚Ò˚Ô‡ÌËfl fl‚Îfl˛ÚÒfl Ì ÒÚÓθ ÒÂ¸ÂÁ-

14

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

Ì˚ÏË, Ë ˝ÚÓ Ó·˚˜ÌÓ Ì Ú·ÛÂÚ ÔÂÍ‡˘ÂÌËfl ÍÛÒ‡ ΘÂÌËfl.) ëËÏÔÚÓÏ˚ ñçë ÒıÓ‰flÚ Ì‡ ÌÂÚ ÔÓÒΠ10-1 4 ‰ÌÂÈ Û ·Óθ¯ËÌÒÚ‚‡, ıÓÚfl Ë ÌÂ Û ‚ÒÂı ·ÓθÌ˚ı. ùîñ Ì ‰ÓÎÊÂÌ ÔËÏÂÌflÚ¸Òfl ‰Îfl ·ÓθÌ˚ı, ÒÚ‡‰‡‚¯Ëı ÒÂ¸ÂÁÌ˚ÏË ÔÒËıˇÚ˘ÂÒÍËÏË ‡ÒÒÚÓÈÒÚ‚‡ÏË, ÊÂÌ˘ËÌ ‰ÂÚÓÓ‰ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ ËÎË ·ÂÂÏÂÌÌ˚ı.ùîñ ÏÓÊÂÚ ·˚Ú¸ ‚˚·‡Ì ‰Îfl Ô‡ˆËÂÌÚÓ‚ Ò ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ ËÌÙÂ͈ËÂÈ íÅ, ‡ çÇè ÏÓÊÂÚ ·˚Ú¸ ÎÛ˜¯ËÏ ‚˚·ÓÓÏ ‰Îfl ÊÂÌ˘ËÌ ‰ÂÚÓÓ‰ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ ËÎË ·ÂÂÏÂÌÌ˚ı. ùîñ Ì ‰ÓÎÊÂÌ Ì‡Á̇˜‡Ú¸Òfl ÊÂÌ˘ËÌ‡Ï ‰ÂÚÓÓ‰ÌÓ„Ó ‚ÓÁ‡ÒÚ‡, Á‡ ËÒÍβ˜ÂÌËÂÏ ÚÂı ÒÎÛ˜‡Â‚, ÍÓ„‰‡ ÏÓÊÂÚ ·˚Ú¸ Ó·ÂÒÔ˜Â̇ ˝ÙÙÂÍÚ˂̇fl ÍÓÌÚ‡ˆÂÔˆËfl. ÇÏÂÒÚÂ Ò ÚÂÏ, ÒΉÛÂÚ ÓÚÏÂÚËÚ¸, ˜ÚÓ ùîñ Ë çÇè ÏÓ„ÛÚ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ó‚‡Ú¸ Ò ÔÓÚË‚ÓÁ‡˜‡ÚÓ˜Ì˚ÏË Ò‰ÒÚ‚‡ÏË, ÒÓ‰Âʇ˘ËÏË ˝ÒÚÓ„ÂÌ. çÇè ÏÓÊÂÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ˜‡ÒÚË ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁ˚ ÍÓÏ·Ë̇ˆËË ËÁ ÚÂı ˜‡ÒÚÂÈ, ÍÓÚÓ‡fl ̇Á̇˜‡ÂÚÒfl ÔË Ì‡Î˘ËË Í‡˜ÂÒÚ‚ÂÌÌ˚ı, ‰Ó͇Á‡‚¯Ëı Ò‚Ó˛ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ·Ëӽ͂˂‡ÎÂÌÚÌ˚ı ÔÂÔ‡‡ÚÓ‚. àÒÔÓθÁÓ‚‡ÌË ÔÓ‰ıÓ‰‡, ÓÒÌÓ‚‡ÌÌÓ„Ó Ì‡ ÙÓÏÛΠËÁ ÔflÚË ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ (d4í ËÎË áÑÇ) + 3íë + (çÇè ËÎË ùîñ), ÏÓÊÂÚ Ì‡ Ô‡ÍÚËÍ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚Ó ‚ÒÂı ˜ÂÚ˚Âı ‚ÓÁÏÓÊÌ˚ı ÒıÂχı ΘÂÌËfl (퇷Îˈ‡ Ç) Ë ‰‡ÂÚ ‚ÓÁÏÓÊÌÓÒÚË ‰Îfl Á‡ÏÂÌ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ Ò Û˜ÂÚÓÏ Ëı ÚÓÍÒ˘ÌÓÒÚË (퇷Îˈ‡ ë). èÓÒÍÓθÍÛ Í‡Ê‰˚È ËÁ ÔÂÔ‡‡ÚÓ‚ fl‚ÎflÂÚÒfl ‰ÓÒÚ‡ÚÓ˜ÌÓ ÒËθÌ˚Ï, ÚÓ Òڇ̉‡Ú˚ ‚ ÓÚÌÓ¯ÂÌËË Ò‡ÏËı ÒıÂÏ Î˜ÂÌËfl, Ò Û˜ÂÚÓÏ Ëı ˝ÙÙÂÍÚË‚ÌÓÒÚË Ë ‰Û„Ëı Ù‡ÍÚÓÓ‚, ‰ÓÎÊÌ˚ ÓÔ‰ÂÎflÚ¸, ͇ÍÛ˛ ËÏÂÌÌÓ ÒıÂÏÛ Î˜ÂÌËfl ÔËÏÂÚ Ú‡ ËÎË Ë̇fl ÒÚ‡Ì‡ ‚ ͇˜ÂÒÚ‚Â ÓÒÌÓ‚ÌÓÈ. Ç í‡·ÎËˆÂ Ç Û͇Á‡Ì˚ Ù‡ÍÚÓ˚, ÍÓÚÓ˚ ‰ÓÎÊÌ˚ Û˜ËÚ˚‚‡Ú¸Òfl ÔË ÔËÌflÚËË Ú‡ÍÓ„Ó ¯ÂÌËfl. ÄêÇ ÔÂÔ‡‡Ú˚ ‚ ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁËÓ‚ÍÂ Ë ·ÎËÒÚÂÌ˚ı ÛÔ‡Íӂ͇ı ËÏÂ˛Ú ÓÔ‰ÂÎÂÌÌ˚ ÔÂËÏÛ˘ÂÒÚ‚‡ ‚ Ò‡‚ÌÂÌËË Ò Ó·˚˜ÌÓÈ ‡ÒÙ‡ÒÓ‚ÍÓÈ ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚: ÓÌË fl‚Îfl˛ÚÒfl ÔÓÒÚÂȯËÏ Ò‰ÒÚ‚ÓÏ ‰Îfl ÛÔÓ˘ÂÌËfl Ò‡ÏÓ„Ó Î˜ÂÌËfl Ë ÒÓ‰ÂÈÒÚ‚Ëfl ‚˚ÔÓÎÌÂÌ˲ Ô‰ÔËÒ‡ÌÌÓ„Ó ÍÛÒ‡. ÅÓΠÚÓ„Ó, ÓÌË ÏÓ„ÛÚ Ò‚ÂÒÚË Í ÏËÌËÏÛÏÛ Ó¯Ë·ÍË ÔË ‚˚ÔËÒÍÂ, Ó·ÂÒÔ˜ËÚ¸ ‚˚ÔÓÎÌÂÌË ‡·ÓÚÌË͇ÏË Á‰‡‚ÓÓı‡ÌÂÌËfl Ú·ӂ‡ÌËÈ, Ô‰˙fl‚ÎflÂÏ˚ı Í ÍÛÒÛ Î˜ÂÌËfl, ÒÓÍ‡ÚËÚ¸ ÍÓ΢ÂÒÚ‚Ó ÔÓÒ˜ÂÚÓ‚ ÔË ËÒÔÓθÁÓ‚‡ÌËË ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚, ÛÎÛ˜¯ËÚ¸ ‚‰ÂÌË ÒıÂÏ Î˜ÂÌËfl (‚ Ò‚flÁË Ò ÏÂ̸¯ËÏ ˜ËÒÎÓÏ ÔÂÔ‡‡ÚÓ‚ Ë Â‰ËÌÓÈ ‰‡Ú˚ „Ó‰ÌÓÒÚË), ÛÎÛ˜¯ËÚ¸ ÔÓ„ÌÓÁ ‚ ÓÚÌÓ¯ÂÌËË ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚, Ëı ÔÓÎÛ˜ÂÌËfl, ‡ÒÔ‰ÂÎÂÌËfl Ë ı‡ÌÂÌËfl, ÔÓÒÍÓθÍÛ ÏÂ̸¯Â ÍÓ΢ÂÒÚ‚Ó Ô‰ÔÓ·„‡ÂÚ ÏÂ̸¯Û˛ ÔÎÓ˘‡‰¸ ‰Îfl ı‡ÌÂÌËfl, Ë ÒÓÍ‡ÚËÚ¸ ÓÔ‡ÒÌÓÒÚ¸ ÁÎÓÛÔÓÚ·ÎÂÌËfl ÓÚ‰ÂθÌ˚ÏË ÔÂÔ‡‡Ú‡ÏË. îËÍÒËÓ‚‡ÌÌ˚ ‰ÓÁ˚ Ú‡ÍÊ ҂flÁ‡Ì˚ Ò ÔÓ·ÎÂχÏË Ë̉˂ˉۇθÌÓ„Ó Ì‡Á̇˜ÂÌËfl ‚ ÓÚÌÓ¯ÂÌËË ÓÚ‰ÂθÌ˚ı ÍÓÏÔÓÌÂÌÚÓ‚, ΘÂÌËfl ‰ÂÚÂÈ Ë ‡Á΢Ì˚ÏË ÔÂËÓ‰‡ÏË ÔÓÎÛ‡ÒÔ‡‰‡ ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚, ÍÓ„‰‡ ΘÂÌË ÔÂ˚‚‡ÂÚÒfl. äÓÏ ÚÓ„Ó, ‰ÓÎÊÌ˚ ·˚Ú¸ Û˜ÚÂÌ˚ Ú·ӂ‡ÌËfl ··Ó‡ÚÓÌÓ„Ó ÏÓÌËÚÓËÌ„‡ (ÒÏ. ‡Á‰ÂÎ VI). Ç ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ d4T/3TC/çÇè ËÎË áÑÇ/3íë/çÇè ËÁ·Ë‡˛ÚÒfl ‚ ͇˜ÂÒÚ‚Â ÒıÂÏ˚ ÔÂ‚Ó„Ó fl‰‡, ̇΢ˠÍÓÏ·Ë̇ˆËË ËÁ ‰‚Ûı ÔÂÔ‡‡ÚÓ‚ (d4T/3íë ËÎË áÑÇ/3íë) Ú‡ÍÊ fl‚ÎflÂÚÒfl Ó˜Â̸ ‚‡ÊÌ˚Ï ‰Îfl ËÒÔÓθÁÓ‚‡ÌËfl ‚ÏÂÒÚÂ Ò çÇè ‚ ͇˜ÂÒÚ‚Â ÓÒÌÓ‚ÌÓ„Ó ÔÂÔ‡‡Ú‡ ÔË ‰ÓÁËÓ‚Í ̇ ÔÓÚflÊÂÌËË ÔÂ‚˚ı ‰‚Ûı ̉Âθ ΘÂÌËfl Ë ‰Îfl ÍÓÌÚÓÎfl ÛÓ‚Ìfl ÚÓÍÒ˘ÌÓÒÚË, ‡ÒÒÓˆËËÛÂÏÓ„Ó Ò çÇè (èËÎÓÊÂÌË D). ÑÓÔÓÎÌËÚÂθÌ˚ ÔÂÔ‡‡Ú˚ ‰ÓÎÊÌ˚ ËÏÂÚ¸Òfl ‚ ‡ÈÓ̇ı (ÛÓ‚Â̸ 2) ËÎË „ËÓ̇θÌ˚ı ·ÓθÌˈ‡ı (ÛÓ‚Â̸ 3). ùÚÓÚ ÒÚÛÔÂ̘‡Ú˚È ÔÓ‰ıÓ‰ Í ÄêÇ ÒıÂÏ‡Ï ‰ÓÎÊÂÌ ÔÓ‚Ó‰ËÚ¸Òfl ̇fl‰Û Ò ÔÓ˝Ú‡ÔÌ˚Ï ÏÓÌËÚÓËÌ„ÓÏ ÒÚ‡Ú„ËË ‚ ÓÚÌÓ¯ÂÌËË ÒËÒÚÂÏ Á‰‡‚ÓÓı‡ÌÂÌËfl (ÒÏ. ‡Á‰ÂÎ VI).

15

íÄÅãàñÄ Ç. ëïÖåõ ÄêÇ - ÚÂ‡ÔËË èÖêÇéÉé êüÑÄ Ñãü Çáêéëãõï à èéÑêéëíäéÇ à èÄêÄåÖíêõ, äéíéêõÖ åéÉìí éèêÖÑÖãüíú ÇõÅéê àÒÔÓθÁÓ‚‡ÌË ÔÓ ÓÚÌÓ¯ÂÌ˲ Í ÊÂÌ˘ËÌ‡Ï (ÂÔÓ‰ÛÍÚË‚ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ ËÎË ·ÂÂÏÂÌÌ˚Ï) ч

ëıÂÏ˚ ÄêÇ ÚÂ‡ÔËË

éÒÌÓ‚Ì˚ ÚÓÍÒ˘ÂÒÍË ҂ÓÈÒÚ‚‡

d4T/3TC/çÇè

ë‚flÁ‡ÌÌ˚Â Ò d4T ÌÂÈÓÔ‡ÚËË, Ô‡ÌÍ‡ÚËÚ Ë ÎËÔÓ‡ÚÓÙËfl; Ò‚flÁ‡Ì̇fl Ò çÇè „ÂÔ‡ÚÓÍÒ˘ÌÓÒÚ¸ Ë ÚflÊÂÎ˚ ÍÓÊÌ˚ ‚˚Ò˚Ô‡ÌËfl ë‚flÁ‡Ì̇fl Ò áÑÇ „‡ÒÚÓ˝ÌÚÂ‡Î¸Ì‡fl ÌÂÔÂÂÌÓÒËÏÓÒÚ¸, ‡ÌÂÏËfl Ë ÌÂÈÚÓÔÂÌËfl; Ò‚flÁ‡Ì̇fl Ò çÇè „ËÔÓÚÓÍÒ˘ÌÓÒÚ¸ Ë ÚflÊÂÎ˚ ÍÓÊÌ˚ ‚˚Ò˚Ô‡ÌËfl ë‚flÁ‡Ì̇fl Ò d4T ÌÂÈÓÔ‡ÚËfl, Ô‡ÌÍ‡ÚËÚ Ë „ËÔÓ‡ÚÓÙËfl; Ò‚flÁ‡Ì̇fl Ò ùîñ ÚÓÍÒ˘ÌÓÒÚ¸ ‰Îfl ñçë Ë ‚ÂÓflÚÌÓÒÚ¸ ÚÂ‡ÚÓ„ÂÌ˘ÌÓÒÚË

áÑÇ/3íë/çÇè

ч

d4T/3íë/ùîñ

çÂÚb

áÑÇ/3íë/ùîñ

ë‚flÁ‡Ì̇fl Ò áÑÇ „‡ÒÚÓ˝ÌÚÂ‡Î¸Ì‡fl ÌÂÔÂÂÌÓÒËÏÓÒÚ¸, ‡ÌÂÏËfl Ë ÌÂÈÚÓÔÂÌËfl; Ò‚flÁ‡Ì̇fl Ò ùîñ ÚÓÍÒ˘ÌÓÒÚ¸ ‰Îfl ñçë Ë ‚ÓÁÏÓÊÌ˚ ÔÓfl‚ÎÂÌËfl ÚÂ‡ÚÓ„ÂÌ˘ÌÓÒÚË;

çÂÚb

a ëÏ. ‡Á‰ÂÎ VIII.ë (ÅÓθÌ˚Â Ò ÚÛ·ÂÍÛÎÂÁÓÏ Ë ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ Çàó-ËÌÙÂ͈ËÂÈ)

b ëÏ. ‡Á‰ÂÎ VIII.Ä (ÜÂÌ˘ËÌ˚ ÂÔÓ‰ÛÍÚË‚ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ ËÎË ·ÂÂÏÂÌÌ˚ ÊÂÌ˘ËÌ˚)

c äÓÏ·Ë̇ˆËË, Ì ÔÓÎۘ˂¯Ë Ô‰‚‡ËÚÂθÌÓÈ ÎˈÂÌÁËË Çéá, ÍÓÚÓ˚ ÏÓ„ÛÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ÔË Ì‡Î˘ËË Ì‡‰ÂÊÌ˚ı ͇˜ÂÒÚ‚ÂÌÌ˚ı ÒÓÒÚ‡‚Îfl˛˘Ëı Ò ‰Ó͇Á‡ÌÌÓÈ ·Ëӽ͂˂‡ÂÌÚÌÓÒÚ¸˛.

d èÓÎÛ˜ÂÌÓ ËÁ: àÒÚÓ˜ÌËÍË Ë ˆÂÌ˚ ÓÚ‰ÂθÌ˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ Ë ‰Ë‡„ÌÓÒÚ˘ÂÒÍËı Ò‰ÒÚ‚ ‰Îfl β‰ÂÈ, ÊË‚Û˘Ëı Ò Çàó/ëèàÑÓÏ, Ë˛Ì¸ 2003 „. (www.who.int/HIV_AIDS).

16

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

àÒÔÓθÁÓ‚‡ÌË ÔË ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ ËÌÙÂ͈ËË íŇ

ç‡Î˘Ë ‚ ͇˜ÂÒÚ‚Â ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁ˚ ÚÂı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚

ñÂ̇ ‰Îfl í·ӂ‡ÌËfl ̇ËÏÂÌ ‡Á‚ËÚ˚ı Í Î‡·Ó‡ÚÓÌÓÏÛ ÒÚ‡Ì, Ë˛Ì¸ 2003 „. ÏÓÌËÚÓ (‰ÓÎÎ. ËÌ„Û ëòÄ/„Ó‰)d çÂÚ 28 1-358

ч, ÔË ÔÓ‰ÓÎÊÂÌËË Î˜ÂÌËfl íÅ ·ÂÁ ËÙ‡ÏÔˈË̇. 燉ÎÂÊËÚ ËÒÔÓθÁÓ‚‡Ú¸ Ò ÓÒÚÓÓÊÌÓÒÚ¸˛ ‚ ÒıÂχı ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ı ̇ ËÙ‡ÏÔˈË̇ ч, ÔË ÔÓ‰ÓÎÊÂÌËË Î˜ÂÌËfl íÅ ·ÂÁ ËÙ‡ÏÔˈË̇. àÒÔÓθÁÓ‚‡Ú¸ Ò ÓÒÚÓÓÊÌÓÒÚ¸˛ ‚ ÒıÂχı ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ı ̇ ËÙ‡ÏÔˈË̇ ч, ÌÓ ùîñ ‰ÓÎÊÂÌ Ì‡Á̇˜‡Ú¸Òfl ·ÂÂÏÂÌÌ˚Ï ÊÂÌ˘ËÌ‡Ï ËÎË ÊÂÌ˘ËÌ‡Ï ÂÔÓ‰ÛÍÚË‚ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ Á‡ ËÒÍβ˜ÂÌËÂÏ ÚÂı ÒÎÛ˜‡Â‚, ÍÓ„‰‡ ÏÓÊÂÚ ·˚Ú¸ Ó·ÂÒÔ˜Â̇ ˝ÙÙÂÍÚ˂̇fl ÍÓÌÚ‡ˆÂÔˆËfl

ч

чÒ

ч

383-41 8

çÂÚ. ùîñ Ì ÏÓÊÂÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ÒÓÒÚ‡‚Îfl˛˘ÂÈ îÑ; ‚ÏÂÒÚÂ Ò ÚÂÏ, ˜‡ÒÚ˘ÌÓ îÑ ÏÓ„ÛÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì˚ ‰Îfl d4T/3TCc

çÂÚ

350-1086

ч, ÌÓ ùîñ Ì ‰ÓÎÊÂÌ Ì‡Á̇˜‡Ú¸Òfl ‰Îfl ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ ËÎË ÊÂÌ˘ËÌ ÂÔÓ‰ÛÍÚË‚ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ Á‡ ËÒÍβ˜ÂÌËÂÏ ÚÂı ÒÎÛ˜‡Â‚, ÍÓ„‰‡ ÏÓÊÂÚ ·˚Ú¸ Ó·ÂÒÔ˜Â̇ ˝ÙÙÂÍÚ˂̇fl ÍÓÌÚ‡ˆÂÔˆËfl

çÂÚ. ùîñ Ì ÏÓÊÂÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ÒÓÒÚ‡‚Îfl˛˘ÂÈ îÑ; ‚ÏÂÒÚÂ Ò ÚÂÏ, ˜‡ÒÚ˘ÌÓ îÑ ÏÓ„ÛÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì˚ ‰Îfl áÑÇ/3TC

ч

6 1 1-986

17

ÑéèéãçàíÖãúçõÖ éëçéÇÄçàü Ñãü Çàó-1 àëèéãúáéÇÄçàü íÖêÄèàà èÖêÇéÉé êüÑÄ, ÇäãûóÄü ãÖóÖçàÖ Çàó-2 à Éêìèèõ 0

ëıÂÏ˚ ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ ̇ àè. ïÓÚfl ÓÒÌÓ‚‡ÌÌ˚ ̇ àè ÒıÂÏ˚ ΘÂÌËfl ÓÒÚ‡˛ÚÒfl ÔËÌflÚÓÈ ÌÓÏÓÈ ‰Îfl ̇˜‡Î‡ ΘÂÌËfl, Ëı ‚˚ÒÓ͇fl ÒÚÓËÏÓÒÚ¸ ‚ Ò‡‚ÌÂÌËË ÒÓ ÒıÂχÏË Î˜ÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ÏË Ì‡ ççàéí, ÒÚ‡‚ËÚ ÔÓ‰ ÒÓÏÌÂÌË Ëı ËÒÔÓθÁÓ‚‡ÌË ‚ ÒÚ‡Ì‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË, ÍÓÚÓ˚ ıÓÚÂÎË ·˚ ‰Ó·ËÚ¸Òfl ·˚ÒÚÓ„Ó ‡Ò¯ËÂÌËfl χүڇ·Ó‚ ËÒÔÓθÁÓ‚‡ÌËfl ˝ÚËı ‚ˉӂ ΘÂÌËfl. é‰Ì‡ÍÓ ÔÂËÏÛ˘ÂÒÚ‚‡ ÒıÂÏ Î˜ÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ı ̇ àè (̇ÔËÏÂ, àè ÔÎ˛Ò çàéí), ‰Ó͇Á‡ÎË Ò‚Ó˛ ÍÎËÌ˘ÂÒÍÛ˛ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸, Ë Ëı ÚÓÍÒ˘ÂÒÍË ҂ÓÈÒÚ‚‡ ıÓÓ¯Ó ÓÔËÒ‡Ì˚. ä ˜ËÒÎÛ Ì‰ÓÒÚ‡ÚÍÓ‚ ÓÚÌÓÒflÚÒfl ·Óθ¯Ó ÍÓ΢ÂÒÚ‚Ó ÔËβθ, ‡ Ú‡ÍÊ Ú·ӂ‡ÌËfl ‚ fl‰Â ÒÎÛ˜‡Â‚ Í Ì‡ÔËÚÍ‡Ï Ë ÔËÚ‡Ì˲, Á̇˜ËÚÂθÌÓ ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂ Ò ‰Û„ËÏË ÎÂ͇ÒÚ‚ÂÌÌ˚ÏË Ò‰ÒÚ‚‡ÏË, ÍÓÚÓ˚ ËÒÍβ˜‡˛Ú ËÎË ÓÒÎÓÊÌfl˛Ú Ëı ËÒÔÓθÁÓ‚‡ÌË ‚ ÒıÂχı ΘÂÌËfl íÅ Ò ËÒÔÓθÁÓ‚‡ÌËÂÏ ËÙ‡ÏÔˈË̇ Ë Ò Û˜ÂÚÓÏ ÏÂÚ‡·Ó΢ÂÒÍËı ̇Û¯ÂÌËÈ Ë ÌÂÓ·ıÓ‰ËÏÓÒÚË ËÏÂÚ¸ ıÓÎÓ‰ËθÌ˚ ÛÒÚ‡ÌÓ‚ÍË ‰Îfl ÒıÂÏ Î˜ÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ı ̇ ‡ÍÚË‚ÌÓÏ ÔËÏÂÌÂÌËË ËÚÓ̇‚Ë‡. ë Û˜ÂÚÓÏ ËÁÎÓÊÂÌÌÓ„Ó Ô‰ÛÒÏÓÚÂÌÌ˚ ‚ ̇ÒÚÓfl˘ÂÏ ÛÍÓ‚Ó‰ÒÚ‚Â ÒıÂÏ˚ ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ ̇ àè, ËÒÔÓθÁÛ˛ÚÒfl „·‚Ì˚Ï Ó·‡ÁÓÏ ‰Îfl ÒıÂÏ ÚÂ‡ÔËË ‚ÚÓÓ„Ó fl‰‡ (ê‡Á‰ÂÎ VII). àı ÒΉÛÂÚ ‡ÒÒχÚË‚‡Ú¸ Í‡Í ÒıÂÏ˚ ΘÂÌËfl ÔÂ‚Ó„Ó fl‰‡, ÍÓ„‰‡ ÂÒÚ¸ ÓÔ‡ÒÂÌËfl, Ò‚flÁ‡ÌÌ˚Â Ò Ì‡Î˘ËÂÏ ÂÁËÒÚÂÌÚÌÓÒÚË Í ççàéí (̇ÔËÏÂ, ÔË ÛÓ‚Ì ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚË ‚ Ó·˘ËÌÂ, Ô‚˚¯‡˛˘ÂÏ 510%)26, ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ËϲÚÒfl ‡ÁÌӂˉÌÓÒÚË ‚ËÛÒ‡, ̘ۂÒÚ‚ËÚÂθÌ˚Â Í ççàéí (̇ÔËÏÂ, Çàó-2 ËÎË „ÛÔÔ‡ 0 Çàó-1), ËÎË ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ËÏÂÂÚÒfl ÌÂÔÂÂÌÓÒËÏÓÒÚ¸ ‚ „ÛÔÔ Ò‰ÒÚ‚ ççàéí. èË ˝ÚÓÏ Óı‚‡Ú˚‚‡ÂÚÒfl „ÛÔÔ‡ ÔÂÔ‡‡ÚÓ‚ (d4í ËÎË áÑÇ) + 3íë ‚ ÒÓ˜ÂÚ‡ÌËË Ò ÎÓÔË̇‚ËÓÏ/ËÚÓ̇‚ËÓÏ (ãèÇ/), c‡Í‚Ë̇‚ËÓÏ/ËÚÓ̇‚ËÓÏ (ëäÇ/), Ë̉Ë̇‚ËÓÏ/ËÚÓ̇‚ËÓÏ (àÑÇ/) ËÎË ÌÂθÙË̇‚ËÓÏ (çîÇ), ÔË ˝ÚÓÏ ‚˚·Ó ÓÔ‰ÂÎflÂÚÒfl ÔËÓËÚÂÚ‡ÏË Ì‡ˆËÓ̇θÌÓÈ ÔÓ„‡ÏÏ˚. èË ˝ÚÓÏ ‡ÍÚË‚ËÓ‚‡ÌÌ˚ ËÚÓ̇‚ËÓÏ ËÌ„Ë·ËÚÓ˚ ÔÓÚ‡Á˚ fl‚Îfl˛ÚÒfl Ô‰ÔÓ˜ÚËÚÂθÌ˚ÏË Ò Û˜ÂÚÓÏ Ëı ‚˚ÒÓÍÓÈ ‡ÍÚË‚ÌÓÒÚË27 Ë ÓÚÌÓÒËÚÂθÌÓ ÏÂ̸¯Â„Ó ˜ËÒ· ËÒÔÓθÁÛÂÏ˚ı ÔÂÔ‡‡ÚÓ‚, ÌÓ Ú·ӂ‡ÌËfl ‚ ÓÚÌÓ¯ÂÌËË ıÓÎÓ‰ËθÌ˚ı ÛÒÚ‡ÌÓ‚ÓÍ Ë ÌÂÓ·ıÓ‰ËÏÓÒÚË ˜‡ÒÚÓ„Ó Î‡·Ó‡ÚÓÌÓ„Ó ÏÓÌËÚÓËÌ„‡ Ô‰ÒÚ‡‚Îfl˛Ú ÔÓ·ÎÂÏÛ ‰Îfl ÏÌÓ„Ëı ÒÚ‡Ì Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË. ãèÇ/ ̇Á̇˜‡ÂÚÒfl ‰‚‡Ê‰˚ ‚ ‰Â̸ Ë ÔÂÂÌÓÒËÚÒfl ‰ÓÒÚ‡ÚÓ˜ÌÓ ıÓÓ¯Ó, ÌÓ ˜‡ÒÚÓ ÔË‚Ó‰ËÚ Í ÔÓ‚˚¯ÂÌ˲ ÎËÔˉÌÓ„Ó ÛÓ‚Ìfl Ô·ÁÏ˚ ‚ ÍÓ‚Ë. ëäÇ/ ̇Á̇˜‡ÂÏ˚È Ó‰ËÌ ‡Á ‚ ‰Â̸ ‰ÓÒÚË„‡ÂÚ ÌÂÓ·ıÓ‰ËÏÓ„Ó ÛÓ‚Ìfl ‚ ÍÓ‚Ë ‚ ÔÂËÓ‰ ·ÂÂÏÂÌÌÓÒÚË Ë ÏÓÊÂÚ ·˚Ú¸ Ò‡‚ÌËÏ Ò Ì‡Á̇˜‡ÂÏ˚Ï Ó‰ÌÓ‚ÂÏÂÌÌÓ ËÙ‡ÏÔˈËÌÓÏ. ÇÏÂÒÚÂ Ò ÚÂÏ, ÍÓ΢ÂÒÚ‚Ó Ì‡Á̇˜‡ÂÏ˚ı Ú‡·ÎÂÚÓÍ Ò Û˜ÂÚÓÏ ÒÛ˘ÂÒÚ‚Û˛˘Ëı Ò„ӉÌfl ÔÂÔ‡‡ÚÓ‚ fl‚ÎflÂÚÒfl ‰ÓÒÚ‡ÚÓ˜ÌÓ ·Óθ¯ËÏ, Ë ˝ÚÓ ˜‡ÒÚÓ ‚˚Á˚‚‡ÂÚ ÔÓ·Ó˜ÌÓ ÊÂÎÛ‰Ó˜ÌÓÍ˯˜ÌÓ ‰ÂÈÒÚ‚ËÂ. çîÇ, ıÓÚfl Ë Ò˜ËÚ‡ÂÚÒfl ÏÂÌ ÒËθÌ˚Ï, ˜ÂÏ ãèÇ/, fl‚ÎflÂÚÒfl ÔËÂÏÎÂÏÓÈ ‡Î¸ÚÂ̇ÚË‚ÓÈ Ë ¯ËÓÍÓ ËÒÔÓθÁÛÂÚÒfl ‚ ÔÂËÓ‰ ·ÂÂÏÂÌÌÓÒÚË, Ì Ú·Ûfl ̇΢Ëfl ıÓÎÓ‰ËθÌ˚ı ÛÒÚ‡ÌÓ‚ÓÍ. ÇÏÂÒÚÂ Ò ÚÂÏ, ÓÌ ÏÂÌ ˝ÙÙÂÍÚË‚ÂÌ ÔÓÚË‚ ËÌÙÂ͈ËË Çàó-2, ˜ÂÏ ‰Û„Ë àè28-30. àÑÇ/ ÏÓÊÂÚ Ú‡ÍÊ ‡ÒÒχÚË‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚ÌÓ„Ó Ò‰ÒÚ‚‡, ÌÓ ËÌÓ„‰‡ ÔË‚Ó‰ËÚ Í ÔӘ˜ÌÓÈ Ì‰ÓÒÚ‡ÚÓ˜ÌÓÒÚË Ë ÓÒÓ·ÂÌÌÓ Í ÌÂÙÓÎËÚˇÁÛ Ë Ú·ÛÂÚ ‡ÍÚË‚ÌÓ„Ó ÔËÏÂÌÂÌËfl „ˉ‡Ú‡ˆËË.

18

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

êÓθ ÔÓÎۘ˂¯Â„Ó Ì‰‡‚ÌÓ Ó‰Ó·ÂÌË ËÌ„Ë·ËÚÓ‡ ÔÓÚ‡Á˚ ‡Ú‡Á‡Ì‡‚Ë‡ (Äáç) ‚ ÒÚ‡Ì‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË Ò„ӉÌfl ¢ Ì‰ÓÒÚ‡ÚÓ˜ÌÓ flÒ̇. ùÚÓÚ ÔÂÔ‡‡Ú ËÏÂÂÚ ÚÓ ÔÂËÏÛ˘ÂÒÚ‚Ó, ˜ÚÓ Ì‡Á̇˜‡ÂÚÒfl ‚ ͇˜ÂÒÚ‚Â Âʉ̂ÌÓÈ ‰ÓÁ˚ Ë Ì ‚˚Á˚‚‡ÂÚ „ËÔÂÎËÔˉÂÏËË ‚ ÒÎÛ˜‡Â ÔËÏÂÌÂÌËfl ·ÂÁ ËÚÓ̇‚Ë‡. éÌ ÏÓÊÂÚ ·˚Ú¸ Ú‡ÍÊ ̇Á̇˜ÂÌ Ò ËÚÓ̇‚ËÓÏ ‚ χÎ˚ı ‰ÓÁ‡ı ‰Îfl ÛÒËÎÂÌËfl ‚ÓÁ‰ÂÈÒÚ‚Ëfl31-33. èÂÔ‡‡Ú fl‚ÎflÂÚÒfl ‡ÁÛÏÌÓÈ ‡Î¸ÚÂ̇ÚË‚ÓÈ, ÌÓ „Ó‡Á‰Ó ·Óθ¯ËÈ ÓÔ˚Ú ·˚Π̇ÍÓÔÎÂÌ Ò ‰Û„ËÏË àè, ÍÓÚÓ˚ ÛÊ ÛÔÓÏË̇ÎËÒ¸ ‚˚¯Â. ÅÓΠÍÓÌÍÂÚÌ˚ ÂÍÓÏẨ‡ˆËË ·Û‰ÛÚ Ò‰Â·Ì˚ ÔÓ ÏÂ ÛÚÓ˜ÌÂÌËfl ÒÚÓËÏÓÒÚË Ë ‰ÓÒÚÛÔÌÓÒÚË ÄíÇ, ‡ Ú‡ÍÊ ̇ÍÓÔÎÂÌÌÓ„Ó ÓÔ˚Ú‡ Ò ˝ÚËÏ ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚ÓÏ. íÓÈÌ˚ ÒıÂÏ˚ ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ ̇ çàéí. Ç ‰‡ÌÌÓÏ êÛÍÓ‚Ó‰ÒÚ‚Â, ËÁ‰‡ÌÌÓÏ ‚ 2002 „., áÑÇ/3íë/‡·‡Í‡‚Ë (ÄÅä) ‡ÒÒχÚË‚‡ÎÒfl Í‡Í Ì‡Ë·ÓΠÔËÂÏÎÂÏ˚È ‚ ͇˜ÂÒڂ ΘÂÌËfl ‚ ÓÚÌÓ¯ÂÌËË Í‡Í ·ÓθÌ˚ı, Ú‡Í Ë ÔÓ„‡ÏÏ (‰‚ ڇ·ÎÂÚÍË Âʉ̂ÌÓ Ë ÓÚÒÛÚÒÚ‚Ë Á̇˜ËÚÂθÌÓ„Ó ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚). éÒÌÓ‚Ì˚Ï Ì‰ÓÒÚ‡ÚÍÓÏ Ò˜Ëڇ·Ҹ ÌÂÓÔ‰ÂÎÂÌÌÓÒÚ¸ ÔÓÁˈËË ‚ ÓÚÌÓ¯ÂÌËË ÒËÎ˚ ‚ÓÁ‰ÂÈÒÚ‚Ëfl ÔÂÔ‡‡Ú‡ ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ‚ËÛÒ̇fl ̇„ÛÁ͇ ·˚· Ó˜Â̸ ‚˚ÒÓÍÓÈ Û ·ÓθÌ˚ı ̇ ÔÓ‰‚ËÌÛÚ˚ı ÒÚ‡‰Ëflı Á‡·Ó΂‡ÌËfl, ÌÂÛ‚ÂÂÌÌÓÒÚ¸ ‚ ÚÓÏ, ÓÒÚ‡ÌÛÚÒfl ÎË ÔÂÔ‡‡Ú˚, ÓÒÓ·ÂÌÌÓ ÄÅä, ‰ÓÒÚÛÔÌ˚ÏË, ‡ Ú‡ÍÊ ‚ÂÓflÚÌÓÒÚ¸ Ò‚Âı˜Û‚ÒÚ‚ËÚÂθÌÓÈ ‡͈ËË Ì‡ ÄÅä ÒÓ ÒÏÂÚÂθÌ˚Ï ËÒıÓ‰ÓÏ. èÓÎÛ˜ÂÌÌ˚ Ì‰‡‚ÌÓ ‰‡ÌÌ˚ ÔÓ ÂÁÛÎ¸Ú‡Ú‡Ï ËÒÒΉӂ‡ÌËfl Ä5095 Éäàë Û͇Á˚‚‡˛Ú ̇ ÚÓ, ˜ÚÓ áÑÇ/3íë/ÄÅä ‰‡ÂÚ Á̇˜ËÚÂθÌÓ ·ÓΠ‚˚ÒÓÍË ÔÓ͇Á‡ÚÂÎË ‚ËÛÒÓÎӄ˘ÂÒÍÓÈ Ì‰ÓÒÚ‡ÚÓ˜ÌÓÒÚË, ÌÂÊÂÎË ‰‚‡ ‰Û„Ëı ÔÂÔ‡‡Ú‡ ‚ÏÂÒÚ ‚ÁflÚ˚ı (áÑÇ/3íë/ùîñ ËÎË áÑÇ/3íë/ÄÅä/ùîñ), Ë ÒÓÒÚ‡‚ÎflÂÚ ÒÓÓÚ‚ÂÚÒÚ‚ÂÌÌÓ 2 1% ‚ Ò‡‚ÌÂÌËË Ò 10%, ÔË ˝ÚÓÏ ÒÓÒÚ‡‚Îfl˛˘‡fl ωˇ̇ ‡‚ÌflÂÚÒfl 32 ̉ÂÎflÏ34. LJÊÌÓ ÓÚÏÂÚËÚ¸, ˜ÚÓ Á̇˜ËÚÂθÌ˚ ‡Á΢Ëfl ‚ ‚ËÛÒÓÎӄ˘ÂÒÍÓÏ ÂÁÛθڇÚ ·˚ÎË ÔÓÎÛ˜ÂÌ˚ Û Îˈ Ò ‚ËÛÒÌÓÈ Ì‡„ÛÁÍÓÈ, ÒÓÒÚ‡‚Îfl˛˘ÂÈ ‚˚¯Â Ë ÌËÊ 100 000 Çàó-‰ËÌˈ êçä/ÏÎ. àÒÒΉӂ‡ÌË Ì ͇҇ÂÚÒfl ‰‚Ûı ‰Û„Ëı ÒıÂÏ, ÒÓ‰Âʇ˘Ëı ùîñ. ÇÍβ˜ÂÌË ˝ÚËı ÂÁÛθڇÚÓ‚ ‚ ÍÎËÌ˘ÂÒÍÛ˛ Ô‡ÍÚËÍÛ Ë ÔÓÎËÚËÍÛ ‰‡ÌÌÓ„Ó êÛÍÓ‚Ó‰ÒÚ‚‡ fl‚ÎflÂÚÒfl ‚‡ÊÌ˚Ï Ò Û˜ÂÚÓÏ Ó˘ÛÚËÏ˚ı ÔÂËÏÛ˘ÂÒÚ‚ ÚÓÈÌÓÈ ÒıÂÏ˚ ΘÂÌËfl ÌÛÍÎÂÓÁˉ‡ÏË, Ë ÓÒÓ·ÂÌÌÓ Ëı ÔË‚ÎÂ͇ÚÂθÌÓÒÚË ‚ ÛÒÎÓ‚Ëflı ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ íÅ ËÌÙÂ͈ËË. é˜Â̸ ‚‡ÊÌÓ ÓÚÏÂÚËÚ¸, ˜ÚÓ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ áÑÇ/3íë/ÄÅä ‚ ËÒÒΉӂ‡ÌËË Ä5095 Éäàë ÒÓÔÓÒÚ‡‚Ëχ Ò ÂÁÛθڇڇÏË, Ô‰ÒÚ‡‚ÎÂÌÌ˚ÏË ‚ Ô‰˚‰Û˘Ëı ËÒÒΉӂ‡ÌËflı ˝ÚÓÈ ÒıÂÏ˚ ΘÂÌËfl ÌÓ‚˚ı Ô‡ˆËÂÌÚÓ‚35-36. äÓÏ ÚÓ„Ó, ‚ ËÒÒΉӂ‡ÌËË Ä5095 Éäàë ÍÎÂÚÍË ëD4 ÔÓ Ò‚ÓÂÈ ‡͈ËË ÒÓÔÓÒÚ‡‚ËÏ˚ Ò ÚÂÏË, ÍÓÚÓ˚ ·˚ÎË Ó·Ì‡ÛÊÂÌ˚ ‚ Ó·˙‰ËÌÂÌÌ˚ı ËÒÒΉӂ‡ÌËflı ùîñ. í‡ÍËÏ Ó·‡ÁÓÏ, ‚ËÛÒÓÎӄ˘ÂÒÍË ÌËÁÍË ÔÓ͇Á‡ÚÂÎË ÓÒÌÓ‚‡ÌÌ˚ı ̇ ùîñ ÍÛÒÓ‚ ‚ ˝ÚËı ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÒÓÔÓÒÚ‡‚ÎflÂÏ˚ı ËÒÒΉӂ‡ÌËflı ÔÓÁ‚ÓÎfl˛Ú ÔÂ‚ÂÒÚË ˝ÚÓ ÒÓ˜ÂÚ‡ÌË çàéí ̇ ·ÓΠÌËÁÍÛ˛ ÒÚÛÔÂ̸ ‡ÒÒÏÓÚÂÌËfl, ÌÓ Ì ËÒÍβ˜‡ÂÚ Ë Ì ‰ÓÎÊÌ˚ ËÒÍβ˜‡Ú¸ ˝ÚÛ ÒıÂÏÛ ËÁ ÒÂ¸ÂÁÌÓ„Ó ‡ÒÒÏÓÚÂÌËfl. é̇ ÏÓÊÂÚ Ó͇Á‡Ú¸Òfl ÔÓÎÂÁÌÓÈ, ̇ÔËÏÂ, ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ççàéí Ì ÏÓÊÂÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ËÁ-Á‡ ÌÂÔÂÂÌÓÒËÏÓÒÚË ËÎË ÂÁËÒÚÂÌÚÌÓÒÚË Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡Ú‡Ï Ë ÍÓ„‰‡ ÓÒÌÓ‚‡ÌÌ˚ ̇ àè ÒıÂÏ˚ ΘÂÌËfl ÓÚÒÛÚÒÚ‚Û˛Ú. чÌ̇fl ÒıÂχ ΘÂÌËfl Ô‰ÒÚ‡‚ÎflÂÚÒfl ÓÒÓ·ÂÌÌÓ ˝ÙÙÂÍÚË‚ÌÓÈ ‡Î¸ÚÂ̇ÚË‚ÓÈ ÔË Î˜ÂÌËË ·ÓθÌ˚ı Ò ÒÓÔÛÚÒÚ‚Û˛˘ËÏ Á‡·Ó΂‡ÌËÂÏ íÅ, ÍÓ„‰‡ ‡ÌÚËÂÚÓ‚ËÛÒ̇fl Ë ÔÓÚË‚ÓÚÛ·ÂÍÛÎÂÁ̇fl ÚÂ‡ÔËfl ÔÓ‚Ó‰flÚÒfl ÒÓ‚ÏÂÒÚÌÓ. ÑÎfl ˆÂÎË Ì‡ÒÚÓfl˘Â„Ó ÛÍÓ‚Ó‰ÒÚ‚‡ Ó̇ ‡ÒÒχÚË‚‡ÂÚÒfl Í‡Í ‚ÚÓ˘̇fl ‡Î¸ÚÂ̇ÚË‚‡ ‰Îfl ËÁ̇˜‡Î¸ÌÓ„Ó ÍÛÒ‡ ÚÂ‡ÔËË ‚ ÓÒÓ·˚ı ÒËÚÛ‡ˆËflı (̇ÔËÏÂ, ‡ÍÚË‚Ì˚ ÙÓÏ˚ Ó‰ÌÓ‚ÂÏÂÌÌÓ„Ó Á‡·Ó΂‡ÌËfl ÚÛ·ÂÍÛÎÂÁÓÏ Ë ËÌÙˈËÓ‚‡ÌË Çàó-2). LJÊÌÓ Ú‡ÍÊ ÓÚÏÂÚËÚ¸, ˜ÚÓ ÓÒÛ˘ÂÒÚ‚ÎflÂÏÓ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ËÒÒÎÂ-

19

‰Ó‚‡ÌË êÄêíÄ ‰‡ÒÚ ‰ÓÔÓÎÌËÚÂθÌÛ˛ ÍÎËÌ˘ÂÒÍÛ˛ ËÌÙÓχˆË˛ Ó ·ÂÁÓÔ‡ÒÌÓÒÚË áÑÇ/3íë/ÄÅä ‚ Ò‡‚ÌÂÌËË Ò áÑÇ/3íë/íÑî Ë áÑÇ/áíë,çÇè ̇ ÔËÏÂ 3000 ÌÓ‚˚ı ·ÓθÌ˚ı ‚ ÄÙËÍÂ37. ç ÒΉÛÂÚ ÔÓ·„‡Ú¸, ˜ÚÓ ÚÓÈ̇fl ÒıÂχ çàéí ÏÓÊÂÚ ·˚Ú¸ ÒÓÔÓÒÚ‡‚Ëχ Ò Î˛·ÓÈ ‰Û„ÓÈ: ͇ʉ‡fl ÒıÂχ ΘÂÌËfl çàéí ‰ÓÎÊ̇ ÓˆÂÌË‚‡Ú¸Òfl Ò ÚÓ˜ÍË ÁÂÌËfl ÒÓ·ÒÚ‚ÂÌÌ˚ı ÔÂËÏÛ˘ÂÒÚ‚. èÓ͇Á‡ÚÂθÌ˚Ï ÔËÏÂÓÏ ˝ÚÓ„Ó ÏÓÊÂÚ ÒÎÛÊËÚ¸ ̉‡‚ÌÓ Ôӂ‰ÂÌÌÓ ËÒÒΉӂ‡ÌË ÍÓÏ·Ë̇ˆËË íÑî/3íë/ÄÅä, ̇Á̇˜‡ÂÏÓÈ ‡Á ‚ ‰Â̸, ‚ ÍÓÚÓÓÈ ·˚Î ÛÒÚ‡ÌÓ‚ÎÂÌ ‚˚ÒÓÍËÈ ÔÓ͇Á‡ÚÂθ ‚ËÛÒÌÓÈ Ì‰ÓÒÚ‡ÚÓ˜ÌÓÒÚË (49%) Ë ¯ËÓÍÓ ‡ÒÔÓÒÚ‡ÌÂÌË ÏÛÚ‡ˆËË ä65R, ˜ÚÓ ÔÓ‰Ú‚Âʉ‡ÂÚ Ó‰ÌÓ‚ÂÏÂÌÌÛ˛ ÂÁËÒÚÂÌÚÌÓÒÚ¸ ‚ ÓÚÌÓ¯ÂÌËË Ì ÒÓ‰Âʇ˘Ëı áÑÇ ‡Ì‡ÎÓ„Ó‚ ÌÛÍÎÂÓÁˉ‡38. ùÚÓÈ ÍÓÏ·Ë̇ˆËË ÒΉÛÂÚ ËÁ·Â„‡Ú¸ Ò Û˜ÂÚÓÏ ÔÓÎÛ˜ÂÌÌ˚ı ‰‡ÌÌ˚ı. Ä̇Îӄ˘Ì˚ı Ó·‡ÁÓÏ, ‚ ÔËÎÓÚÌÓÏ ËÒÒΉӂ‡ÌËË, Ôӂ‰ÂÌÌÓÏ Ì‡ 24 ·ÓθÌ˚ı, íÑî/ddl/3TC, ̇Á̇˜‡ÂÏ˚È ‚ Ó‰ÌÓÈ ‰ÓÁ ‡Á ‚ ‰Â̸, ‰‡ÂÚ ÔÓ͇Á‡ÚÂθ, ÒÓÒÚ‡‚Îfl˛˘ËÈ 9 1% ‚ËÛÒÓÎӄ˘ÂÒÍÓÈ Ì‰ÓÒÚ‡ÚÓ˜ÌÓÒÚË, Ë ÔÓ͇Á‡‚¯ËÈ ‚˚ÒÓÍÛ˛ ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚ¸ ÏÛÚ‡ˆËË ä65R39. ֢ ӉÌÓ Ôӂ‰ÂÌÌӠ̉‡‚ÌÓ ËÒÒΉӂ‡ÌË Û͇Á˚‚‡ÂÚ Ì‡ ÌËÁÍÛ˛ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ Ë ¯ËÓÍÓ ‡ÒÔÓÒÚ‡ÌÂÌË Ì··„ÓÔËflÚÌ˚ı ÔÓÒΉÒÚ‚ËÈ, Ò‚flÁ‡ÌÌ˚ı Ò d4í/ddl/ÄÅä40. í‡ÍËı ÍÓÏ·Ë̇ˆËÈ ÒΉÛÂÚ ËÁ·Â„‡Ú¸.

20

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

V. éÅéëçéÇÄçàü Ñãü äéêêÖäñàà Äêí ì Çáêéëãõï à èéÑêéëíäéÇ äÓÂ͈Ëfl Äêí ÏÓÊÂÚ ·˚Ú¸ ÌÂÓ·ıÓ‰Ëχ Ò Û˜ÂÚÓÏ Í‡Í ÚÓÍÒ˘ÌÓÒÚË, Ú‡Í Ë Ì½ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl.

íéäëàóçéëíú íÓÍÒ˘ÌÓÒÚ¸ Ò‚flÁ‡Ì‡ Ò ÌÂÔÂÂÌÓÒËÏÓÒÚ¸˛ ÔÓ·Ó˜ÌÓ„Ó ‰ÂÈÒÚ‚Ëfl ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó Ò‰ÒÚ‚‡ Ë Á̇˜ËÚÂθÌÓÈ ‰ËÒÙÛÌ͈ËÂÈ ÓÔ‰ÂÎÂÌÌ˚ı Ó„‡ÌÓ‚, ÍÓÚÓ‡fl ÏÓÊÂÚ ÒÚ‡Ú¸ ÂÁÛθڇÚÓÏ ˝ÚÓ„Ó ‰ÂÈÒÚ‚Ëfl. ᇠ˝ÚËÏ ÌÂÓ·ıÓ‰ËÏ ÍÎËÌ˘ÂÒÍËÈ ÏÓÌËÚÓËÌ„ ̇ ÓÒÌÓ‚Â ÒÓÓ·˘ÂÌËÈ ·ÓθÌÓ„Ó Ë ÙËÁ˘ÂÒÍËı ÓÒÏÓÚÓ‚. èË ˝ÚÓÏ ÏÓÊÂÚ ·˚Ú¸ Ú‡ÍÊ ÓÒÛ˘ÂÒÚ‚ÎÂÌ fl‰ ··Ó‡ÚÓÌ˚ı ‡Ì‡ÎËÁÓ‚ ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ÍÓÌÍÂÚÌ˚ı ÓÒÓ·ÂÌÌÓÒÚÂÈ ËÒÔÓθÁÛÂÏÓÈ ÒıÂÏ˚ ΘÂÌËfl Ë ÛÒÎÓ‚ËÈ Ï‰ˈËÌÒÍÓ„Ó Û˜ÂʉÂÌËfl. Ç ÒÎÛ˜‡Â, ÂÒÎË ÌÂÓ·ıÓ‰ËÏÓ ËÁÏÂÌÂÌË ÒıÂÏ˚ ΘÂÌËfl ‚ Ò‚flÁË Ò Â„Ó Ì½ÙÙÂÍÚË‚ÌÓÒÚ¸˛, ÌÂÓ·ıÓ‰ËÏÓ Ôӂ‰ÂÌË ÚÂ‡ÔËË ‚ÚÓÓ„Ó fl‰‡. Ç ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ÚÓÍÒ˘ÌÓÒÚ¸ ÓÔ‰ÂÎÂÌÌÓ Ò‚flÁ˚‚‡ÂÚÒfl Ò ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡ÚÓÏ, ÔËÒÛÚÒÚ‚Û˛˘ËÏ ‚ ÒıÂϠΘÂÌËfl, ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘Â ÎÂ͇ÒÚ‚ÂÌÌÓ Ò‰ÒÚ‚Ó ÏÓÊÂÚ ·˚Ú¸ Á‡ÏÂÌÂÌÓ ‰Û„ËÏ, ÍÓÚÓÓ Ì ӷ·‰‡ÂÚ ÚÂÏ Ê ÔÓ·Ó˜Ì˚Ï ‰ÂÈÒÚ‚ËÂÏ, Ú‡Í, ̇ÔËÏÂ, ÔÓËÁ‚‰Â̇ Á‡ÏÂ̇ áÑÇ Ì‡ d4í (‚ ÒÎÛ˜‡Â ‡ÌÂÏËË) ËÎË ùîñ ̇ çÇè (‚ ÒÎÛ˜‡Â ÚÓÍÒ˘ÌÓÒÚË ‰Îfl ñçë ËÎË ‚ ÔÂËÓ‰ ·ÂÂÏÂÌÌÓÒÚË). ë Û˜ÂÚÓÏ Ó„‡Ì˘ÂÌÌÓ„Ó ˜ËÒ· ‚‡ˇÌÚÓ‚ ÒÓ˜ÂÚ‡ÌËÈ ÄêÇ ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚ Ô‰ÒÚ‡‚ÎflÂÚÒfl ˆÂÎÂÒÓÓ·‡ÁÌ˚Ï Á‡ÏÂÌflÚ¸ ÎÂ͇ÒÚ‚ÂÌÌ˚ ÔÂÔ‡‡Ú˚ – Ú‡Ï, „‰Â ˝ÚÓ ‚ÓÁÏÓÊÌÓ, – Ò ÚÂÏ ˜ÚÓ·˚ ‰ÓÒÓ˜Ì˚È ÔÂÂıÓ‰ ̇ ÌÓ‚˚ ‡Î¸ÚÂ̇ÚË‚Ì˚ ÒıÂÏ˚ ΘÂÌËfl ·˚Π҂‰ÂÌ ‰Ó ÏËÌËÏÛχ. Ç í‡·Îˈ ë ÔË‚Ó‰flÚÒfl ‚ÓÁÏÓÊÌ˚ ‚‡ˇÌÚ˚ ÔÂÂıÓ‰‡ ̇ ‰ۄˠωË͇ÏÂÌÚ˚ Ò Û˜ÂÚÓÏ ÚÓÍÒ˘ÌÓÒÚË ÔÂÔ‡‡ÚÓ‚ ÔÂ‚Ó„Ó fl‰‡ ‰Îfl ÒıÂÏ Î˜ÂÌËfl, Ô˂‰ÂÌÌ˚ı ‚ 퇷Îˈ Ç. èË Û„ÓÁ ‰Îfl ÊËÁÌË ËÎË ‚ ·ÓΠÒÎÓÊÌ˚ı ÍÎËÌ˘ÂÒÍËı ÒËÚÛ‡ˆËflı ÂÍÓÏẨÛÂÚÒfl ̇Ô‡‚ÎÂÌË ·ÓθÌÓ„Ó ‚ ‡ÈÓÌÌ˚È ËÎË „ËÓ̇θÌ˚È ÒÚ‡ˆËÓ̇.

çÖùîîÖäíàÇçéëíú ãÖóÖçàü ç½ÙÙÂÍÚË‚ÌÓÒÚ¸ ΘÂÌËfl ‰ÓÎÊ̇ ÓÔ‰ÂÎflÚ¸Òfl ÍÎËÌ˘ÂÒÍË Ì‡ ÓÒÌÓ‚Â ÓˆÂÌÍË ıÓ‰‡ Á‡·Ó΂‡ÌËfl, ËÏÏÛÌÓÎӄ˘ÂÒÍÓ„Ó ÒÓÔÓÒÚ‡‚ÎÂÌËfl ‰‡ÌÌ˚ı Ó ÍÓ΢ÂÒÚ‚Â ÍÎÂÚÓÍ ëD4 Ë/ËÎË Ì‡ ‚ËÛÒÓÎӄ˘ÂÒÍÓÈ ÓÒÌÓ‚Â Á‡ Ò˜ÂÚ ÓÔ‰ÂÎÂÌËfl ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË. äÎËÌ˘ÂÒÍËÈ ıÓ‰ Á‡·Ó΂‡ÌËfl ‰ÓÎÊÂÌ ‡ÒÒχÚË‚‡Ú¸Òfl ÓÚ‰ÂθÌÓ ÓÚ ÒË̉Óχ ËÏÏÛÌÌÓ„Ó ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌËfl, ˜ÚÓ ÔÓËÒıÓ‰ËÚ ‚ÒÍÓ ÔÓÒΠ̇˜‡Î‡ ‡ÌÚËÂÚÓ‚ËÛÒÌÓ„Ó Î˜ÂÌËfl. ì͇Á‡ÌÌ˚È ÒË̉ÓÏ ı‡‡ÍÚÂËÁÛÂÚÒfl ̇΢ËÂÏ ÔËÁ̇ÍÓ‚ Ë ÒËÏÔÚÓÏÓ‚ ÛÒÎÓ‚ÌÓ-Ô‡ÚÓ„ÂÌÌÓ„Ó Á‡·Ó΂‡ÌËfl ˜ÂÂÁ ÌÂÒÍÓθÍÓ Ì‰Âθ ÔÓÒΠ̇˜‡Î‡ ‡ÍÚË‚ÌÓ„Ó ÍÛÒ‡ ÄêÇÚÂ‡ÔËË ‚ ÛÒÎÓ‚Ëflı ÔÓ„ÂÒÒËÛ˛˘Â„Ó ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ‚ ͇˜ÂÒÚ‚Â Ò‚flÁ‡ÌÌÓ„Ó Ò ‚ÓÒÔ‡ÎÂÌËÂÏ ÔÓˆÂÒÒ‡ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÓÈ ËÌÙÂ͈ËË. ÇÓÁÏÓÊÌÓ Ú‡ÍÊÂ, ˜ÚÓ ˝ÚÓ ËÏÏÛÌÓÎӄ˘ÂÒÍÓ ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌË ÏÓÊÂÚ ÔË‚ÂÒÚË Í ‡Á‚ËÚ˲ ‡ÚËÔ˘Ì˚ı ÔÓfl‚ÎÂÌËÈ Í‡ÍÓÈ-ÎË·Ó ËÁ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍËı ËÌÙÂ͈ËÈ.

21

íÄÅãàñÄ C. éëçéÇçõÖ ÇàÑõ èéíÖçñàÄãúçéâ íéäëàóçéëíà ëïÖå ÄêÇ-íÖêÄèàà èÖêÇéÉé êüÑÄ à êÖäéåÖçÑéÇÄççÄü áÄåÖçÄ ãÖäÄêëíÇÖççõï èêÖèÄêÄíéÇ ëıÂχ ΘÂÌËfl D4T/3TC/çÇè íÓÍÒ˘ÌÓÒÚ¸ • ë‚flÁ‡Ì̇fl Ò d4T Ì‚ÓÔ‡ÚËfl ËÎË Ô‡ÌÍ‡ÚËÚ • ë‚flÁ‡Ì̇fl Ò d4T ÎËÔÓ‡ÚÓÙËfl á‡ÏÂ̇ ÔÂÔ‡‡ÚÓ‚ • á‡ÏÂÌËÚ¸ d4T ̇ áÑÇ

• á‡ÏÂÌËÚ¸ d4T ̇ íÑî ËÎË ÄÅäa • ë‚flÁ‡Ì̇fl Ò çÇè ÓÒÚ‡fl „ÂÔ‡- • á‡ÏÂÌËÚ¸ çÇè ̇ ùîñ (ÍÓÏ ÒÎÛ˜‡fl ·ÂÂÏÂÌÚÓÚÓÍÒ˘ÌÓÒÚ¸ ÌÓÒÚË) • ë‚flÁ‡Ì̇fl Ò çÇè ÒËθ̇fl Ò˚Ô¸ • á‡ÏÂÌËÚ¸ çÇè ̇ ùîñ (ÌÓ Ì ۄÓʇ˛˘‡fl ÊËÁÌË) • ë‚flÁ‡Ì̇fl Ò çÇè Û„Óʇ˛˘‡fl • á‡ÏÂÌËÚ¸ çÇè ̇ àèb ÊËÁÌË Ò˚Ô¸ (ëË̉ÓÏ ëÚË‚ÂÌÒ‡-ÑÊÓÌÒÓ̇) áÑÇ/3TC/çÇè • ë‚flÁ‡Ì̇fl Ò áÑÇ ÔÂÒËÒÚËÛ˛˘‡fl „‡ÒÚÓ˝ÌÚÂ‡Î¸Ì‡fl ËÎË ÓÒÚ‡fl „ÂχÚÓÎӄ˘ÂÒ͇fl ÚÓÍÒ˘ÌÓÒÚ¸ • ë‚flÁ‡Ì̇fl Ò çÇè ÓÒÚ‡fl „ÂÔ‡ÚÓÚÓÍÒ˘ÌÓÒÚ¸ • á‡ÏÂÌËÚ¸ áÑÇ Ì‡ d4T

• á‡ÏÂÌËÚ¸ çÇè ̇ ùîñ (ÍÓÏ ÒÎÛ˜‡fl ·ÂÂÏÂÌÌÓÒÚË; ‚ Ú‡ÍËı ÒÎÛ˜‡flı Á‡ÏÂÌËÚ¸ ̇ çîÇ, ãèÇ/ ËÎË AÅä) • ë‚flÁ‡Ì̇fl Ò çÇè ÒËθ̇fl Ò˚Ô¸ • á‡ÏÂÌËÚ¸ çÇè ̇ ùîñ (ÌÓ Ì ۄÓʇ˛˘‡fl ÊËÁÌË) • ë‚flÁ‡Ì̇fl Ò çÇè Û„Óʇ˛˘‡fl • á‡ÏÂÌËÚ¸ çÇè ̇ àèb ÊËÁÌË Ò˚Ô¸ (ëË̉ÓÏ ëÚË‚ÂÌÒ‡-ÑÊÓÌÒÓ̇) D4T/3TC/ùîñ • ë‚flÁ‡Ì̇fl Ò d4T Ì‚ÓÔ‡ÚËfl ËÎË Ô‡ÌÍ‡ÚËÚ • ë‚flÁ‡Ì̇fl Ò d4T ÎËÔÓ‡ÚÓÙËfl • ë‚flÁ‡Ì̇fl Ò ùîñ ÔÂÒËÒÚÂÌÚ̇fl ÚÓÍÒ˘ÌÓÒÚ¸ ñçë áÑÇ/3TC/ùîñ • ë‚flÁ‡Ì̇fl Ò áÑÇ ÔÂÒËÒÚËÛ˛˘‡fl „‡ÒÚÓ˝ÌÚÂ‡Î¸Ì‡fl ËÎË ÓÒÚ‡fl „ÂχÚÓÎӄ˘ÂÒ͇fl ÚÓÍÒ˘ÌÓÒÚ¸ • ë‚flÁ‡Ì̇fl Ò ùîñ ÔÂÒËÒÚËÛ˛˘‡fl ÚÓÍÒ˘ÌÓÒÚ¸ ‰Îfl ñçë • á‡ÏÂÌËÚ¸ d4T ̇ áÑÇ • á‡ÏÂÌËÚ¸ d4T ̇ íÑî ËÎË AÅäa • á‡ÏÂÌËÚ¸ ùîñ̇ çÇè • á‡ÏÂÌËÚ¸ áÑÇ Ì‡ d4T

• á‡ÏÂÌËÚ¸ ùîñ ̇ çÇè

a á‡ÏÂ̇ d4T Ó·˚˜ÌÓ Ì ‚˚Á˚‚‡ÂÚ ‚ÂÒËË ÎËÔÓ‡ÚÓÙËË, ÌÓ ÏÓÊÂÚ Á‡Ï‰ÎËÚ¸  ÔÓ„ÂÒÒËÓ‚‡ÌËÂ. íÑî Ë AÅä ÏÓ„ÛÚ ‡ÒÒχÚË‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚ ÌÓ Ëı ̇΢ˠ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl Ó„‡Ì˘ÂÌÓ. Ç ÓÚÒÛÚÒÚ‚Ë íÑî ËÎË AÅä, ‰ÓÔÓÎÌËÚÂθÌ˚ÏË ‡Î¸ÚÂ̇ÚË‚‡ÏË fl‚Îfl˛ÚÒfl ddI ËÎË áÑÇ.

b àè ÏÓÊÂÚ ·˚Ú¸ ãèÇ/ ËÎË ëäÇ/. àÑÇ/ ËÎË çîÇ ÏÓ„ÛÚ ‡ÒÒχÚË‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚ (ÒÏ.ÚÂÍÒÚ).

22

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

éÔ‰ÂÎÂÌËfl ̽ÙÙÂÍÚË‚ÌÓÒÚË ÍÎËÌ˘ÂÒÍÓ„Ó Ë Ò‚flÁ‡ÌÌÓ„Ó Ò CD4 ΘÂÌËfl Ô˂‰ÂÌ˚ ‚ 퇷Îˈ D. èÓÒÍÓθÍÛ ÓÔ‰ÂÎÂÌË ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË Ó·˚˜ÌÓ Ì‚ÓÁÏÓÊÌÓ ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË, ÂÍÓÏẨÛÂÚÒfl, ˜ÚÓ·˚ ÔÓ„‡ÏÏ˚ ‰Îfl ÓÔ‰ÂÎÂÌËfl ÌÂÛ‰‡˜Ë ΘÂÌËfl ËÒÔÓθÁÓ‚‡ÎË, „·‚Ì˚Ï Ó·‡ÁÓÏ, ÍÎËÌ˘ÂÒÍË ÍËÚÂËË Ë, ÔÓ ‚ÓÁÏÓÊÌÓÒÚË, ÔÓ‰Ò˜ÂÚ ÍÎÂÚÓÍ CD4. èÓ‰Ó·ÌÓ ˝ÚÓÏÛ, ÚÂÒÚËÓ‚‡ÌË ̇ ÂÁËÒÚÂÌÚÌÓÒÚ¸ Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡Ú‡Ï ‚ Ó·ÓÁËÏÓÏ ·Û‰Û˘ÂÏ Ì ÒÚ‡ÌÂÚ „ÛÎflÌÓÈ ˜‡ÒÚ¸˛ ÍÎËÌ˘ÂÒÍÓ„Ó Î˜ÂÌËfl ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË, Ë ÔÓ˝ÚÓÏÛ ÓÌÓ Ì ‡ÒÒχÚË‚‡ÂÚÒfl ‚ ̇ÒÚÓfl˘Ëı ÂÍÓÏẨ‡ˆËflı. ÇÏÂÒÚÂ Ò ÚÂÏ ÒΉÛÂÚ ÔËÁ̇ڸ, ˜ÚÓ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı Ì··„ÓÔËflÚÌ˚È ËÒıÓ‰ ΘÂÌËfl ·Û‰ÂÚ ‡ÒÔÓÁÌ‡Ì ÔÓÁ‰Ì ̇ ÓÒÌÓ‚Â ÍÎËÌ˘ÂÒÍËı ËÎË Ò‚flÁ‡ÌÌ˚ı Ò CD4 ÍËÚÂË‚, ÒÓÁ‰‡‚ ÚÂÏ Ò‡Ï˚Ï ·Óθ¯Â ‚ÓÁÏÓÊÌÓÒÚË ‰Îfl ÏÛÚ‡ˆËÈ ÂÁËÒÚÂÌÚÌÓÒÚË Í ÎÂ͇ÒÚ‚‡Ï, ÔÂʉ ˜ÂÏ ·Û‰ÂÚ ËÁÏÂÌÂ̇ ÒıÂχ ΘÂÌËfl. ùÚÓ ÏÓÊÂÚ ÒÍÓÏÔÓÏÂÚËÓ‚‡Ú¸ ÍÓÏÔÓÌÂÌÚ çàéí ‡Î¸ÚÂ̇ÚË‚ÌÓÈ ÒıÂÏ˚ ‚ ÂÁÛθڇÚ ÔÂÂÍÂÒÚÌÓÈ ÂÁËÒÚÂÌÚÌÓÒÚË ‚ Í·ÒÒ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚. (ëÏ. ê‡Á‰ÂÎ VII.)

íÄÅãàñÄ D. éëçéÇÄççõÖ çÄ äãàçàóÖëäàï äêàíÖêàüï à èéÑëóÖíÖ äãÖíéä CD4+ éèêÖÑÖãÖçàü çÖùîîÖäíàÇçéëíà ãÖóÖçàü Çàó-èéáàíàÇçõï Çáêéëãõï à èéÑêéëíäéÇ äÎËÌ˘ÂÒÍË ÔËÁ̇ÍË Ì½ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl • èÓfl‚ÎÂÌË ÌÓ‚ÓÈ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÓÈ ËÌÙÂ͈ËË ËÎË ÁÎÓ͇˜ÂÒÚ‚ÂÌÌÓÒÚË, ÓÁ̇˜‡˛˘Ëı ÍÎËÌ˘ÂÒÍÓ ÔÓ„ÂÒÒËÓ‚‡ÌË ·ÓÎÂÁÌË. ùÚÓ ÒΉÛÂÚ ÓÚ΢‡Ú¸ ÓÚ ÒË̉Óχ ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌËfl ËÏÏÛÌÌÓÈ ÒËÒÚÂÏ˚, ÍÓÚÓ˚È ÏÓÊÂÚ ‚ÓÁÌËÍÌÛÚ¸ ‚ Ú˜ÂÌË ÔÂ‚˚ı ÚÂı ÏÂÒflˆÂ‚ ÔÓÒΠ̇˜‡Î‡ Äêí.a èÓÒΉÌËÈ Ì ÓÁ̇˜‡ÂÚ Ì½ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl, Ë ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÛ˛ ËÌÙÂÍˆË˛ ÒΉÛÂÚ Î˜ËÚ¸, Í‡Í Ó·˚˜ÌÓ, ·ÂÁ ËÁÏÂÌÂÌËÈ ‚ ÒıÂÏ ‡ÌÚËÂÚÓ‚ËÛÒÌÓ„Ó Î˜ÂÌËfl. • èÓ‚ÚÓÌÓ ÔÓfl‚ÎÂÌË Ô‰˚‰Û˘ÂÈ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÓÈ ËÌÙÂ͈ËË.b • ç‡ÒÚÛÔÎÂÌË ËÎË ÔÓ‚ÚÓÌÓ ÔÓfl‚ÎÂÌË ÒÓÒÚÓflÌËÈ ÒÚ‡‰ËË III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (‚Íβ˜‡fl ÒÓÒÚÓflÌË ËÒÚÓ˘ÂÌËfl ÔË Çàó, ıÓÌ˘ÂÒÍÛ˛ ‰Ë‡² ÌÂËÁ‚ÂÒÚÌÓÈ ˝ÚËÓÎÓ„ËË, ÔÓ‰ÓÎÊËÚÂθÌÛ˛ ÎËıÓ‡‰ÍÛ ÌÂËÁ‚ÂÒÚÌÓÈ ˝ÚËÓÎÓ„ËË, ÔÓ‚ÚÓfl˛˘ËÂÒfl ËÌ‚‡ÁË‚Ì˚ ·‡ÍÚÂˇθÌ˚ ËÌÙÂ͈ËË ËÎË ÔÓ‚ÚÓfl˛˘ËÈÒfl/ÔÂÒËÒÚËÛ˛˘ËÈ Í‡Ì‰Ë‰ÓÁ ÒÎËÁËÒÚ˚ı Ó·ÓÎÓ˜ÂÍ, ÌÓ Ì ӄ‡Ì˘˂‡flÒ¸ ËÏË). a

èÓ‰Ò˜ÂÚ ÍÎÂÚÓÍ CD4 ‰Îfl ÛÒÚ‡ÌÓ‚ÎÂÌËfl ̽ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl • ÇÓÁ‚‡Ú ˜ËÒ· ÍÎÂÚÓÍ CD4 Í ·‡ÁËÒÌÓÈ ÎËÌËË ‰Ó ΘÂÌËfl ËÎË ÌËÊ ·ÂÁ ‰Û„ÓÈ ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ ËÌÙÂ͈ËË, ÍÓÚÓ‡fl Ïӄ· ·˚ Ó·˙flÒÌËÚ¸ ‚ÂÏÂÌÌÓ ÛÏÂ̸¯ÂÌË ˜ËÒ· ÍÎÂÚÓÍ CD4.c • ëÌËÊÂÌË ̇ >50% ÓÚ ÔËÍÓ‚Ó„Ó ÛÓ‚Ìfl CD4 ·ÂÁ ‰Û„ÓÈ ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ ËÌÙÂ͈ËË, ÍÓÚÓ‡fl Ïӄ· ·˚ Ó·˙flÒÌËÚ¸ ‚ÂÏÂÌÌÓ ÛÏÂ̸¯ÂÌË ˜ËÒ· ÍÎÂÚÓÍ CD4.c

ëË̉ÓÏ ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌËfl ËÏÏÛÌÌÓÈ ÒËÒÚÂÏ˚ (IRS) ı‡‡ÍÚÂËÁÛÂÚÒfl ÔÓfl‚ÎÂÌËÂÏ ÔËÁ̇ÍÓ‚ Ë ÒËÏÔÚÓÏÓ‚ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÓÈ ·ÓÎÂÁÌË ˜ÂÂÁ ÌÂÒÍÓθÍÓ Ì‰Âθ ÔÓÒΠ̇˜‡Î‡ ÒËθÌÓ‰ÂÈÒÚ‚Û˛˘ÂÈ ‡ÌÚËÂÚÓ‚ËÛÒÌÓÈ ÚÂ‡ÔËË ‚ ÛÒÎÓ‚Ëflı ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ̇ ÔÓ‰‚ËÌÛÚÓÈ ÒÚ‡‰ËË Í‡Í ‚ÓÒÔ‡ÎËÚÂθ̇fl ‡͈Ëfl ̇ Ô‰˚‰Û˘Û˛ ÒÛ·ÍÎËÌ˘ÂÒÍÛ˛ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÛ˛ ËÌÙÂÍˆË˛. ÇÓÁÏÓÊÌÓ Ú‡ÍÊÂ, ˜ÚÓ Ú‡ÍÓ ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌË ËÏÏÛÌÌÓÈ ÒËÒÚÂÏ˚ Ô˂‰ÂÚ Í ‡ÚËÔ˘Ì˚Ï ÔÓfl‚ÎÂÌËflÏ ÌÂÍÓÚÓ˚ı ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍËı ËÌÙÂ͈ËÈ.

b èÓ‚ÚÓÌÓ ÔÓfl‚ÎÂÌË íÅ ÏÓÊÂÚ Ì Ô‰ÒÚ‡‚ÎflÚ¸ ÒÓ·ÓÈ ÔÓ„ÂÒÒËÓ‚‡ÌË Á‡·Ó΂‡ÌËfl, Ò‚flÁ‡ÌÌÓ„Ó Ò Çàó, ËÁ-Á‡ ‚ÓÁÏÓÊÌÓ„Ó ÂËÌÙˈËÓ‚‡ÌËfl. çÂÓ·ıÓ‰Ëχ ÍÎËÌ˘ÂÒ͇fl ÓˆÂÌ͇. c

ÖÒÎË Ô‡ˆËÂÌÚ Ì ËÏÂÂÚ ÒËÏÔÚÓÏÓ‚, ‡ ̽ÙÙÂÍÚË‚ÌÓÒÚ¸ ΘÂÌËfl ÓÔ‰ÂÎflÂÚÒfl ÚÓθÍÓ ÔÓ ÍËÚÂ˲ ÔÓ‰Ò˜ÂÚ‡ ÍÎÂÚÓÍ CD4, ÔË Ì‡Î˘ËË ÂÒÛÒÓ‚ ÒΉÛÂÚ ‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ Ôӂ‰ÂÌËfl ÔÓ‰Ú‚Âʉ‡˛˘Â„Ó ÔÓ‰Ò˜ÂÚ‡ ÍÎÂÚÓÍ CD4.

23

VI. äãàçàóÖëäàâ à ãÄÅéêÄíéêçõâ åéçàíéêàçÉ

Ç

éá ÂÍÓÏẨÛÂÚ, ˜ÚÓ·˚ ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË ·‡ÁËÒ̇fl ÍÎËÌ˘ÂÒ͇fl ÓˆÂÌ͇ ‰Ó ̇˜‡Î‡ Äêí ‚Íβ˜‡Î‡ ‡ÒÒÏÓÚÂÌË ËÒÚÓËË ·ÓÎÂÁÌË, ‚˚fl‚ÎÂÌË ÚÂÍÛ˘Ëı Ë ÔÓ¯Î˚ı Á‡·Ó΂‡ÌËÈ, Ò‚flÁ‡ÌÌ˚ı Ò Çàó, ‚˚fl‚ÎÂÌË ÒÓÒÛ˘ÂÒÚ‚Û˛˘Ëı ωˈËÌÒÍËı ÒÓÒÚÓflÌËÈ, ÍÓÚÓ˚ ÏÓ„ÛÚ ÔÓ‚ÎËflÚ¸ ̇ ÒÓÍË Ì‡˜‡Î‡ Ë ‚˚·Ó Äêí (Ú‡ÍËÂ Í‡Í íÅ ËÎË ·ÂÂÏÂÌÌÓÒÚ¸), ‡ Ú‡ÍÊ ÚÂÍÛ˘Ë ÒËÏÔÚÓÏ˚ Ë ÙËÁ˘ÂÒÍË ÔËÁ̇ÍË. ÄÍÚË‚Ì˚È íÅ ÒΉÛÂÚ Î˜ËÚ¸ ‚ ÒÓÓÚ‚ÂÚÒÚ‚ËË Ò ÂÍÓÏẨ‡ˆËflÏË Ì‡ˆËÓ̇θÌ˚ı ÔÓ„‡ÏÏ ·Ó¸·˚ Ò íÅ. Ç ˆÂÎflı ÒÓ‰ÂÈÒÚ‚Ëfl ‡Ò¯ËÂÌ˲ χүڇ·Ó‚ ËÒÔÓθÁÓ‚‡ÌËfl ÄêÇ ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË Çéá ‡ÒÔ‰ÂÎË· Ò‚ÓË ÂÍÓÏẨ‡ˆËË ‚ ÓÚÌÓ¯ÂÌËË ÏÓÌËÚÓËÌ„‡ ̇ ÒÎÂ‰Û˛˘Ë ÛÓ‚ÌË: ˆÂÌÚ˚ ÔÂ‚˘ÌÓÈ Ï‰ËÍÓ-Ò‡ÌËÚ‡ÌÓÈ ÔÓÏÓ˘Ë (ÛÓ‚Â̸ 1), ‡ÈÓÌÌ˚ ·ÓθÌˈ˚ (ÛÓ‚Â̸ 2) Ë „ËÓ̇θÌ˚ ÒÔˆˇÎËÁËÓ‚‡ÌÌ˚ ˆÂÌÚ˚ (ÛÓ‚Â̸ 3) (퇷Îˈ‡ Ö). Çéá ÔËÁ̇ÂÚ Á̇˜ÂÌË ··Ó‡ÚÓÌÓ„Ó ÏÓÌËÚÓËÌ„‡ ‰Îfl ˝ÙÙÂÍÚË‚ÌÓÒÚË Ë ·ÂÁÓÔ‡ÒÌÓÒÚË, ÌÓ Ì Ê·ÂÚ ÒÓÁ‰‡‚‡Ú¸ ËÁÎ˯ÌË ÚÛ‰ÌÓÒÚË ‰Îfl ÛÒËÎËÈ ÔÓ ‡Ò¯ËÂÌ˲ χүڇ·Ó‚ ‚ ÏÂÒÚ‡ı, Ëϲ˘Ëı Ó„‡Ì˘ÂÌÌ˚ ‚ÓÁÏÓÊÌÓÒÚË Ë Ò‰ÒÚ‚‡ ‰Îfl Ôӂ‰ÂÌËfl ˝ÚËı ÚÂÒÚÓ‚.

íÄÅãàñÄ E. êÖäéåÖçÑéÇÄççõÖ ìêéÇçà ãÄÅéêÄíéêçõï ÇéáåéÜçéëíÖâ Ñãü åéçàíéêàçÉÄ ÄêÇ Ç åÖëíÄï ë éÉêÄçàóÖççõåà êÖëìêëÄåà‡ ñÂÌÚ˚ ÔÂ‚˘ÌÓÈ Ï‰ËÍÓ-Ò‡ÌËÚ‡ÌÓÈ ÔÓÏÓ˘Ë (ÛÓ‚Â̸ 1) Å˚ÒÚÓ ÚÂÒÚËÓ‚‡ÌË ̇ Çàóab É ÂÏÓ„ÎÓ·ËÌ (ÂÒÎË ËÁÛ˜‡ÂÚÒfl ‚ÓÁÏÓÊÌÓÒÚ¸ ËÒÔÓθÁÓ‚‡ÌËfl áÑÇ)b íÂÒÚËÓ‚‡ÌË ·ÂÂÏÂÌÌÓÒÚËd ç‡Ô‡‚ÎÂÌË ̇ ËÒÒΉӂ‡ÌË χÁ͇ ÏÓÍÓÚ˚ ̇ íÅ (ÂÒÎË ÏËÍÓÒÍÓÔËfl ÓÚÒÛÚÒÚ‚ÛÂÚ) ê‡ÈÓÌÌ˚ ·ÓθÌˈ˚ (ÛÓ‚Â̸ 2) Å˚ÒÚÓ ÚÂÒÚËÓ‚‡ÌË ̇ Çàóab ëÔÓÒÓ·ÌÓÒÚ¸ ÔÓ‚ÂÒÚË ÌÂÓÔ‰ÂÎÂÌÌ˚È ·˚ÒÚ˚È ÚÂÒÚ Ì‡ Çàóab Ò ÔÓÏÓ˘¸˛ ÒÂÓÎӄ˘ÂÒÍÓ„Ó ÏÂÚÓ‰‡ ‚ÚÓÓ„Ó ÔÓÍÓÎÂÌËfl èÄä Ë ‰ËÙÙÂÂ̈ˇθÌ˚È ÔÓ‰Ò˜ÂÚ ÍÎÂÚÓÍ CD4c ÄíÄ íÂÒÚ Ì‡ ·ÂÂÏÂÌÌÓÒÚ¸d å‡ÁÓÍ ÏÓÍÓÚ˚ ̇ TÅ ê„ËÓ̇θÌ˚ ÒÔˆˇÎËÁËÓ‚‡ÌÌ˚ ˆÂÌÚ˚ (ÛÓ‚Â̸ 3) Å˚ÒÚÓ ÚÂÒÚËÓ‚‡ÌË ̇ Çàó ab èÄä Ë ‰ËÙÙÂÂ̈ˇθÌ˚È ÔÓ‰Ò˜ÂÚ ÍÎÂÚÓÍ D4+c èÓÎÌ˚È ıËÏ˘ÂÒÍËÈ ‡Ì‡ÎËÁ Ò˚‚ÓÓÚÍË (‚Íβ˜‡fl ˝ÎÂÍÚÓÎËÚ˚, ÔӘ˜ÌÛ˛ ÙÛÌÍˆË˛, ÙÂÏÂÌÚ˚ Ô˜ÂÌË, ÎËÔˉ˚, ÌÓ Ì ӄ‡Ì˘˂‡flÒ¸ ËÏË) íÂÒÚ Ì‡ ·ÂÂÏÂÌÌÓÒÚ¸d å‡ÁÓÍ ÏÓÍÓÚ˚ ̇ íÅ íÂÒÚËÓ‚‡ÌË ‚ËÛÒÌÓÈ Ì‡„ÛÁÍËe a

Ç Ì‡ÒÚÓfl˘ÂÈ Ú‡·Îˈ ‡ÒÒχÚË‚‡ÂÚÒfl ÚÓθÍÓ ÚÓ ÚÂÒÚËÓ‚‡ÌËÂ, ÍÓÚÓÓ Ê·ÚÂθÌÓ ‰Îfl ̇‰ÎÂʇ˘Â„Ó ÏÓÌËÚÓËÌ„‡ ÚÓÍÒ˘ÌÓÒÚË ÄêÇ, ˝ÙÙÂÍÚË‚ÌÓÒÚË Ë ‰‚Ûı ‚‡ÊÌ˚ı ÒÓÒÚÓflÌËÈ (·ÂÂÏÂÌÌÓÒÚË Ë íÅ). é̇

Ì fl‚ÎflÂÚÒfl ‚ÒÂÓ·˙ÂÏβ˘ÂÈ ‚ ÓÚÌÓ¯ÂÌËË ‰Û„Ëı ‰Ë‡„ÌÓÒÚ˘ÂÒÍËı ‚ÓÁÏÓÊÌÓÒÚÂÈ, ÍÓÚÓ˚ fl‚Îfl˛ÚÒfl ‚‡ÊÌ˚ÏË ÔË ‚ÒÂÒÚÓÓÌÌÂÈ ÔÓÏÓ˘Ë Çàó-ËÌÙˈËÓ‚‡ÌÌ˚Ï Î˛‰flÏ. ÑÎfl ˝ÚÓ„Ó ËϲÚÒfl ‰Û„Ë ÂÒÛÒ˚.

24

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

b Ç ˆÂÌÚ‡ı ÔÂ‚˘ÌÓÈ Ï‰ËÍÓ-Ò‡ÌËÚ‡ÌÓÈ ÔÓÏÓ˘Ë, ‚ ÍÓÚÓ˚ı ÓÚÒÛÚÒÚ‚Û˛Ú Î‡·Ó‡ÚÓÌ˚ Ò‰ÒÚ‚‡ ËÎË ‚ÓÁÏÓÊÌÓÒÚË ‰Îfl „ÂÏÓ„ÎÓ·ËÌÓÏÂÚËË, ‰Îfl ÓˆÂÌÍË ‡ÌÂÏËË ÏÓÊÌÓ ËÒÔÓθÁÓ‚‡Ú¸ „ÂÏÓ„ÎÓ·ËÌÓ‚Û˛ ˆ‚ÂÚÌÛ˛ ¯Í‡ÎÛ Çéá ‚ÏÂÒÚÂ Ò ÍÎËÌ˘ÂÒÍËÏË ÔËÁ͇̇ÏË (·ÓΠÔÓ‰Ó·ÌÓ ÒÏ. ̇ Ò‡ÈÚ www.who.int/bct/).

d ùîñ Ì ÒΉÛÂÚ Ì‡Á̇˜‡Ú¸ ÊÂÌ˘ËÌ‡Ï ‰ÂÚÓÓ‰ÌÓ„Ó ‚ÓÁ‡ÒÚ‡, ÂÒÎË Ì ӷÂÒÔ˜Â̇ ‡‰ÂÍ‚‡Ú̇fl ÍÓÌÚ‡ˆÂÔˆËfl, ‡ Ú‡ÍÊ ÊÂÌ˘ËÌ‡Ï ‚ ÔÂ‚ÓÏ ËÎË ‚ÚÓÓÏ ÚËÏÂÒÚ ·ÂÂÏÂÌÌÓÒÚË

c ê‡Ò¯ËÂÌË Äêí ‚ ‡Ï͇ı Ô·̇ “3 Í 5” Ì Ú·ÛÂÚ Ì‡Î˘Ëfl ‚ÓÁÏÓÊÌÓÒÚË ‰Îfl ‰ËÌÓÓ·‡ÁÌÓ„Ó ÚÂÒÚËÓ‚‡ÌËfl CD4, Ӊ̇ÍÓ, Û˜ËÚ˚‚‡fl ˆÂÌÌÓÒÚ¸ ˝ÚÓ„Ó ÚÂÒÚ‡ ‰Îfl ÏÓÌËÚÓËÌ„‡ Ô‡ˆËÂÌÚÓ‚, Çéá ‚ÏÂÒÚÂ Ò „ÓÒÛ‰‡ÒÚ‚‡ÏË-˜ÎÂ̇ÏË ‡·ÓÚ‡ÂÚ Ì‡‰ ÚÂÏ, ˜ÚÓ·˚ ҉·ڸ ˝ÚÓ ‡θÌÓÒÚ¸˛.

e àÁ-Á‡ ÒÚÓËÏÓÒÚË Ë ÚÂıÌ˘ÂÒÍËı ÔÓ·ÎÂÏ, Ò‚flÁ‡ÌÌ˚ı Ò ÚÂÒÚËÓ‚‡ÌËÂÏ ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË, ˝ÚÓÚ ÚÂÒÚ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ‚ Ì˚̯ÌËı ÛÍÓ‚Ó‰fl˘Ëı ÔË̈ËÔ‡ı ΘÂÌËfl Ì ÂÍÓÏẨÛÂÚÒfl. é‰Ì‡ÍÓ ÂÒÚ¸ ̇‰Âʉ‡, ˜ÚÓ ·ÓΠ˝ÙÙÂÍÚË‚Ì˚Â Ò ÚÓ˜ÍË ÁÂÌËfl Á‡Ú‡Ú ÚÂıÌÓÎÓ„ËË ‰‡‰ÛÚ „ËÓ̇θÌ˚Ï ÒÔˆˇÎËÁËÓ‚‡ÌÌ˚Ï ˆÂÌÚ‡Ï ‚ÓÁÏÓÊÌÓÒÚ¸ ÔËÓ·ÂÚ‡Ú¸ Ú‡ÍË ÚÂıÌÓÎÓ„ËË, Û˜ËÚ˚‚‡fl Ëı ÔÓÎÂÁÌÓÒÚ¸ ‚ ÓˆÂÌ̽͠ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl.

чÌÌ˚È ‡Á‰ÂÎ ÒÓÒ‰ÓÚÓ˜ÂÌ Ì‡ ·‡ÁËÒÌÓÏ ÍÎËÌ˘ÂÒÍÓÏ Ë Î‡·Ó‡ÚÓÌÓÏ ÏÓÌËÚÓËÌ„Â, Û͇Á‡ÌÌÓÏ ‰Îfl ÂÍÓÏẨӂ‡ÌÌ˚ı Çéá ÒıÂÏ Î˜ÂÌËfl ÔÂ‚Ó„Ó fl‰‡, Ô‰ÒÚ‡‚ÎÂÌÌ˚ı ‚ 퇷Îˈ Ç. ùÚË ÂÍÓÏẨ‡ˆËË Ô‰̇Á̇˜ÂÌ˚ ‰Îfl ‚˚ÔÓÎÌÂÌËfl ̇ ÛÓ‚Ì ˆÂÌÚÓ‚ Á‰‡‚ÓÓı‡ÌÂÌËfl Ó·˘ËÌ˚ Ë/ËÎË ‡ÈÓÌÌ˚ı ·ÓθÌˈ, ‡·ÓÚ‡˛˘Ëı Òӄ·ÒÓ‚‡ÌÌÓ Ë ÔË ÔÓ‰‰ÂÊÍ ÒÓ ÒÚÓÓÌ˚ „ËÓ̇θÌ˚ı ÒÔˆˇÎËÁËÓ‚‡ÌÌ˚ı ˆÂÌÚÓ‚. êÛÍÓ‚Ó‰ËÚÂÎË Ì‡ˆËÓ̇θÌ˚ı ÔÓ„‡ÏÏ, ‡·ÓÚ‡fl ‚ÏÂÒÚÂ Ò Çéá, ‰ÓÎÊÌ˚ ÓÔ‰ÂÎËÚ¸ ÍÓÌÍÂÚÌÛ˛ ÔÓÎËÚËÍÛ ÒÚ‡Ì˚ ‚ ÓÚÌÓ¯ÂÌËË ÚÓ„Ó, Í‡Í Ë „‰Â ‰ÓÎÊÌ˚ ÔËÌËχڸÒfl ¯ÂÌËfl Ó Ì‡˜‡Î Î˜ÂÌËfl ‰Îfl ÓÚ‰ÂθÌ˚ı Ô‡ˆËÂÌÚÓ‚. èÓ‰Ó·ÌÓ ˝ÚÓÏÛ, ÍÓÌÍÂÚÌÓ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ë ÛÓ‚ÌÂÈ ÒËÒÚÂÏ˚ ωËÍÓ-Ò‡ÌËÚ‡ÌÓÈ ÔÓÏÓ˘Ë ‚ ˆÂÎflı ‰Ó‚‰ÂÌËfl ‰Ó χÍÒËÏÛχ ˝ÙÙÂÍÚË‚ÌÓÒÚË Ë ·ÂÁÓÔ‡ÒÌÓÒÚË Äêí Ú·ÛÂÚ, ˜ÚÓ·˚ ¯ÂÌËfl ÔËÌËχÎËÒ¸ ̇ ÛÓ‚Ì ̇ˆËÓ̇θÌÓÈ ÔÓ„‡ÏÏ˚. äÎËÌ˘ÂÒÍËÂ Ë Î‡·Ó‡ÚÓÌ˚ ӈÂÌÍË ‰ÓÎÊÌ˚ ‡ÒÒχÚË‚‡Ú¸Òfl ̇ ·‡ÁËÒÌÓÈ ÎËÌËË (ÔÂ‰ Äêí) Ë ‚Ó ‚ÂÏfl ΘÂÌËfl. åÌÓ„Ó˜ËÒÎÂÌÌ˚ ËÒÒΉӂ‡ÌËfl, Ôӂ‰ÂÌÌ˚ ‚ ‡Á‚ËÚ˚ı Ë ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ÔÓ‰ÂÏÓÌÒÚËÓ‚‡ÎË ‡ÁÛÏÌÛ˛ Ò‚flÁ¸ ÏÂÊ‰Û ÛÓ‚ÌflÏË éäã Ë CD4 Û ÒËÏÔÚÓχÚ˘ÂÒÍËı Ô‡ˆËÂÌÚÓ‚ 5-10. ùÚÓ ÓÁ̇˜‡ÂÚ, ˜ÚÓ, ÂÒÎË Ì‚ÓÁÏÓÊÌÓ ÔÓ‚ÂÒÚË ÚÂÒÚËÓ‚‡ÌËÂ Ò ÔÓÏÓ˘¸˛ ÔÓ‰Ò˜ÂÚ‡ ÍÎÂÚÓÍ CD4, ÏÓÊÌÓ ËÒÔÓθÁÓ‚‡Ú¸ ÔÓÒÚ˚ Ò‰ÒÚ‚‡, Ú‡ÍËÂ Í‡Í ËÁÏÂÂÌË „ÂÏÓ„ÎÓ·Ë̇, ‡ éäã ÏÓÊÂÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl ‚ ͇˜ÂÒڂ ··Ó‡ÚÓÌ˚ı χÍÂÓ‚ ‰Îfl ̇˜‡Î‡ ÇÄÄêí ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË. ŇÁËÒ̇fl ÎËÌËfl ÍÎËÌ˘ÂÒÍÓÈ ÓˆÂÌÍË fl‚ÎflÂÚÒfl Ó‰ÌÓÈ Ë ÚÓÈ Ê ‰Îfl ‚ÒÂı ˜ÂÚ˚Âı ÂÍÓÏẨӂ‡ÌÌ˚ı ÒıÂÏ Î˜ÂÌËfl ÔÂ‚Ó„Ó fl‰‡. é̇ ‰ÓÎÊ̇ ‚Íβ˜‡Ú¸: ◗ ÛÒÚ‡ÌÓ‚ÎÂÌË ÒÚ‡‰ËË Á‡·Ó΂‡ÌËfl Çàó; ◗ ÓÔ‰ÂÎÂÌË ÒÓÔÛÚÒÚ‚Û˛˘Ëı ωˈËÌÒÍËı ÒÓÒÚÓflÌËÈ (̇ÔËÏÂ, íÅ, ·ÂÂÏÂÌÌÓÒÚË, ÒÂ¸ÂÁÌ˚ı ÔÒËıˇÚ˘ÂÒÍËı Á‡·Ó΂‡ÌËÈ); ◗ ÔÓÎÛ˜ÂÌË ÔÓ‰Ó·ÌÓÈ ËÌÙÓχˆËË Ó· Ó‰ÌÓ‚ÂÏÂÌÌÓÏ ÎÂ͇ÒÚ‚ÂÌÌÓÏ Î˜ÂÌËË, ‚Íβ˜‡fl Ò‰ÒÚ‚‡ ̇Ó‰ÌÓÈ Ï‰ˈËÌ˚; ◗ ÓÔ‰ÂÎÂÌË χÒÒ˚ Ú·; ◗ ÓˆÂÌÍÛ „ÓÚÓ‚ÌÓÒÚË Ô‡ˆËÂÌÚ‡ Í ÚÂ‡ÔËË. èÓÒΠÚÓ„Ó, Í‡Í ÚÂ‡ÔËfl ·Û‰ÂÚ Ì‡˜‡Ú‡, ÍÎËÌ˘ÂÒ͇fl ÓˆÂÌ͇ ‰ÓÎÊ̇ Óı‚‡Ú˚‚‡Ú¸: ◗ ÔËÁ̇ÍË/ÒËÏÔÚÓÏ˚ ÔÓÚÂ̈ˇθÌÓÈ ÚÓÍÒ˘ÌÓÒÚË ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ (퇷Îˈ‡ D);

25

◗ Òӷβ‰ÂÌË ÒıÂÏ˚ ΘÂÌËfl; ◗ Â‡ÍˆË˛ ̇ ÚÂ‡Ô˲; ◗ χÒÒÛ Ú·; ◗ ·‡ÁËÒÌ˚ ‡ÒÔÂÍÚ˚ ··Ó‡ÚÓÌÓ„Ó ÏÓÌËÚÓËÌ„‡, ÔÂ˜ËÒÎÂÌÌ˚ ‚ 퇷Îˈ F.

íÄÅãàñÄ F. ÅÄáàëçõâ ãÄÅéêÄíéêçõâ åéçàíéêàçÉ Ñãü êÖäéåÖçÑéÇÄççõï ëïÖå ÄêÇ-íÖêÄèàà èÖêÇéÉé êüÑÄ Ç ñÖçíêÄï èÖêÇàóçéâ åÖÑàäé-ëÄçàíÄêçéâ èéåéôà (ìêéÇÖçú 1) à êÄâéççõï ÅéãúçàñÄï (ìêéÇÖçú 2) ëıÂχ ΘÂÌËfl d4T/3TC/çÇè ㇷÓ‡ÚÓ̇fl ÓˆÂÌ͇ ̇ ·‡ÁËÒÌÓÏ ÛÓ‚Ì (ÔÂ‰ ΘÂÌËÂÏ) Ü·ÚÂθÌÓ, ÌÓ Ì ÌÂÓ·ıÓ‰ËÏÓ: CD4 ㇷÓ‡ÚÓ̇fl ÓˆÂÌ͇ ‚Ó ‚ÂÏfl ΘÂÌËfl éËÂÌÚËÓ‚‡Ì̇fl ̇ ÒËÏÔÚÓÏ˚ ÓˆÂÌ͇ ÄíÄ ‰Îfl ÓÔ‰ÂÎÂÌËfl ÚÓÍÒ˘ÌÓÒÚË CD4 q6—1 2 ÏÂÒflˆÂ‚, ÂÒÎË ËÏÂÂÚÒfl, ‰Îfl ÓÔ‰ÂÎÂÌËfl ˝ÙÙÂÍÚË‚ÌÓÒÚË

áÑÇ/3TC/çÇè

éËÂÌÚËÓ‚‡Ì̇fl ̇ ÒËÏÔÚÓÏ˚ êÂÍÓÏẨӂ‡ÌÓ: Hgb ÓˆÂÌ͇ Hgb, äÅä, ÄíÄ ‰Îfl ÓÔ‰ÂÎÂÜ·ÚÂθÌÓ, ÌÓ Ì ÌÂÓ·ıÓ‰ËÏÓ: èÄä, CD4 ÌËfl ÚÓÍÒ˘ÌÓÒÚË CD4 q6-1 2 ÏÂÒflˆÂ‚, ÂÒÎË ËÏÂÂÚÒfl, ‰Îfl ÓÔ‰ÂÎÂÌËfl ˝ÙÙÂÍÚË‚ÌÓÒÚË íÂÒÚ Ì‡ ·ÂÂÏÂÌÌÓÒÚ¸ (Ó·flÁ‡ÚÂθÌÓ) Ü·ÚÂθÌÓ, ÌÓ Ì ÌÂÓ·ıÓ‰ËÏÓ: CD4 éËÂÌÚËÓ‚‡ÌÌÓ ̇ ÒËÏÔÚÓÏ˚ ÚÂÒÚËÓ‚‡ÌËÂ, ÌÓ Ì Ú·ÛÂÚÒfl ÌË͇ÍÓ„Ó „ÛÎflÌÓ„Ó ÚÂÒÚËÓ‚‡ÌËfl ‰Îfl ÓÔ‰ÂÎÂÌËfl ÚÓÍÒ˘ÌÓÒÚË CD4 q6-1 2 ÏÂÒflˆÂ‚, ÂÒÎË ËÏÂÂÚÒfl, ‰Îfl ÓÔ‰ÂÎÂÌËfl ˝ÙÙÂÍÚË‚ÌÓÒÚË éËÂÌÚËÓ‚‡Ì̇fl ̇ ÒËÏÔÚÓÏ˚ ÓˆÂÌ͇ Hgb, äÅä ‰Îfl ÓÔ‰ÂÎÂÌËfl ÚÓÍÒ˘ÌÓÒÚË CD4 q6-1 2 ÏÂÒflˆÂ‚, ÂÒÎË ËÏÂÂÚÒfl, ‰Îfl ÓÔ‰ÂÎÂÌËfl ˝ÙÙÂÍÚË‚ÌÓÒÚË

d4T/3TC/ùîñ

áÑÇ/3TC/ùîñ

íÂÒÚ Ì‡ ·ÂÂÏÂÌÌÓÒÚ¸ (Ó·flÁ‡ÚÂθÌÓ) êÂÍÓÏẨӂ‡ÌÓ: Hgb Ü·ÚÂθÌÓ, ÌÓ Ì ÌÂÓ·ıÓ‰ËÏÓ: èÄä, CD4

çÂÓ·ıÓ‰ËÏÓÒÚ¸ ‚ ‡Ò¯ËÂÌËË Î‡·Ó‡ÚÓÌÓ„Ó ÔÓÚÂ̈ˇ· Çéá ÔËÁ̇ÂÚ Ì˚̯ÌË ӄ‡Ì˘ÂÌËfl ··Ó‡ÚÓÌ˚ı ‚ÓÁÏÓÊÌÓÒÚÂÈ ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË. èÎ‡Ì “3 Í 5” ‡Á‡·ÓÚ‡Ì Ò ˆÂθ˛ ‰Ó·ËÚ¸Òfl ÔÓ„ÂÒÒ‡ ‚ ˝ÚÓÈ Ó·Î‡ÒÚË. Çéá ·Û‰ÂÚ ‡·ÓÚ‡Ú¸ ‚ÏÂÒÚÂ Ò „ÓÒÛ‰‡ÒÚ‚‡Ï˘ÎÂ̇ÏË Ë ÔÓËÁ‚Ó‰ËÚÂÎflÏË ‰Ë‡„ÌÓÒÚ˘ÂÒÍËı Ò‰ÒÚ‚ ̇‰ ‡Ò¯ËÂÌËÂÏ Î‡·Ó‡ÚÓÌÓÈ ËÌÙ‡ÒÚÛÍÚÛ˚ ̇ ÛÓ‚Ì ÒÚ‡Ì, Ò ÚÂÏ ˜ÚÓ·˚ ‰ÓÒÚ˘¸ Ó‰Ë̇ÍÓ‚ÓÈ ‰ÓÒÚÛÔÌÓÒÚË ÚÂÒÚËÓ‚‡ÌËfl CD4, ·ÓΠ¯ËÓÍÓ„Ó Ì‡Î˘Ëfl ‡‚ÚÓχÚËÁËÓ‚‡ÌÌÓ„Ó „ÂχÚÓÎӄ˘ÂÒÍÓ„Ó Ë ıËÏ˘ÂÒÍÓ„Ó ÚÂÒÚËÓ‚‡ÌËfl, ‡ Ú‡ÍÊ ̇΢Ëfl ÚÂÒÚËÓ‚‡ÌËfl ‚ËÛÒÌÓÈ Ì‡„ÛÁÍË ‚ „ËÓ̇ı. ùÚÓ ÔÓÚ·ÛÂÚ ‚˚·Ó‡ ‰ËÌÓÓ·‡ÁÌ˚ı, ˝ÍÓÌÓÏ˘ÂÒÍË ˝ÙÙÂÍÚË‚Ì˚ı ÏÂÚÓ‰ÓÎÓ„ËÈ Ì‡ ÒÚ‡ÌÓ‚ÓÏ ÛÓ‚ÌÂ Ë Ó·ÂÒÔ˜ÂÌËfl ÔÓÒÚ‡‚ÓÍ ‡ÍÚË‚Ó‚, ‡ Ú‡ÍÊ ÚÂıÌ˘ÂÒÍÓ„Ó Ó·ÒÎÛÊË‚‡ÌËfl Ó·ÓÛ‰Ó‚‡ÌËfl.

26

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

ëïÖå ÄêÇ íÖêÄèàà Ç ëãìóÄÖ çÖùîîÖäíàÇçéëíà ãÖóÖçàü äéåÅàçÄñàüåà èÖêÇéÉé êüÑÄ Çáêéëãõï à èéÑêéëíäéÇ

VII. ÇõÅéê

Ç

ÒÎÛ˜‡Â ̽ÙÙÂÍÚË‚ÌÓÒÚË Î˜ÂÌËfl Çéá ÂÍÓÏẨÛÂÚ ÔÓÎÌÓÒÚ¸˛ Á‡ÏÂÌËÚ¸ ÒıÂÏÛ Î˜ÂÌËfl Ò ÍÓÏ·Ë̇ˆËË ÔÂ‚Ó„Ó fl‰‡ ̇ ÍÓÏ·Ë̇ˆË˛ ‚ÚÓÓ„Ó fl‰‡. çÓ‚‡fl ÒıÂχ ΘÂÌËfl ‚ÚÓÓ„Ó fl‰‡ ‰ÓÎÊ̇ ‚Íβ˜‡Ú¸ ÎÂ͇ÒÚ‚ÂÌÌ˚ ÔÂÔ‡‡Ú˚, ÍÓÚÓ˚ ÒÓı‡Ìfl˛Ú ‡ÍÚË‚ÌÓÒÚ¸ ÔÓÚË‚ ¯Ú‡Ïχ ‚ËÛÒ‡ Ô‡ˆËÂÌÚ‡, Ë Ô‰ÔÓ˜ÚËÚÂθÌÓ ‚Íβ˜‡Ú¸ ÔÓ Í‡ÈÌÂÈ ÏÂ ÚË ÌÓ‚˚ı ÔÂÔ‡‡Ú‡, Ô˘ÂÏ Ó‰ËÌ ËÎË ·ÓΠËÁ ÌËı ‰ÓÎÊÌ˚ ÓÚÌÓÒËÚ¸Òfl Í ÌÓ‚ÓÏÛ Í·ÒÒÛ, ˜ÚÓ·˚ ÔÓ‚˚ÒËÚ¸ ‚ÂÓflÚÌÓÒÚ¸ ÛÒÔÂı‡ ΘÂÌËfl Ë Ò‚ÂÒÚË Í ÏËÌËÏÛÏÛ ËÒÍ ÔÂÂÍÂÒÚÌÓÈ ÂÁËÒÚÂÌÚÌÓÒÚË. ç‡ êËÒ. 1 Ô˂‰ÂÌ˚ ÒıÂÏ˚ ΘÂÌËfl ‚ÚÓÓ„Ó fl‰‡, ÍÓÚÓ˚ ÏÓ„ÛÚ ·˚Ú¸ ‡ÒÒÏÓÚÂÌ˚ ‰Îfl ̇Á̇˜ÂÌËfl ‚ÁÓÒÎ˚Ï Ë ÔÓ‰ÓÒÚÍ‡Ï ‚ ͇˜ÂÒÚ‚Â ÒıÂÏ Î˜ÂÌËfl ÔÂ‚Ó„Ó fl‰‡, ÓÔ‰ÂÎÂÌÌ˚ı ‚ 퇷Îˈ Ç. ÖÒÎË ÒıÂχ (d4T ËÎË áÑÇ) + 3TC ËÒÔÓθÁÛÂÚÒfl ‚ ͇˜ÂÒÚ‚Â ˜‡ÒÚË ÒıÂÏ˚ ΘÂÌËfl ÔÂ‚Ó„Ó fl‰‡, ÌÛÍÎÂÓÁˉ̇fl ÔÂÂÍÂÒÚ̇fl ÂÁËÒÚÂÌÚÌÓÒÚ¸ ÏÓÊÂÚ ÒÍÓÏÔÓÏÂÚËÓ‚‡Ú¸ ÒËθÌÓ‰ÂÈÒÚ‚Ë ‡Î¸ÚÂ̇ÚË‚Ì˚ı ‰‚ÓÈÌ˚ı ÍÓÏÔÓÌÂÌÚÓ‚ ÒıÂÏ˚ ÔÂ‚Ó„Ó fl‰‡, ÓÒÓ·ÂÌÌÓ ‚ ÛÒÎÓ‚Ëflı ÔÓ‰ÓÎÊËÚÂθÌÓÈ ‚ËÛÒÓÎӄ˘ÂÒÍÓÈ ÌÂÛ‰‡˜Ë. Ç Ú‡ÍÓÈ ÒËÚÛ‡ˆËË ÌÂÓ·ıÓ‰ËÏÓ Ò‰Â·ڸ ‡Î¸ÚÂ̇ÚË‚Ì˚È ˝ÏÔË˘ÂÒÍËÈ ‚˚·Ó Ò ˆÂθ˛ Ó·ÂÒÔ˜ÂÌËfl Í‡Í ÏÓÊÌÓ ·Óθ¯ÂÈ ‡ÌÚË‚ËÛÒÌÓÈ ‡ÍÚË‚ÌÓÒÚË. ì˜ËÚ˚‚‡fl ÔÂÂÍÂÒÚÌÛ˛ ÂÁËÒÚÂÌÚÌÓÒÚ¸ ÏÂÊ‰Û d4T Ë áÑÇ, ÒıÂÏ˚ ‚ÚÓÓ„Ó fl‰‡, ÍÓÚÓ˚ ÏÓ„ÛÚ Ó·ÂÒÔ˜ËÚ¸ ·Óθ¯Û˛ ‡ÍÚË‚ÌÓÒÚ¸, ‚Íβ˜‡˛Ú íÑî/ddI ËÎË ABä/ddI. çÓ ÔË ÄÅä ÔÓ‰ÓÎʇ˛Ú ÓÒÚ‡‚‡Ú¸Òfl ÔÓ·ÎÂÏ˚ ÒÚÓËÏÓÒÚË Ë „ËÔÂ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚË Í ÔÂÔ‡‡Ú‡Ï. äÓÏ ÚÓ„Ó, ‚˚ÒÓÍËÈ ÛÓ‚Â̸ ÍÓÂÁËÒÚÂÌÚÌÓÒÚË áÑÇ/3TC ÔË‚Ó‰ËÚ Í ÛÏÂ̸¯ÂÌ˲ ‚ÓÒÔËËϘ˂ÓÒÚË Í ÄÅä. íÑî ÏÓÊÂÚ ·˚Ú¸ ÒÍÓÏÔÓÏÂÚËÓ‚‡Ì ‚ ÂÁÛθڇÚ ÏÌÓÊÂÒÚ‚ÂÌÌ˚ı ÏÛÚ‡ˆËÈ ‡Ì‡ÎÓ„‡ ÌÛÍÎÂÓÁˉ‡ (åÄç), ÌÓ ˜‡ÒÚÓ ÒÓı‡ÌflÂÚ ‡ÍÚË‚ÌÓÒÚ¸ ÔÓÚË‚ ÌÛÍÎÂÓÁˉ-ÂÁËÒÚÂÌÚÌ˚ı ¯Ú‡ÏÏÓ‚ ‚ËÛÒ‡. éÌ ıÓÓ¯ ÚÂÏ, ˜ÚÓ, ÔÓ‰Ó·ÌÓ ddI, Â„Ó ÏÓÊÌÓ Ì‡Á̇˜‡Ú¸ ‰Îfl ÔËÂχ Ó‰ËÌ ‡Á ‚ ‰Â̸. íÑî ÔÓ‰ÌËχÂÚ ÛÓ‚Â̸ ddI, ‰ÓÁÛ ÍÓÚÓÓ„Ó ÔÓ˝ÚÓÏÛ ÒΉÛÂÚ ÛÏÂ̸¯ËÚ¸, ÂÒÎË Ó·‡ ˝ÚË ÔÂÔ‡‡Ú‡ ‰‡˛ÚÒfl ‚ÏÂÒÚÂ, Ò ÚÂÏ ˜ÚÓ·˚ ÛÏÂ̸¯ËÚ¸ ‚ÂÓflÚÌÓÒÚ¸ Ò‚flÁ‡ÌÌÓÈ Ò ddI ÚÓÍÒ˘ÌÓÒÚË (Ú.Â. Ì‚ÓÔ‡ÚËË Ë Ô‡ÌÍ‡ÚËÚ‡). àÁ-Á‡ ÛÏÂ̸¯ÂÌÌÓ„Ó ÔÓÚÂ̈ˇ· Ô‡ÍÚ˘ÂÒÍË Î˛·Ó„Ó ÌÛÍÎÂÓÁˉÌÓ„Ó ÍÓÏÔÓÌÂÌÚ‡ ‚ÚÓÓ„Ó fl‰‡ ÛÒËÎÂÌÌ˚È ËÚÓ̇‚ËÓÏ ÍÓÏÔÓÌÂÌÚ àè (êíÇ-àè), Ú.Â. ÎÓÔË̇‚Ë (ãèÇ)/, ҇͂Ë̇‚Ë (ëäÇ)/ ËÎË Ë̉Ë̇‚Ë (àÑÇ)/, Û˜ËÚ˚‚‡fl Ëı ÒËθÌÓ ‰ÂÈÒÚ‚ËÂ, fl‚ÎflÂÚÒfl ·ÓΠÔ‰ÔÓ˜ÚËÚÂθÌ˚Ï, ˜ÂÏ ÌÂÎÙË̇‚Ë (çîÇ), ‚ ÒıÂχı ΘÂÌËfl ‚ÚÓÓ„Ó fl‰‡27. çîÇ ÏÓÊÂÚ ‡ÒÒχÚË‚‡Ú¸Òfl ‚ ͇˜ÂÒÚ‚Â

27

‡Î¸ÚÂ̇ÚË‚˚ ÍÓÏÔÓÌÂÌÚÛ àè, ÂÒÎË ÓÚÒÛÚÒÚ‚ÛÂÚ ÛÒËÎÂÌÌ˚È Óڇ̇‚ËÓÏ àè, ÂÒÎË Ì ӷÂÒÔ˜Â̇ ıÓÎÓ‰Ó‚‡fl ˆÂÔ¸ ËÎË ÂÒÎË ËϲÚÒfl ÍÎËÌ˘ÂÒÍË ÔÓÚË‚ÓÔÓ͇Á‡ÌËfl Í ËÒÔÓθÁÓ‚‡Ì˲ ‰Û„Ó„Ó ËÌ„Ë·ËÚÓ‡ ÔÓÚ‡Á˚. àÑÇ/, ÌÂÒÏÓÚfl ̇ ÚÓ, ˜ÚÓ ÓÌ Ò˜ËÚ‡ÂÚÒfl ÒËθÌÓ‰ÂÈÒÚ‚Û˛˘ËÏ ‚‡ˇÌÚÓÏ, Ò‚flÁ‡Ì Ò ÒÂ¸ÂÁÌ˚ÏË ÔÓ·Ó˜Ì˚ÏË ÔӘ˜Ì˚ÏË ˝ÙÙÂÍÚ‡ÏË, Ë Â„Ó ÒΉÛÂÚ Ú‡ÍÊ ‡ÒÒÏÓÚÂÚ¸ ‚ ͇˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚˚. ä‡Í ÓÚϘÂÌÓ ‚˚¯Â, Û͇Á‡Ú¸ Óθ Ë Ì‡Î˘Ë Äáç/ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ‚ ÌÂÒÚÓfl˘Â ‚ÂÏfl ÔÓÎÌÓÒÚ¸˛ Ì‚ÓÁÏÓÊÌÓ.

êàë. 1. êÖäéåÖçÑéÇÄççõÖ ëïÖåõ ãÖóÖçàü ÇíéêéÉé êüÑÄ Ñãü Çáêéëãõï à èéÑêéëíäéÇ Ç ëãìóÄÖ çÖùîîÖäíàÇçéëíà ëïÖå ÄêÇ íÖêÄèàà èÖêÇéÉé êüÑÄ Ç ÒÎÛ˜‡Â ̽ÙÙÂÍÚË‚ÌÓÒÚË: d4T ËÎË áÑÇ + áíë + çÇè ËÎË ùîñ á‡ÏÂÌËÚ¸ ̇: íÑî ËÎË ABC + ddI a + ãèÇ/ ËÎË ëäÇ/

b

a

èË Ó‰ÌÓ‚ÂÏÂÌÌÓÏ Ì‡Á̇˜ÂÌËË Ò íÑî ‰ÓÁÛ ddI ÒΉÛÂÚ ÒÓÍ‡ÚËÚ¸ Ò 400 Ï„ ‰Ó 250 Ï„.

b ãèÇ/ Ë ëäÇ/ ÚÂ·Û˛Ú Ó·ÂÒÔ˜ÂÌËfl ıÓÎÓ‰Ó‚ÓÈ ˆÂÔË. Ç Í‡˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚˚ ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË ·ÂÁ ıÓÎÓ‰ËθÌ˚ı ÛÒÚ‡ÌÓ‚ÓÍ ÏÓÊÂÚ ·˚Ú¸ ‡ÒÒÏÓÚÂÌ çîÇ.

Ç ÒÎÛ˜‡Â ̽ÙÙÂÍÚË‚ÌÓÒÚË ÒıÂÏ˚ ΘÂÌËfl ÔÂ‚Ó„Ó fl‰‡ ̇ ÓÒÌÓ‚Â àè, ‚˚·Ó ‡Î¸ÚÂ̇ÚË‚ÌÓ„Ó Î˜ÂÌËfl ·Û‰ÂÚ Á‡‚ËÒÂÚ¸ ÓÚ Ô˘ËÌ˚ ÔÂ‚Ó̇˜‡Î¸ÌÓ„Ó ‚˚·Ó‡ ÒıÂÏ˚ ΘÂÌËfl, ÓÒÌÓ‚‡ÌÌÓÈ ÒÍÓ ̇ àè, ˜ÂÏ Ì‡ ççàéí. ÖÒÎË Ô˘Ë̇ Á‡Íβ˜‡Î‡Ò¸ ‚ Ô‰ÔÓ·„‡ÂÏÓÈ ÂÁËÒÚÂÌÚÌÓÒÚË Í ççàéí ËÎË ‚ ËÌÙÂ͈ËË Çàó-2, ‚˚·Ó ‡Î¸ÚÂ̇ÚË‚ÌÓÈ ÒıÂÏ˚ Ì fl‚ÎflÂÚÒfl ÔflÏ˚Ï. Ç Ú‡ÍËı ÒËÚÛ‡ˆËflı ‚‡ˇÌÚ˚ ‚˚·Ó‡ ·Û‰ÛÚ Á‡‚ËÒÂÚ¸ ÓÚ Ó„‡Ì˘ÂÌËÈ, ̇·„‡ÂÏ˚ı Ó·ÒÚÓflÚÂθÒÚ‚‡ÏË Ë̉˂ˉۇθÌ˚ı Ô‡ˆËÂÌÚÓ‚, ÒÔÓÒÓ·ÌÓÒÚË Ë̉˂ˉۇθÌÓ„Ó Ôӂ‰ÂÌËfl ÚÂÒÚ‡ ̇ ÂÁËÒÚÂÌÚÌÓÒÚ¸ Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡Ú‡Ï Ë ÙÓχθÌ˚ÏË Ó„‡Ì˘ÂÌËflÏË Ì‡ ÄêÇ, ÍÓÚÓ˚ ÏÓ„ÛÚ ÒÛ˘ÂÒÚ‚Ó‚‡Ú¸ ‚ ÍÓÌÍÂÚÌ˚ı ÒÚ‡ÌÓ‚˚ı ÔÓ„‡Ïχı. ç½ÙÙÂÍÚË‚ÌÓÒÚ¸ ΘÂÌËfl ‚ ÂÁÛθڇÚ ÚÓÈÌÓÈ ÒıÂÏ˚ çàéí ΄˜Â ÔÂÓ‰Ó΂‡ÂÚÒfl ‚ Ò‚flÁË Ò ÚÂÏ, ˜ÚÓ ÏÓÊÌÓ ·Û‰ÂÚ Ó·ÓÈÚËÒ¸ ·ÂÁ ‰‚Ûı ‚‡ÊÌ˚ı Í·ÒÒÓ‚ ÔÂÔ‡‡ÚÓ‚ – ççàéí Ë àè. èÓ˝ÚÓÏÛ ‚ ͇˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚˚ çàéís ÏÓÊÌÓ ‡ÒÒÏÓÚÂÚ¸ êíÇ-àè + ççàéí +/- (̇ÔËÏÂ, ddI Ë/ËÎË íÑî), ÂÒÎË ÔÓÁ‚ÓÎËÚ Ì‡Î˘Ë ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚.

28

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

VIII. èêéÅãÖåõ, äÄëÄûôàÖëü äéçäêÖíçõï äÄíÖÉéêàâ èÄñàÖçíéÇ A. ÜÖçôàçõ, ëèéëéÅçõÖ ä ÑÖíéêéÜÑÖçàû, àãà ÅÖêÖåÖççõÖ É Î‡‚Ì˚Ï ÔË̈ËÔÓÏ Î˜ÂÌËfl ÒÔÓÒÓ·Ì˚ı Í ‰ÂÚÓÓʉÂÌ˲ ËÎË ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ fl‚ÎflÂÚÒfl ÚÓ, ˜ÚÓ ÚÂ‡Ô‚Ú˘ÂÒÍË ¯ÂÌËfl ‰ÓÎÊÌ˚ ÓÒÌÓ‚˚‚‡Ú¸Òfl ËÒÍβ˜ËÚÂθÌÓ Ì‡ Ëı ÔÓÚ·ÌÓÒÚflı Ë ‚ÓÁÏÓÊÌÓÒÚË ÔËÏÂÌÂÌËfl Äêí, Í‡Í ˝ÚÓ ËÁÎÓÊÂÌÓ ‚ ê‡Á‰ÂΠIII. éÒÓ·˚ ӷÒÚÓflÚÂθÒÚ‚‡ ·ÂÂÏÂÌÌ˚ı ËÎË ÍÓÏfl˘Ëı „Û‰¸˛ ÊÂÌ˘ËÌ ÒÓÁ‰‡˛Ú ‰ÓÔÓÎÌËÚÂθÌ˚ ÔÓ·ÎÂÏ˚, Ò‚flÁ‡ÌÌ˚Â Ò ÚÓÍÒ˘ÌÓÒÚ¸˛ ‰Îfl χÚÂÂÈ Ë ‰ÂÚÂÈ, ‚˚·ÓÓÏ ÄêÇ ÔÂÔ‡‡ÚÓ‚ Ë Ô‰ÛÔÂʉÂÌËÂÏ ÔÂ‰‡˜Ë Çàó ÓÚ Ï‡ÚÂÂÈ Ëı Ï·‰Â̈‡Ï. ùÚË ÔÓ·ÎÂÏ˚ ‰ÓÎÊÌ˚ ¯‡Ú¸Òfl ‚ ÍÓÌÚÂÍÒÚ ӷÂÒÔ˜ÂÌËfl ÓÔÚËχθÌÓ„Ó Î˜ÂÌËfl ‰Îfl Óı‡Ì˚ Á‰ÓÓ‚¸fl χÚÂÂÈ. èÓ˝ÚÓÏÛ ÂÍÓÏẨӂ‡ÌÌÓÈ Çéá ÒıÂÏÓÈ Î˜ÂÌËfl ÔÂ‚Ó„Ó fl‰‡ ‰Îfl ˝ÚÓÈ ÔÓ‰„ÛÔÔ˚ Ô‡ˆËÂÌÚÓ‚ fl‚ÎflÂÚÒfl ÒÎÂ‰Û˛˘‡fl:

(d4T or áÑÇ) + 3TC + çÇè. Ç˚·Ó Äêí ‰Îfl ÊÂÌ˘ËÌ, ÍÓÚÓ˚ ÏÓ„ÛÚ Á‡·ÂÂÏÂÌÂÚ¸, ‰ÓÎÊÂÌ Û˜ËÚ˚‚‡Ú¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ÚÓ„Ó, ˜ÚÓ ÄêÇ-ÔÂÔ‡‡Ú˚ ÏÓ„ÛÚ ÔËÌËχڸÒfl ‚ ̇˜‡Î ÔÂ‚Ó„Ó ÚËÏÂÒÚ‡ ‰Ó ‡ÒÔÓÁ̇‚‡ÌËfl ·ÂÂÏÂÌÌÓÒÚË Ë ‚ Ú˜ÂÌË ̇˜‡Î¸ÌÓ„Ó ÔÂËÓ‰‡ ‡Á‚ËÚËfl Ó„‡ÌÓ‚ Û ÔÎÓ‰‡. ëΉÛÂÚ ËÁ·Â„‡Ú¸ ̇Á̇˜ÂÌËfl ùîñ Ú‡ÍËÏ ÊÂÌ˘ËÌ‡Ï ËÁ-Á‡ Â„Ó Ú‡‡ÚÓ„ÂÌÌÓÒÚË. ÜÂÌ˘ËÌ˚, ÔÓÎÛ˜‡˛˘Ë Äêí Ë Ì Ê·˛˘Ë Á‡·ÂÂÏÂÌÂÚ¸, ‰ÓÎÊÌ˚ ÔËÏÂÌflÚ¸ ̇‰ÎÂʇ˘Ë ÏÂÚÓ‰˚ ÍÓÌÚ‡ˆÂÔˆËË, ÍÓÚÓ˚ ËϲÚÒfl ‚ Ëı ‡ÒÔÓflÊÂÌËË, ˜ÚÓ·˚ ÒÌËÁËÚ¸ ‚ÂÓflÚÌÓÒÚ¸ ÌÂÊ·ÚÂθÌÓÈ ·ÂÂÏÂÌÌÓÒÚË. ÑÎfl ÚÂı ÊÂÌ˘ËÌ, ÍÓÚÓ˚Ï ÏÓÊÌÓ Ó·ÂÒÔ˜ËÚ¸ ˝ÙÙÂÍÚË‚ÌÛ˛ ÍÓÌÚ‡ˆÂÔˆË˛, ùîñ ÓÒÚ‡ÂÚÒfl ‚‡ÊÌ˚Ï ‚‡ˇÌÚÓÏ ‰Îfl ççàéí ÍÓÏÔÓÌÂÌÚ‡ ÒıÂÏ˚ ΘÂÌËfl. ÜÂÌ˘ËÌ˚, ÍÓÚÓ˚ ÔÓÎÛ˜‡˛Ú Äêí Ë ·ÂÂÏÂ̲Ú, ‰ÓÎÊÌ˚ ÔÓ‰ÓÎʇڸ Ò‚Ó˛ ÒıÂÏÛ Î˜ÂÌËfl, ÂÒÎË ÚÓθÍÓ ÓÌË Ì ̇ıÓ‰flÚÒfl ‚ ÔÂ‚ÓÏ ÚËÏÂÒÚ ·ÂÂÏÂÌÌÓÒÚË Ë ‚ ÒıÂÏÛ Î˜ÂÌËfl ‚ıÓ‰ËÚ ùîñ, – ‚ Ú‡ÍÓÏ ÒÎÛ˜‡Â ÔËÂÏ ùîñ ÒΉÛÂÚ ÔÂÍ‡ÚËÚ¸ Ë Á‡ÏÂÌËÚ¸ Â„Ó Ì‡ çÇè. ÑÎfl ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ Ê·ÚÂθÌÓ Ì‡˜Ë̇ڸ Äêí ÔÓÒΠÔÂ‚Ó„Ó ÚËÏÂÒÚ‡, ıÓÚfl ‰Îfl ÚÂı ÊÂÌ˘ËÌ, ÍÓÚÓ˚ ÒÂ¸ÂÁÌÓ ·ÓθÌ˚, ÔÂËÏÛ˘ÂÒÚ‚‡ ‡ÌÌÂ„Ó Ì‡˜‡Î‡ ΘÂÌËfl ˜ÂÚÍÓ ÔÂ‚¯˂‡˛Ú ÔÓÚÂ̈ˇθÌ˚È ËÒÍ ‰Îfl ÔÎÓ‰‡, Ë ‚ Ú‡ÍËı ÒÎÛ˜‡flı ÒΉÛÂÚ Ì‡˜Ë̇ڸ ÚÂ‡Ô˲. äÓÏ ÚÓ„Ó, ÔË ·ÂÂÏÂÌÌÓÒÚË ÒΉÛÂÚ ËÁ·Â„‡Ú¸ ‰‚ÓÈÌÛ˛ çàéí-ÍÓÏ·Ë̇ˆË˛ d4T/ddI Ë Ì‡Á̇˜‡Ú¸  ÚÓθÍÓ ‚ ÚÓÏ ÒÎÛ˜‡Â, ÂÒÎË ÌÂÚ ‰Û„Ëı ‡Î¸ÚÂ̇ÚË‚, Ú‡Í Í‡Í ÔË ˝ÚÓÈ ÍÓÏ·Ë̇ˆËË Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ ‚ÓÁÌË͇ÂÚ ÔÓ‚˚¯ÂÌÌ˚È ËÒÍ Î‡ÍÚӈˉÓÁ‡. ëËÏÔÚÓχÚ˘ÂÒ͇fl Ò‚flÁ‡Ì̇fl Ò çÇè ÚÓÍÒ˘ÌÓÒÚ¸ ‰Îfl Ô˜ÂÌË ËÎË ÚÓÍÒ˘ÌÓÒÚ¸, ‚˚Á˚‚‡˛˘‡fl ÒËθÌÛ˛ Ò˚Ô¸, ıÓÚfl Ë Ì fl‚ÎflÂÚÒfl ‡ÒÔÓÒÚ‡ÌÂÌÌÓÈ, ˜‡˘Â ‚ÓÁÌË-

29

͇ÂÚ Û ÊÂÌ˘ËÌ, ˜ÂÏ Û ÏÛʘËÌ, Ë Ò ·Óθ¯ÂÈ ‚ÂÓflÚÌÓÒÚ¸˛ Û ÊÂÌ˘ËÌ Ò ÓÚÌÓÒËÚÂθÌÓ ·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ÍÎÂÚÓÍ CD4 (>250/ÏÏ3)41-44. çÂËÁ‚ÂÒÚÌÓ, ‚˚Á˚‚‡ÂÚ ÎË ·ÂÂÏÂÌÌÓÒÚ¸ Ô‰‡ÒÔÓÎÓÊÂÌÌÓÒÚ¸ Í Ú‡ÍÓÈ ÚÓÍÒ˘ÌÓÒÚË, ÌÓ ÓÚ‰ÂθÌ˚ ÒÎÛ˜‡Ë ·˚ÎË Á‡„ËÒÚËÓ‚‡Ì˚ Û ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ45, 46. LJÊÌ˚Ï ‚ÓÔÓÒÓÏ fl‚ÎflÂÚÒfl ÔÓÚÂ̈ˇθÌÓ ‚ÓÁ‰ÂÈÒÚ‚Ë ÔÓÙË·ÍÚËÍË çÇè ‰Îfl Ô‰ÛÔÂʉÂÌËfl èåê ̇ ÔÓÒÎÂ‰Û˛˘Â Î˜ÂÌË χÚÂÂÈ Ë Ëı ËÌÙˈËÓ‚‡ÌÌ˚ı Ï·‰Â̈‚. ùÚÓÚ ‚ÓÔÓÒ ‚ÓÁÌËÍ ‚ Ú˜ÂÌË ÔÓÒΉÌËı ‰‚Ûı ÎÂÚ ËÁ-Á‡ Ò‚flÁË Ó‰ÌÓ̇Ô‡‚ÎÂÌÌÓÈ ÚӘ˜ÌÓÈ ÏÛÚ‡ˆËË Ò ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ çÇè. åÛÚ‡ˆËË, Ò‚flÁ‡ÌÌ˚Â Ò ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Í ÔÂÔ‡‡Ú‡Ï ççàéí, ·˚ÎË Ó·Ì‡ÛÊÂÌ˚ Û ‚ËÛÒ‡ Ô·ÁÏ˚ ÔË·ÎËÁËÚÂθÌÓ Û 20% ÊÂÌ˘ËÌ ÔÓÒΠӉÌÓÈ ÔÓÙË·ÍÚ˘ÂÒÍÓÈ ‰ÓÁ˚ çÇè ˜ÂÂÁ ¯ÂÒÚ¸ ̉Âθ ÔÓÒΠÓ‰Ó‚; ·ÓΠ‚˚ÒÓ͇fl ÒÚÂÔÂ̸ ÒÓ‰ÂʇÌËfl ÏÛÚ‡ÌÚÌ˚ı ‚ËÛÒÓ‚ (67%) ·˚· ӷ̇ÛÊÂ̇ ˜ÂÂÁ ¯ÂÒÚ¸ ̉Âθ ÔÓÒΠÓ‰Ó‚ Û ÊÂÌ˘ËÌ, ÍÓÚÓ˚ ‰Îfl Ô‰ÛÔÂʉÂÌËfl ÔÂ‰‡˜Ë ÔÓÎÛ˜‡ÎË ‰‚ ‰ÓÁ˚ ‚ÏÂÒÚÓ Ó‰ÌÓÈ ËÌÚ‡Ì‡Ú‡Î¸ÌÓÈ ‰ÓÁ˚ çÇè47, 48. äÓÏ ÚÓ„Ó, ÂÁËÒÚÂÌÚÌÓÒÚ¸ Í çÇè ÏÓÊÂÚ ‡Á‚Ë‚‡Ú¸Òfl ‰‡ÊÂ Û ÊÂÌ˘ËÌ, ÔÓÎÛ˜‡˛˘Ëı ‰ÓÔÓÎÌËÚÂθÌ˚ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ ÔÂÔ‡‡Ú˚, ÂÒÎË Û ÌËı ÔÓËÒıÓ‰ËÚ ÔÓ‰‰‡˛˘ÂÂÒfl ӷ̇ÛÊÂÌ˲ ‡ÁÏÌÓÊÂÌË ‚ËÛÒÓ‚ ‚Ó ‚ÂÏfl ÔËÂχ Ó‰ÌÓÈ ‰ÓÁ˚ çÇè; „ÂÌÓÚËÔ˘ÂÒ͇fl ÂÁËÒÚÂÌÚÌÓÒÚ¸ Í çÇè ·˚· ӷ̇ÛÊÂ̇ ˜ÂÂÁ ¯ÂÒÚ¸ ̉Âθ ÔÓÒΠÓ‰Ó‚ Û 1 5% ÊÂÌ˘ËÌ, ÍÓÚÓ˚ ÔÓÎÛ˜‡ÎË Ó‰ÌÛ ‰ÓÁÛ çÇè Ë ÍÓÚÓ˚ ÔÓÎÛ˜‡ÎË ÚÓθÍÓ áÑÇ ËÎË ÍÓÏ·Ë̇ˆË˛ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ı ÔÂÔ‡‡ÚÓ‚ ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË Ë ‚ ËÌÚ‡Ì‡Ú‡Î¸Ì˚È ÔÂËÓ‰49, 50. êÂÁËÒÚÂÌÚÌÓÒÚ¸ Í áíë Ú‡ÍÊ ҂flÁ‡Ì‡ Ò Ó‰ÌÓ̇Ô‡‚ÎÂÌÌÓÈ ÏÛÚ‡ˆËÂÈ. Ç ËÒÒΉӂ‡ÌËË, Ôӂ‰ÂÌÌÓÏ ‚Ó î‡ÌˆËË, áíë ·˚Î ‰Ó·‡‚ÎÂÌ Í áÑÇ ˜ÂÂÁ 32 ̉ÂÎË ·ÂÂÏÂÌÌÓÒÚË, ÏÛÚ‡ˆËfl ÂÁËÒÚÂÌÚÌÓÒÚË Í áíë M1 84V ̇·Î˛‰‡Î‡Ò¸ ˜ÂÂÁ ¯ÂÒÚ¸ ̉Âθ ÔÓÒΠÓ‰Ó‚ Û 39% ÊÂÌ˘ËÌ51; ÂÁËÒÚÂÌÚÌÓÒÚ¸ Í áíë ̇·Î˛‰‡Î‡Ò¸ Ú‡ÍÊ ˜ÂÂÁ Ó‰ÌÛ Ì‰Âβ ÔÓÒΠÓ‰Ó‚ Û 1 2% ÊÂÌ˘ËÌ, ÔÓÎÛ˜‡‚¯Ëı áÑÇ/áíë ‚ Ú˜ÂÌË ˜ÂÚ˚Âı ̉Âθ ‰Îfl Ô‰ÓÚ‚‡˘ÂÌËfl èåê ‚ ‡Ï͇ı ËÒÒΉӂ‡ÌËfl “PETRA”52. çË͇ÍÓÈ ÂÁËÒÚÂÌÚÌÓÒÚË Í áÑÇ ËÎË áíë Ì ·˚ÎÓ ÓÚϘÂÌÓ ÔË Î˜ÂÌËË áÑÇ/ áíë ‚ ËÌÚ‡Ì‡Ú‡Î¸Ì˚È ÔÂËÓ‰/˜ÂÂÁ ̉Âβ ÔÓÒΠÓ‰Ó‚ ‚ ËÒÒΉӂ‡ÌËË “SAINT” ‚ ûÊÌÓÈ ÄÙËÍÂ48, 52. éÚÒÛÚÒÚ‚ÛÂÚ ËÌÙÓχˆËfl Ó ÍÎËÌ˘ÂÒÍËı ÔÓÒΉÒÚ‚Ëflı ‚˚·Ó‡ ˝ÚËı ÏÛÚ‡ˆËÈ ÂÁËÒÚÂÌÚÌÓÒÚË ‰Îfl ‡„ËÓ‚‡ÌËfl ̇ ·Û‰Û˘Û˛ ‡ÌÚËÂÚÓ‚ËÛÒÌÛ˛ ÚÂ‡Ô˲ ÊÂÌ˘ËÌ ËÎË ËÌÙˈËÓ‚‡ÌÌ˚ı Ï·‰Â̈‚. åÛÚ‡ˆËË Á‡ÚËı‡˛Ú ÒÓ ‚ÂÏÂÌÂÏ, ÌÓ, ·ÂÁ ÒÓÏÌÂÌËfl, ÒÓı‡Ìfl˛ÚÒfl ‚ ÌÂÁ̇˜ËÚÂθÌ˚ı ÒÛ·ÔÓÔÛÎflˆËflı ‚ËÛÒÓ‚ Ë ÏÓ„ÛÚ ÔÓ‚ÚÓÌÓ ‚ÓÁÌËÍÌÛÚ¸, ÂÒÎË ‚ÔÓÒΉÒÚ‚ËË ‚‚ÂÒÚË ÒıÂÏÛ, ÒÓ‰Âʇ˘Û˛ ççàéí ËÎË áíë. ljÛÚÒfl ËÎË Ô·ÌËÛ˛ÚÒfl ËÒÒΉӂ‡ÌËfl, ˆÂθ ÍÓÚÓ˚ı ÒÓÒÚÓËÚ ‚ ÚÓÏ, ˜ÚÓ·˚ ÓÔ‰ÂÎËÚ¸, ÍÓÏÔÓÏÂÚËÛÂÚ ÎË ÔÓÙË·ÍÚË͇ Ó‰ÌÓÈ ‰ÓÁÓÈ çÇè ÔÓÒÎÂ‰Û˛˘Û˛ ÇÄÄêí Ò ÔÓÏÓ˘¸˛ ÒıÂÏ Î˜ÂÌËfl, ÓÒÌÓ‚‡ÌÌ˚ı ̇ ççàéí. ùÚÓ fl‚ÎflÂÚÒfl Ò‡Ï˚Ï ÌÂÓÚÎÓÊÌ˚Ï ‚ÓÔÓÒÓÏ ÓÔÂ‡ÚË‚Ì˚ı ËÒÒΉӂ‡ÌËÈ ‚ ˝ÚÓÈ Ó·Î‡ÒÚË. ÑÓ ÚÂı ÔÓ, ÔÓ͇ Ì ·Û‰ÂÚ ÔÓÎÛ˜ÂÌ ÓÍÓ̘‡ÚÂθÌ˚È ÓÚ‚ÂÚ Ì‡ ˝ÚÓÚ ‚ÓÔÓÒ, ÊÂÌ˘ËÌ, ÔÓÎۘ˂¯Ëı Ó‰ÌÓ‰ÓÁÓ‚Û˛ ÔÓÙË·ÍÚËÍÛ çÇè ËÎË ÔÓÙË·ÍÚËÍÛ áíë ‰Îfl Ô‰ÓÚ‚‡˘ÂÌËfl èåê, ÒΉÛÂÚ Ò˜ËÚ‡Ú¸ ÔË„Ó‰Ì˚ÏË ‰Îfl ÒıÂÏ, ÓÒÌÓ‚‡ÌÌ˚ı ̇ ççàéí, Ë ËÏ Ì ÒΉÛÂÚ ÓÚ͇Á˚‚‡Ú¸ ‚ ‰ÓÒÚÛÔÂ Í Î˜ÂÌ˲, ÔÓ‰‰ÂÊË‚‡˛˘ÂÏÛ ÊËÁ̸. çÂÍÓÚÓ˚ ÔÓ„‡ÏÏ˚ ‚ ÒÚ‡Ì‡ı ÛÊ ‡ÒÒχÚË‚‡˛Ú ‚ÓÁÏÓÊÌÓÒÚ¸ ËÒÔÓθÁÓ‚‡ÌËfl Í‡ÚÍÓÒÓ˜ÌÓ„Ó ÍÛÒ‡ ÚÓÈÌÓÈ ÍÓÏ·Ë̇ˆËÓÌÌÓÈ ÚÂ‡ÔËË ‰Îfl

30

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

Ô‰ÛÔÂʉÂÌËfl èåê Û ÊÂÌ˘ËÌ, ÍÓÚÓ˚ ¢ Ì ÌÛʉ‡˛ÚÒfl ‚ ΘÂÌËË Ëı ÒÓ·ÒÚ‚ÂÌÌÓÈ Çàó-ËÌÙÂ͈ËË, Ë ÔÂÍ‡˘ÂÌËfl ÚÂ‡ÔËË ÔÓÒΠÓ‰Ó‚, ÂÒÎË Â„Ó ÔÓ‰ÓÎÊÂÌË Ì Ú·ÛÂÚÒfl ËÁ-Á‡  ÒÓÒÚÓflÌËfl Á‰ÓÓ‚¸fl. àÒÔÓθÁÓ‚‡ÌË ‚˚ÒÓÍÓ‡ÍÚË‚ÌÓÈ ÍÓÏ·Ë̇ˆËÓÌÌÓÈ ÚÂ‡ÔËË ‚ Ú‡ÍËı ÒËÚÛ‡ˆËflı ‰ÓÎÊÌÓ Ô‰ÓÚ‚‡ÚËÚ¸ ‚ÓÁÌËÍÌÓ‚ÂÌË ÂÁËÒÚÂÌÚÌÓÒÚË Í ÔÂÔ‡‡Ú‡Ï Ë ‰ÓÎÊÌÓ Ú‡ÍÊ ·˚Ú¸ ‚˚ÒÓÍÓ˝ÙÙÂÍÚË‚Ì˚Ï ‚ ÛÏÂ̸¯ÂÌËË ÔÂË̇ڇθÌÓÈ ÔÂ‰‡˜Ë Çàó Ï·‰Â̈‡Ï. é‰Ì‡ÍÓ ˝ÚÓ ÔÓ‰‚Â„‡ÂÚ Ú‡ÍÊÂ Í‡Í Ï‡Ú¸, Ú‡Í Ë ÔÎÓ‰ ÔÓÚÂ̈ˇθÌÓÏÛ ‚ÓÁ‰ÂÈÒڂ˲ ÚÓÍÒ˘ÌÓÒÚË ÔÂÔ‡‡ÚÓ‚ ‚ ÒËÚÛ‡ˆËflı, ÍÓ„‰‡ ÚÂ‡ÔËfl Ì Ú·ÛÂÚÒfl ‰Îfl Á‰ÓÓ‚¸fl χÚÂË. Ç Ì‡ÒÚÓfl˘Â ‚ÂÏfl ‚‰ÛÚÒfl ËÒÒΉӂ‡ÌËfl ‰Îfl ÓˆÂÌÍË ·ÂÁÓÔ‡ÒÌÓÒÚË Ë ˝ÙÙÂÍÚË‚ÌÓÒÚË ˝ÚÓ„Ó ÔÓ‰ıÓ‰‡ ‰Îfl ÊÂÌ˘ËÌ Ë Ëı Ï·‰Â̈‚, ÓÒÓ·ÂÌÌÓ ‚ ˆÂÎflı Ô‰ÛÔÂʉÂÌËfl èåê Û ÍÓÏfl˘Ëı χÚÂÂÈ. ÖÒÎË ‚‡ˇÌÚ, ÓÒÌÓ‚‡ÌÌ˚È Ì‡ ËÌ„Ë·ËÚÓ ÔÓÚ‡Á˚, fl‚ÎflÂÚÒfl Ô‰ÔÓ˜ÚËÚÂθÌ˚Ï ÔÓ Ò‡‚ÌÂÌ˲ ÒÓ ÒıÂÏÓÈ, ÓÒÌÓ‚‡ÌÌÓÈ Ì‡ ççàéí, ̇Á̇˜‡ÂÏÓÈ ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË, ëäÇ/ ËÎË çîÇ fl‚Îfl˛ÚÒfl ‡ÁÛÏÌ˚Ï ‚˚·ÓÓÏ, Û˜ËÚ˚‚‡fl ‰Ó͇Á‡ÌÌÛ˛ ·ÂÁÓÔ‡ÒÌÓÒÚ¸ ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË. LJÊÌÓ ÓÚÏÂÚËÚ¸, ˜ÚÓ ÄêÇ-ÔÂÔ‡‡Ú˚ ÏÓ„ÛÚ ÎË·Ó ÛÏÂ̸¯‡Ú¸, ÎË·Ó Û‚Â΢˂‡Ú¸ ·ËÓ‰ÓÒÚÛÔÌÓÒÚ¸ ÒÚÂÓˉÌ˚ı „ÓÏÓÌÓ‚ ‚ „ÓÏÓ̇θÌ˚ı ÍÓÌÚ‡ˆÂÔÚË‚‡ı. çÂÍÓÚÓ˚ Ëϲ˘ËÂÒfl ‰‡ÌÌ˚ ҂ˉÂÚÂθÒÚ‚Û˛Ú Ó ÚÓÏ, ˜ÚÓ ‚ÓÁÏÓÊÌÓ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ë ÔÂÔ‡‡ÚÓ‚ ÏÂÊ‰Û ÏÌÓ„ËÏË ‚ˉ‡ÏË ÄêÇ (ÓÒÓ·ÂÌÌÓ ÌÂÍÓÚÓ˚ÏË ççàéí Ë àè) Ë „ÓÏÓ̇θÌ˚ÏË ÍÓÌÚ‡ˆÂÔÚË‚‡ÏË ÏÓ„ÛÚ ·ÂÁÓÔ‡ÒÌÓ Ë ˝ÙÙÂÍÚË‚ÌÓ ËÁÏÂÌflÚ¸ Í‡Í „ÓÏÓ̇θÌ˚ ÍÓÌÚ‡ˆÂÔÚË‚˚, Ú‡Í Ë ÄêÇ. çÂËÁ‚ÂÒÚÌÓ, ·Û‰ÂÚ ÎË ÔÓ‰‚Â„‡Ú¸Òfl ÓÔ‡ÒÌÓÒÚË ÍÓÌÚ‡ˆÂÔÚ˂̇fl ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ÓÒÌÓ‚‡ÌÌ˚ı ÚÓθÍÓ Ì‡ ÔÓ„ÂÒÚÓ„ÂÌ ËÌ˙ˆËÛÂÏ˚ı ÍÓÌÚ‡ˆÂÔÚË‚Ó‚ (Ú‡ÍËı Í‡Í ‰ÂÔÓωÓÍÒËÔÓ„ÂÒÚÂÓ̇ ‡ˆÂÚ‡Ú Ë ÌÓ˝ÚËÒÚÂÓ̇ ˝Ì‡ÌÚ‡Ú), Ú‡Í Í‡Í ˝ÚË ÏÂÚÓ‰˚ Ó·ÂÒÔ˜˂‡˛Ú ·ÓΠ‚˚ÒÓÍË ÛÓ‚ÌË „ÓÏÓ̇ ‚ ÍÓ‚Ë, ˜ÂÏ ‰Û„Ë „ÓÏÓ̇θÌ˚ ÍÓÌÚ‡ˆÂÔÚË‚˚, ÓÒÌÓ‚‡ÌÌ˚ ÚÓθÍÓ Ì‡ ÔÓ„ÂÒÚÓ„ÂÌÂ, Ë ˜ÂÏ ÍÓÏ·ËÌËÓ‚‡ÌÌ˚ Ó‡Î¸Ì˚ ÍÓÌÚ‡ˆÂÔÚË‚˚. ljÛÚÒfl ËÒÒΉӂ‡ÌËfl, ˜ÚÓ·˚ ÓˆÂÌËÚ¸ ‚ÓÁÏÓÊÌ˚ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl ÏÂÊ‰Û ‰ÂÔÓ-ωÓÍÒËÔÓ„ÂÒÚÂÓ̇ ‡ˆÂÚ‡ÚÓÏ, ÓÚ‰ÂθÌ˚ÏË àè Ë ÔÂÔ‡‡Ú‡ÏË ççàéí. í‡ÍËÏ Ó·‡ÁÓÏ, ÂÒÎË ÊÂÌ˘Ë̇, ̇ıÓ‰fl˘‡flÒfl ̇ ÄêÇ-ÚÂ‡ÔËË, ¯‡ÂÚ Ì‡˜‡Ú¸ ËÎË ÔÓ‰ÓÎÊËÚ¸ ËÒÔÓθÁÓ‚‡ÌË „ÓÏÓ̇θÌ˚ı ÍÓÌÚ‡ˆÂÔÚË‚Ó‚, ‰Îfl Ô‰ÛÔÂʉÂÌËfl ÔÂ‰‡˜Ë Çàó ÒΉÛÂÚ ÂÍÓÏẨӂ‡Ú¸ ÔÓÒÚÓflÌÌÓ ÔÓθÁÓ‚‡Ú¸Òfl ÔÂÁÂ‚‡ÚË‚‡ÏË, ˜ÚÓ ÏÓÊÂÚ Ú‡ÍÊ ÍÓÏÔÂÌÒËÓ‚‡Ú¸ β·Ó ‚ÓÁÏÓÊÌÓ ÒÌËÊÂÌË ˝ÙÙÂÍÚË‚ÌÓÒÚË „ÓÏÓ̇θÌÓ„Ó ÍÓÌÚ‡ˆÂÔÚË‚‡.

B. ÑÖíà äÓ„‰‡ ̇˜Ë̇ڸ ÄêÇ-ÚÂ‡Ô˲ Û Ï·‰Â̈‚ Ë ‰ÂÚÂÈ ã‡·Ó‡ÚÓ̇fl ‰Ë‡„ÌÓÒÚË͇ Çàó-ËÌÙÂ͈ËË Û Ï·‰Â̈‚ ‚ ‚ÓÁ‡ÒÚ ‰Ó 1 8 ÏÂÒflˆÂ‚ fl‚ÎflÂÚÒfl ÚÛ‰ÌÓÈ ËÁ-Á‡ ÒÓÔÓÚË‚ÎflÂÏÓÒÚË Ï‡ÚÂËÌÒÍËı ‡ÌÚËÚÂÎ. ÑÎfl ÓÍÓ̘‡ÚÂθÌÓ„Ó ‰Ë‡„ÌÓÁ‡ ‚ ˝ÚÓÈ ‚ÓÁ‡ÒÚÌÓÈ „ÛÔÔ ÌÂÓ·ıÓ‰ËÏÓ Ò‰Â·ڸ ‚ËÛÒÓÎӄ˘ÂÒÍË ÚÂÒÚ˚. èÓ˝ÚÓÏÛ ÂÍÓÏẨ‡ˆËË Çéá ‚ ÓÚÌÓ¯ÂÌËË Ì‡˜‡Î‡ ÄêÇ-ÚÂ‡ÔËË Û ‰ÂÚÂÈ ‰ÂÎflÚÒfl ̇ ‰‚ ͇Ú„ÓËË, Ò‚flÁ‡ÌÌ˚Â Ò ‚ÓÁ‡ÒÚÓÏ Ë Ì‡Î˘ËÂÏ ‚ËÛÒÓÎӄ˘ÂÒÍËı ‰Ë‡„ÌÓÒÚ˘ÂÒÍËı ÚÂÒÚÓ‚ (퇷Îˈ‡ G). ÖÒÎË ÂÒÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ҉·ڸ ‡Ì‡ÎËÁ ÍÎÂÚÓÍ CD4, ÚÓ ‰Îfl ÔËÌflÚËfl ¯ÂÌËfl ÓÚÌÓÒËÚÂθÌÓ ÄêÇ-ÚÂ‡ÔËË ÂÍÓÏẨÛÂÚÒfl ÒÍÓ ËÒÔÓθÁÓ‚‡Ú¸ ÔÓˆÂÌÚÌÓ ÓÚÌÓ¯ÂÌË ÍÎÂÚÓÍ CD4, ˜ÂÏ ‡·ÒÓβÚÌÓ Ëı ˜ËÒÎÓ, Ú‡Í Í‡Í ÔÓˆÂÌÚÌÓ ÓÚÌÓ¯ÂÌË ÏÂ̸¯Â ËÁÏÂÌflÂÚÒfl Ò ‚ÓÁ‡ÒÚÓÏ (èËÎÓÊÂÌË B) 53-55. Çéá ‡ÍÚË‚ÌÓ ÔÓÓ˘flÂÚ ‡Á‡·ÓÚÍÛ ÚÂÒÚÓ‚, ÔËÏÂÌËÏ˚ı ‚ ÏÂÒÚ‡ı Ò Ó„‡ÌË-

31

˜ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË, ÍÓÚÓ˚ ‰‡‰ÛÚ ‚ÓÁÏÓÊÌÓÒÚ¸ ‡ÌÌÂÈ ‰Ë‡„ÌÓÒÚËÍË Çàó Û Ï·‰Â̈‚. ç‡Î˘Ë ڇÍËı ÚÂÒÚÓ‚ ËÏÂÂÚ ·Óθ¯Ó Á̇˜ÂÌË ‰Îfl ‡Á‡·ÓÚÍË ÛÎÛ˜¯ÂÌÌ˚ı ÂÍÓÏẨ‡ˆËÈ ‚ ÓÚÌÓ¯ÂÌËË Ì‡˜‡Î‡ ÚÂ‡ÔËË Û ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ ‰Ó 1 8 ÏÂÒflˆÂ‚. ◗ ÑÎfl Çàó-ÒÂÓÔÓÁËÚË‚Ì˚ı Ï·‰Â̈‚ ‚ ‚ÓÁ‡ÒÚ ‰Ó 1 8 ÏÂÒflˆÂ‚ Çéá ÂÍÓÏẨÛÂÚ Ì‡˜Ë̇ڸ ÄêÇ-ÚÂ‡Ô˲ ‚ ÒÎÂ‰Û˛˘Ëı Ó·ÒÚÓflÚÂθÒÚ‚‡ı. ◗ àÌÙÂ͈Ëfl Û ·ÂÌ͇ ÔÓ‰Ú‚ÂʉÂ̇ ‚ËÛÒÓÎӄ˘ÂÒÍË (Ò ÔÓÏÓ˘¸˛ ÎË·Ó ‡Ì‡ÎËÁ‡ èñê Ñçä ̇ Çàó, ‡Ì‡ÎËÁ‡ êçä ̇ Çàó, ÎË·Ó ËÏÏÛÌÓÍÓÏÔÎÂÍÒ‡ ‰ËÒÒÓˆËËÓ‚‡ÌÌÓ„Ó ‡ÌÚË„Â̇ p24) Ë ËÏÂÂÚ: ◗ ᇷÓ΂‡ÌË Çàó Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (ÚÓ ÂÒÚ¸ ÍÎËÌ˘ÂÒÍËÈ ëèàÑ) (èËÎÓÊÂÌË E), ÌÂÁ‡‚ËÒËÏÓ ÓÚ % CD4; ËÎË ◗ ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (èËÎÓÊÂÌË E), Ò ‡ÒÒÏÓÚÂÌËÂÏ ‚ÓÁÏÓÊÌÓÒÚË ËÒÔÓθÁÓ‚‡ÌËfl CD4 <20% ‰Îfl ÔÓÏÓ˘Ë ‚ ÔËÌflÚËË ¯ÂÌËfl; ËÎË ◗ è‰ˇÚ˘ÂÒÍÛ˛ ÒÚ‡‰Ë˛ I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (ÚÓ ÂÒÚ¸ ·ÂÒÒËÏÔÚÓÏÌÛ˛) (èËÎÓÊÂÌË E) Ë CD4 <20% (·ÂÒÒËÏÔÚÓÏÌ˚ ‰ÂÚË, ÚÓ ÂÒÚ¸ Ëϲ˘Ë ÒÚ‡‰Ë˛ I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá, ‰ÓÎÊÌ˚ ÔÓıÓ‰ËÚ¸ ΘÂÌË ÚÓθÍÓ ÂÒÎË ÂÒÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ‡Ì‡ÎËÁ‡ ÍÎÂÚÓÍ CD4). ◗ ÖÒÎË ‚ÓÁÏÓÊÌÓÒÚË ‰Îfl Ôӂ‰ÂÌËfl ‚ËÛÒÓÎӄ˘ÂÒÍËı ÚÂÒÚÓ‚ ‰Îfl ÔÓ‰Ú‚ÂʉÂÌËfl ÒÚ‡ÚÛÒ‡ Çàó-ËÌÙÂ͈ËË ÓÚÒÛÚÒÚ‚Û˛Ú, ÌÓ ÂÒÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ÔÓ‚ÂÒÚË ‡Ì‡ÎËÁ ÍÎÂÚÓÍ CD4, Çéá ÂÍÓÏẨÛÂÚ Ì‡˜Ë̇ڸ ÄêÇÚÂ‡Ô˲ Çàó-ÔÓÁËÚË‚Ì˚ı ‰ÂÚÂÈ, Ëϲ˘Ëı Á‡·Ó΂‡ÌË ÒÚ‡‰ËË II ËÎË III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá Ë ÏÂÌ 20% CD4. Ç Ú‡ÍËı ÒÎÛ˜‡flı ÚÂÒÚËÓ‚‡ÌË ̇ ‡ÌÚËÚ· Í Çàó ÒΉÛÂÚ ÔÓ‚ÚÓËÚ¸ ‚ ‚ÓÁ‡ÒÚ 1 8 ÏÂÒflˆÂ‚, Ò ÚÂÏ ˜ÚÓ·˚ ÓÍÓ̘‡ÚÂθÌÓ ÔÓ‰Ú‚Â‰ËÚ¸ ̇΢ˠÇàó-ËÌÙÂ͈ËË Û ‰ÂÚÂÈ; ÄêÇ-ÚÂ‡Ô˲ ÒΉÛÂÚ ÔÓ‰ÓÎʇڸ ÚÓθÍÓ Û ‰ÂÚÂÈ Ò ÔÓ‰Ú‚ÂʉÂÌÌÓÈ ËÌÙÂ͈ËÂÈ. ◗ ÑÎfl Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ı ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ 1 8 ÏÂÒflˆÂ‚ ËÎË ÒÚ‡¯Â Çéá ÂÍÓÏẨÛÂÚ Ì‡˜Ë̇ڸ ÄêÇ-ÚÂ‡Ô˲ ‚ ÒÎÂ‰Û˛˘Ëı Ó·ÒÚÓflÚÂθÒÚ‚‡ı ◗ ᇷÓ΂‡ÌË Çàó Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (ÚÓ ÂÒÚ¸ ÍÎËÌ˘ÂÒÍËÈ ëèàÑ) (èËÎÓÊÂÌË E), ÌÂÁ‡‚ËÒËÏÓ ÓÚ % CD4; ËÎË ◗ ᇷÓ΂‡ÌË Çàó Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (èËÎÓÊÂÌË E), Ò ‚ÓÁÏÓÊÌÓÒÚ¸˛ ‡ÒÒÏÓÚÂÌËfl CD4 <1 5% ‰Îfl ÔÓÏÓ˘Ë ‚ ÔËÌflÚËË ¯ÂÌËfl; ËÎË ◗ è‰ˇÚ˘ÂÒ͇fl ÒÚ‡‰Ëfl I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá, ÚÓ ÂÒÚ¸ ·ÂÒÒËÏÔÚÓÏ̇fl) (èËÎÓÊÂÌË E), Ë CD4 <1 5%. ëΉÛÂÚ Û˜ËÚ˚‚‡Ú¸, ˜ÚÓ ‰ÂÚË, ̇ıÓ‰fl˘ËÂÒfl ̇ „Û‰ÌÓÏ ‚Ò͇ÏÎË‚‡ÌËË, ÔÓ‰‚Â„‡˛ÚÒfl ËÒÍÛ Çàó-ËÌÙÂ͈ËË ‚ Ú˜ÂÌË ‚ÒÂ„Ó ÔÂËÓ‰‡ „Û‰ÌÓ„Ó ‚Ò͇ÏÎË‚‡ÌËfl Ë ˜ÚÓ ÓÚˈ‡ÚÂθÌ˚ ÂÁÛθڇÚ˚ ‚ËÛÒÓÎӄ˘ÂÒÍÓ„Ó ÚÂÒÚ‡ ËÎË ÚÂÒÚ‡ ̇ ‡ÌÚËÚ· ‚ Ó‰ÌÓÏ ‚ÓÁ‡ÒÚ Ì ËÒÍβ˜‡˛Ú ‚ÓÁÏÓÊÌÓÒÚË ÔÓÒÎÂ‰Û˛˘Â„Ó ËÌÙˈËÓ‚‡ÌËfl, ÂÒÎË „Û‰ÌÓ ‚Ò͇ÏÎË‚‡ÌË ÔÓ‰ÓÎʇÂÚÒfl.

32

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

í‡Í ÊÂ, Í‡Í Ë Û ‚ÁÓÒÎ˚ı, Ó·˘Â ˜ËÒÎÓ ÎËÏÙÓˆËÚÓ‚ ËÏÂÂÚ Á̇˜ËÚÂθÌÛ˛ Ò‚flÁ¸ Ò ËÒÍÓÏ ÒÏÂÚÌÓÒÚË Û Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ı ‰ÂÚÂÈ 56, 57. Ñ‚Â̇‰ˆ‡ÚËÏÂÒfl˜Ì˚È ËÒÍ ÒÏÂÚÌÓÒÚË ÒÓÒÚ‡‚ÎflÂÚ >20% ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ ‰Ó 1 8 ÏÂÒflˆÂ‚ Ò Ó·˘ËÏ ˜ËÒÎÓÏ ÎÂÈÍÓˆËÚÓ‚ <2500/ÏÏ3 Ë ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ 1 8 ÏÂÒflˆÂ‚ ËÎË ÒÚ‡¯Â Ò Ó·˘ËÏ ˜ËÒÎÓÏ ÎËÏÙÓˆËÚÓ‚ <1 500/ÏÏ3. ÖÒÎË Ì‚ÓÁÏÓÊÌÓ ÓˆÂÌËÚ¸ ˜ËÒÎÓ ÍÎÂÚÓÍ CD4, ÚÓ ‚ ͇˜ÂÒÚ‚Â Á‡ÏÂÌfl˛˘Â„Ó ÔÓ͇Á‡ÚÂÎfl ÏÓÊÌÓ ËÒÔÓθÁÓ‚‡Ú¸ Ó·˘Â ˜ËÒÎÓ ÎËÏÙÓˆËÚÓ‚ ‰Îfl ΘÂÌËfl ‰ÂÚÂÈ „Û‰ÌÓ„Ó ËÎË ‡ÌÌÂ„Ó ‚ÓÁ‡ÒÚ‡ Ò ‰ÓÍÛÏÂÌڇθÌÓ ÔÓ‰Ú‚ÂʉÂÌÌÓÈ Çàó-ËÌÙÂ͈ËÂÈ ‚ ÔËÒÛÚÒÚ‚ËË ÒËÏÔÚÓχÚ˘ÂÒÍÓ„Ó Á‡·Ó΂‡ÌËfl (Ô‰ˇÚ˘ÂÒ͇fl ÒÚ‡‰Ëfl II ËÎË III Çéá). è‰ÔÓ˜ÚËÚÂθÌÓ, ˜ÚÓ·˚ ÓÚÍÎÓÌÂÌË ÓÚ ÌÓÏ˚ Ó·˘Â„Ó ˜ËÒ·/ÔÓˆÂÌÚ‡ ÎËÏÙÓˆËÚÓ‚ ËÎË ÍÎÂÚÓÍ CD4 ·˚ÎÓ ÔÓ‰Ú‚ÂʉÂÌÓ ‚ÚÓ˚Ï ÚÂÒÚÓÏ ‰Ó ÔËÌflÚËfl ÚÂ‡Ô‚Ú˘ÂÒÍËı ¯ÂÌËÈ, ÌÓ ÒΉÛÂÚ ÔËÁ̇ڸ, ˜ÚÓ ˝ÚÓ Ì ‚Ò„‰‡ ‚ÓÁÏÓÊÌÓ. Çéá ÔËÁ̇ÂÚ, ˜ÚÓ Ì˚̯Ìflfl ÒËÒÚÂχ ÒÚ‡‰ËÈ Çàó-ËÌÙÂ͈ËË Û ‰ÂÚÂÈ ·˚· ‡Á‡·Óڇ̇ ÌÂÒÍÓθÍÓ ÎÂÚ Ì‡Á‡‰ Ë ˜ÚÓ ÏÌÓ„Ë ÍÎËÌ˘ÂÒÍË ÒËÏÔÚÓÏ˚ Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II Ë III ÌÂÒÔˆËÙ˘Ì˚ ‰Îfl Çàó-ËÌÙÂ͈ËË Ë ÏÓ„ÛÚ ‚ Á̇˜ËÚÂθÌÓÈ ÒÚÂÔÂÌË Ì‡·Î˛‰‡Ú¸Òfl Û ‰ÂÚÂÈ, Ì ËÌÙˈËÓ‚‡ÌÌ˚ı Çàó, ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË. Ç Ò‚flÁË Ò ˝ÚËÏ Çéá Ô·ÌËÛÂÚ ÔÓ‚ÂÒÚË ÍÓÌÒÛθڇˆË˛ Ò ˝ÍÒÔÂÚ‡ÏË ‚ ӷ·ÒÚË Ô‰ˇÚËË Ò ˆÂθ˛ ÔÂÂÒÏÓÚ‡ ÒËÒÚÂÏ˚ Í·ÒÒËÙË͇ˆËË ‚ 2004 „Ó‰Û. íÂÏ Ì ÏÂÌÂÂ, ËÒÔÓθÁÓ‚‡ÌË ‰‡ÌÌÓÈ Í·ÒÒËÙË͇ˆËË ·ÓÎÂÁÌÂÈ Çéá (èËÎÓÊÂÌË F) ÏÓÊÂÚ ·˚Ú¸ ÔÓÎÂÁÌ˚Ï ‰Îfl ÓÔ‰ÂÎÂÌËfl Ô‡‡ÏÂÚÓ‚ ‰Îfl ̇˜‡Î‡ ÚÂ‡ÔËË ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË, ıÓÚfl Ë̉˂ˉۇθ̇fl ‡‰‡ÔÚ‡ˆËfl ̇ ÛÓ‚Ì ÒÚ‡ÌÓ‚ÓÈ ÔÓ„‡ÏÏ˚ ÏÓÊÂÚ ·˚Ú¸ ˆÂÎÂÒÓÓ·‡ÁÌÓÈ. èÓÌËÍÌÓ‚ÂÌË ÄêÇ ‚ „Û‰ÌÓ ÏÓÎÓÍÓ ÍÓÏfl˘Ëı ÊÂÌ˘ËÌ ÍÓ΢ÂÒÚ‚ÂÌÌÓ Ì ·˚ÎÓ ÛÒÚ‡ÌÓ‚ÎÂÌÓ ‰Îfl ·Óθ¯ËÌÒÚ‚‡ ÄêÇ. ïÓÚfl Ë ËÁ‚ÂÒÚÌÓ, ˜ÚÓ ÌÂÍÓÚÓ˚ ÄêÇ, Ú‡ÍËÂ Í‡Í Ì‚Ë‡ÔËÌ, ÔËÒÛÚÒÚ‚Û˛Ú ‚ „Û‰ÌÓÏ ÏÓÎÓÍÂ, ÍÓ̈ÂÌÚ‡ˆËfl Ë ÍÓ΢ÂÒÚ‚Ó ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó ÔÂÔ‡‡Ú‡, ÔÓ„ÎÓ˘ÂÌÌÓ„Ó ·ÂÌÍÓÏ, ·Û‰ÛÚ ÏÂ̸¯ËÏË, ˜ÂÏ ÌÂÓ·ıÓ‰ËÏÓ ‰Îfl ‰ÓÒÚËÊÂÌËfl ÚÂ‡Ô‚Ú˘ÂÒÍÓ„Ó ˝ÙÙÂÍÚ‡. ëΉӂ‡ÚÂθÌÓ, ÂÒÎË ‚Ò͇ÏÎË‚‡ÂÏ˚È „Û‰¸˛ ·ÂÌÓÍ Ì‡ÒÚÓθÍÓ ·ÓÎÂÌ, ˜ÚÓ ÂÏÛ ÒΉÛÂÚ Ì‡Á̇˜ËÚ¸ ÄêÇ-ÚÂ‡Ô˲ (퇷Îˈ‡ G), ÚÓ ÒΉÛÂÚ Ì‡˜‡Ú¸ ÄêÇ ‚ Òڇ̉‡ÚÌ˚ı Ô‰ˇÚ˘ÂÒÍËı ‰ÓÁ‡ı ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÚÓ„Ó, ÔÓÎÛ˜‡ÂÚ ÎË Ï‡Ú¸ ÄêÇ-ÚÂ‡Ô˲ ÎË ÌÂÚ. àÌÙˈËÓ‚‡ÌÌ˚ ‰ÂÚË Ì‡ „Û‰ÌÓÏ ‚Ò͇ÏÎË‚‡ÌËË, χÚÂË ÍÓÚÓ˚ı ÔÓÎÛ˜‡˛Ú ÄêÇ-ÚÂÔ˲, ÏÓ„ÛÚ ÔÓ„ÎÓÚËÚ¸ ÒÛ·ÚÂ‡Ô‚Ú˘ÂÒÍË ÛÓ‚ÌË ÌÂÍÓÚÓ˚ı ÄêÇ, Ë ˝ÚÓ ÏÓÊÂÚ ÔË‚ÂÒÚË Í ÂÁËÒÚÂÌÚÌÓÒÚË ‚ËÛÒ‡ Û ·ÂÌ͇ Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡Ú‡Ï. çÂËÁ‚ÂÒÚÌÓ, ÒΉÛÂÚ ÎË Ì‡Á̇˜‡Ú¸ ÄêÇ-ÔÂÔ‡‡Ú˚ ‚ ÔÂËÓ‰ „Û‰ÌÓ„Ó ‚Ò͇ÏÎË‚‡ÌËfl ‰ÂÚflÏ Ò ‰ÓÍÛÏÂÌڇθÌÓ ÔÓ‰Ú‚ÂʉÂÌÌÓÈ Çàó-ËÌÙÂ͈ËÂÈ, ÍÓÚÓ˚Ï Ì Ú·ÛÂÚÒfl ÄêÇ-ÚÂ‡ÔËfl, ÌÓ Ï‡ÚÂË ÍÓÚÓ˚ı ÔÓÎÛ˜‡˛Ú ÄêÇ-ÚÂ‡Ô˲, Ë ˝ÚÓÚ ‚ÓÔÓÒ Ú·ÛÂÚ ‰‡Î¸ÌÂÈ¯Â„Ó ËÁÛ˜ÂÌËfl.

33

íÄÅãàñÄ G. êÖäéåÖçÑÄñàà Ñãü çÄóÄãÄ Äêí ì åãÄÑÖçñÖÇ à ÑÖíÖâ íÂÒÚËÓ‚‡ÌË CD4 ÇÓÁ‡ÒÚ Ñˇ„ÌÓÒÚ˘ÂÒÍÓ ÚÂÒÚËÓ‚‡ÌË ̇ Çàó ÇËÛÒÓÎӄ˘ÂÒÍÓ ÚÂÒÚËÓ‚‡ÌË ̇ Çàó ÓÚÒÛÚÒÚ‚ÛÂÚ, ÌÓ Ï·‰Â̈ fl‚ÎflÂÚÒfl ÒÂÓÔÓÁËÚË‚Ì˚Ï Ì‡ ‡ÌÚËÚ· Í Çàó (èËϘ‡ÌËÂ: ÚÂÒÚ Ì‡ ‡ÌÚËÚ· Í Çàó ‰ÓÎÊÂÌ ·˚Ú¸ ÔÓ‚ÚÓÂÌ ‚ ‚ÓÁ‡ÒÚ 1 8 ÏÂÒflˆÂ‚ ‰Îfl ÔÓÎÛ˜ÂÌËfl ÓÍÓ̘‡ÚÂθÌÓ„Ó ‰Ë‡„ÌÓÁ‡ Çàó-ËÌÙÂ͈ËË) <1 8 ÏÂÒflˆÂ‚ èÓÎÓÊËÚÂθÌ˚È ‚ËÛÒÓÎӄ˘ÂÒÍËÈ ÚÂÒÚ Ì‡ Çàób

ÖÒÎË ËÏÂÂÚÒfl ÚÂÒÚËÓ‚‡ÌË CD4

≥1 8 ÏÂÒflˆÂ‚

ëÂÓÔÓÎÓÊËÚÂθ̇fl ‡͈Ëfl ̇ ‡ÌÚËÚ· Í Çàó

ÇËÛÒÓÎӄ˘ÂÒÍË ÚÂÒÚËÓ‚‡ÌË ̇ Çàó <1 8 ÏÂÒflˆÂ‚ ÓÚÒÛÚÒÚ‚ÛÂÚ, ÌÓ Û ·ÂÌ͇ ÒÂÓÔÓÎÓÊËÚÂθ̇fl ‡͈Ëfl ̇ ‡ÌÚËÚ· Í Çàó

ÖÒÎË ÓÚÒÛÚÒÚ‚ÛÂÚ ‚ÓÁÏÓÊÌÓÒÚ¸ ÚÂÒÚËÓ‚‡ÌËfl CD4 ≥≥1 8ÏÂÒflˆÂ‚

èÓÎÓÊËÚÂθÌ˚È ‚ËÛÒÓÎӄ˘ÂÒÍËÈ ÚÂÒÚ Ì‡ Çàó

ëÂÓÔÓÁËÚ˂̇fl ‡͈Ëfl ̇ ‡ÌÚËÚ· Í Çàó

a èÓˆÂÌÚÌÓ ÓÚÌÓ¯ÂÌË ÍÎÂÚÓÍ CD4 <20% ÒÓÓÚ‚ÂÚÒÚ‚ÛÂÚ ‡·ÒÓβÚÌÓÏÛ ˜ËÒÎÛ ÍÎÂÚÓÍ CD4 ÔË·ÎËÁËÚÂθÌÓ <1000/ÏÏ3 ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ <1 2 ÏÂÒflˆÂ‚ Ë <750/ÏÏ3 ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ 1 2-1 8 ÏÂÒflˆÂ‚; CD4 <1 5% ÒÓÓÚ‚ÂÚÒÚ‚ÛÂÚ <500/ÏÏ3 ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ 1-5 ÎÂÚ Ë ‰Ó <200/ÏÏ3 ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ >6 ÎÂÚ. b Ä̇ÎËÁ èñê Ñçä ̇ Çàó ËÎË êçä ̇ Çàó Ò ‡ÏÔÎËÙË͇ˆËÂÈ ËÎË ËÏÏÛÌÓÍÓÏÔÎÂÍÒÌ˚È ‰ËÒÒÓˆËËÓ‚‡ÌÌ˚È ‡Ì‡ÎËÁ ‡ÌÚË„Â̇ p24.

d ÖÒÎË ·ÂÌÓÍ Ì ËÏÂÂÚ ÒËÏÔÚÓÏÓ‚, ‡ ΘÂÌË ̇˜Ë̇ÂÚÒfl ̇ ÓÒÌÓ‚Â ÍËÚÂËfl CD4, ÒΉÛÂÚ ‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ Ôӂ‰ÂÌËfl ÔÓ‰Ú‚Âʉ‡˛˘Â„Ó ‡Ì‡ÎËÁ‡ CD4, ÂÒÎË ÔÓÁ‚ÓÎflÚ ÂÒÛÒ˚..

e

c ñÂÎÂÒÓÓ·‡ÁÌÓ ËÒÔÓθÁÓ‚‡Ú¸ ÔÓˆÂÌÚÌÓ ÓÚÌÓ¯ÂÌË ÍÎÂÚÓÍ ëD4 ‰Îfl Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë ‚ ÓÔ‰ÂÎÂÌËË ÌÂÓ·ıÓ‰ËÏÓÒÚË ‚ ÌÂωÎÂÌÌÓÏ Î˜ÂÌËË.

åÌÓ„Ë ËÁ ÍÎËÌ˘ÂÒÍËı ÒËÏÔÚÓÏÓ‚ Ô‰ˇÚ˘ÂÒÍËı ÒÚ‡‰ËÈ II and III ÔÓ Í·ÒÒËÙË͇ˆËË Á‡·Ó΂‡ÌËÈ Çéá ÌÂÒÔˆËÙ˘Ì˚ ‰Îfl Çàó-ËÌÙÂ͈ËË Ë ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË ˜‡ÒÚÓ ÏÓ„ÛÚ Ì‡·Î˛‰‡Ú¸Òfl Û ‰ÂÚÂÈ, Ì ËÌÙˈËÓ‚‡ÌÌ˚ı Çàó; ÔÓ˝ÚÓÏÛ ‚ ÓÚÒÛÚÒÚ‚Ë ‚ËÛÒÓÎӄ˘ÂÒÍÓ„Ó ÚÂÒÚËÓ‚‡ÌËfl Ë ‡Ì‡ÎËÁ‡ ÍÎÂÚÓÍ CD4 ÒËÏÔÚÓχÚ˘Ì˚ Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ ‰ÂÚË ‚ ‚ÓÁ‡ÒÚ <1 8 ÏÂÒflˆÂ‚ ÏÓ„ÛÚ Ò˜ËÚ‡Ú¸Òfl ÔË„Ó‰Ì˚ÏË ‰Îfl ÄêÇ-ÚÂ‡ÔËË ÚÓθÍÓ ‚ ËÒÍβ˜ËÚÂθÌ˚ı

34

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

êÂÍÓÏẨ‡ˆËË ‚ ÓÚÌÓ¯ÂÌËË Î˜ÂÌËfl

ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍËı ÒÚ‡‰ËÈ II Ë III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá Ò CD4 <20%a

ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (Ú.Â.ëèàÑ) (èËÎÓÊÂÌË F) ÌÂÁ‡‚ËÒËÏÓ ÓÚ % CD4 ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (èËÎÓÊÂÌË F) Ò ‡ÒÒÏÓÚÂÌËÂÏ ‚ÓÁÏÓÊÌÓÒÚË ËÒÔÓθÁÓ‚‡ÌËfl CD4 <20% ‰Îfl Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë ‚ ÔËÌflÚËË ¯ÂÌËfla, c ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá (ÚÓ ÂÒÚ¸ ·ÂÒÒËÏÔÚÓÏÌÓÂ) (èËÎÓÊÂÌË F), CD4 <20% a, d ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá ÌÂÁ‡‚ËÒËÏÓ ÓÚ % CD4 ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II ÔÓ Í·ÒÒËÙË͇ˆËË Çéá Ò ‡ÒÒÏÓÚÂÌËÂÏ ‚ÓÁÏÓÊÌÓÒÚË ËÒÔÓθÁÓ‚‡ÌËfl CD4 <1 5% ‰Îfl Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë ‚ ÔËÌflÚËË ¯ÂÌËfl a, c ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá Ò CD4 <1 5% a, d ã˜ÂÌË ̇˜Ë̇ڸ Ì ÂÍÓÏẨÛÂÚÒfl e è‰ˇÚ˘ÂÒ͇fl ÒÚ‡‰Ëfl III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá, ÌÂÁ‡‚ËÒËÏÓ ÓÚ Ó·˘Â„Ó ˜ËÒ· ÎËÏÙÓˆËÚÓ‚ ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II ÔÓ Í·ÒÒËÙË͇ˆËË Çéá, Ò ‡ÒÒÏÓÚÂÌËÂÏ ‚ÓÁÏÓÊÌÓÒÚË ËÒÔÓθÁÓ‚‡ÌËfl Ó·˘Â„Ó ˜ËÒ· ÎËÏÙÓˆËÚÓ‚ <2500/ÏÏ3 ‰Îfl Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë ‚ ÔËÌflÚËË ¯ÂÌËfl f è‰ˇÚ˘ÂÒ͇fl ÒÚ‡‰Ëfl III ÔÓ Í·ÒÒËÙË͇ˆËË Çéá, ÌÂÁ‡‚ËÒËÏÓ ÓÚ Ó·˘Â„Ó ˜ËÒ· ÎËÏÙÓˆËÚÓ‚ ᇷÓ΂‡ÌË Ô‰ˇÚ˘ÂÒÍÓÈ ÒÚ‡‰ËË II ÔÓ Í·ÒÒËÙË͇ˆËË Çéá Ò ‡ÒÒÏÓÚÂÌËÂÏ ‚ÓÁÏÓÊÌÓÒÚË ËÒÔÓθÁÓ‚‡ÌËfl Ó·˘Â„Ó ˜ËÒ· ÎËÏÙÓˆËÚÓ‚ <1 500/ÏÏ3 ‰Îfl Ó͇Á‡ÌËfl ÔÓÏÓ˘Ë ‚ ÔËÌflÚËË ¯ÂÌËfl f Ó·ÒÚÓflÚÂθÒÚ‚‡ı (̇ÔËÏÂ, ·ÂÌÓÍ Ò Í·ÒÒ˘ÂÒÍÓÈ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÓÈ ËÌÙÂ͈ËÂÈ, Ò‚flÁ‡ÌÌÓÈ ÒÓ ëèàÑÓÏ, Ú‡ÍÓÈ Í‡Í Ò‡ÍÓχ ä‡ÔÓ¯Ë, ÔÌ‚ÏÓÌËfl, ‚˚Á‚‡Ì̇fl Pneumocystis carinii ËÎË ÍËÔÚÓÍÓÍÍÓ‚˚È ÏÂÌËÌ„ËÚ). ÖÒÎË ÄêÇ-ÔÂÔ‡‡Ú˚ ‰‡˛ÚÒfl ÒËÏÔÚÓχÚ˘ÂÒÍÓÏÛ Çàó-ÔÓÁËÚË‚ÌÓÏÛ ·ÂÌÍÛ ·ÂÁ ÓÍÓ̘‡ÚÂθÌÓ„Ó ‚ËÛÒÓÎӄ˘ÂÒÍÓ„Ó ‰Ë‡„ÌÓÁ‡, ÚÂÒÚËÓ‚‡ÌË ̇ ‡ÌÚËÚ· Í Çàó ÒΉÛÂÚ ÔÓ‚ÚÓËÚ¸ ‚ ‚ÓÁ‡ÒÚ 1 8 ÏÂÒflˆÂ‚ ‰Îfl ÔÓ‰Ú‚ÂʉÂÌËfl ÒÓÒÚÓflÌËfl ËÌÙˈËÓ‚‡ÌËfl; ÄêÇ-ÚÂ‡Ô˲ ÒΉÛÂÚ ÔÓ‰ÓÎʇڸ ÚÓθÍÓ Û ‰ÂÚÂÈ Ò ÔÓ‰Ú‚ÂʉÂÌÌÓÈ Çàó-ËÌÙÂ͈ËÂÈ. f

<1 500/ÏÏ3 Û ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ ≥1 8 ÏÓÊÂÚ Á‡ÏÂÌËÚ¸ ÔÓˆÂÌÚÌÓ ÓÚÌÓ¯ÂÌË CD4, ÂÒÎË ÔÓÒΉÌ ÓÔ‰ÂÎËÚ¸ Ì‚ÓÁÏÓÊÌÓ, ‡ Ò‚flÁ‡ÌÌ˚Â Ò Çàó ÒËÏÔÚÓÏ˚ ÔËÒÛÚÒÚ‚Û˛Ú. ñÂÎÂÒÓÓ·‡ÁÌÓÒÚ¸ Â„Ó ÓÔ‰ÂÎÂÌËfl Û ·ÂÒÒËÏÔÚÓÏÌ˚ı ‰ÂÚÂÈ Ì ËÁ‚ÂÒÚ̇. èÓ˝ÚÓÏÛ, ‚ ÓÚÒÛÚÒÚ‚Ë ÚÂÒÚËÓ‚‡ÌËfl ÍÎÂÚÓÍ CD4, ·ÂÒÒËÏÔÚÓÏÌ˚Ï Çàó-ËÌÙˈËÓ‚‡ÌÌ˚Ï ‰ÂÚflÏ (Ô‰ˇÚ˘ÂÒ͇fl ÒÚ‡‰Ëfl I ÔÓ Í·ÒÒËÙË͇ˆËË Çéá) ΘÂÌË ̇Á̇˜‡Ú¸ Ì ÒΉÛÂÚ, Ú‡Í Í‡Í ‚ ÏÂÒÚ‡ı Ò ÒËθÌÓ Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ÌÂÚ ‰Û„Ëı ̇‰ÂÊÌ˚ı χÍÂÓ‚.

鷢 ˜ËÒÎÓ ÎËÏÙÓˆËÚÓ‚ <2500/ÏÏ3 Û ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ <18 ÏÂÒflˆÂ‚ ËÎË

35

êÂÍÓÏẨӂ‡ÌÌ˚ ÒıÂÏ˚ ÄêÇ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ ‰Îfl Ï·‰Â̈‚ Ë ‰ÂÚÂÈ àÒÒΉӂ‡ÌËfl ÇÄÄêí ÒÂ‰Ë ‰ÂÚÂÈ ‰ÂÏÓÌÒÚËÛ˛Ú, ˜ÚÓ ÏÌÓ„Ë ‰Û„Ë ÒËθÌÓ‰ÂÈÒÚ‚Û˛˘Ë ÒıÂÏ˚ ÄêÇ ÚÂ‡ÔËË ‰‡˛Ú ‡Ì‡Îӄ˘Ì˚ ÛÎÛ˜¯ÂÌËfl ‚ Á‡·Ó΂‡ÂÏÓÒÚË, ÒÏÂÚÌÓÒÚË Ë ‚ χÍÂ‡ı-Á‡ÏÂÒÚËÚÂÎflı58, 59. èÓ ÏÂ ‡Á‚ËÚËfl ·ÂÌ͇ ‰ÓÁ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ ‰ÓÎÊÌ˚ ÍÓÂÍÚËÓ‚‡Ú¸Òfl, ˜ÚÓ·˚ ËÁ·Âʇڸ ËÒ͇ ̉ÓÒÚ‡ÚÓ˜ÌÓÈ ‰ÓÁËÓ‚ÍË Ë ‡Á‚ËÚËfl ÂÁËÒÚÂÌÚÌÓÒÚË; ÒΉӂ‡ÚÂθÌÓ, ‰ÓÁËӂ͇ Û ‰ÂÚÂÈ ‰ÓÎÊ̇ ÓÒÌÓ‚˚‚‡Ú¸Òfl ÎË·Ó Ì‡ ÔÎÓ˘‡‰Ë ÔÓ‚ÂıÌÓÒÚË Ú·, ÎË·Ó Ì‡ χÒÒ Ú·. ëڇ̉‡ÚËÁ‡ˆËfl ËÏÂÂÚ ·Óθ¯Ó Á̇˜ÂÌË ‰Îfl ÚÓ„Ó, ˜ÚÓ·˚ Ì Ëϲ˘ËÈ ‰ÓÒÚ‡ÚÓ˜ÌÓ„Ó ÓÔ˚Ú‡ ÔÂÒÓ̇ΠÏÓ„ ·ÂÁÓÔ‡ÒÌ˚Ï Ó·‡ÁÓÏ ‰‡‚‡Ú¸ Ô‡‚ËθÌ˚ ‰ÓÁ˚, Ë ÔÓ˝ÚÓÏÛ Ê·ÚÂθÌÓ Ô‰ÓÒÚ‡‚ÎflÚ¸ ‡·ÓÚÌËÍ‡Ï Á‰‡‚ÓÓı‡ÌÂÌËfl Ú‡·ÎËˆÛ ‰ÓÁ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚, ̇Á̇˜‡ÂÏ˚ı ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ ‚ÂÒÓ‚˚ı ͇Ú„ÓËÈ. í‡ÍË ڇ·Îˈ˚ ÏÓ„ÛÚ ‚‡¸ËÓ‚‡Ú¸Òfl ÏÂÊ‰Û ‡ÈÓ̇ÏË ‚ Á‡‚ËÒËÏÓÒÚË ÓÚ Ì‡Î˘Ëfl Ë ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÙÓÏ ÄêÇ-ÔÂÔ‡‡ÚÓ‚ ‚ ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘ÂÈ ÒÚ‡ÌÂ. Ç ˆÂÎflı ÛÎÛ˜¯ÂÌËfl Òӷβ‰ÂÌËfl ÒıÂÏ Î˜ÂÌËfl Ú‡ÍË ÒıÂÏ˚, ‚˚·‡ÌÌ˚ ‰Îfl ‰ÂÚÂÈ, ‰ÓÎÊÌ˚ Û˜ËÚ˚‚‡Ú¸ ÒıÂÏ˚ ΘÂÌËfl, ̇Á̇˜ÂÌÌ˚ ‰Îfl Ëı Ó‰ËÚÂÎÂÈ, ˜ÚÓ·˚ ËÁ·Âʇڸ ‡Á΢ÌÓ„Ó ‚ÂÏÂÌË ÔËÂχ ÎÂ͇ÒÚ‚ Ë, ÔÓ ‚ÓÁÏÓÊÌÓÒÚË, ‰‡Ú¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ËÒÔÓθÁÓ‚‡Ú¸ Ó‰ÌË Ë Ú Ê ÔÂÔ‡‡Ú˚. Çéá ÔËÁ̇ÂÚ ÌÂÓ·ıÓ‰ËÏÓÒÚ¸ Ó͇Á˚‚‡Ú¸ ÔÓÏÓ˘¸ ÒÚ‡Ì‡Ï ‚ ‡Á‡·ÓÚÍ ڇÍËı Ú‡·Îˈ ‰Îfl ۘ·Ì˚ı ˆÂÎÂÈ, ˜ÚÓ·˚ ÏÓÊÌÓ ·˚ÎÓ ÛÎÛ˜¯ËÚ¸ ÔÓ„‡ÏÏ˚ ÄêÇ. Ç ÒÎÛ˜‡Â ‰ÓÒÚËÊÂÌËfl ÍÓÌÒÂÌÒÛÒ‡ ‚ ÓÚÌÓ¯ÂÌËË Ú‡ÍËı Ú‡·Îˈ ‚ Ú˜ÂÌË 2004 „Ó‰‡ Ó·‡Áˆ˚ Ú‡·Îˈ, ËÒÔÓθÁÛÂÏ˚ı ÌÂÍÓÚÓ˚ÏË Ô‰ˇÚ‡ÏË, ÏÓ„ÛÚ ·˚Ú¸ Ô‰ÓÒÚ‡‚ÎÂÌ˚ ÔÓ Á‡ÔÓÒÛ. çÂÍÓÚÓ˚ ÄêÇ-ÔÂÔ‡‡Ú˚, Ëϲ˘ËÂÒfl ‰Îfl ‚ÁÓÒÎ˚ı, ËϲÚÒfl Ú‡ÍÊ ‚ ÔÓÔËÒflı, ÒÔˆˇθÌÓ Ô‰̇Á̇˜ÂÌÌ˚ı ‰Îfl ‰ÂÚÂÈ. íÂÏ Ì ÏÂÌÂÂ, ÎÂ͇ÒÚ‚ÂÌÌ˚ ÙÓÏ˚, ÔÓ‰ıÓ‰fl˘Ë ‰Îfl ̇Á̇˜ÂÌËfl ‰ÂÚflÏ ‡ÌÌÂ„Ó ‚ÓÁ‡ÒÚ‡, ÍÓÚÓ˚ ¢ Ì ÏÓ„ÛÚ ÔÓ„ÎÓÚËÚ¸ ˆÂÎ˚ ڇ·ÎÂÚÍË ËÎË Í‡ÔÒÛÎ˚, ÔÓ͇ ¢ Ì fl‚Îfl˛ÚÒfl ¯ËÓÍÓ ‰ÓÒÚÛÔÌ˚ÏË ‚ ÏÂÒÚ‡ı Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË. çÂÍÓÚÓ˚ ÄêÇÔÂÔ‡‡Ú˚ ‚ ͇ÔÒÛ·ı Ë Ú‡·ÎÂÚ͇ı ËϲÚÒfl ‚ ‰ÓÒÚ‡ÚÓ˜ÌÓ ÌËÁÍËı ‰ÓÁ‡ı, ˜ÚÓ·˚ Ó·ÂÒÔ˜ËÚ¸ ‰ÓÒÚ‡ÚÓ˜ÌÛ˛ ‰ÓÁËÓ‚ÍÛ ‰ÂÚflÏ (̇ÔËÏÂ, d4T ‚ ͇ÔÒÛ·ı 1 5, 20 Ë 30 Ï„ ËÎË Ú‡·ÎÂÚÍË çîÇ Ò ·ÓÓÁ‰Í‡ÏË, ˜ÚÓ·˚ Ëı ÏÓÊÌÓ ·˚ÎÓ ‡Á‰ÂÎËÚ¸ ̇ ÔÓÎÓ‚ËÌ˚ Ë ËÁÏÂθ˜ËÚ¸) Ë ÓˆÂÌËÚ¸ Ù‡χÍÓÍËÌÂÚËÍÛ ÔÂÔ‡‡Ú‡ ‚ ËÁÏÂθ˜ÂÌÌ˚ı Ú‡·ÎÂÚ͇ı ËÎË ‚˚Ò˚Ô‡ÌÌÓ„Ó ËÁ ͇ÔÒÛÎ˚. é‰Ì‡ÍÓ ÏÌÓ„Ë ÔÂÔ‡‡Ú˚ Ì ËÏÂ˛Ú Ú‚Â‰˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÙÓÏ ‚ ‰ÓÁ‡ı, ÔÓ‰ıÓ‰fl˘Ëı ‰Îfl Ô‰ˇÚ˘ÂÒÍÓ„Ó ËÒÔÓθÁÓ‚‡ÌËfl, ‡ ÌÂÍÓÚÓ˚ ڂÂ‰˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ ÙÓÏ˚ Ì ËÏÂ˛Ú ‚ÒÂı ÚÂı ÍÓÏÔÓÌÂÌÚÓ‚, ÍÓÚÓ˚ ‡‚ÌÓÏÂÌÓ ‡ÒÔ‰ÂÎÂÌ˚ ‚ Ú‡·ÎÂÚ͇ı (̇ÔËÏÂ, áÑÇ/áíë ‚ ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁÂ). àÒÔÓθÁÓ‚‡ÌË ڇ·ÎÂÚÓÍ, ÍÓÚÓ˚ ÌÂÓ·ıÓ‰ËÏÓ ‰ÂÎËÚ¸, ÓÒÓ·ÂÌÌÓ ·ÂÁ ·ÓÓÁ‰ÓÍ, ÏÓÊÂÚ ÔË‚ÂÒÚË Í Ì‰ÓÒÚ‡ÚÓ˜ÌÓÈ ‰ÓÁËÓ‚Í ËÎË ÔÂ‰ÓÁËÓ‚Í ‰ÂÚÂÈ, ‡ ˝ÚÓ ÏÓÊÂÚ ÔË‚ÂÒÚË Í ÔÓ‚˚¯ÂÌÌÓÏÛ ËÒÍÛ ÂÁËÒÚÂÌÚÌÓÒÚË ËÎË ÚÓÍÒ˘ÌÓÒÚË. äÓÏ ÚÓ„Ó, Ú‡ÍË ‰ÓÁ˚ Ì‚ÓÁÏÓÊÌÓ Î„ÍÓ ÍÓÂÍÚËÓ‚‡Ú¸ ÔÓ ÏÂ ÓÒÚ‡ ·ÂÌ͇. íÂÏ Ì ÏÂÌÂÂ, Çéá ÔËÁ̇ÂÚ, ˜ÚÓ ‰Ó ÚÂı ÔÓ, ÔÓ͇ ̇‰ÎÂʇ˘Ë ÎÂ͇ÒÚ‚ÂÌÌ˚ ÙÓÏ˚ Ì ·Û‰ÛÚ ‚ ·ÓΠ¯ËÓÍÓÏ Ì‡Î˘ËË, ‡Á‰ÂÎÂÌË ‚ÁÓÒÎ˚ı ‰ÓÁ Ú‚Â‰˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÙÓÏ ÄêÇ-ÔÂÔ‡‡ÚÓ‚, ıÓÚfl Ë Ì fl‚ÎflÂÚÒfl ÓÔÚËχθÌ˚Ï, ÏÓÊÂÚ ·˚Ú¸ ‰ËÌÒÚ‚ÂÌÌ˚Ï ÒÔÓÒÓ·ÓÏ Ó·ÂÒÔ˜ÂÌËfl ÚÂ‡ÔËË ÒÂ¸ÂÁÌÓ ·ÓθÌÓÏÛ ·ÂÌÍÛ, Ë ˝ÚÓ ÒΉÛÂÚ Û˜ËÚ˚‚‡Ú¸, ÂÒÎË ÓÚÒÛÚÒÚ‚Û˛Ú ‰Û„Ë ‡Î¸ÚÂ̇ÚË‚˚. èÓ‚‡È‰Â˚ ωˈËÌÒÍÓÈ ÔÓÏÓ˘Ë ‰ÓÎÊÌ˚ Á̇ڸ, ˜ÚÓ ÒÛ˘ÂÒÚ‚Û˛˘Ë ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ÍÓÏ·Ë̇ˆËË ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÙÓÏ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁ‡ı ÏÓ„ÛÚ Ì ÒÓ‰Âʇڸ ̇‰ÎÂʇ˘Ë ‰ÓÁ˚ Í‡Ê‰Ó„Ó ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó ÍÓÏÔÓÌÂÌÚ‡ ‰Îfl ‰ÂÚÂÈ ‚ ‡Ò˜ÂÚ ̇ χÒÒÛ Ú·. ùÚ‡ ÔÓ·ÎÂχ ÍÓÌÍÂÚÌÓ ÓÚÌÓÒËÚÒfl Í ÍÓÏÔÓÌÂÌÚÛ çÇè ‚ ÒıÂÏ áÑÇ/3TC/çÇè Ò ÙËÍÒËÓ‚‡ÌÌ˚ÏË ‰ÓÁ‡ÏË, ‰Îfl ÍÓÚÓ-

36

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

ÓÈ ÏÓÊÂÚ ÔÓÚ·ӂ‡Ú¸Òfl ‰ÓÔÓÎÌËÚÂθÌ˚È çÇè, ÂÒÎË Ú‡·ÎÂÚÍË ËÒÔÓθÁÛ˛ÚÒfl ‰Îfl ΘÂÌËfl ‰ÂÚÂÈ ‡ÌÌÂ„Ó ‚ÓÁ‡ÒÚ‡ (èËÎÓÊÂÌË F). Çéá ‡ÍÚË‚ÌÓ ÔÓÓ˘flÂÚ ‡Á‡·ÓÚÍÛ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÙÓÏ, ÔÓ‰ıÓ‰fl˘Ëı ‰Îfl Ô‰ˇÚ˘ÂÒÍÓ„Ó ËÒÔÓθÁÓ‚‡ÌËfl, ÓÒÓ·ÂÌÌÓ Ú‚Â‰˚ı ÙÓÏ, ‚ ‰ÓÁ‡ı, ÍÓÚÓ˚ ÏÓ„ÛÚ ËÒÔÓθÁÓ‚‡Ú¸Òfl Ô‰ˇÚ˘ÂÒÍËÏË Ô‡ˆËÂÌÚ‡ÏË (̇ÔËÏÂ, Ú‡·ÎÂÚÓÍ ‰Îfl Ê‚‡ÌËfl ËÎË ÓÚÍ˚‚‡˛˘ËıÒfl ͇ÔÒÛÎ), Ú‡Í Í‡Í ÊˉÍË ÎÂ͇ÒÚ‚ÂÌÌ˚ ÙÓÏ˚ ÏÓ„ÛÚ ËÏÂÚ¸ ·ÓΠӄ‡Ì˘ÂÌÌ˚È ÒÓÍ „Ó‰ÌÓÒÚË, ˜ÂÏ Ú‚Â‰˚Â, ÏÓ„ÛÚ ·˚Ú¸ ·ÓΠ‰ÓÓ„ÓÒÚÓfl˘ËÏË, Ëı Úۉ̠ı‡ÌËÚ¸ Ë ‰Îfl Ô‡‚ËθÌÓ„Ó ‚‚‰ÂÌËfl ÏÓÊÂÚ ·˚Ú¸ ÌÂÓ·ıÓ‰ËÏ˚Ï ËÒÔÓθÁÓ‚‡ÌË ¯Ôˈ‚. èÓ ÚÂÏ Ê Ô˘Ë̇Ï, ÍÓÚÓ˚ ·˚ÎË Ó·ÒÛʉÂÌ˚ ‚ ÓÚÌÓ¯ÂÌËË Ì‡˜‡Î¸Ì˚ı ÒıÂÏ ÄêÇ-ÚÂ‡ÔËË ‰Îfl ‚ÁÓÒÎ˚ı, Ô‰ÔÓ˜ÚËÚÂθÌ˚È ‚‡ˇÌÚ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ ‰Îfl ‰ÂÚÂÈ ‚Íβ˜‡ÂÚ (d4T ËÎË áÑÇ) + 3TC ÔÎ˛Ò ççàéí (çÇè ËÎË ùîñ) (퇷Îˈ‡ H). ëΉÛÂÚ Ô‰ÛÔ‰ËÚ¸, ˜ÚÓ ùîñ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ÌÂθÁfl ËÒÔÓθÁÓ‚‡Ú¸ ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ ‰Ó 3 ÎÂÚ ËÁ-Á‡ ÓÚÒÛÚÒÚ‚Ëfl ̇‰ÎÂʇ˘ÂÈ ÎÂ͇ÒÚ‚ÂÌÌÓÈ ÙÓÏ˚ Ë ËÌÙÓχˆËË Ó ‰ÓÁËÓ‚ÍÂ, ıÓÚfl ˝ÚË ‚ÓÔÓÒ˚ Ë ËÁÛ˜‡˛ÚÒfl. èÓ˝ÚÓÏÛ ‰Îfl ‰ÂÚÂÈ Ï·‰¯Â 3 ÎÂÚ Ë Ï‡ÒÒÓÈ Ú· ÏÂÌ 10 Í„ Ô‰ÔÓ˜ÚËÚÂθÌÓÈ ççàéí ‰ÓÎÊÂÌ ·˚Ú¸ çÇè. àÒÔÓθÁÓ‚‡ÌË áÑÇ/3TC/ ÄÅä ‰Îfl ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ‡ÒÒχÚË‚‡ÂÚÒfl ‚ ͇˜ÂÒÚ‚Â ‚ÚÓÓÈ ‡Î¸ÚÂ̇ÚË‚˚, ˜ÚÓ Ò‚flÁ‡ÌÓ Ò ÂÁÛθڇڇÏË, ÔÓÎÛ˜ÂÌÌ˚ÏË ‚ ÓÚÌÓ¯ÂÌËË Éäàë A5095 Û ‚ÁÓÒÎ˚ı (ÒÏ. ê‡Á‰ÂÎ IV); ÓÊˉ‡ÂÚÒfl ÔÓÎÛ˜ÂÌË ‰‡Î¸ÌÂȯÂÈ ËÌÙÓχˆËË. ùîñ ·Û‰ÂÚ Ô‰ÔÓ˜ÚËÚÂθÌÓÈ ççàéí ‰Îfl ‰ÂÚÂÈ, ÍÓÚÓ˚Ï ÌÂÓ·ıÓ‰Ëχ ÄêÇÚÂ‡ÔËfl Ë ÍÓÚÓ˚ ÌÛʉ‡˛ÚÒfl ËÎË ÔÓÎÛ˜‡˛Ú ÚÂ‡Ô˲ ÔÓÚË‚ ÚÛ·ÂÍÛÎÂÁ‡ Ò ÒÓ‰ÂʇÌËÂÏ ËÙ‡ÏÔˈË̇. ÑÎfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ ‰Ó 3 ÎÂÚ, ÍÓÚÓ˚ ÔÓÎÛ˜‡˛Ú ÄêÇ-ÚÂ‡Ô˲ Ë Ó‰ÌÓ‚ÂÏÂÌÌÓ ÚÂ‡Ô˲ ÔÓÚË‚ íÅ, ÒΉÛÂÚ ‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ̇Á̇˜ÂÌËfl áÑÇ/3TC/AÅä ÔË Ì‡Á̇˜ÂÌËË ÚÂ‡ÔËË ÔÓÚË‚ íÅ, Ú‡Í Í‡Í ëäÇ/ ÓÚÒÛÚÒÚ‚ÛÂÚ ‚ ÎÂ͇ÒÚ‚ÂÌÌÓÈ ÙÓÏÂ, ÔÓ‰ıÓ‰fl˘ÂÈ ‰Îfl ‰ÂÚÂÈ ˝ÚÓ„Ó ‚ÓÁ‡ÒÚ‡. ëΉÛÂÚ ÔÓ‚ÂÒÚË ÏÓÌËÚÓËÌ„ ̇ ‚ÓÁÏÓÊÌÛ˛ „ËÔÂ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚ¸ Í ÄÅä. åÓÊÌÓ Ú‡ÍÊ ‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ËÒÔÓθÁÓ‚‡ÌËfl ëäÇ/ ‰Îfl ‰ÂÚÂÈ ·ÓΠÒÚ‡¯Â„Ó ‚ÓÁ‡ÒÚ‡, ÍÓÚÓ˚ ÏÓ„ÛÚ ÔÓÎÛ˜‡Ú¸ ‚ÁÓÒÎ˚ ‰ÓÁ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ (ÚÓ ÂÒÚ¸ ‰Îfl ‰ÂÚÂÈ Ò Ï‡ÒÒÓÈ Ú· ≥25 Í„).

íÄÅãàñÄ H. êÖäéåÖçÑìÖåõÖ ëïÖåõ ÄêÇ íÖêÄèàà èÖêÇéÉé êüÑÄ Ñãü åãÄÑÖçñÖÇ à ÑÖíÖâ ëıÂÏ˚ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ d4T ËÎË áÑÇ èËϘ‡ÌËfl

ÔÎ˛Ò áíë ÔÎ˛Ò çÇè ËÎË ùîñ Ç˚·Ó ççàéí: ÖÒÎË ‚ÓÁ‡ÒÚ <3 ÎÂÚ ËÎË ‚ÂÒ <10 Í„, çÇè ÖÒÎË ‚ÓÁ‡ÒÚ >3 ÎÂÚ ËÎË ‚ÂÒ >10 Í„, çÇè ËÎË ùîñ

ÖÒÎË Ï‡Ú¸ ÔÓıÓ‰ËÚ ÄêÇ-ÚÂ‡Ô˲ ‚Ó ‚ÂÏfl ·ÂÂÏÂÌÌÓÒÚË, ·Û‰¸ ÚÓ Ò ˆÂθ˛ ÒÌËÊÂÌËfl ËÒ͇ èåê ËÎË Î˜ÂÌËfl ÒÓ·ÒÚ‚ÂÌÌÓÈ ·ÓÎÂÁÌË, ÚÓ ÒÛ˘ÂÒÚ‚ÛÂÚ ‚ÂÓflÚÌÓÒÚ¸ ÚÓ„Ó, ˜ÚÓ ·ÂÌÓÍ ·Û‰ÂÚ ËÌÙˈËÓ‚‡Ì ÎÂ͇ÒÚ‚ÂÌÌÓ-ÛÒÚÓȘ˂˚Ï ‚ËÛÒÓÏ. äÓÏ ÚÓ„Ó, ÂÁËÒÚÂÌÚÌÓÒÚ¸ ÏÓÊÂÚ ‡Á‚ËÚ¸Òfl Ë Û ËÌÙˈËÓ‚‡ÌÌÓ„Ó ·ÂÌ͇, ÍÓÚÓ˚È ÔÓ‰‚Â„Òfl ‚ÓÁ‰ÂÈÒڂ˲ ÄêÇ-ÔÂÔ‡‡Ú‡, ËÒÔÓθÁÓ‚‡ÌÌÓ„Ó ‚ ÔÓÙË·ÍÚ˘ÂÒÍËı ˆÂÎflı, ‰Ó ÚÓ„Ó Í‡Í ·˚ÎÓ Ó·Ì‡ÛÊÂÌÓ, ˜ÚÓ ÓÌ ËÌÙˈËÓ‚‡Ì. ùÚ‡ ÔÓ·ÎÂχ ÓÒÓ·ÂÌÌÓ ı‡‡ÍÚÂ̇ ‰Îfl ÒıÂÏ ÔÓÙË·ÍÚËÍË èåê, ‚ ÒÓÒÚ‡‚ ÍÓÚÓ˚ı ‚ıÓ‰flÚ çÇè ËÎË 3TC (·Û‰¸ ÚÓ ÔÓ ÓÚ‰ÂθÌÓÒÚË ËÎË ‚ ͇˜ÂÒÚ‚Â Ó‰ÌÓ„Ó ËÁ

37

ÍÓÏÔÓÌÂÌÚÓ‚ ÒıÂÏ˚ ËÁ ‰‚Ûı ÎÂ͇ÒÚ‚), Ú‡Í Í‡Í Â‰ËÌÒÚ‚ÂÌ̇fl ÚÓ˜ÍÓ‚‡fl ÏÛÚ‡ˆËfl Ò‚flÁ‡Ì‡ Ò ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Í ˝ÚËÏ ‰‚ÛÏ ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ÔÂÔ‡‡Ú‡Ï47, 51. èÓÒΠӉÌÓÍ‡ÚÌÓÈ ‰ÓÁ˚ çÇè, Û 46% Ï·‰Â̈‚ ÔÓËÒıÓ‰ËÚ ÏÛÚ‡ˆËfl, Ò‚flÁ‡Ì̇fl Ò ççàéí („·‚Ì˚Ï Ó·‡ÁÓÏ, ÏÛÚ‡ˆËfl Y1 8 1C, ÍÓÚÓ‡fl Ì ‚Ò„‰‡ ÏÓÊÂÚ ·˚Ú¸ Ò‚flÁ‡Ì‡ Ò ÔÂÂÍÂÒÚÌÓÈ ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Í ùîñ). êÂÁÛθڇÚ˚ ̇·Î˛‰ÂÌËfl ÒÂ‰Ë Ï‡ÚÂÂÈ Ò‚Ë‰ÂÚÂθÒÚ‚Û˛Ú Ó ÚÓÏ, ˜ÚÓ ˝ÚË ÏÛÚ‡ˆËË ÒÓ ‚ÂÏÂÌÂÏ ÔÓÒÚÂÔÂÌÌÓ ËÒ˜ÂÁ‡˛Ú, Ӊ̇ÍÓ, ‚ÓÁÏÓÊÌÓ, ÓÒÚ‡˛ÚÒfl ‚ ͇˜ÂÒÚ‚Â ÌÂÁ̇˜ËÚÂθÌ˚ı ‚ËÛÒÌ˚ı ÔÓ‰ÔÓÔÛÎflˆËÈ47. ëΉÛÂÚ ÎË ËÁÏÂÌflÚ¸ ÄêÇ-ÚÂ‡Ô˲ ‰Îfl ‰ÂÚÂÈ, ÔÓ‰‚Â„¯ËıÒfl ‚ÓÁ‰ÂÈÒڂ˲ ÄêÇ-ÔÂÔ‡‡ÚÓ‚, ËÒÔÓθÁÓ‚‡ÌÌ˚ı ‰Îfl Ô‰ÛÔÂʉÂÌËfl èåê, ÌÂËÁ‚ÂÒÚÌÓ. ëÂȘ‡Ò, ÔÓ ‡Ì‡ÎÓ„ËË Ò Ó·ÒΉӂ‡ÌËflÏË Ï‡ÚÂÂÈ, ÔÓ‚Ó‰flÚÒfl ËÎË Ô·ÌËÛ˛ÚÒfl ËÒÒΉӂ‡ÌËfl ÒÂ‰Ë ‰ÂÚÂÈ Ò ˆÂθ˛ ‚˚flÒÌËÚ¸ ‚ÓÔÓÒ Ó ÚÓÏ, ÏÓÊÂÚ ÎË ÔÓÙË·ÍÚË͇ Ò ÔËÏÂÌÂÌËÂÏ Ó‰ÌÓÍ‡ÚÌÓÈ ‰ÓÁ˚ çÇè ÒÌËÁËÚ¸ ˝ÙÙÂÍÚË‚ÌÓÒÚ¸ ÔÓÒÎÂ‰Û˛˘ÂÈ ÇÄÄêí Ò ËÒÔÓθÁÓ‚‡ÌËÂÏ ÒıÂÏ Ì‡ ÓÒÌÓ‚Â ççàéí. Çéá ÔËÁ̇ÂÚ ·ÂÁÓÚ·„‡ÚÂθÌÓÒÚ¸ Ú‡ÍËı ËÒÒΉӂ‡ÌËÈ. é‰Ì‡ÍÓ ‰Ó ÚÂı ÔÓ, ÔÓ͇ Ì ·Û‰ÛÚ ÔÓÎÛ˜ÂÌ˚ ‰‡ÌÌ˚Â, ÍÓÚÓ˚ ÔÓÁ‚ÓÎflÚ ‰‡Ú¸ Ó‰ÌÓÁ̇˜Ì˚È ÓÚ‚ÂÚ Ì‡ ˝ÚË ‚ÓÔÓÒ˚, ‰ÂÚÂÈ, ÌÛʉ‡˛˘ËıÒfl ‚ ÄêÇ-ÚÂ‡ÔËË Ë Ô‰‚‡ËÚÂθÌÓ ÔÓÎۘ˂¯Ëı Ó‰ÌÓÍ‡ÚÌ˚ ‰ÓÁ˚ çÇè Ë áíë ‚ ÔÓfl‰Í ÔÓÙË·ÍÚËÍË èåê, ÒΉÛÂÚ Ò˜ËÚ‡Ú¸ ͇̉ˉ‡Ú‡ÏË Ì‡ ÔÓıÓʉÂÌË ÍÛÒ‡ ΘÂÌËfl ̇ ÓÒÌÓ‚Â ççàéí; ÔË ˝ÚÓÏ ËÏ Ì ÒΉÛÂÚ ÓÚ͇Á˚‚‡Ú¸ ‚ ‰ÓÒÚÛÔÂ Í ÊËÁÌÂÔÓ‰‰ÂÊË‚‡˛˘ÂÏÛ Î˜ÂÌ˲.

äÎËÌ˘ÂÒ͇fl ÓˆÂÌ͇ ‰Îfl Ï·‰Â̈‚ Ë ‰ÂÚÂÈ, ÔÓıÓ‰fl˘Ëı ÄêÇ-ÚÂ‡Ô˲ ä ‚‡ÊÌ˚Ï ÍÎËÌ˘ÂÒÍËÏ ÔËÁÌ‡Í‡Ï ‡͈ËË Ì‡ ÄêÇ ÚÂ‡Ô˲ ÓÚÌÓÒËÚÒfl ÛÎÛ˜¯ÂÌË ÔÓ͇Á‡ÚÂÎÂÈ ÙËÁ˘ÂÒÍÓ„Ó ‡Á‚ËÚËfl, ÂÒÎË ‰Ó ˝ÚÓ„Ó ·ÂÌÓÍ ÓÚÒÚ‡‚‡Î ‚ ÓÒÚÂ; ÛÎÛ˜¯ÂÌË Ì‚ÓÎӄ˘ÂÒÍËı ÒËÏÔÚÓÏÓ‚ Ë ÔÓ͇Á‡ÚÂÎÂÈ ‡Á‚ËÚËfl, ÂÒÎË Û ·ÂÌ͇ ̇·Î˛‰‡Î‡Ò¸ Á‡‰ÂÊ͇ ‡Á‚ËÚËfl ËÎË ˝ÌˆÂÙ‡ÎÓÔ‡ÚËfl; Ë/ËÎË ÒÌËÊÂÌË ˜‡ÒÚÓÚ˚ ‚ÓÁÌËÍÌÓ‚ÂÌËfl ËÌÙÂ͈ËÓÌÌ˚ı Á‡·Ó΂‡ÌËÈ (·‡ÍÚÂˇθÌ˚ı, ÏÓÎÓ˜Ìˈ˚ Ë/ËÎË ‰Û„Ëı ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍËı ËÌÙÂ͈ËÈ). ㇷÓ‡ÚÓÌ˚ ӈÂÌÍË ‰Îfl ‰ÂÚÂÈ, ÔÓıÓ‰fl˘Ëı ÄêÇ-ÚÂ‡Ô˲, ‡Ì‡Îӄ˘Ì˚ ÓˆÂÌ͇Ï, ÂÍÓÏẨÛÂÏ˚Ï ‰Îfl ‚ÁÓÒÎ˚ı (퇷Îˈ‡ G). äÓÏ ÍÎËÌ˘ÂÒÍËı ÓˆÂÌÓÍ, ÂÍÓÏẨÛÂÏ˚ı ‰Îfl ‚ÁÓÒÎ˚ı, ÍÎËÌ˘ÂÒÍËÈ ÏÓÌËÚÓËÌ„ ÄêÇ-ÚÂ‡ÔËË ÒÂ‰Ë ‰ÂÚÂÈ ‰ÓÎÊÂÌ Óı‚‡Ú˚‚‡Ú¸: ◗ ÔËÚ‡ÌËÂ Ë ÒÓÒÚÓflÌË ·ÂÌ͇ Ò ÚÓ˜ÍË ÁÂÌËfl ÔËÚ‡ÌËfl; ◗ Û‚Â΢ÂÌË ‚ÂÒ‡ Ë ÓÒÚ‡; ◗ ÔÓ͇Á‡ÚÂÎË ‡Á‚ËÚËfl; ◗ Ì‚ÓÎӄ˘ÂÒÍË ÒËÏÔÚÓÏ˚.

è˘ËÌ˚ ‰Îfl ËÁÏÂÌÂÌËfl ÄêÇ-ÚÂ‡ÔËË ‰Îfl Ï·‰Â̈‚ Ë ‰ÂÚÂÈ èË̈ËÔ˚, ÍÓÚÓ˚ ӷÛÒ·‚ÎË‚‡˛Ú ËÁÏÂÌÂÌË ÚÂ‡ÔËË Û ‰ÂÚÂÈ, ‡Ì‡Îӄ˘Ì˚ ÔË̈ËÔ‡Ï, ÔËÏÂÌËÏ˚Ï Í ‚ÁÓÒÎ˚Ï, Ô˘ÂÏ „ÛÎËÓ‚‡ÌË ÚÓÍÒ˘ÌÓÒÚË ÔÂÔ‡‡ÚÓ‚ ÓÒÚ‡ÂÚÒfl ÚÂÏ ÊÂ. ÖÒÎË ÚÓÍÒ˘ÌÓÒÚ¸ Ò‚flÁ‡Ì‡ Ò Ë‰ÂÌÚËÙˈËÛÂÏ˚Ï ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚ÓÏ, ÔËÏÂÌflÂÏÓÏ ‚ ÒÎÛ˜‡Â ‰‡ÌÌÓ„Ó ÂÊËχ ΘÂÌËfl, ÚÓ Ì··„ÓÔËflÚÌ˚È ÔÂÔ‡‡Ú ÏÓÊÌÓ Á‡ÏÂÌËÚ¸ Ó‰ÌËÏ ËÁ ÚÂı, ÍÓÚÓ˚ Ì ‰‡˛Ú ÔÓ·Ó˜ÌÓ„Ó ˝ÙÙÂÍÚ‡. ä ‚‡ÊÌ˚Ï ÍÎËÌ˘ÂÒÍËÏ ÔËÁÌ‡Í‡Ï Ì½ÙÙÂÍÚË‚ÌÓÒÚË ÚÓ„Ó ËÎË ËÌÓ„Ó ÔÂÔ‡‡Ú‡, ËÒÔÓθÁÛÂÏÓ„Ó ‰Îfl ΘÂÌËfl ‰ÂÚÂÈ, ÏÓÊÌÓ ÓÚÌÂÒÚË: ÓÚÒÛÚÒÚ‚Ë ÓÒÚ‡ Û ‰ÂÚÂÈ, Û ÍÓÚÓ˚ı ÔÓfl‚Ë·Ҹ ̇˜‡Î¸Ì‡fl ‡͈Ëfl ̇ ÚÂ‡Ô˲, ËÎË ÒÌËÊÂÌË ÚÂÏÔÓ‚ ÓÒÚ‡ Û ‰ÂÚÂÈ, Û ÍÓÚÓ˚ı ÔÓfl‚Ë·Ҹ ̇˜‡Î¸Ì‡fl ‡͈Ëfl ÓÒÚ‡ ̇ ÚÂ‡Ô˲, ËÒ˜ÂÁÌÓ‚ÂÌË ÔÓ͇Á‡ÚÂÎÂÈ

38

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

ÌÂÈÓ‡Á‚ËÚËfl ËÎË ‡Á‚ËÚË ˝ÌˆÂÙ‡ÎÓÔ‡ÚËË, ÔÓ‚ÚÓÌÓ ÔÓfl‚ÎÂÌË ËÌÙÂ͈ËË, ͇Í, ̇ÔËÏÂ, ͇̉ˉ‡ÏËÍÓÁ‡, ÍÓÚÓ˚È Ì ÔÓ‰‰‡ÂÚÒfl ΘÂÌ˲60-63 (퇷Îˈ‡ I). Ñ·ڸ ‚˚‚Ó‰˚ Ó Ì½ÙÙÂÍÚË‚ÌÓÒÚË ÄêÇ ÒıÂÏ˚ ̇ ÓÒÌÓ‚Â ÍÎËÌ˘ÂÒÍËı ÍËÚÂË‚ Ì ÒΉÛÂÚ ‰Ó ÚÂı ÔÓ, ÔÓ͇ ·ÂÌÓÍ Ì ÔÓȉÂÚ ‡ÁÛÏÌ˚È ÔÓ ‰ÎËÚÂθÌÓÒÚË ÍÛÒ Î˜ÂÌËfl (̇ÔËÏÂ, ·ÂÌÓÍ ‰ÓÎÊÂÌ ÔÓÈÚË ÒıÂÏÛ ÚÂ‡ÔËË ÔÓ‰ÓÎÊËÚÂθÌÓÒÚ¸˛ Ì ÏÂÌ 24 ̉Âθ). ÇÒΉÒÚ‚Ë ҂flÁ‡ÌÌÓ„Ó Ò ‚ÓÁ‡ÒÚÓÏ ÒÌËÊÂÌËfl ‡·ÒÓβÚÌÓ„Ó ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ CD4 ‚ ‚ÓÁ‡ÒÚ ‰Ó 6 ÎÂÚ, ÍÓ„‰‡ ‰ÓÒÚË„‡ÂÚÒfl ÛÓ‚Â̸, ·ÎËÁÍËÈ Í ‚ÁÓÒÎÓÏÛ, ˝ÚÓÚ ÔÓ͇Á‡ÚÂθ ‰ÓÒÚ‡ÚÓ˜ÌÓ ÒÎÓÊÌÓ ËÒÔÓθÁÓ‚‡Ú¸ ‰Îfl ÓˆÂÌÍË Ì½ÙÙÂÍÚË‚ÌÓÒÚË ÚÂ‡ÔËË Û ‰ÂÚÂÈ ·ÓΠÏ·‰¯Â„Ó ‚ÓÁ‡ÒÚ‡. é‰Ì‡ÍÓ ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ 6 ÎÂÚ Ë ÒÚ‡¯Â ‚ÔÓÎÌ ÔÓ‰ıÓ‰ËÚ ÍËÚÂËÈ ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ CD4, ‡Ì‡Îӄ˘Ì˚È ÚÓÏÛ, ÍÓÚÓ˚È ËÒÔÓθÁÛÂÚÒfl ‰Îfl ‚ÁÓÒÎ˚ı (퇷Îˈ‡ Ö). í‡Í Í‡Í ÔÓˆÂÌÚÌÓ ÒÓ‰ÂʇÌËfl ÍÎÂÚÓÍ CD4+ ‚‡¸ËÛÂÚÒfl Ò ‚ÓÁ‡ÒÚÓÏ, ÓÌÓ ÏÓÊÂÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡ÌÓ ‰Îfl ÓˆÂÌÍË ‡͈ËË Ì‡ ΘÂÌË ‚Ì Á‡‚ËÒËÏÓÒÚË ÓÚ ‚ÓÁ‡ÒÚ‡. óÚÓ Í‡Ò‡ÂÚÒfl ËÒÔÓθÁÓ‚‡ÌËfl Ó·˘Â„Ó ÍÓ΢ÂÒÚ‚‡ ÎËÏÙÓˆËÚÓ‚ ‰Îfl ÓˆÂÌÍË ‡͈ËË Ì‡ ÄêÇ-ÚÂ‡Ô˲, ÚÓ Ú‡ÍËı ‰‡ÌÌ˚ı Ì ÒÛ˘ÂÒÚ‚ÛÂÚ.

íÄÅãàñÄ I. åÖíéÑàäÄ éèêÖÑÖãÖçàü çÖùîîÖäíàÇçéëíà ãÖóÖçàü åãÄÑÖçñÖÇ à ÑÖíÖâ çÄ éëçéÇÖ äãàçàóÖëäàï äêàíÖêàÖÇ à èéÑëóÖíÄ CD4 äÎËÌ˘ÂÒÍË ÔËÁ̇ÍË Ì½ÙÙÂÍÚË‚ÌÓ„Ó Î˜ÂÌËfl éÚÒÛÚÒÚ‚Ë ÓÒÚ‡ Û ‰ÂÚÂÈ, Û ÍÓÚÓ˚ı ÔÓfl‚Ë·Ҹ ̇˜‡Î¸Ì‡fl ‡͈Ëfl ̇ ÚÂ‡Ô˲, ËÎË ÒÌËÊÂÌË ÚÂÏÔÓ‚ ÓÒÚ‡ Û ‰ÂÚÂÈ, Û ÍÓÚÓ˚ı ÔÓfl‚Ë·Ҹ ̇˜‡Î¸Ì‡fl ‡͈Ëfl ÓÒÚ‡ ̇ ÚÂ‡Ô˲. äËÚÂËË Ì½ÙÙÂÍÚË‚ÌÓ„Ó Î˜ÂÌËfl ÏÂÚÓ‰ÓÏ ÔÓ‰Ò˜ÂÚ‡ ÍÎÂÚÓÍ CD4 a ÇÓÁ‚‡˘ÂÌË ÔÓˆÂÌÚÌÓ„Ó ÒÓÓÚÌÓ¯ÂÌËfl ÍÎÂÚÓÍ CD4 Í ÔÂÊÌÂÏÛ ËÒıÓ‰ÌÓÏÛ ÛÓ‚Ì˛, Ô‰¯ÂÒÚ‚Ó‚‡‚¯ÂÏÛ ÚÂ‡ÔËË, ËÎË ÌËÊ (ËÎË ‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ >6 ÎÂÚ – Í ‡·ÒÓβÚÌÓÏÛ ÍÓ΢ÂÒÚ‚Û ÍÎÂÚÓÍ CD4) ÔË ÛÒÎÓ‚ËË ÓÚÒÛÚÒÚ‚Ëfl ‰Û„Ëı ÒÓÔÛÚÒÚ‚Û˛˘Ëı ËÌÙÂ͈ËÈ, ÍÓÚÓ˚ ÏÓ„ÎË ·˚ Ó·˙flÒÌËÚ¸ ‚ÂÏÂÌÌÓ ÒÌËÊÂÌË CD4. 臉ÂÌË χÍÒËχθÌÓ„Ó ÛÓ‚Ìfl ÔÓˆÂÌÚÌÓ„Ó ÒÓÓÚÌÓ¯ÂÌËfl CD4 ‚ ÔÓˆÂÒÒ ÚÂ‡ÔËË Ì‡ ‚Â΢ËÌÛ ≥50% (‰Îfl ‰ÂÚÂÈ ‚ ‚ÓÁ‡ÒÚ >6 ÎÂÚ – Í ‡·ÒÓβÚÌÓÏÛ ÍÓ΢ÂÒÚ‚Û ÍÎÂÚÓÍ CD4) ÔË ÛÒÎÓ‚ËË ÓÚÒÛÚÒÚ‚Ëfl ‰Û„Ëı ÒÓÔÛÚÒÚ‚Û˛˘Ëı ËÌÙÂ͈ËÈ, ÍÓÚÓ˚ ÏÓ„ÎË ·˚ Ó·˙flÒÌËÚ¸ ‚ÂÏÂÌÌÓ ÒÌËÊÂÌË CD4.

àÒ˜ÂÁÌÓ‚ÂÌË ÔÓ͇Á‡ÚÂÎÂÈ ÌÂÈÓ‡Á‚ËÚËfl ËÎË ‡Á‚ËÚË ˝ÌˆÂÙ‡ÎÓÔ‡ÚËË

ê‡ÒÔÓÒÚ‡ÌÂÌË ÌÓ‚ÓÈ ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍÓÈ ËÌÙÂ͈ËË ËÎË ÁÎÓ͇˜ÂÒÚ‚ÂÌÌÓÒÚË, Û͇Á˚‚‡˛˘ÂÈ Ì‡ ÍÎËÌ˘ÂÒÍÓ ‡Á‚ËÚË ·ÓÎÂÁÌË.b êˆˉ˂ ÔÂÊÌËı ÓÔÔÓÚÛÌËÒÚ˘ÂÒÍËı ËÌÙÂ͈ËÈ, ̇ÔËÏÂ, ͇̉ˉ‡ÏËÍÓÁ‡, ÍÓÚÓ˚È Ì ÔÓ‰‰‡ÂÚÒfl ΘÂÌ˲ a ÖÒÎË ·ÂÌÓÍ Ì ӷ̇ÛÊË‚‡ÂÚ ÒËÏÔÚÓÏÓ‚ Á‡·Ó΂‡ÌËfl Ë Ì½ÙÙÂÍÚË‚ÌÓÒÚ¸ ΘÂÌËfl ·˚· ÓÔ‰ÂÎÂ̇ Î˯¸ ̇ ÓÒÌÓ‚‡ÌËË ÍËÚÂË‚ ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ CD4, ÒΉÛÂÚ ‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ Ôӂ‰ÂÌËfl ÔÓ‰Ú‚Âʉ‡˛˘Â„Ó ÔÓ‰Ò˜ÂÚ‡ ÍÓ΢ÂÒÚ‚‡ ëD4, ÂÒÎË ˝ÚÓ ÔÓÁ‚ÓÎfl˛Ú ÂÒÛÒ˚. b

Ö„Ó ÒΉÛÂÚ ÓÚ΢‡Ú¸ ÓÚ ÒË̉Óχ ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌËfl ËÏÏÛÌÌÓÈ ÒËÒÚÂÏ˚, ÍÓÚÓ˚È ÏÓÊÂÚ ÔÓfl‚ËÚ¸Òfl ‚ Ú˜ÂÌË ÔÂ‚˚ı ÚÂı ÏÂÒflˆÂ‚, ÒÎÂ‰Û˛˘Ëı ÔÓÒΠ̇˜‡Î‡ ÇÄÄêí, ˜ÚÓ Ì Û͇Á˚‚‡ÂÚ Ì‡ ̽ÙÙÂÍÚË‚ÌÓÒÚ¸ ÚÂ‡ÔËË.

39

êÂÍÓÏẨÛÂÏ˚ ÒıÂÏ˚ ÄêÇ-ÚÂ‡ÔËË ‚ÚÓÓ„Ó fl‰‡ ‰Îfl Ï·‰Â̈‚ Ë ‰ÂÚÂÈ Ç ÒÎÛ˜‡Â ̽ÙÙÂÍÚË‚ÌÓÒÚË ÒıÂÏ˚ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ ÚÂ‡ÔËfl ‚ÚÓÓ„Ó fl‰‡ ‰Îfl ‰ÂÚÂÈ ‚Íβ˜‡ÂÚ ËÁÏÂÌÂÌË ÌÛÍÎÂÓÁˉÌÓÈ ÓÒÌÓ‚˚ ‚ ÒÓÓÚ‚ÂÚÒÚ‚ËË Ò ÚÂÏË Ê ÔË̈ËÔ‡ÏË, ÍÓÚÓ˚ ÔËÏÂÌËÏ˚ Ë Í ‚ÁÓÒÎ˚Ï (̇ÔËÏÂ, Ò áÑÇ + áíë ̇ ÄÅä + ddl), ÔÎ˛Ò ËÌ„Ë·ËÚÓ ÔÓÚ‡Á˚ (퇷Îˈ‡ J). àÒÔÓθÁÓ‚‡ÌË ‰Îfl ‰ÂÚÂÈ àè, ËÌÓ„Ó, ˜ÂÏ ãèÇ/ Ë çîÇ, fl‚ÎflÂÚÒfl ·ÓΠÔÓ·ÎÂχÚ˘Ì˚Ï ‚ÒΉÒÚ‚Ë ÓÚÒÛÚÒÚ‚Ëfl ÔËÏÂÌËÏ˚ı Ô‰ˇÚ˘ÂÒÍËı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÙÓÏ ‰Îfl àÑÇ Ë ëäÇ Ë ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘ÂÈ ËÌÙÓχˆËË Ó ‰ÓÁËÓ‚Í ËÌ„Ë·ËÚÓÓ‚ ÔÓÚ‡Á˚, ÛÒËÎÂÌÌ˚ı ÂÚÓ̇‚ËÓÏ, ËÌ˚ı ˜ÂÏ ãèÇ/. íÂÏ Ì ÏÂÌ ËÒÔÓθÁÓ‚‡ÌË ëäÇ/ ÏÓÊÌÓ Ò˜ËÚ‡Ú¸ ‡Î¸ÚÂ̇ÚË‚ÌÓÈ ÚÂ‡ÔËÂÈ ‰Îfl ‰ÂÚÂÈ, ÍÓÚÓ˚ ÏÓ„ÛÚ „ÎÓÚ‡Ú¸ ͇ÔÒÛÎ˚ Ë ‚ÂÒ ÍÓÚÓ˚ı ÒÓÒÚ‡‚ÎflÂÚ 25 Í„ ËÎË ·ÓÎÂÂ, ˜ÚÓ ÔÓÁ‚ÓÎflÂÚ ËÏ ÔËÌËχڸ ‚ÁÓÒÎ˚ ‰ÓÁ˚. Ç Ì‡ÒÚÓfl˘Â ‚ÂÏfl íÑî ÌÂθÁfl ÂÍÓÏẨӂ‡Ú¸ ‰Îfl Ô‰ˇÚ˘ÂÒÍÓ„Ó Î˜ÂÌËfl ‚ÒΉÒÚ‚Ë ÌÂı‚‡ÚÍË ‰‡ÌÌ˚ı, ͇҇˛˘ËıÒfl ̇‰ÎÂʇ˘ÂÈ ‰ÓÁËÓ‚ÍË ‰Îfl ‰ÂÚÂÈ, ‚ ÓÒÓ·ÂÌÌÓÒÚË Ï·‰¯Â 8 ÎÂÚ, ‡ Ú‡ÍÊ ‚ÒΉÒÚ‚Ë ̇΢Ëfl ÔÓ·ÎÂÏ˚ ÚÓÍÒ˘ÌÓÒÚË, ÔÓ‰‡‚Îfl˛˘ÂÈ ÍÓÒÚÌ˚È ÏÓÁ„, ÍÓÚÓ‡fl ÏÓÊÂÚ ÒÚÓflÚ¸ ·ÓΠÓÒÚÓ Ë/ËÎË ˜‡˘Â ‚ÓÁÌË͇ڸ ÒÂ‰Ë ÔÓ‰ÓÒÚÍÓ‚, ÌÂÊÂÎË ‚ÁÓÒÎ˚ı.

íÄÅãàñÄ J. êÖäéåÖçÑìÖåõÖ ëïÖåõ ÄêÇ íÖêÄèàà Ñãü åãÄÑÖçñÖÇ à ÑÖíÖâ, ãÖóÖçàÖ äéíéêõï éäÄáÄãéëú çÖùîîÖäíàÇçõå ëıÂχ ÔÂ‚Ó„Ó fl‰‡ d4T ËÎË áÑÇ ëıÂχ ‚ÚÓÓ„Ó fl‰‡ ÄÅä

ÔÎ˛Ò áíë ÔÎ˛Ò ççàéí: çÇè ËÎË ùîñ

ÔÎ˛Ò ddl ÔÎ˛Ò àÌ„Ë·ËÚÓ ÔÓÚ‡Á˚: ãèÇ/ ËÎË çîÇ, ËÎË ëäÇ/, ÂÒÎË ‚ÂÒ ≥25 Í„

ë. ãûÑà, ÅéãúçõÖ íìÅÖêäìãÖáéå, ë ëéèìíëíÇìûôÖâ Çàó-àçîÖäñàÖâ íÛ·ÂÍÛÎÂÁ fl‚ÎflÂÚÒfl ÔÓ͇Á‡ÌËÂÏ ‰Îfl Á̇˜ËÚÂθÌÓ„Ó ÍÓ΢ÂÒÚ‚‡ Ô‡ˆËÂÌÚÓ‚Ë ‰Îfl Ôӂ‰ÂÌËfl Äêí. Äêí ÂÍÓÏẨÛÂÚÒfl ‰Îfl ‚ÒÂı ·ÓθÌ˚ı íÅ, Û ÍÓÚÓ˚ı ÍÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ CD4 ÌËÊ 200 /ÏÏ3 Ë ‰ÓÎÊ̇ Ú‡ÍÊ ·˚Ú¸ ‡ÒÒÏÓÚÂÚÂ̇ ‰Îfl Ô‡ˆËÂÌÚÓ‚ Ò ÍÓ΢ÂÒÚ‚ÓÏ ÍÎÂÚÓÍ CD4 ÌËÊ 350/ÏÏ3. Ç ÒÎÛ˜‡Â ÓÚÒÛÚÒÚ‚Ëfl ‰‡ÌÌ˚ı Ó ÍÓ΢ÂÒÚ‚Â ÍÎÂÚÓÍ CD4 Äêí ÂÍÓÏẨÛÂÚÒfl ‰Îfl ‚ÒÂı ·ÓθÌ˚ı íÅ. Ç ÔË̈ËÔÂ, ÔËÁ̇ÂÚÒfl, ˜ÚÓ ˝ÚÓ ‰‡ÂÚ ‚ÓÁÏÓÊÌÓÒÚ¸ ΘËÚ¸ Ô‡ˆËÂÌÚÓ‚ Ò ÍÓ΢ÂÒÚ‚ÓÏ ÍÎÂÚÓÍ CD4 ·ÓΠ350/ÏÏ3, ÍÓÚÓ˚ ‚ ÔÓÚË‚ÌÓÏ ÒÎÛ˜‡Â Ì ÔÓÎÛ˜ËÎË ·˚ ‰ÓÒÚÛÔ‡ Í Äêí. ã˜ÂÌË íÅ ÓÒÚ‡ÂÚÒfl „·‚Ì˚Ï ÔËÓËÚÂÚÓÏ ‰Îfl ‚‰ÂÌËfl Ô‡ˆËÂÌÚÓ‚ Ë Ì ‰ÓÎÊÌÓ ÒÚ‡‚ËÚ¸Òfl ÔÓ‰ Û„ÓÁÛ ‚ ÂÁÛθڇÚ ÔËÏÂÌÂÌËfl Äêí64—67. 臈ËÂÌÚ˚, ·ÓθÌ˚ íÅ, Á‡ÒÎÛÊË‚‡˛Ú ÓÒÓ·Ó„Ó ‚ÌËχÌËfl, Ú‡Í Í‡Í Ô‡‡ÎÎÂθÌӠΘÂÌË Çàó Ë íÅ ÛÒÎÓÊÌflÂÚÒfl ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂÏ ËÙ‡ÏÔˈË̇ Ò ççàéí Ë àè, ÎÂ͇ÒÚ‚ÂÌÌÓÈ Ì‡„ÛÁÍÓÈ ÓÚ ÔËÌËχÂÏ˚ı Ú‡·ÎÂÚÓÍ, Òӷβ‰ÂÌËÂÏ ÍÛÒ‡ ΘÂÌËfl Ë ÚÓÍÒ˘ÌÓÒÚ¸˛ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚. èÓÒÍÓθÍÛ ‰‡ÌÌ˚Â, ̇ ÓÒÌÓ‚Â ÍÓÚÓ˚ı ‡Á‡·‡Ú˚‚‡˛ÚÒfl ÍÓÌÍÂÚÌ˚ ÂÍÓÏẨ‡ˆËË ÔÓ Î˜ÂÌ˲, ̉ÓÒÚ‡ÚÓ˜Ì˚, ÌÂÓ·ıÓ‰ËÏÓ ÒÓ˜ÌÓ ÔÓ‚ÂÒÚË ËÒÒÎÂ-

40

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

‰Ó‚‡ÌËfl ‚ ˝ÚÓÈ Ó·Î‡ÒÚË68-71. ë Û˜ÂÚÓÏ Ëϲ˘ËıÒfl ̇ Ò„ӉÌfl¯ÌËÈ ‰Â̸ ‰‡ÌÌ˚ı, ÂÍÓÏẨ‡ˆËË ÔÓ ÒıÂÏ ÚÂ‡ÔËË ÔÂ‚Ó„Ó fl‰‡ ‰Îfl Ô‡ˆËÂÌÚÓ‚, ·ÓθÌ˚ı Ó‰ÌÓ‚ÂÏÂÌÌÓ íÅ Ë Çàó, ‚Íβ˜‡˛Ú ÔËÏÂÌÂÌË (áÑÇ ËÎË d4T) + áíë + ùîñ (600 ËÎË 800 Ï„/‰Â̸). ÑÓÁ‡ ‚ 800 Ï„ ùîñ ÔÓÁ‚ÓÎflÂÚ ‰ÓÒÚ˘¸ ·ÓΠ‚˚ÒÓÍËı ÛÓ‚ÌÂÈ ÎÂ͇ÒÚ‚ÂÌÌÓÈ ˝ÙÙÂÍÚË‚ÌÓÒÚË, ÔÓ Ò‡‚ÌÂÌ˲ Ò ÚÂÏË, ÍÓÚÓ˚ ̇·Î˛‰‡˛ÚÒfl ‚ ÒÎÛ˜‡Â ÓÚÒÛÚÒÚ‚Ëfl ËÙ‡ÏÔˈË̇, Ë ÒÌËÁËÚ¸ ‚ÂÓflÚÌÓÒÚ¸ ÂÁËÒÚÂÌÚÌÓÒÚË Çàó Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï. íÂÏ Ì ÏÂÌÂÂ, ˝ÚÓ Ú‡ÍÊ ÏÓÊÂÚ ÔÓ‚˚ÒËÚ¸ ÓÔ‡ÒÌÓÒÚ¸ ËÌÚÓÍÒË͇ˆËË. ÄθÚÂ̇ÚË‚ÓÈ ùîñ ÏÓ„ÛÚ ÒÎÛÊËÚ¸ ëäÇ/êíÇ 400/400 Ï„ ‰‚‡ ‡Á‡ ‚ ‰Â̸, ëäÇ/ 1600/200Ï„ Ó‰ËÌ ‡Á ‚ ‰Â̸ (‚ ÙÓÏ Ïfl„ÍÓ„Ó „ÂÎfl ‚ ͇ÔÒÛ·ı) ËÎË ãèÇ/êíÇ 400/400 Ï„ ‰‚‡ ‡Á‡ ‚ ‰Â̸ ‚ ÒÓ˜ÂÚ‡ÌËË Ò ÓÒÌÓ‚ÓÈ çàéí, ıÓÚfl ÔÂÂÌÓÒËÏÓÒÚ¸, ÍÎËÌ˘ÂÒÍËÈ ÏÓÌËÚÓËÌ„ Ë ËÒÍ, Ò‚flÁ‡ÌÌ˚È Ò ÂÁËÒÚÂÌÚÌÓÒÚ¸˛, ÔË ˝ÚÓÏ ÓÒÚ‡˛ÚÒfl ÌÂflÒÌ˚ÏË. ÑÎfl Ó‰Ó·ÂÌËfl ˝ÚËı ÒıÂÏ, ÓÒÌÓ‚‡ÌÌ˚ı ̇ àè, Ú·ÛÂÚÒfl ‰ÓÔÓÎÌËÚÂθ̇fl ËÌÙÓχˆËfl. ֢ ӉÌÓÈ ‡Î¸ÚÂ̇ÚË‚ÓÈ ùîñ fl‚ÎflÂÚÒfl ÄÅä, ÔÂËÏÛ˘ÂÒÚ‚‡ ÍÓÚÓÓ„Ó Á‡Íβ˜‡˛ÚÒfl ‚ ÌËÁÍÓÏ ÛÓ‚Ì ÎÂ͇ÒÚ‚ÂÌÌÓÈ Ì‡„ÛÁÍË ÓÚ ÔËÌËχÂÏ˚ı Ú‡·ÎÂÚÓÍ, ÓÚÒÛÚÒÚ‚ËÂÏ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ò ËÙ‡ÏÔˈËÌÓÏ Ë ‚ÓÁÏÓÊÌÓÒÚ¸˛ Â„Ó ÔËÂχ ‰ÂÚ¸ÏË ‚ÂÒÓÏ 25 Í„ ËÎË ÏÂ̸¯Â, ‰Îfl ÍÓÚÓ˚ı ¢ ÌÂÚ ËÌÙÓχˆËË Ó ‰ÓÁËÓ‚Í ùîñ. çÂflÒÌ˚ ‚ÓÔÓÒ˚ ÔÓ ˝ÚÓÈ ÒıÂÏ ҂flÁ‡Ì˚ Î˯¸ Ò ÏÓÌËÚÓËÌ„ÓÏ ÒËÏÔÚÓχ „ËÔÂ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚË Ë ÔÓÚË‚Ó‚ËÛÒÌÓÈ ‡ÍÚË‚ÌÓÒÚË. чÌÌ˚Â Ó ÔËÏÂÌÂÌËË çÇè + ËÙ‡ÏÔˈË̇ ÒÍÛ‰Ì˚ Ë ÔÓÚË‚Ó˜˂˚. Ç ÔËÒÛÚÒÚ‚ËË ËÙ‡ÏÔˈË̇ ÛÓ‚ÌË çÇè ÒÌËʇ˛ÚÒfl, ‡ ÔËÏÂÌÂÌË ‰ÓÁ çÇè ·ÓΠ‚˚ÒÓÍÓ„Ó ÔÓfl‰Í‡ ÔÓ͇ Ì ӈÂÌÂÌÓ. ïÓÚfl ÌÂÍÓÚÓ˚ ÍÎËÌ˘ÂÒÍË ˝ÍÒÔÂËÏÂÌÚ˚ ÔÓ͇Á˚‚‡˛Ú ‡‰ÂÍ‚‡ÚÌÛ˛ ‚ËÛÒÌÛ˛ Ë ËÏÏÛÌÓÎӄ˘ÂÒÍÛ˛ Â‡ÍˆË˛ Ë ÔËÂÏÎÂÏÛ˛ ÚÓÍÒ˘ÌÓÒÚ¸, ˝ÚÛ ÒıÂÏÛ ‚Ò Ê ÒΉÛÂÚ ‡ÒÒχÚË‚‡Ú¸ ÚÓθÍÓ ÚÓ„‰‡, ÍÓ„‰‡ ‰Û„Ëı ‚‡ˇÌÚÓ‚ Ì ÒÛ˘ÂÒÚ‚ÛÂÚ. ÑÎfl ÊÂÌ˘ËÌ ÂÔÓ‰ÛÍÚË‚ÌÓ„Ó ‚ÓÁ‡ÒÚ‡ (Ì ÔÓθÁÛ˛˘ËıÒfl ˝ÙÙÂÍÚË‚Ì˚ÏË ÍÓÌÚ‡ˆÂÔÚË‚‡ÏË), ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ Ë ‰ÂÚÂÈ, ·ÓθÌ˚ı íÅ, ÂÍÓÏẨÛÂÚÒfl ÔËÏÂÌÂÌË ëäÇ/ ËÎË ÄÅä + (d4T ËÎË áÑÇ) + áíë. ÑÎfl ‰ÂÚÂÈ ‚ÂÒÓÏ 25 Í„ ËÎË ÏÂ̸¯Â ‚ ͇˜ÂÒÚ‚Â ‡Î¸ÚÂ̇ÚË‚ÌÓÈ ÒıÂÏ˚ ÂÍÓÏẨÛÂÚÒfl (d4T ËÎË áÑÇ)/ áíë/ÄÅä72-79. éÔÚËχθÌ˚È ÏÓÏÂÌÚ ‚ÂÏÂÌË, ÍÓ„‰‡ ÏÓÊÌÓ Ì‡˜Ë̇ڸ ÔËÏÂÌÂÌË Äêí, ÌÂËÁ‚ÂÒÚÂÌ. Ç Ú˜ÂÌË ÔÂ‚˚ı ‰‚Ûı ÏÂÒflˆÂ‚ ÛÓ‚Â̸ ÒÏÂÚÌÓÒÚË ÒÂ‰Ë ÏÌÓ„Ëı Ô‡ˆËÂÌÚÓ‚, ·ÓθÌ˚ı íÅ, ‚˚ÒÓÍ, ÓÒÓ·ÂÌÌÓ ‚ ÚÂı ÒÎÛ˜‡flı, ÍÓ„‰‡ ÓÌË Ì‡ıÓ‰flÚÒfl ̇ ÔÓÁ‰ÌÂÈ ÒÚ‡‰ËË Çàó. Ç Ú‡ÍÓÈ ÒËÚÛ‡ˆËË Äêí ÏÓÊÂÚ Ó͇Á‡Ú¸Òfl ÒÔ‡ÒËÚÂθÌÓÈ. ë ‰Û„ÓÈ ÒÚÓÓÌ˚, ‚ ÔÓˆÂÒÒ ÓÔ‰ÂÎÂÌËfl ̇˷ÓΠÔÓ‰ıÓ‰fl˘Â„Ó ÏÓÏÂÌÚ‡ ‚ÂÏÂÌË, ÍÓ„‰‡ ÏÓÊÌÓ ÔËÒÚÛÔ‡Ú¸ Í ÚÂ‡ÔËË, ÒΉÛÂÚ ÔËÌËχڸ ‚Ó ‚ÌËχÌË ÎÂ͇ÒÚ‚ÂÌÌÛ˛ ̇„ÛÁÍÛ ÓÚ ÔËÌËχÂÏ˚ı Ú‡·ÎÂÚÓÍ, ÎÂ͇ÒÚ‚ÂÌÌÓ ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂ, ÔÓÚÂ̈ˇθÌÛ˛ ÚÓÍÒ˘ÌÓÒÚ¸ Ë ÒË̉ÓÏ ‚ÓÒÒÚ‡ÌÓ‚ÎÂÌËfl ËÏÏÛÌÌÓÈ ÒËÒÚÂÏ˚68, 69, 80, 81. ljÂÌË ԇˆËÂÌÚÓ‚ ·ÓθÌ˚ı Çàó Ë íÅ Ò‚flÁ‡ÌÓ ÒÓ ÏÌÓ„ËÏË ÔÓ·ÎÂχÏË, ‚Íβ˜‡fl Ë ÔÓ·ÎÂÏÛ ÔÓÎÛ˜ÂÌËfl Òӄ·ÒËfl Ô‡ˆËÂÌÚ‡ ̇ ΘÂÌË ÔÓ Ó·ÓËÏ ‰Ë‡„ÌÓÁ‡Ï. ÑÓ ÔÓÎÛ˜ÂÌËfl ÂÁÛθڇÚÓ‚ ÚÂÍÛ˘Ëı ËÒÒΉӂ‡ÌËÈ, Çéá ÂÍÓÏẨÛÂÚ Ì‡˜Ë̇ڸ ÔËÏÂÌÂÌË Äêí ̇ Ô‡ˆËÂÌÚ‡ı Ò ÍÓ΢ÂÒÚ‚ÓÏ ÍÎÂÚÓÍ CD4 ÏÂÌ 200/ÏÏ3 ‚ ÔÓÏÂÊÛÚÍ ÓÚ ‰‚Ûı ̉Âθ ‰Ó ‰‚Ûı ÏÂÒflˆÂ‚ ÔÓÒΠ̇˜‡Î‡ ΘÂÌËfl íÅ, ÍÓ„‰‡ ‚ ÔÓˆÂÒÒ ˝ÚÓ„Ó Î˜ÂÌËfl ÒÓÒÚÓflÌË ԇˆËÂÌÚ‡ ÒÚ‡·ËÎËÁËÓ‚‡ÎÓÒ¸. ùÚ‡ ‚ÂÏÂÌ̇fl ÂÍÓÏẨ‡ˆËfl ËÏÂÂÚ ˆÂθ˛ ÒÓ‰ÂÈÒÚ‚Ó‚‡Ú¸ ·˚ÒÚÓÏÛ ÔËÏÂÌÂÌ˲ ÚÂ‡ÔËË ÒÂ‰Ë ÚÂı „ÛÔÔ Ô‡ˆËÂÌÚÓ‚, ‰Îfl ÍÓÚÓ˚ı ı‡‡ÍÚÂÂÌ ‚˚ÒÓÍËÈ ÛÓ‚Â̸ ÒÏÂÚÌÓÒÚË. íÂÏ Ì ÏÂÌÂÂ, ‚ ˆÂÎÓÏ fl‰Â ‡Á΢Ì˚ı ÍÎËÌ˘ÂÒÍËı ÒËÚÛ‡ˆËÈ Ì‡˜‡ÎÓ Äêí ÏÓÊÌÓ ‚ÔÓÎÌ ÓÚÎÓÊËÚ¸. ç‡ÔËÏÂ, ‰Îfl Ô‡ˆËÂÌÚÓ‚ Ò ·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ÍÎÂÚÓÍ CD4 ‚ÓÁÓ·ÌÓ‚ÎÂÌË Äêí ÏÓÊÌÓ ÓÚÎÓÊËÚ¸, ‚ ÔÓfl‰Í ÛÔÓ˘ÂÌËfl ‚‰ÂÌËfl ΘÂÌËfl, ‰Ó ÚÓ„Ó ÏÓÏÂÌÚ‡, ÔÓ͇ Ì ·Û‰ÂÚ Á‡‚Â¯Â̇ ‚‚Ӊ̇fl Ù‡Á‡ ÚÂ‡ÔËË íÅ.

41

íÄÅãàñÄ L. êÖäéåÖçÑÄñàà èé Äêí Ñãü ãûÑÖâ, äéàçîàñàêéÇÄççõï íÅ à Çàó äÓ΢ÂÒÚ‚Ó ÍÎÂÚÓÍ CD4 CD4 <200 ÏÏ3 êÂÍÓÏẨÛÂχfl ÒıÂχ 燘‡Ú¸ ΘÂÌË íÅ. 燘‡Ú¸ Äêí Í‡Í ÚÓθÍÓ ·ÓθÌÓÈ ÔÓfl‚ËÚ ÚÓÎÂ‡ÌÚÌÓÒÚ¸ Í Î˜ÂÌ˲ íÅ (ÓÚ 2 ̉Âθ ‰Ó 2 ÏÂÒflˆÂ‚) a: ëıÂÏ˚ Ò ÔËÏÂÌÂÌËÂÏ ùîñb, c, d. CD4 200-350/ÏÏ3 èËϘ‡ÌËfl êÂÍÓÏẨӂ‡Ú¸ Äêí. ùîñ ÔÓÚË‚Óԇ͇Á‡Ì ‰Îfl ·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ Ë ÊÂÌ˘ËÌ ÂÔÓ‰ÛÍÚË‚ÌÓ„Ó ‚ÓÁ‡ÒÚ‡, Ì ÔÓθÁÛ˛˘ËıÒfl ˝ÙÙÂÍÚË‚Ì˚ÏË ÍÓÌÚ‡ˆÂÔÚË‚‡ÏË.

ê‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊ燘‡Ú¸ ΘÂÌËÂ. 燘‡Ú¸ ÌÓÒÚ¸ ÔËÏÂÌÂÌËfl Aêí. Ó‰ÌÛ ËÁ Ô˂‰ÂÌÌ˚ı ÌËÊ ÒıÂÏ ÔÓ Á‡‚Â¯ÂÌËË Ì‡˜‡Î¸ÌÓÈ Ù‡Á˚ ΘÂÌËfl (̇˜‡Ú¸ ‡Ì¸¯Â ‚ ÒÎÛ˜‡Â ÂÁÍÓ„Ó ÒÌËÊÂÌËfl ˝ÙÙÂÍÚË‚ÌÓÒÚË): ëıÂÏ˚ Ò ÔËÏÂÌÂÌËÂÏ ùîñ b àÎË ÒıÂÏ˚ Ò ÔËÏÂÌÂÌËÂÏ çÇè ‚ ÒÎÛ˜‡Â ÔÓ‰ÓÎÊÂÌËfl ÒıÂÏ˚ ΘÂÌËfl íÅ ·ÂÁ ËÙ‡ÏÔˈË̇

CD4 >350 ÏÏ3 CD4 (‰‡ÌÌ˚ı ÌÂÚ)

燘‡Ú¸ ΘÂÌË íÅ. 燘‡Ú¸ ΘÂÌË íÅ

éÚÎÓÊËÚ¸ AêTe. ê‡ÒÒÏÓÚÂÚ¸ ‚ÓÁÏÓÊÌÓÒÚ¸ ÔËÏÂÌÂÌËfl AêTa, f

a Ç˚·Ó ÏÓÏÂÌÚ‡ ‚ÂÏÂÌË, ÍÓ„‰‡ ̇˜Ë̇ڸ ΘÂÌËÂ, ‰ÓÎÊÂÌ ÔÓËÁ‚Ó‰ËÚ¸Òfl ̇ ÓÒÌÓ‚Â ÍÎËÌ˘ÂÒÍÓ„Ó Á‡Íβ˜ÂÌËfl Ò Û˜ÂÚÓÏ ‰Û„Ëı ÔËÁ̇ÍÓ‚ ËÏÏÛÌÓ‰ÂÙˈËÚ‡ (퇷Îˈ‡ Ä). ÑÎfl ‚ÌÂ΄ӘÌÓ„Ó ÚÛ·ÂÍÛÎÂÁ‡, Äêí ÌÂÓ·ıÓ‰ËÏÓ Ì‡˜Ë̇ڸ, Í‡Í ÚÓθÍÓ ·ÓθÌÓÈ ÔÓfl‚ËÚ ÚÓÎÂ‡ÌÚÌÓÒÚ¸ Í Î˜ÂÌ˲ íÅ, ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÍÓ΢ÂÒÚ‚‡ ÍÎÂÚÓÍ ëD4.

d

ëıÂÏ˚ Ò ÔËÏÂÌÂÌËÂÏ ùîñ ‚Íβ˜‡˛Ú d4T/ áíë/ùîñ Ë áÑÇ/ áíë/ùîñ.

e íÓθÍÓ ÔË ÓÚÒÛÚÒÚ‚ËË ÒËÏÔÚÓÏÓ‚ íṦ ÒÚ‡‰ËË IV (퇷Îˈ‡ Ä). Ç ÔÓÚË‚ÌÓÏ ÒÎÛ˜‡Â ÒΉÛÂÚ Ì‡˜Ë̇ڸ Äêí ÔÓ Á‡‚Â¯ÂÌ˲ ΘÂÌËfl íÅ.

ÄθÚÂ̇ÚË‚˚ ÌÂÍÓÚÓ˚Ï ÒıÂÏ‡Ï Ò ÔËÏÂÌÂÌËÂÏ ùîñ ‚Íβ˜‡˛Ú: ëäÇ/ê (400/400 Ï„ ‰‚‡ ‡Á‡ ‚ ‰Â̸, ëäÇ/ 1600/200Ï„ Ó‰ËÌ ‡Á ‚ ‰Â̸ ‚ ÙÓÏ Ïfl„ÍÓ„Ó „ÂÎfl ‚ ͇ÔÒÛ·ı), ãèÇ/ê (400/400 Ï„ ‰‚‡ ‡Á‡ ‚ ‰Â̸) Ë ÄÅä. c çÇè (200 Ï„ Ó‰ËÌ ‡Á ‚ ‰Â̸ ‚ Ú˜ÂÌË ‰‚Ûı ̉Âθ, Á‡ÚÂÏ 200 Ï„ ‰‚‡ ‡Á‡ ‚ ‰Â̸) ÏÓÊÂÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì ‚ÏÂÒÚÓ ùîñ ‚ ÒÎÛ˜‡Â ÓÚÒÛÚÒÚ‚Ëfl ‰Û„Ëı ‚‡ˇÌÚÓ‚. ëıÂÏ˚ Ò ÔËÏÂÌÂÌËÂÏ çÇè ‚Íβ˜‡˛Ú: d4T/áíë/çÇè ËÎË áÑÇ/ áíë/çÇè.

b

f ÖÒÎË ‰Û„Ëı ÔËÁ̇ÍÓ‚ ËÏÏÛÌÓ‰ÂÙˈËÚ‡ Ì ̇·Î˛‰‡ÂÚÒfl Ë ÒÓÒÚÓflÌË ԇˆËÂÌÚ‡ ‚ ÂÁÛθڇڠΘÂÌËfl íÅ ÛÎÛ˜¯‡ÂÚÒfl, Äêí ÒΉÛÂÚ Ì‡˜Ë̇ڸ ÔÓ Á‡‚Â¯ÂÌ˲ ΘÂÌËfl íÅ.

42

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

D. èéíêÖÅàíÖãà àçöÖäñàéççõï çÄêäéíàäéÇ äÎËÌ˘ÂÒÍËÂ Ë ËÏÏÛÌÓÎӄ˘ÂÒÍË ÍËÚÂËË ÔËÏÂÌÂÌËfl ÇÄÄêí ÒÂ‰Ë Ô‡ˆËÂÌÚÓ‚ Ò Ì‡ÍÓÚ˘ÂÒÍÓÈ Á‡‚ËÒËÏÓÒÚ¸˛ Ì ÓÚ΢‡ÂÚÒfl ÓÚ ÚÂı, ̇ ÍÓÚÓ˚ı ÓÒÌÓ‚‡Ì˚ Ó·˘Ë ÂÍÓÏẨ‡ˆËË. èÓ˝ÚÓÏÛ ÔÓÚ·ËÚÂÎflÏ ËÌ˙Â͈ËÓÌÌ˚ı ̇ÍÓÚËÍÓ‚, ÍÓÚÓ˚ fl‚Îfl˛ÚÒfl ͇̉ˉ‡Ú‡ÏË Ì‡ ÔÓıÓʉÂÌË Äêí, ÒΉÛÂÚ „‡‡ÌÚËÓ‚‡Ú¸ ‰ÓÒÚÛÔ Í ˝ÚÓÈ ÒÔ‡ÒËÚÂθÌÓÈ ÚÂ‡ÔËË. ëÔˆËÙ˘ÂÒÍË ÔÓ·ÎÂÏ˚, Ò‚flÁ‡ÌÌ˚Â Ò ˝ÚÓÈ Í‡Ú„ÓËÂÈ ·ÓθÌ˚ı, Á‡Íβ˜‡˛ÚÒfl ‚ ÚÓÏ, ˜ÚÓ Ëı ΘÂÌË ‚Ó ÏÌÓ„Ëı ÒÎÛ˜‡flı ·Û‰ÂÚ ÔÓ‚Ó‰ËÚ¸Òfl ̇ ÙÓÌ ·ÂÒÔÓfl‰Ó˜ÌÓ„Ó Ó·‡Á‡ ÊËÁÌË, ÍÓÚÓ˚È Ì ÔÓÁ‚ÓÎflÂÚ Òӷβ‰‡Ú¸ ÒıÂÏÛ Ì‡Á̇˜ÂÌÌÓÈ ÚÂ‡ÔËË. äÓÏ ÚÓ„Ó, ÌÂÓ·ıÓ‰ËÏÓ ÔËÌËχڸ ‚Ó ‚ÌËχÌË ‚ÓÁÏÓÊÌÓÒÚ¸ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl ÄêÇÔÂÔ‡‡ÚÓ‚ Ò Ú‡ÍËÏË ‚¢ÂÒÚ‚‡ÏË, Í‡Í ÏÂÚ‡‰ÓÌ. Ç ˝ÚÓÈ Ò‚flÁË ÒΉÛÂÚ ÔÓÓ˘flÚ¸ ‡Á‡·ÓÚÍÛ ÔÓ„‡ÏÏ, ÍÓÚÓ˚ ÔÓÁ‚ÓÎfl˛Ú Ó‰ÌÓ‚ÂÏÂÌÌÓ Î˜ËÚ¸ ̇ÍÓÚ˘ÂÒÍÛ˛ Á‡‚ËÒËÏÓÒÚ¸ (‚Íβ˜‡fl ÚÂ‡Ô˲ Á‡Ï¢ÂÌËfl ̇ÍÓÚË͇) Ë ÇàóËÌÙÂÍˆË˛. Ç Ú‡ÍÓÈ ÒËÚÛ‡ˆËË ˆÂÎÂÒÓÓ·‡ÁÌÓ ÔËÏÂÌflÚ¸ ÍÓ̈ÂÔˆËË Í‡ÚÍÓÒÓ˜ÌÓ„Ó ÍÛÒ‡ ΘÂÌËfl ÔÓ‰ ωˈËÌÒÍËÏ ÍÓÌÚÓÎÂÏ. Ç Ì‡ÒÚÓfl˘Â ‚ÂÏfl ÒÂ‰Ë ·ÓθÌ˚ı ˝ÚÓÈ Í‡Ú„ÓËË ËÁÛ˜‡ÂÚÒfl ‚ÓÁÏÓÊÌÓÒÚ¸ ÔËÏÂÌÂÌËfl ÒıÂÏ Ò Ó‰ÌÓÍ‡ÚÌ˚Ï Âʉ̂Ì˚Ï ÔËÂÏÓÏ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚, ÍÓÚÓ˚ ÔÓ‰Ú‚Âʉ‡˛Ú Ô‡‚ËθÌÓÒÚ¸ ˝ÚÓÈ ÍÓ̈ÂÔˆËË. äÓ΢ÂÒÚ‚Ó Ó‰Ó·ÂÌÌ˚ı ËÎË ËÒÒΉӂ‡ÌÌ˚ı ÄêÇ-ÔÂÔ‡‡ÚÓ‚ ‰Îfl Ó‰ÌÓÍ‡ÚÌÓ„Ó Âʉ̂ÌÓ„Ó ÔËÂχ ÌÂÛÍÎÓÌÌÓ ‡ÒÚÂÚ. éÌË ‚Íβ˜‡˛Ú áíë, ùíñ, ddl, d4T, íÑî, ÄÅä, ùîñ, ëäÇ/, ãèÇ/ Ë ÄíÇ. ëÓ‚ÏÂÒÚÌÓ ÔËÏÂÌÂÌË ÏÂÚ‡‰Ó̇ Ò ùîñ, çÇè ËÎË êíÇ ÒÂ‰Ë Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ı β‰ÂÈ, ‰ÎËÚÂθÌÓ ‚ÂÏfl ÔÓÚ·Îfl˛˘Ëı ËÌ˙Â͈ËÓÌÌ˚ ̇ÍÓÚËÍË, ‚˚Á‚‡ÎÓ ÒÌËÊÂÌË ÛÓ‚Ìfl ÏÂÚ‡‰Ó̇ ‚ Ô·ÁÏÂ Ë ÔËÁ̇ÍÓ‚ ÒË̉Óχ ÓÚÏÂÌ˚ ÓÔËÓˉӂ. Ç ˝ÚÓÈ Ò‚flÁË ÒΉÛÂÚ ÔÓ‚Ó‰ËÚ¸ ̇·Î˛‰ÂÌË Á‡ ÔÓfl‚ÎÂÌËÂÏ Û Ô‡ˆËÂÌÚÓ‚ ÔËÁ̇ÍÓ‚ ˝ÚÓ„Ó ÒË̉Óχ, ‡ ‚‚Ó‰ËÏÛ˛ ËÏ ‰ÓÁÛ ÏÂÚ‡‰Ó̇ ÒΉÛÂÚ ÒÓ ‚ÂÏÂÌÂÏ ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘ËÏ Ó·‡ÁÓÏ Û‚Â΢˂‡Ú¸, Ò ÚÂÏ ˜ÚÓ·˚ ÓÒ··ËÚ¸ ÒËÏÔÚÓÏ˚ ÒË̉Óχ ÓÚÏÂÌ˚. í‡ÍËÏ Ó·‡ÁÓÏ, ÏÓÊÂÚ ·˚Ú¸ Ó·ÂÒÔ˜ÂÌ ‚‡ÊÌ˚È ‚‡ˇÌÚ ÚÂ‡Ô‚Ú˘ÂÒÍËı ÔÓ„‡ÏÏ, ÓËÂÌÚËÓ‚‡ÌÌ˚ı ̇ ˝ÚÛ ÛflÁ‚ËÏÛ˛ „ÛÔÔÛ Ô‡ˆËÂÌÚÓ‚.

43

IX. ëéÅãûÑÖçàÖ êÖÜàåÄ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà

é

·˘ÂÔËÁ̇ÌÌÓ, ˜ÚÓ Ó‰ÌËÏ ËÁ Íβ˜Â‚˚ı Ù‡ÍÚÓÓ‚ ÛÒÔ¯ÌÓ„Ó Ë̉˂ˉۇθÌÓ„Ó Ë ÔÓ„‡ÏÏÌÓ„Ó Î˜ÂÌËfl fl‚ÎflÂÚÒfl ÒÚÓ„Ó Òӷβ‰ÂÌË ÂÊËχ Äêí11, 14, 17, 23, 28, 33, 47, 48, 51, 56, 60, 65, 82. àÒÒΉӂ‡ÌËfl ÔÓ ÔÓ‚ÂÍ Òӷβ‰ÂÌËfl ÔËÂχ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚, Ôӂ‰ÂÌÌ˚ ‚ ‡Á‚ËÚ˚ı ÒÚ‡Ì‡ı, ÔÓ͇Á‡ÎË, ˜ÚÓ ·ÓΠ‚˚ÒÓÍËÈ ÛÓ‚Â̸ Òӷβ‰ÂÌËfl ÔËÂχ ÔÂÔ‡‡ÚÓ‚ ‡ÒÒÓˆËËÛÂÚÒfl Ò ÛÎÛ˜¯ÂÌËÂÏ ‚ËÛÒÓÎӄ˘ÂÒÍËı Ë ÍÎËÌ˘ÂÒÍËı ÂÁÛθڇÚÓ‚ Ë, ˜ÚÓ ‰Îfl ËÁ‚ΘÂÌËfl χÍÒËχθÌÓÈ ÔÓθÁ˚ ÓÚ Äêí Ê·ÚÂθÌÓ Ó·ÂÒÔ˜ËÚ¸ ÛÓ‚Â̸ Òӷβ‰ÂÌËfl ‚˚¯Â 95%. í‡ÍÓÈ ‚˚ÒÓÍËÈ ÛÓ‚Â̸ ‰ÓÒÚ‡ÚÓ˜ÌÓ ÒÎÓÊÌÓ ÔÓ‰‰ÂÊË‚‡Ú¸ ‚ Ú˜ÂÌË ‰ÓÎ„Ó„Ó ÔÂËÓ‰‡ ‚ÂÏÂÌË. Ç ‡Á‚ËÚ˚ı ÒÚ‡Ì‡ı ·˚Î ÔӇ̇ÎËÁËÓ‚‡Ì ˆÂÎ˚È fl‰ ÔÓ‰ıÓ‰Ó‚ Í ¯ÂÌ˲ ÔÓ·ÎÂÏ˚ ·ÓΠÒÚÓ„Ó„Ó Òӷβ‰ÂÌËfl ÚÂ‡ÔËË, ÍÓÚÓ˚ ‚ ÔÓÒΉÌ ‚ÂÏfl ÒÚ‡ÎË ËÁÛ˜‡Ú¸ Ë ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı. ÇÏÂÒÚÂ Ò ÚÂÏ ÔÓ ÒÚÓËÏÓÒÚÌ˚Ï Ë ÚÂıÌ˘ÂÒÍËÏ ÒÓÓ·‡ÊÂÌËflÏ ‡Ì‡ÎËÁ˚, ÔÓÁ‚ÓÎfl˛˘Ë ÓÔ‰ÂÎËÚ¸ ‚ËÛÒÌÛ˛ ̇„ÛÁÍÛ, ‚ ·ÎËʇȯÂÏ ·Û‰Û˘ÂÏ ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı Ì ÔÓÎÛ˜‡Ú ¯ËÓÍÓ„Ó ‡ÒÔÓÒÚ‡ÌÂÌËfl. èÓ ˝ÚÓÈ Ô˘ËÌ ÓÒÓ·ÂÌÌÓ ‚‡ÊÌÓ ÒÍÓ̈ÂÌÚËÓ‚‡Ú¸ ÛÒËÎËfl ̇ χÍÒËχθÌÓÏ Òӷβ‰ÂÌËË ÚÂ‡ÔËË Ò ˆÂθ˛ ËÁ·Âʇڸ ÔÓ·ÎÂÏ˚ ÂÁËÒÚÂÌÚÌÓÒÚË Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï Ë Ó·ÂÒÔ˜ËÚ¸ ‰Ó΄ӂÂÏÂÌÌÓ ‚ÓÁ‰ÂÈÒÚ‚Ë ÒıÂÏ ÄêÇ-ÚÂ‡ÔËË. ÜËÁÌÂÌÌÓ ‚‡ÊÌ˚Ï Ù‡ÍÚÓÓÏ, ÓÔ‰ÂÎfl˛˘ËÏ ÛÒÔÂı ÒÚ‡Ú„ËÈ ÔÓ Òӷβ‰ÂÌ˲ ÚÂ‡ÔËË fl‚ÎflÂÚÒfl Ôӂ‰ÂÌË ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘ÂÈ ÔÓÒ‚ÂÚËÚÂθÒÍÓÈ ‡·ÓÚ˚ ÒÂ‰Ë Ô‡ˆËÂÌÚÓ‚ ‰Ó ̇˜‡Î‡ ΘÂÌËfl. í‡Í‡fl ‡·ÓÚ‡ ‰ÓÎÊ̇ ‚Íβ˜‡Ú¸ ÓÁ̇ÍÓÏÎÂÌËÂ Ò ÓÒÌÓ‚ÌÓÈ ËÌÙÓχˆËÂÈ Ó Çàó-ËÌÙÂ͈ËË Ë Â ÔÓfl‚ÎÂÌËË, ÔÓθÁÂ Ë ÔÓ·Ó˜Ì˚ı ˝ÙÙÂÍÚ‡ı ÄêÇ-ÔÂÔ‡‡ÚÓ‚, Ó ÚÓÏ, Í‡Í ÒΉÛÂÚ ÔËÏÂÌflÚ¸ ÎÂ͇ÒÚ‚ÂÌÌ˚ Ò‰ÒÚ‚‡ Ë Ó ‚‡ÊÌÓÒÚË Ì ÔÓÔÛÒ͇ڸ ÔËÂÏ˚ ÎÂ͇ÒÚ‚‡. éÒÓ·ÂÌÌÓ ˝ÙÙÂÍÚË‚ÌÓ ÒÓ‰ÂÈÒÚ‚Ó‚‡Ú¸ ˝ÚÓÏÛ ÔÓˆÂÒÒÛ ÏÓ„ÛÚ ÍÓÌÒÛθڇÌÚ˚ ËÁ ˜ËÒ· Ú‡ÍËı Ê ԇˆËÂÌÚÓ‚ Ë ‚ËÁۇθÌ˚ χÚÂˇÎ˚. èÓÒΠ̇˜‡Î‡ ÚÂ‡ÔËË Íβ˜ Í ÛÒÔÂıÛ Á‡Íβ˜‡ÂÚÒfl ‚ ÒÚÂÏÎÂÌËË ÛÏÂ̸¯ËÚ¸ ÍÓ΢ÂÒÚ‚Ó ÔËÌËχÂÏ˚ı Ú‡·ÎÂÚÓÍ (ÓÚ˜‡ÒÚË Á‡ Ò˜ÂÚ ÔËÂχ îÑ) Ë ˜‡ÒÚÓÚ˚ Ëı ÔËÂχ (ÒıÂÏ˚, ÔÓ‰‡ÁÛÏ‚‡˛˘Ë ÔËÂÏ ÎÂ͇ÒÚ‚ Ì ·ÓΠ‰‚Ûı ‡Á ‚ ‰Â̸), ‡ÒÙ‡ÒÓ‚Í ڇ·ÎÂÚÓÍ (ÔÓ ‚ÓÁÏÓÊÌÓÒÚË, ‚ ·ÎËÒÚÂÌ˚ ÛÔ‡ÍÓ‚ÍË), ‚ ÓÒÚÓÓÊÌÓÏ ÓÚÌÓ¯ÂÌËË Í ÔˢÂ, ‚Íβ˜ÂÌËË ÄêÇ ‚ ÊËÁ̸ Ô‡ˆËÂÌÚ‡ Ë ‚ӂΘÂÌËË Ó‰ÒÚ‚ÂÌÌËÍÓ‚, ‰ÛÁÂÈ Ë/ËÎË ˜ÎÂÌÓ‚ Ó·˘ËÌ˚ ‚ ÔÓˆÂÒÒ ÔÓ‰‰ÂÊÍË Ô‡ˆËÂÌÚ‡ Ò ˆÂθ˛ ÔÓÏÓ˜¸ ÂÏÛ ‚ Òӷβ‰ÂÌËË Ì‡Á̇˜ÂÌÌÓ„Ó ÍÛÒ‡ ΘÂÌËfl. èÓÒΠ̇˜‡Î‡ ÍÛÒ‡ ÚÂ‡ÔËË „·‚ÌÓÈ Á‡‰‡˜ÂÈ fl‚ÎflÂÚÒfl ÔÓˆÂÒÒ ÔÓ‰‰ÂʇÌËfl Â„Ó ÒÚÓ„Ó„Ó Òӷβ‰ÂÌËfl, ÍÓÚÓ˚È ‰ÓÎÊÂÌ ‚Íβ˜‡Ú¸ ÓˆÂÌÍÛ Òӷβ‰ÂÌËfl Ô‡ˆËÂÌÚÓÏ Ì‡Á̇˜ÂÌÌÓ„Ó ÂÏÛ ÍÛÒ‡ ÔË Í‡Ê‰ÓÏ Â„Ó ÔÓÒ¢ÂÌËË Ï‰ˈËÌÒÍÓ„Ó ˆÂÌÚ‡, ÛÍÂÔÎÂÌË ÔË̈ËÔÓ‚ Òӷβ‰ÂÌËfl Ô‡ˆËÂÌÚÓÏ ÚÂ‡ÔËË Ò ÔÓÏÓ˘¸˛ Îˈ, ÔÓ‰‰ÂÊË‚‡˛˘Ëı ΘÂÌËÂ, Ë ÌÂÔÂ˚‚ÌÓ ۘ‡ÒÚË Ó‰ÒÚ‚ÂÌÌËÍÓ‚, ‰ÛÁÂÈ Ë/ËÎË ‚ÒÔÓÏÓ„‡ÚÂθÌÓ„Ó ÔÂÒÓ̇· Ó·˘ËÌ˚. ïÓÚfl ÔÓ Ò‡‚ÌÂÌ˲ Ò ‡ÒÔÓÒÚ‡ÌÂÌËÂÏ ·ÂÏÂÌË ·ÓÎÂÁÌÂÈ ‡ÒÔÓÒÚ‡ÌÂÌË Äêí ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ÔÓËÒıÓ‰ËÚ Ï‰ÎÂÌÌÓ, ‚Ò ÊÂ Ú‡Ï Ú‡ÍÊ ·˚ÎË ÛÒ‚ÓÂÌ˚ ‚‡ÊÌ˚ ÛÓÍË, ÍÓÚÓ˚ ÏÓÊÌÓ ·˚ÎÓ ·˚ ‚Íβ˜ËÚ¸ ‚ ÌÓ‚˚ ‡Á‡·‡Ú˚‚‡ÂÏ˚ ËÎË ‡Ò¯ËflÂÏ˚ ÔÓ„‡ÏÏ˚. ùÚË ÛÓÍË Ò‚flÁ‡Ì˚ ÒÓ ÒÎÂ‰Û˛˘ËÏË ÏÂ‡ÏË:

44

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

◗ é·ÂÒÔ˜ÂÌË β‰ÂÈ, ÍÓÚÓ˚ Ì ‚ ÒÓÒÚÓflÌËË ÔÓÁ‚ÓÎËÚ¸ Ò· Î˜ÂÌËÂ, ·ÂÒÔ·ÚÌ˚ÏË ÎÂ͇ÒÚ‚ÂÌÌ˚ÏË Ò‰ÒÚ‚‡ÏË Ò ÔÓÏÓ˘¸˛ ÒÛ·ÒˉËÈ Ë ‰Û„Ëı ÙË̇ÌÒÓ‚˚ı ÏÂ. Ç ˝ÚÓÈ Ò‚flÁË ‚˚Ò͇Á˚‚‡ÂÚÒfl ˉÂfl Ó ÚÓÏ, ˜ÚÓ ‡ÒÔ‰ÂÎÂÌË Á‡Ú‡Ú ÏÓÊÂÚ ÒÓ‰ÂÈÒÚ‚Ó‚‡Ú¸ Òӷβ‰ÂÌ˲ ÚÂ‡ÔËË, ıÓÚfl ÓÔ˚Ú Ú‡ÍÓ„Ó ‡ÒÔ‰ÂÎÂÌËfl ·Û‰ÂÚ, Í‡Í ÓÊˉ‡ÂÚÒfl, ‚ ‡ÁÌ˚ı ÒÚ‡Ì‡ı ÌÂÓ‰Ë̇ÍÓ‚˚Ï. çÓ‚ÂȯË ‰‡ÌÌ˚ ËÁ ëÂÌ„‡Î‡ Ë ‰Û„Ëı ‡ÙË͇ÌÒÍËı ÒÚ‡Ì Û͇Á˚‚‡˛Ú ̇ ÚÓ, ˜ÚÓ ‡ÒÔ‰ÂÎÂÌË Á‡Ú‡Ú ÓÚˈ‡ÚÂθÌÓ Ò͇Á˚‚‡ÂÚÒfl ̇ ‰Ó΄ÓÒÓ˜ÌÓÏ Òӷβ‰ÂÌËË ÚÂ‡ÔËË. ùÚË ‚ÓÔÓÒ˚ ÌÛʉ‡˛ÚÒfl ‚ ‰‡Î¸ÌÂȯÂÏ ËÁÛ˜ÂÌËË 83, 84. ◗ è˂ΘÂÌË ÒÂÏ¸Ë ËÎË ˜ÎÂÌÓ‚ Ó·˘ËÌ˚ Í Ó·Û˜ÂÌ˲ ̇‚˚Í‡Ï Òӷβ‰ÂÌËfl ÚÂ‡ÔËË Ë ÔÓ‰‰ÂʇÌËfl ÔÓ„‡ÏÏ. ÇÂҸχ ˝ÙÙÂÍÚË‚Ì˚Ï ‚ ˝ÚÓÏ Ô·Ì ÏÓÊÂÚ Ó͇Á‡Ú¸Òfl ÔÓÒ¢ÂÌË β‰ÂÈ Ì‡ ‰ÓÏÛ. çÂÓ·ıÓ‰ËÏ˚Ï ˝ÎÂÏÂÌÚÓÏ fl‚ÎflÂÚÒfl ÓÒ··ÎÂÌË ˜Û‚ÒÚ‚‡ ÓÚ˜ÛʉÂÌÌÓÒÚË ÔÓÒ‰ÒÚ‚ÓÏ Ó͇Á‡ÌËfl ÔÒËıÓÎӄ˘ÂÒÍÓÈ ÔÓ‰‰ÂÊÍË. ◗ é͇Á‡ÌË ÔÓÏÓ˘Ë ‚ ÍÛ„Û ÒÂϸË, ÍÓ„‰‡ ËÌÙÂ͈ËÂÈ Çàó ÔÓ‡ÊÂÌ Ì ӉËÌ ˜ÎÂÌ ÒÂϸË, ‡ ·ÓÎÂÂ. ùÚÓ ÓÒÓ·ÂÌÌÓ ‚‡ÊÌÓ, ÍÓ„‰‡ ËÌÙˈËÓ‚‡Ì˚ χڸ Ë ·ÂÌÓÍ. ◗ àÒÔÓθÁÓ‚‡ÌË ÍÓÓ·Ó˜ÂÍ ‰Îfl Ú‡·ÎÂÚÓÍ ËÎË ·ÎËÒÚÂÌ˚ı ÛÔ‡ÍÓ‚ÓÍ. ◗ ä‡ÚÍÓÒÓ˜Ì˚È ÍÛÒ Î˜ÂÌËfl ÔÓ‰ ωˈËÌÒÍËÏ ÍÓÌÚÓÎÂÏ (Ñéí) ËÎË ÏÓ‰ËÙˈËÓ‚‡ÌÌ˚ ÔÓ„‡ÏÏ˚ Ñéí. ùÚÓÚ ÔÓ‰ıÓ‰ fl‚ÎflÂÚÒfl ÂÒÛÒÓÂÏÍËÏ Ë ÒÎÓÊÌ˚Ï ‰Îfl χÒÒÓ‚Ó„Ó ‚̉ÂÌËfl Ë ÔÓ‰‰ÂʇÌËfl Äêí ̇ ÔÓÚflÊÂÌËË ‚ÒÂ„Ó ÍÛÒ‡ ΘÂÌËfl. íÂÏ Ì ÏÂÌ ÓÌ ÏÓÊÂÚ Ó͇Á‡Ú¸Òfl ÔÓÎÂÁÌ˚Ï ‰Îfl ÌÂÍÓÚÓ˚ı „ÛÔÔ Ô‡ˆËÂÌÚÓ‚ Ë Ëı ̇˜‡Î¸ÌÓÈ ÔÓ‰„ÓÚÓ‚ÍË. ◗ àÒÔÓθÁÓ‚‡ÌË ÏËÍÓ‡‚ÚÓ·ÛÒÓ‚ ‰Îfl ÔÓÒ¢ÂÌËfl ÒÂθÒÍËı Ó·˘ËÌ. ◗ çÂÓ·ıÓ‰ËÏÓÒÚ¸ Ó·ÂÒÔ˜ÂÌËfl ̇ ÔÓ„‡ÏÏÌÓÏ ÛÓ‚Ì ̇‰ÎÂʇ˘Ëı Á‡Ô‡ÒÓ‚ Ë ı‡ÌÂÌËfl ÄêÇ-ÔÂÔ‡‡ÚÓ‚, ‡ Ú‡ÍÊ ÂÒÛÒÓ‚, Ú·ÛÂÏ˚ı ‰Îfl ‡ÎËÁ‡ˆËË Ú‡ÍËı ÔÓ„‡ÏÏ ÔÓ Òӷβ‰ÂÌ˲ ÚÂ‡ÔËË, ÍÓÚÓ˚ ÒÓÓÚ‚ÂÚÒÚ‚Ó‚‡ÎË ·˚ ÍÛθÚÛÌÓÈ ÒÔˆËÙËÍÂ. ëӷβ‰ÂÌË ÒıÂÏ ÚÂ‡ÔËË ÏÓÊÂÚ Ó͇Á‡Ú¸Òfl ·ÓΠÒÎÓÊÌ˚Ï ‚ ÒÎÛ˜‡Â ·ÂÂÏÂÌÌ˚ı Ë Ì‰‡‚ÌÓ Ӊ˂¯Ëı ÊÂÌ˘ËÌ, ÌÂÊÂÎË ‚ ÒÎÛ˜‡Â Ì·ÂÂÏÂÌÌ˚ı ÊÂÌ˘ËÌ. ìÚÂÌÌ ̉ÓÏÓ„‡ÌËÂ, Ò‚flÁ‡ÌÌÓÂ Ò ·ÂÂÏÂÌÌÓÒÚ¸˛, Ë ÊÂÎÛ‰Ó˜ÌÓ-Í˯˜Ì˚ ‡ÒÒÚÓÈÒÚ‚‡ ÏÓ„ÛÚ ÓÒÎÓÊÌËÚ¸ Äêí. äÓÏ ÚÓ„Ó, ÒËÚÛ‡ˆËfl ÏÓÊÂÚ ÛÒÛ„Û·ËÚ¸Òfl ÔÓ·Ó˜Ì˚ÏË ˝ÙÙÂÍÚ‡ÏË, ‚˚Á‚‡ÌÌ˚ÏË ÄêÇ-ÔÂÔ‡‡Ú‡ÏË, ËÎË ÔÓ·ÎÂχÏË, Ò‚flÁ‡ÌÌ˚ÏË Ò ÔÓÚÂ̈ˇθÌ˚Ï ‚ÓÁ‰ÂÈÒÚ‚ËÂÏ ÔÂÔ‡‡ÚÓ‚ ̇ ÔÎÓ‰. Ç ÔÓÒÎÂÓ‰Ó‚ÓÈ ÔÂËÓ‰ ÙËÁ˘ÂÒÍË ËÁÏÂÌÂÌËfl Ë ÔÓÚ·ÌÓÒÚ¸ ‚ ÛıӉ Á‡ ÌÓ‚ÓÓʉÂÌÌ˚ÏË ÏÓ„ÛÚ Á‡ÚÛ‰ÌËÚ¸ Òӷβ‰ÂÌË χÚÂflÏË Ì‡Á̇˜ÂÌÌ˚ı ËÏ ÒıÂÏ ÔËÏÂÌÂÌËfl ÔÂÔ‡‡ÚÓ‚. Ç ˆÂÎflı ¯ÂÌËfl ÓÚ‰ÂθÌ˚ı ÔÓ·ÎÂÏ, Ò ÍÓÚÓ˚ÏË ÒÚ‡ÎÍË‚‡˛ÚÒfl ·ÂÂÏÂÌÌ˚Â Ë Ì‰‡‚ÌÓ Ӊ˂¯Ë ÊÂÌ˘ËÌ˚, ÒΉÛÂÚ ‡Á‡·‡Ú˚‚‡Ú¸ ̇ ̇ˆËÓ̇θÌÓÏ ÛÓ‚Ì ÔÓ„‡ÏÏ˚ ÔÓ ÔÓ‰‰ÂÊÍ Òӷβ‰ÂÌËfl ÚÂ‡ÔËË, ÍÓÚÓ˚ ÒÓÓÚ‚ÂÚÒÚ‚Ó‚‡ÎË ·˚ ÍÛθÚÛÌÓÈ ÒÔˆËÙËÍÂ. éÒÓ·Û˛ ÚÛ‰ÌÓÒÚ¸ Ô‰ÒÚ‡‚ÎflÂÚ ÒÓ·ÓÈ Òӷβ‰ÂÌË ÒıÂÏ˚ ÚÂ‡ÔËË ‰ÂÚ¸ÏË, ÓÒÓ·ÂÌÌÓ ‚ ÚÓÏ ÒÎÛ˜‡Â, ÂÒÎË ÒÂÏÂÈ̇fl fl˜ÂÈ͇ ‡Á˙‰ËÌÂ̇ ‚ÒΉÒÚ‚Ë ÔÓ·ÎÂÏ ÒÓ Á‰ÓÓ‚¸ÂÏ Ë Ï‡ÚÂˇθÌÓ„Ó ÔÓÎÓÊÂÌËfl. é‰ÌËÏ ËÁ ÎÛ˜¯Ëı ÔÓ‰ıÓ‰Ó‚ Í Ó·ÂÒÔ˜ÂÌ˲ Á‰ÓÓ‚¸fl ‰ÂÚÂÈ fl‚Îfl˛ÚÒfl ÔÓ„‡ÏÏ˚ ÔÓÏÓ˘Ë ÇàóËÌÙˈËÓ‚‡ÌÌ˚Ï Ì‡ ·‡Á ÒÂϸË. äÓÏ ÚÓ„Ó, ÌÂÓ·ıÓ‰ËÏÓ ‚ Ó·flÁ‡ÚÂθÌÓÏ ÔÓfl‰Í ÛÎÛ˜¯ËÚ¸ ÙÓÏ˚ Ô‰ˇÚ˘ÂÒÍËı ÎÂ͇ÒÚ‚ÂÌÌ˚ı Ò‰ÒÚ‚ Ë Ó·ÂÒÔ˜ËÚ¸ Ëı ¯ËÓÍÛ˛ ‰ÓÒÚÛÔÌÓÒÚ¸. í‡Ï, „‰Â ˝ÚÓ ‚ÓÁÏÓÊÌÓ, Ëı ÒΉÛÂÚ ÔË‚Ó‰ËÚ¸ ‚ ÒÓÓÚ‚ÂÚÒÚ‚Ë ÒÓ ‚ÁÓÒÎ˚ÏË ÒıÂχÏË, ‰Îfl ÚÓ„Ó ˜ÚÓ·˚ ÔÓ„‡ÏÏ˚ ÔÓÏÓ˘Ë Ì‡ ÓÒÌÓ‚Â ÒÂÏ¸Ë ÏÓ„ÎË ˝ÙÙÂÍÚË‚ÌÓ ‡·ÓÚ‡Ú¸. ä ÚÓÏÛ ÊÂ, ˝ÚÓ ÔÓÁ‚ÓÎËÚ Ì‡‰ÎÂʇ˘ËÏ Ó·‡ÁÓÏ ‰ÓÁËÓ‚‡Ú¸ ÎÂ͇ÒÚ‚ÂÌÌ˚ ÔÂÔ‡‡Ú˚ ‰Îfl ‰ÂÚÂÈ.

45

X. ùèàÑçÄçáéê áÄ êÖáàëíÖçíçéëíúû ä ãÖäÄêëíÇÖççõå ëêÖÑëíÇÄå

é

‰ÌÓÈ ËÁ ÒÂ¸ÂÁÌÂȯËı ÔÓ·ÎÂÏ, ÒÚÓfl˘Ëı ÔÂ‰ Θ·Ì˚ÏË ÔÓ„‡ÏχÏË Í‡Í ‚ ‡Á‚ËÚ˚ı, Ú‡Í Ë ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı, fl‚ÎflÂÚÒfl ÂÁËÒÚÂÌÚÌÓÒÚ¸ Í ÄêÇ-ÔÂÔ‡‡Ú‡Ï. ç‡ Ò„ӉÌfl¯ÌËÈ ‰Â̸ ÓÍÓÎÓ 10% ÌÓ‚˚ı ËÌÙÂ͈ËÈ Çàó-1 ‚ ëòÄ Ë Ö‚ÓÔ ‚˚Á‚‡Ì˚ ¯Ú‡ÏχÏË ‚ËÛÒÓ‚, ÔÓfl‚Îfl˛˘ËÏË ÂÁËÒÚÂÌÚÌÓÒÚ¸, Í‡Í ÏËÌËÏÛÏ, Í Ó‰ÌÓÏÛ ÎÂ͇ÒÚ‚ÂÌÌÓÏÛ ÔÂÔ‡‡ÚÛ. Ç ‡·ÓÚ ÔÓ ‡Ò¯ËÂÌ˲ Óı‚‡Ú‡ ̇ÒÂÎÂÌËfl ÔÓ„‡ÏχÏË ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ÏÓÊÌÓ ‚ÓÒÔÓθÁÓ‚‡Ú¸Òfl ÔÓÎÓÊËÚÂθÌ˚Ï ÓÔ˚ÚÓÏ, ̇ÍÓÔÎÂÌÌ˚Ï ‡Á‚ËÚ˚ÏË ÒÚ‡Ì‡ÏË ‚ ‰ÂΠÒÓÁ‰‡ÌËfl ˝ÙÙÂÍÚË‚Ì˚ı ÒıÂÏ ÚÂ‡ÔËË, ‚̉ÂÌËfl ‚ Ô‡ÍÚËÍÛ ËÌÙÓχˆËÓÌÌÓ-ÔÓÒ‚ÂÚËÚÂθÒÍËı ÔÓ„‡ÏÏ Ë ÔÓ„‡ÏÏ ÔÓ‰‰ÂÊÍË, ÍÓÚÓ˚ ÒÓÓÚ‚ÂÚÒÚ‚Û˛Ú ÍÛθÚÛÌÓÈ ÒÔˆËÙËÍÂ, ‡ Ú‡ÍÊ Ëı ÒËÌıÓÌËÁ‡ˆËË Ò ‰ÂflÚÂθÌÓÒÚ¸˛ ÔÓ ˝Ôˉ̇‰ÁÓÛ Á‡ ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Ë ÏÓÌËÚÓËÌ„Û. Çfl‰ ÎË ÒÚÓËÚ ‡ÒÒ˜ËÚ˚‚‡Ú¸, ˜ÚÓ ‚ ·ÎËʇȯÂÈ ËÎË Ò‰ÌÂÒÓ˜ÌÓÈ ÔÂÒÔÂÍÚË‚Â ÏÓÊÌÓ ·Û‰ÂÚ Ô˷„ÌÛÚ¸ Í ÏÂÚÓ‰ËÍ ËÁÏÂÌÂÌËfl „ÂÌÓÚËÔ‡ ÔÓ ÂÁËÒÚÂÌÚÌÓÒÚË Í ÎÂ͇ÒÚ‚ÂÌÌ˚Ï Ò‰ÒÚ‚‡Ï ‰Îfl ‚‰ÂÌËfl ÓÚ‰ÂθÌ˚ı Ô‡ˆËÂÌÚÓ‚ ‚ ÛÒÎÓ‚Ëflı Ó„‡Ì˘ÂÌÌ˚ı ÂÒÛÒÓ‚, Ӊ̇ÍÓ ÔÓ„‡ÏÏ‡Ï Ì‡ ÛÓ‚Ì ÒÚ‡Ì Ó͇Á˚‚‡ÂÚÒfl ÔÓ‰‰ÂÊ͇ ‚ ‡Á‡·ÓÚÍ ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘Ëı ÒıÂÏ ˝Ôˉ̇‰ÁÓ‡ Á‡ ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Ë ÏÓÌËÚÓËÌ„‡ ‚ ˆÂÎflı ÒÓ‰ÂÈÒÚ‚Ëfl ‡Á‡·ÓÚÍ ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘Ëı Ô·ÌÓ‚ ̇ ÛÓ‚Ì ̇ÒÂÎÂÌËfl. ùÚÓÚ ÔÓˆÂÒÒ ÏÓÊÂÚ ‚Íβ˜‡Ú¸ ÒÓÁ‰‡ÌË ËÎË Ì‡‡˘Ë‚‡ÌË ÔÓÚÂ̈ˇ· Ó·‡ÁˆÓ‚Ó-ÔÓ͇Á‡ÚÂθÌ˚ı ̇ˆËÓ̇θÌ˚ı Ë „ËÓ̇θÌ˚ı ˆÂÌÚÓ‚ ‚ ‡·ÓÚ ÔÓ ËÁÏÂÌÂÌ˲ „ÂÌÓÚËÔÓ‚. èÓ‰Ó·Ì˚È ÔÓÚÂ̈ˇΠÏÓÊÌÓ ‡ÒÒχÚË‚‡Ú¸ ‚ ͇˜ÂÒÚ‚Â ‚‡ÊÌÓ„Ó ËÌÒÚÛÏÂÌÚ‡ Ó·˘ÂÒÚ‚ÂÌÌÓ„Ó Á‰‡‚ÓÓı‡ÌÂÌËfl, ÍÓÚÓ˚È ÏÓÊÂÚ ·˚Ú¸ ËÒÔÓθÁÓ‚‡Ì ‰Îfl Ó·ÓÒÌÓ‚‡ÌËfl ̇ˆËÓ̇θÌ˚ı, „ËÓ̇θÌ˚ı Ë „ÎÓ·‡Î¸Ì˚ı ÔÓ„‡ÏÏ ÔÓ ‡Ò¯ËÂÌ˲ ÄêÇÚÂ‡ÔËË Ò Û˜ÂÚÓÏ ÚẨÂ̈ËÈ ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚË ÂÁËÒÚÂÌÚÌÓÒÚË ‚ ˆÂÎflı ÔËÌflÚËfl ÏÂ ÔÓ Ò‚Â‰ÂÌ˲ Í ÏËÌËÏÛÏÛ Â ‚ÓÁ‰ÂÈÒÚ‚Ëfl. Çéá ÂÍÓÏẨÛÂÚ ÒÚ‡Ì‡Ï, Ô·ÌËÛ˛˘ËÏ ÓÒÛ˘ÂÒÚ‚ËÚ¸ ÔÓ„‡ÏÏ˚ Äêí, ‚̉flÚ¸ Ô‡‡ÎÎÂθÌÓ ÍÓÌÚÓθÌ˚ ÒËÒÚÂÏ˚ ˝Ôˉ̇‰ÁÓ‡ Á‡ ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Çàó. ùÚÓ ‰‡ÒÚ ËÏ ‚ÓÁÏÓÊÌÓÒÚ¸ ӷ̇ÛÊË‚‡Ú¸ ÔÓÚÂ̈ˇθÌ˚ ÒÎÛ˜‡Ë ÎÂ͇ÒÚ‚ÂÌÌÓÈ ÛÒÚÓȘ˂ÓÒÚË ‚ËÛÒ‡ ̇ ÛÓ‚Ì ̇ÒÂÎÂÌËfl Ë ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘ËÏ Ó·‡ÁÓÏ ÏÓ‰ËÙˈËÓ‚‡Ú¸ ÂÍÓÏẨÛÂÏ˚ ÒıÂÏ˚ ÚÂ‡ÔËË. ç‡ Ì‡˜‡Î¸ÌÓÈ ÒÚ‡‰ËË Îˈ‡, Ì ÔÓıӉ˂¯Ë Î˜ÂÌËfl, ‰ÓÎÊÌ˚ ÔÓÈÚË Ì‡·Î˛‰ÂÌË ‚ ˆÂÎflı ÓÔ‰ÂÎÂÌËfl ÛÓ‚Ìfl ‡ÒÔÓÒÚ‡ÌÂÌÌÓÒÚË ÂÁËÒÚÂÌÚÌÓÒÚË ‚ ËÌÙˈËÓ‚‡ÌÌÓÈ „ÛÔÔ ̇ÒÂÎÂÌËfl, ‡ Îˈ‡, Ôӯ‰¯Ë Î˜ÂÌËÂ, ‰ÓÎÊÌ˚ ÔÓÈÚË ÔÓ‚ÂÍÛ, ÓÒÓ·ÂÌÌÓ Ú ËÁ ÌËı, Û ÍÓÚÓ˚ı ÔÂ‚ӠΘÂÌËÂ, Í‡Í ÔÓ͇Á‡Î ‰Ë‡„ÌÓÁ, Ó͇Á‡ÎÓÒ¸ ̽ÙÙÂÍÚË‚Ì˚Ï. Ç ˆÂÎflı Ó͇Á‡ÌËfl „ÓÒÛ‰‡ÒÚ‚‡Ï-Û˜‡ÒÚÌËÍ‡Ï ÒÓ‰ÂÈÒÚ‚Ëfl ‚ ‡·ÓÚ ‚ ˝ÚÓÈ Ó·Î‡ÒÚË Çéá, ÒÓ‚ÏÂÒÚÌÓ Ò Ó„‡ÌËÁ‡ˆËflÏË-Ô‡ÚÌÂ‡ÏË, ÒÓÁ‰‡ÂÚ É ÎÓ·‡Î¸ÌÛ˛ ÒÂÚ¸ ̇·Î˛‰ÂÌËfl Á‡ ÂÁËÒÚÂÌÚÌÓÒÚ¸˛ Çàó82.

46

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

XI. ÇõÇéÑõ ÓÒÛ‰‡ÒÚ‚‡-˜ÎÂÌ˚ Çéá ÒÚÓflÚ ÔÂ‰ ·Óθ¯ÓÈ ÔÓ·ÎÂÏÓÈ, ÌÓ ‚ ÚÓ Ê ‚ÂÏfl ÔÂ‰ ÌËÏË ÓÚÍ˚‚‡˛ÚÒfl Ë ·Óθ¯Ë ‚ÓÁÏÓÊÌÓÒÚË. åËÓ‚Ó ÒÓÓ·˘ÂÒÚ‚Ó ÒÔÓÒÓ·ÌÓ ÔÓÚË‚ÓÒÚÓflÚ¸ ԇ̉ÂÏËË ëèàч ‚ ‡Á‚Ë‚‡˛˘ËıÒfl ÒÚ‡Ì‡ı ·Î‡„Ó‰‡fl Äêí – Ò‡ÏÓÏÛ ˝ÙÙÂÍÚË‚ÌÓÏÛ Ò‰ÒÚ‚Û ÔÓ ÔÓ‰‰ÂʇÌ˲ ÊËÁÌË Î˛‰ÂÈ ËÁ Ëϲ˘Â„ÓÒfl Ò„ӉÌfl ‡ÒÂ̇· ωËÍÓ-Ò‡ÌËÚ‡Ì˚ı ÛÒÎÛ„ ‰Îfl Çàó-ËÌÙˈËÓ‚‡ÌÌ˚ı. ùÚË ‚ÓÁÏÓÊÌÓÒÚË ÒÓÁ‰‡Ì˚ Á‡ Ò˜ÂÚ ˆÂÎÓÈ ÒËÒÚÂÏ˚ ÔÓÎËÚ˘ÂÒÍËı Ó·flÁ‡ÚÂθÒÚ‚, ÌÓ‚˚ı ËÒÚÓ˜ÌËÍÓ‚ ÙË̇ÌÒËÓ‚‡ÌËfl, ‰ÓÒÚÛÔÌÓÒÚË Äêí Ë ·ÓΠÌËÁÍËı ˆÂÌ Ì‡ ÎÂ͇ÒÚ‚‡. Çéá ÒÚÂÏËÚÒfl Ó͇Á˚‚‡Ú¸ ÔÓÏÓ˘¸ ÒÚ‡Ì‡Ï Ò Ó„‡Ì˘ÂÌÌ˚ÏË ÂÒÛÒ‡ÏË ‚ ̇‡˘Ë‚‡ÌËË Ï‡Ò¯Ú‡·Ó‚ ÄêÇ-ÚÂ‡ÔËË ÔÓ ÎËÌËË Ò‚ÓÂ„Ó ‚ÒÂÒÚÓÓÌÌÂ„Ó Ô·̇ «3 Í 5». ç‡ÒÚÓfl˘Â ӷÌÓ‚ÎÂÌÌÓ ÛÍÓ‚Ó‰ÒÚ‚Ó ÔÓ ‡ÌÚËÂÚÓ‚ËÛÒÌÓÈ ÚÂ‡ÔËË ËÏÂÂÚ ˆÂθ˛ ÔÓÏÓ˜¸ ̇ˆËÓ̇θÌ˚Ï ÔÓ„‡ÏÏ‡Ï ‚ Ó·ÂÒÔ˜ÂÌËË ‰ÓÒÚÛÔ‡ Í Î˜ÂÌ˲ Ò ÔÓÏÓ˘¸˛ ÄêÇ-ÔÂÔ‡‡ÚÓ‚ ‚ÒÂÏ ËÌÙˈËÓ‚‡ÌÌ˚Ï ‚ÁÓÒÎ˚Ï Ë ‰ÂÚflÏ, ÍÓÚÓ˚ ‚ ÌÂÏ ÌÛʉ‡˛ÚÒfl.

É

47

èêàãéÜÖçàÖ A. ÑéáàêéÇäÄ ÄçíàêÖíêéÇàêìëçõï ãÖäÄêëíÇÖççõï èêÖèÄêÄíéÇ Ñãü Çáêéëãõï à èéÑêéëíäéÇ ä·ÒÒ ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó ÔÂÔ‡‡Ú‡/ÔÂÔ‡‡Ú çÛÍÎÂÓÁˉÌ˚ àéí Ä·‡Í‡‚Ë (ÄÅä) Ñˉ‡ÌÓÁËÌ (ddl) 300 Ï„ 2 ‡Á‡ ‚ ‰Â̸ 400 Ï„ 1 ‡Á ‚ ‰Â̸ (250 Ï„ 1 ‡Á ‚ ‰Â̸ ÔË Ï‡ÒÒ Ú· <60 Í„) (250 Ï„ 1 ‡Á ‚ ‰Â̸ ÔË ÔËÂÏÂ Ò íÑî) 1 50 Ï„ 2 ‡Á‡ ‚ ‰Â̸ ËÎË 300 Ï„ 1 ‡Á ‚ ‰Â̸ 40 Ï„ 2 ‡Á‡ ‚ ‰Â̸ (30 Ï„ 2 ‡Á‡ ‚ ‰Â̸ ÔË Ï‡ÒÒ Ú· <60 Í„) 300 Ï„ 2 ‡Á‡ ‚ ‰Â̸ ÑÓÁËӂ͇ a

ã‡ÏË‚Û‰ËÌ (áíë) ëÚ‡‚Û‰ËÌ (d4T) áˉӂۉËÌ (áÑÇ) çÛÍÎÂÓÚˉÌ˚ àéí

íÂÌÓÙÓ‚Ë‰ËÁÓÔÓÍÒË· 300 Ï„ 1 ‡Á ‚ ‰Â̸ ÙÛχ‡Ú (íÑî) (èËϘ‡ÌËÂ: ‚ Ò‚flÁË Ò ÎÂ͇ÒÚ‚ÂÌÌ˚Ï ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂÏ Ò ddl ‰ÓÁÛ ÔÓÒΉÌÂ„Ó ÌÂÓ·ıÓ‰ËÏÓ ÒÌËÁËÚ¸) çÂÌÛÍÎÂÓÁˉÌ˚ àéí ùÙ‡‚ËÂ̈ (ùîñ) ç‚Ë‡ÔËÌ (çÇè) àÌ„Ë·ËÚÓ˚ ÔÓÚ‡Á˚ à̉Ë̇‚Ë/ËÚÓ̇‚Ë (àÑÇ/) ãÓÔË̇‚Ë/ËÚÓ̇‚Ë (ãèÇ/) çÂÎÙË̇‚Ë (çîÇ) ë‡Í‚Ë̇‚Ë/ËÚÓ̇‚Ë (ëäÇ/) 800 Ï„/100 Ï„ 2 ‡Á‡ ‚ ‰Â̸c, d 400 Ï„ /100 Ï„ 2 ‡Á‡ ‚ ‰Â̸ (533 Ï„ /1 33 Ï„ 2 ‡Á‡ ‚ ‰Â̸ ‚ ÍÓÏ·Ë̇ˆËË Ò ùîñ ËÎË çÇè) 1 250 Ï„ 2 ‡Á‡ ‚ ‰Â̸ 1000 Ï„ /100 Ï„ 2 ‡Á‡ ‚ ‰Â̸ ËÎË 1600 Ï„ /200 Ï„ 1 ‡Á ‚ ‰Â̸b, d, e c ùÚ‡ ÒıÂχ ‰ÓÁËÓ‚ÍË ¯ËÓÍÓ ÔËÏÂÌflÂÚÒfl ‚ ÍÎËÌ˘ÂÒÍÓÈ Ô‡ÍÚËÍÂ. ÑÛ„Ë ÒıÂÏ˚ ‰ÓÁËÓ‚ÓÍ àÑÇ/ ‚ ‰Ë‡Ô‡ÁÓÌ ÓÚ 800 Ï„/200 Ï„ 2 ‡Á‡ ‚ ‰Â̸ ‰Ó 400 Ï„/100 Ï„ 2 ‡Á‡ ‚ ‰Â̸ Ú‡ÍÊ ËÒÔÓθÁÛ˛ÚÒfl ‚ ÍÎËÌ˘ÂÒÍÓÈ Ô‡ÍÚËÍÂ. d èË Ó‰ÌÓ‚ÂÏÂÌÌÓÏ ËÒÔÓθÁÓ‚‡ÌËË Ò ççàéí ÌÂÓ·ıÓ‰ËÏ ÔÓ‰·Ó ‰ÓÁ˚, ÌÓ ÓÙˈˇθÌ˚ ÂÍÓÏẨ‡ˆËË ÔÓ ˝ÚÓÏÛ ‚ÓÔÓÒÛ ‚ ̇ÒÚÓfl˘Â ‚ÂÏfl ÓÚÒÛÚÒÚ‚Û˛Ú. Ö‰ËÌÒÚ‚ÂÌ̇fl ÂÍÓÏẨ‡ˆËfl Á‡Íβ˜‡ÂÚÒfl ‚ ÚÓÏ, ˜ÚÓ ÔË Ó‰ÌÓ‚ÂÏÂÌÌÓÏ Ì‡Á̇˜ÂÌËË Ò ùîñ ËÎË çÇè ‰ÓÁÛ êíÇ ÒΉÛÂÚ ‰Ó‚ÂÒÚË ‰Ó 200 Ï„ 2 ‡Á‡ ‚ ‰Â̸. ÑÎfl ÓÔ‰ÂÎÂÌËfl ÎÂ͇ÒÚ‚ÂÌÌ˚ı ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÈ ÌÂÓ·ıÓ‰ËÏ˚ ‰‡Î¸ÌÂȯË ËÒÒΉӂ‡ÌËfl. e èË Ó‰ÌÓ‚ÂÏÂÌÌÓÏ Ì‡Á̇˜ÂÌËË ëäÇ Ë êíÇ ÏÓÊÌÓ ËÒÔÓθÁÓ‚‡Ú¸ ͇ÔÒÛÎ˚ Í‡Í Ò ÔÎÓÚÌ˚Ï, Ú‡Í Ë Ò ÊˉÍËÏ „ÂÎÂÏ.

600 Ï„ 1 ‡Á ‚ ‰Â̸b 200 Ï„ 1 ‡Á ‚ ‰Â̸ ‚ Ú˜ÂÌË 1 4 ‰ÌÂÈ, Á‡ÚÂÏ 200 Ï„ 2 ‡Á‡ ‚ ‰Â̸

a é·˘ÂÔËÌflÚ˚ ÍÎËÌ˘ÂÒÍË ‰ÓÁ˚. ÑÓÁ˚, Ô˂‰ÂÌÌ˚ ‚ ˝ÚÓÈ Ú‡·ÎˈÂ, ·˚ÎË ÓÚÓ·‡Ì˚ ̇ ÓÒÌÓ‚Â Ò‡Ï˚ı ̇‰ÂÊÌ˚ı ÍÎËÌ˘ÂÒÍËı ‰‡ÌÌ˚ı. ÑÓÁ˚, ÍÓÚÓ˚ ÒΉÛÂÚ ÔËÌËχڸ 1 ËÎË 2 ‡Á‡ ‚ ‰Â̸, ·˚ÎË ÒÓ˜ÚÂÌ˚ Ô‰ÔÓ˜ÚËÚÂθÌ˚ÏË, ÔÓÒÍÓθÍÛ ÓÌË Ó·ÂÒÔ˜˂‡˛Ú ·ÓΠÒÚÓ„Ó Òӷβ‰ÂÌË ÚÂ‡ÔËË. Ç˚¯ÂÔÂ˜ËÒÎÂÌÌ˚ ‰ÓÁ˚ Û͇Á‡Ì˚ ‰Îfl Îˈ Ò ÌÓχθÌÓÈ ÙÛÌ͈ËÂÈ ÔÓ˜ÂÍ Ë Ô˜ÂÌË. à̉˂ˉۇθÌ˚È ÔÓ‰·Ó ‰ÓÁ ·ÓθÌ˚Ï Ò Ì‡Û¯ÂÌÌÓÈ ÙÛÌ͈ËÂÈ ÔÓ˜ÂÍ ËÎË Ô˜ÂÌË, ‡ Ú‡ÍÊ ‚ ÒÎÛ˜‡flı ‚ÓÁÏÓÊÌ˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÈ (Í‡Í Ò ‡ÌÚËÂÚÓ‚ËÛÒÌ˚ÏË, Ú‡Í Ë Ò Ì‡ÌÚËÂÚÓ‚ËÛÒÌ˚ÏË ÔÂÔ‡‡Ú‡ÏË) ÔÓËÁ‚Ó‰ËÚÒfl ̇ ÓÒÌÓ‚Â ÒÔˆˇθÌÓÈ ËÌÙÓχˆËË ‰Îfl Í‡Ê‰Ó„Ó Ù‡χˆÂ‚Ú˘ÂÒÍÓ„Ó ÔÓ‰ÛÍÚ‡.

äÓÌÍÂÚÌ˚ ‰ÓÁËÓ‚ÍË ‰Îfl íÅ ÒÏ. ‚ ‡Á‰ÂΠÔÓ íÅ.

b

48

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

èêàãéÜÖçàÖ B. ëàëíÖåÄ èÖÑàÄíêàóÖëäéâ äãÄëëàîàäÄñàà äÄíÖÉéêàâ ÇàêìëÄ àååìçéÑÖîàñàíÄ óÖãéÇÖäÄ çÄ éëçéÇÖ äéãàóÖëíÇÄ äãÖíéä CD4+ T à àï èêéñÖçíçéÉé ëéÑÖêÜÄçàü ë ìóÖíéå ÇéáêÄëíÄ é·‡·ÓÚ‡ÌÓ ÔÓ ËÁ‰‡Ì˲: ñÂÌÚ˚ ÔÓ ÔÓÙË·ÍÚËÍ ·ÓÎÂÁÌÂÈ Ë ·Ó¸·Â Ò ÌËÏË. é·ÌÓ‚ÎÂÌ̇fl ‚ 1 994 „. ÒËÒÚÂχ Í·ÒÒËÙË͇ˆËË ‚ËÛÒ‡ ËÏÏÛÌÓ‰ÂÙˈËÚ‡ ˜ÂÎÓ‚Â͇ Û ‰ÂÚÂÈ Ï·‰¯Â 1 3 ÎÂÚ), MMWR 1 994;43 (No. RR-1 2):1-10.

<12 ÏÂÒflˆÂ‚ àÏÏÛÌ̇fl ͇Ú„ÓËfl ä‡Ú„ÓËfl 1: èÓ‰‡‚ÎÂÌËfl ÌÂÚ ≥ ä‡Ú„ÓËfl 2: èÓ‰‡‚ÎÂÌË Ò‰ÌÂÈ ÒÚÂÔÂÌË ä‡Ú„ÓËfl 3: èÓ‰‡‚ÎÂÌË ‚˚ÒÓÍÓÈ ÒÚÂÔÂÌË 750–1 499 1 5%–24% ÍÓÎ./ÏÏ3 %

1–5 ÎÂÚ ÍÓÎ./ ÏÏ3 %

6–12 ÎÂÚ ÍÓÎ./ ÏÏ3 %

≥1 500

≥25%

≥1000

≥25%

≥500

≥25%

500–999

1 5%–24%

200–499

1 5%–24%

<750

<1 5%

<500

<1 5%

<200

<1 5%

49

èêàãéÜÖçàÖ C. ëÇéÑäÄ ÑÄççõï èé èÖÑàÄíêàóÖëäàå îéêåÄå à ÑéáÄå ãÖäÄêëíÇÖççõï èêÖèÄêÄíéÇ ç‡Á‚‡ÌË ÎÂ͇ÒÚ‚‡ îÓÏ˚ ‚˚ÔÛÒ͇ ÑÓÒÚÛÔÌ˚ ‰‡ÌÌ˚Â Ó Ù‡χÍÓÍËÌÂÚËÍÂ

çÛÍÎÂÓÁˉÌ˚ ËÌ„Ë·ËÚÓ˚ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ áˉӂۉËÌ (áÑÇ) ëËÓÔ 10 Ï„/ÏÎ ä‡ÔÒÛÎ˚: 100 Ï„; 250 Ï„ 퇷ÎÂÚÍË: 300 Ï„ ÇÒ ‚ÓÁ‡ÒÚÌ˚ „ÛÔÔ˚

ã‡ÏË‚Û‰ËÌ (3TC)

èÂÓ‡Î¸Ì˚È ‡ÒÚ‚Ó: 10 Ï„/ÏΠ퇷ÎÂÚÍË: 1 50 Ï„

ÇÒ ‚ÓÁ‡ÒÚÌ˚ „ÛÔÔ˚

äÓÏ·Ë̇ˆËfl áÑÇ ÔÎ˛Ò 3TC Ò ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁÓÈ

ÜˉÍÓÈ ÙÓÏ˚ ÌÂÚ í‡·ÎÂÚÍË: 300 Ï„ áÑÇ ÔÎ˛Ò 1 50 Ï„ 3TC

èÓ‰ÓÒÚÍË Ë ‚ÁÓÒÎ˚Â

50

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

ÑÓÁ‡ ÔÓ ‚ÓÁ‡ÒÚÛ/‚ÂÒÛ Ë ˜‡ÒÚÓÚ‡ ÔËÂχ

ÑÛ„Ë ÔËϘ‡ÌËfl

<4 ̉Âθ: ‰ÓÁ‡ 4Ï„/Í„ 2 ‡Á‡ ‚ ‰Â̸ ÓÚ 4 ̉Âθ ‰Ó 1 3 ÎÂÚ: ‰ÓÁ‡ 1 80 Ï„/Ï2/ ‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸‡ å‡ÍÒËχθ̇fl ‰ÓÁ‡: ≥13 ÎÂÚ: 300 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸

ÅÓθ¯ÓÈ Ó·˙ÂÏ ÒËÓÔ‡ ÔÎÓıÓ ÔÂÂÌÓÒËÚÒfl ‰ÂÚ¸ÏË ÒÚ‡¯Â„Ó ‚ÓÁ‡ÒÚ‡ ëËÓÔ ‰ÓÎÊÂÌ ı‡ÌËÚ¸Òfl ‚ ÒÚÂÍÎflÌÌÓÈ ÔÓÒÛ‰Â; ˜Û‚ÒÚ‚ËÚÂÎÂÌ Í Ò‚ÂÚÛ åÓÊÌÓ ÔËÌËχڸ Ò ÔˢÂÈ èË Î˜ÂÌËË Çàó-˝ÌˆÂÙ‡ÎÓÔ‡ÚËË ÚÂ·Û˛ÚÒfl ‰ÓÁ˚ ËÁ ‡Ò˜ÂÚ‡ 600 Ï„/Ï2/‰ÓÁ‡ Âʉ̂ÌÓ ä‡ÔÒÛÎ˚ ÏÓÊÌÓ ‡ÒÍ˚‚‡Ú¸ Ë ‡ÒÚ‚ÓflÚ¸ Ëı ÒÓ‰ÂÊËÏÓÂ, Ú‡·ÎÂÚÍË ÏÓÊÌÓ ‰Ó·ËÚ¸ Ë ‡Áϯ˂‡Ú¸ Ò Ì·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ‚Ó‰˚ ËÎË ÔË˘Ë ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÔÂ‰ ÔËÂÏÓÏ (‡ÒÚ‚Ó ÒÚ‡·ËÎÂÌ ÔË ÍÓÏ̇ÚÌÓÈ ÚÂÏÔÂ‡ÚÛÂ) ç ËÒÔÓθÁÓ‚‡Ú¸ ‚ÏÂÒÚÂ Ò d4T (‡ÌÚ‡„ÓÌËÒÚ˘ÂÒÍËÈ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚È ˝ÙÙÂÍÚ)

<30 ‰ÌÂÈ: 2 Ï„/Í„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ ≥30 ‰ÌÂÈ ËÎË <60 Í„: 4Ï„/Í„/ 2 ‡Á‡ ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: >60 Í„: 1 50 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸

ïÓÓ¯Ó ÔÂÂÌÓÒËÚÒfl åÓÊÌÓ ÔËÌËχڸ Ò ÔˢÂÈ ï‡ÌËÚ¸ ‡ÒÚ‚Ó ÔË ÍÓÏ̇ÚÌÓÈ ÚÂÏÔÂ‡ÚÛ (ËÒÔÓθÁÓ‚‡Ú¸ ÒÓ‰ÂÊËÏÓ Ù·ÍÓ̇ ‚ Ú˜ÂÌË ÏÂÒflˆ‡ ÔÓÒΠ‚ÒÍ˚ÚËfl) 퇷ÎÂÚÍË ÏÓÊÌÓ ‡Á‰Ó·ËÚ¸ Ë ‡Áϯ‡Ú¸ Ò Ì·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ‚Ó‰˚ ËÎË ÔË˘Ë ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÔÂ‰ Ëı ÔËÂÏÓÏ

å‡ÍÒËχθ̇fl ‰ÓÁ‡: >1 3 ÎÂÚ ËÎË >60 Í„: 1 Ú‡·ÎÂÚ͇/ 2 ‡Á‡ ‚ ‰Â̸ (Ì ÒΉÛÂÚ‰‡‚‡Ú¸ ÔË ‚ÂÒ <30 Í„)

퇷ÎÂÚÍË ÌÂθÁfl ‰ÂÎËÚ¸ ̇ ˜‡ÒÚË í‡·ÎÂÚÍË ÏÓÊÌÓ ‰Ó·ËÚ¸ Ë ‡Áϯ˂‡Ú¸ Ò Ì·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ‚Ó‰˚ ËÎË ÔË˘Ë ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÔÂ‰ Ëı ÔËÂÏÓÏ èË ‚ÂÒ <30 Í„, áÑÇ Ë áíë Ì‚ÓÁÏÓÊÌÓ ÚÓ˜ÌÓ ‰ÓÁËÓ‚‡Ú¸ ‚ Ú‡·ÎÂÚ͇ı.

51

ëÚ‡‚Û‰ËÌ (d4T)

èÂÓ‡Î¸Ì˚È ‡ÒÚ‚Ó: 1 Ï„/ÏÎ ä‡ÔÒÛÎ˚: 1 5 Ï„, 20 Ï„, 30Ï„, 40 Ï„

ÇÒ ‚ÓÁ‡ÒÚÌ˚ „ÛÔÔ˚

äÓÏ·Ë̇ˆËfl d4T ÔÎ˛Ò áíë Ò ÙËÍÒËÓ‚‡ÌÌÓÈ ‰ÓÁÓÈ

ÜˉÍÓÈ ÙÓÏ˚ ÌÂÚ í‡·ÎÂÚÍË: 30 Ï„ d4T ÔÎ˛Ò 1 50 Ï„ áíë; 40 Ï„ d4T ÔÎ˛Ò 1 50 Ï„ áíë;

èÓ‰ÓÒÚÍË Ë ‚ÁÓÒÎ˚Â

Ñˉ‡ÌÓÁËÌ(ddl) (‰Ë‰ÂÓÍÒËËÌÓÁËÌ)

è‰ˇÚ˘ÂÒ͇fl ÔÂÓ‡Î¸Ì‡fl ÒÛÒÔÂÌÁËfl ÔÓӯ͇/ ‚Ó‰˚: 10 Ï„/ÏÎ; ‚Ó ÏÌÓ„Ëı ÒÚ‡Ì‡ı ‚ ÌÂ„Ó ÌÂÓ·ıÓ‰ËÏÓ ‰Ó·‡‚ÎflÚ¸ ‡ÌÚ‡ˆË‰ Ü‚‡ÚÂθÌ˚ ڇ·ÎÂÚÍË: 25 Ï„; 50 Ï„; 100 Ï„; 1 50 Ï„; 200 Ï„ É ‡ÌÛÎ˚ ‚ ͇ÔÒÛ·ı Ò Í˯˜ÌÓ-‡ÒÚ‚ÓËÏ˚Ï ÔÓÍ˚ÚËÂÏ: 1 25 Ï„; 200 Ï„; 250 Ï„; 400 Ï„

ÇÒ ‚ÓÁ‡ÒÚÌ˚ „ÛÔÔ˚

Ä·‡Í‡‚Ë (ÄÅä)

èÂÓ‡Î¸Ì˚È ‡ÒÚ‚Ó: 20 Ï„/ÏΠ퇷ÎÂÚÍË: 300 Ï„

ëÚ‡¯Â 3 ÏÂÒflˆÂ‚

52

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

<30 Í„: 1 Ï„/Í„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ ÓÚ 30 ‰Ó 60 Í„: 30 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: >60 Í„: 40 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸

ÅÓθ¯ÓÈ Ó·˙ÂÏ ‡ÒÚ‚Ó‡ ê‡ÒÚ‚Ó ‰ÓÎÊÂÌ ı‡ÌËÚ¸Òfl ‚ ıÓÎÓ‰ËθÌËÍÂ; ÒÓı‡ÌflÂÚ ÒÚ‡·ËθÌÓÒÚ¸ 30 ‰ÌÂÈ; ÔÂ‰ ÛÔÓÚ·ÎÂÌËÂÏ ÌÂÓ·ıÓ‰ËÏÓ ıÓÓ¯Ó ‚ÒÚflıÌÛÚ¸. çÂÓ·ıÓ‰ËÏÓ ı‡ÌËÚ¸ ‚ ÒÚÂÍÎflÌÌ˚ı ·ÛÚ˚Î͇ı ä‡ÔÒÛÎ˚ ÏÓÊÌÓ ‚ÒÍ˚Ú¸ Ë Ëı ÒÓ‰ÂÊËÏÓ ÔÂÂϯ‡Ú¸ Ò Ì·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ÔË˘Ë ËÎË ‚Ó‰˚ (ÒÚ‡·ËθÌÓÒÚ¸ ÊˉÍÓÈ Ù‡Á˚ ÒÓı‡ÌflÂÚÒfl ‚ Ú˜ÂÌË 24 ˜‡ÒÓ‚ ÔË ı‡ÌÂÌËË ‚ ıÓÎÓ‰ËθÌËÍÂ) ç ̇Á̇˜‡Ú¸ ‚ÏÂÒÚÂ Ò AZT (‡ÌÚ‡„ÓÌËÒÚ˘ÂÒÍËÈ ‡ÌÚËÂÚÓ‚ËÛÒÌ˚È ˝ÙÙÂÍÚ)

å‡ÍÒËχθ̇fl ‰ÓÁ‡: 30-60 Í„:Ӊ̇ 30 Ï„ Ú‡·ÎÂÚ͇ ̇ ÓÒÌÓ‚Â d4T 2 ‡Á‡ ‚ ‰Â̸ ≥60 Í„: Ӊ̇ 40 Ï„ Ú‡·ÎÂÚ͇ ̇ ÓÒÌÓ‚Â d4T 2 ‡Á‡ ‚ ‰Â̸ <3 ÏÂÒflˆÂ‚: 50 Ï„/Ï2/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸a 3 ÏÂÒflˆ‡ ‰Ó <1 3 ÎÂÚ: 90-1 20 Ï„/Ï2 /‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ ËÎË 240 Ï„/Ï2/‰ÓÁ‡ 1 ‡Á ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: ≥1 3 ÎÂÚ ËÎË >60 Í„: 200 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ ËÎË 400 Ï„ 1 ‡Á ‚ ‰Â̸

퇷ÎÂÚÍË Ê·ÚÂθÌÓ Ì ‰ÂÎËÚ¸ ̇ ˜‡ÒÚË ëÏ. ÓÚ‰ÂθÌ˚ ÔËϘ‡ÌËfl ÔÓ ÒÓÒÚ‡‚Îfl˛˘ËÏ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚

ëÛÒÔÂÌÁËfl ‰ÓÎÊ̇ ı‡ÌËÚ¸Òfl ‚ ıÓÎÓ‰ËθÌËÍÂ; ÒÓı‡ÌflÂÚ ÒÚ‡·ËθÌÓÒÚ¸ 30 ‰ÌÂÈ; ÔÂ‰ ÛÔÓÚ·ÎÂÌËÂÏ ÌÂÓ·ıÓ‰ËÏÓ Ú˘‡ÚÂθÌÓ ‚ÒÚflıË‚‡Ú¸. èËÌËχڸ ̇ „ÓÎÓ‰Ì˚È ÊÂÎÛ‰ÓÍ Ì ÏÂÌ ˜ÂÏ Á‡ 30 ÏËÌÛÚ ‰Ó ‰˚ ËÎË ˜ÂÂÁ 2 ˜‡Ò‡ ÔÓÒΠ‰˚ ÑÎfl Ú‡·ÎÂÚÓÍ, ‡ÒÚ‚ÓËÏ˚ı ‚ ‚Ó‰Â: ‡ÒÚ‚ÓËÚ¸ ÏËÌËÏÛÏ 2 Ú‡·ÎÂÚÍË ÒÓÓÚ‚ÂÚÒÚ‚Û˛˘ÂÈ ‰ÓÁËÓ‚ÍË ‰Îfl ÒÓÁ‰‡ÌËfl ‰ÓÒÚ‡ÚÓ˜ÌÓ„Ó ·ÛÙÂ‡ É ‡ÌÛÎ˚ ‚ ͇ÔÒÛ·ı Ò Í˯˜ÌÓ-‡ÒÚ‚ÓËÏ˚Ï ÔÓÍ˚ÚËÂÏ ÏÓÊÌÓ ‚ÒÍ˚Ú¸ Ë ÔÓÒ˚Ô‡Ú¸ ËÏË Ì·Óθ¯Ó ÍÓ΢ÂÒÚ‚Ó Â‰˚

<16 ÎÂÚ ËÎË <37,5 Í„: 8 Ï„/Í„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: >16 ÎÂÚ ËÎË ≥37,5 Í„: 300 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸

åÓÊÌÓ ÔËÌËχڸ Ò ÔˢÂÈ í‡·ÎÂÚÍË ÏÓÊÌÓ ‰Ó·ËÚ¸ Ë ‡Áϯ˂‡Ú¸ Ò Ì·Óθ¯ËÏ ÍÓ΢ÂÒÚ‚ÓÏ ‚Ó‰˚ ËÎË ÔË˘Ë ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÔÂ‰ Ëı ÔËÂÏÓÏ çÖéÅïéÑàåé èêÖÑìèêÖÑàíú êéÑàíÖãÖâ é ÇéáåéÜçéâ êÖÄäñàà ÉàèÖêóìÇëíÇàíÖãúçéëíà èË ÒËÏÔÚÓχı ‡͈ËË „ËÔÂ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚË ÔËÂÏ ÄÅä ÒΉÛÂÚ ÔÂÍ‡ÚËÚ¸

53

ÜˉÍÓÈ ÙÓÏ˚ ÌÂÚ äÓÏ·Ë̇ˆËfl áÑÇ ÔÎ˛Ò áíë ÔÎ˛Ò ÄÅä 퇷ÎÂÚÍË: 300 Ï„ áÑÇ ÔÎ˛Ò Ò ÙËÍÒËÓ‚‡ÌÌÓÈ 1 50 Ï„ áíë ÔÎ˛Ò 300 Ï„ ÄÅä ‰ÓÁÓÈ

èÓ‰ÓÒÚÍË Ë ‚ÁÓÒÎ˚Â

çÂÌÛÍÎÂÓÁˉÌ˚ ËÌ„Ë·ËÚÓ˚ Ó·‡ÚÌÓÈ Ú‡ÌÒÍËÔÚ‡Á˚ ç‚Ë‡ÔËÌ (çÇè) èÂÓ‡Î¸Ì‡fl ÒÛÒÔÂÌÁËfl: 10 Ï„/ÏΠ퇷ÎÂÚÍË: 200 Ï„ ÇÒ ‚ÓÁ‡ÒÚÌ˚ „ÛÔÔ˚

54

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

å‡ÍÒËχθ̇fl ‰ÓÁ‡: >40 Í„: 1 Ú‡·ÎÂÚ͇/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸

퇷ÎÂÚÍË Ê·ÚÂθÌÓ Ì ‰ÂÎËÚ¸ ̇ ˜‡ÒÚË èË ‚ÂÒ <30 Í„, áÑÇ/ áíë/ÄÅä ÚӘ̇fl ‰ÓÁËӂ͇ ‚ Ú‡·ÎÂÚ͇ı Ì‚ÓÁÏÓÊ̇ çÖéÅïéÑàåé èêÖÑìèêÖÑàíú êéÑàíÖãÖâ é ÇéáåéÜçéâ êÖÄäñàà ÉàèÖêóìÇëíÇàíÖãúçéëíà èË ÒËÏÔÚÓχı ‡͈ËË „ËÔÂ˜Û‚ÒÚ‚ËÚÂθÌÓÒÚË ÔËÂÏ áÑÇ/ áíë/ÄÅä ÒΉÛÂÚ ÔÂÍ‡ÚËÚ¸

éÚ 1 5 ‰Ó 30 ‰ÌÂÈ: 5 Ï„/Í„ / ‰ÓÁ‡ Ó‰ËÌ ‡Á ‚ ‰Â̸ ı 2 ̉ÂÎË, Á‡ÚÂÏ 1 20 Ï„/Ï2 /‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ ı 2 ̉ÂÎË, Á‡ÚÂÏ 200 Ï„/Ï2/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸ a ÓÚ >30 ‰ÌÂÈ ‰Ó 1 3 ÎÂÚ: 1 20 Ï„/Ï2 /‰ÓÁ‡ 1 ‡Á ‚ ‰Â̸ ‚ Ú˜ÂÌË 2-ı ̉Âθ), Á‡ÚÂÏ 1 20-200 Ï„/Ï2/‰ÓÁ‡ 2 a ‡Á‡ ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: >1 3 ÎÂÚ: 200 Ï„/‰ÓÁ‡ 1 ‡Á ‚ ‰Â̸ ‚ Ú˜ÂÌË ÔÂ‚˚ı 2-ı ̉Âθ), Á‡ÚÂÏ 200 Ï„/‰ÓÁ‡ 2 ‡Á‡ ‚ ‰Â̸

èË Ó‰ÌÓ‚ÂÏÂÌÌÓÏ Ì‡Á̇˜ÂÌËË ËÙ‡ÏÔˈË̇ ËÁ·Â„‡ÈÚ ÔËÏÂÌÂÌËfl (ÒÏ. ‡Á‰ÂÎ íÅ) ï‡ÌËÚ¸ ÒÛÒÔÂÌÁ˲ ÔË ÍÓÏ̇ÚÌÓÈ ÚÂÏÔÂ‡ÚÛÂ; ÔÂ‰ ÛÔÓÚ·ÎÂÌËÂÏ Ú˘‡ÚÂθÌÓ ‚Á·‡ÎÚ˚‚‡Ú¸. åÓÊÌÓ ÔËÌËχڸ Ò ÔˢÂÈ í‡·ÎÂÚÍË ÏÓÊÌÓ ‰ÂÎËÚ¸ ̇ ‰‚ ‡‚Ì˚ ˜‡ÒÚË (ÔÓ ÓÚÏÂÚÍ ̇ ÌËı) Ë ÔËÌËχڸ ‰ÓÁ‡ÏË ÔÓ 100Ï„: ÏÓÊÌÓ ‰Ó·ËÚ¸ Ë ‡Áϯ˂‡Ú¸ ‚ Ì·Óθ¯ÓÏ ÍÓ΢ÂÒÚ‚Â ‚Ó‰˚ ËÎË ÔË˘Ë ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÔÂ‰ ÔËÂÏÓÏ çÖéÅïéÑàåé èêÖÑìèêÖÑàíú êéÑàíÖãÖâ é ÇéáåéÜçéëíà èéüÇãÖçàü ëõèà. èË ÔÓfl‚ÎÂÌËË Ò˚ÔË Ì ۂÂ΢˂‡ÈÚ ‰ÓÁÛ (ÔË Î„ÍÓÈ/ÛÏÂÂÌÌÓÈ Ò˚ÔË ‚ÂÏÂÌÌÓ ÔËÓÒÚ‡ÌÓ‚ËÚ ÔËÂÏ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚, ‡ ÔÓÒΠËÒ˜ÂÁÌÓ‚ÂÌËfl Ò˚ÔË ‚ÓÁÓ·ÌÓ‚ËڠΘÂÌËÂ, Í‡Í ‚ Ò‡ÏÓÏ Ì‡˜‡ÎÂ, Ò ÔÓÒÚÂÔÂÌÌ˚Ï ÔÓ‚˚¯ÂÌËÂÏ ‰ÓÁ˚; ÔË ÚflÊÂÎÓÈ Ò˚ÔË ÓÚÏÂÌËÚ ÔËÂÏ ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚) ÇÓÁÏÓÊÌ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl

55

ùÙ‡‚ËÂ̈ (ùîñ)

ëËÓÔ: 30 Ï„/ÏÎ (èËϘ‡ÌËÂ: ÔË ËÒÔÓθÁÓ‚‡ÌËË ÒËÓÔ‡ ÚÂ·Û˛ÚÒfl ·ÓΠ‚˚ÒÓÍË ‰ÓÁ˚ ÔÓ Ò‡‚ÌÂÌ˲ Ò Í‡ÔÒÛ·ÏË; ÒÏ. ÒıÂÏÛ ‰ÓÁËÓ‚ÍË) ä‡ÔÒÛÎ˚: 50 Ï„, 100 Ï„, 200 Ï„

íÓθÍÓ ‰Îfl ‰ÂÚÂÈ ÒÚ‡¯Â 3 ÎÂÚ

äÓÏ·Ë̇ˆËfl d4T ÔÎ˛Ò áíë ÔÎ˛Ò çÇè

ÜˉÍÓÈ ÙÓÏ˚ ÌÂÚ í‡·ÎÂÚÍË: 30 Ï„ d4T / 1 50 Ï„ áíë/ 200 Ï„ çÇè; 40 Ï„ d4T / 1 50 Ï„ áíë / 200 Ï„ çÇè

èÓ‰ÓÒÚÍË Ë ‚ÁÓÒÎ˚Â

56

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

ÑÓÁ˚ ͇ÔÒÛÎ (ÊˉÍÓÒÚË) ‰Îfl ·ÓθÌ˚ı >3 ÎÂÚ:

ä‡ÔÒÛÎ˚ ÏÓÊÌÓ ‚ÒÍ˚‚‡Ú¸ Ë Òϯ˂‡Ú¸ Ëı ÒÓ‰ÂÊËÏÓÂ Ò ÔˢÂÈ (ÔË ˝ÚÓÏ ÔÓfl‚ÎflÂÚÒfl ‚˚‡ÊÂÌÌ˚È Â‰ÍËÈ ÔË‚ÍÛÒ); ‰Îfl ÒÏfl„˜ÂÌËfl ÓÚ 10 ‰Ó 1 5 Í„: 200 Ï„ (270 Ï„ = 9 ÏÎ) ˝ÚÓ„Ó ÔË‚ÍÛÒ‡ ÏÓÊÌÓ Òϯ˂‡Ú¸ ÎÂ͇ÒÚ‚ÂÌÌ˚È ÔÂÔ‡‡Ú ÒÓ Ò·‰ÍÓÈ ÔˢÂÈ ËÎË ‰ÊÂÏÓÏ Ó‰ËÌ ‡Á ‚ ‰Â̸ ÓÚ 1 5 ‰Ó <20 Í„: 250 Ï„ (300 Ï„ = 10 ÏÎ) Ó‰ËÌ ‡Á ‚ ‰Â̸ ÓÚ 20 ‰Ó <25 Í„: 300 Ï„ (360 Ï„ = 1 2 ÏÎ) Ó‰ËÌ ‡Á ‚ ‰Â̸ ÓÚ 25 ‰Ó <33 Í„: 350 Ï„ (450 Ï„ = 1 5 ÏÎ) Ó‰ËÌ ‡Á ‚ ‰Â̸ ÓÚ 33 ‰Ó <40 Í„: 400 Ï„ (510 Ï„ = 17 ÏÎ) Ó‰ËÌ ‡Á ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: ≥40 Í„: 600 Ï„ Ó‰ËÌ ‡Á ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: 30-60 Í„: Ӊ̇ 30 Ï„ Ú‡·ÎÂÚ͇ ̇ ÓÒÌÓ‚Â d4T 2 ‡Á‡ ‚ ‰Â̸ ≥60 Í„: Ӊ̇40 Ï„ Ú‡·ÎÂÚ͇ ̇ ÓÒÌÓ‚Â d4í 2 ‡Á‡ ‚ ‰Â̸ 퇷ÎÂÚÍË Ê·ÚÂθÌÓ Ì ‰ÂÎËÚ¸ ̇ ˜‡ÒÚË èË ‚ÂÒ <30 Í„ d4T/ áíë/çÇè ÚӘ̇fl ‰ÓÁËӂ͇ ‚ Ú‡·ÎÂÚ͇ı Ì‚ÓÁÏÓÊ̇. ÖÒÎË Ú‡·ÎÂÚÍË ‰Ó·ËÚ¸, ÚÓ ‰ÓÁ˚ çÇè ‰Îfl Ò‡Ï˚ı χÎÂ̸ÍËı ‰ÂÚÂÈ Ó͇ÊÛÚÒfl ̉ÓÒÚ‡ÚÓ˜Ì˚ÏË, ˜ÚÓ ÔÓÚ·ÛÂÚ ‰ÓÔÓÎÌËÚÂθÌÓ„Ó ÔËÂχ çÇè, ‰ÓÁËӂ͇ ÍÓÚÓÓ„Ó ‰ÓÎÊ̇ ‚ ˆÂÎÓÏ ÒÓÒÚ‡‚ÎflÚ¸ 200 Ï„/ m2/‰ÓÁ‡ ‰‚‡ ‡Á‡ ‚ ‰Â̸ ëÓ‰ÂÊËÚ çÇè, ÔÓ˝ÚÓÏÛ ÌÂÓ·ıÓ‰ËÏÓ Û‚Â΢ÂÌË ‰ÓÁ˚ (ÒÏ. ÂÍÓÏẨ‡ˆËË ÔÓ ‰ÓÁËÓ‚Í çÇè) ëÏ. ÔËϘ‡ÌËfl ÔÓ ÒÓÒÚ‡‚Îfl˛˘ËÏ ÓÚ‰ÂθÌ˚ı ÎÂ͇ÒÚ‚ÂÌÌ˚ı ÔÂÔ‡‡ÚÓ‚ åÓÊÌÓ ‰‡‚‡Ú¸ Ò ÔˢÂÈ (ÔË ˝ÚÓÏ ËÁ·Â„‡ÈÚ ËÒÔÓθÁÓ‚‡ÌËfl ÔÓ‰ÛÍÚÓ‚ Ò ‚˚ÒÓÍËÏ ÒÓ‰ÂʇÌËÂÏ ÊËÓ‚, ËÁ-Á‡ ÍÓÚÓÓ„Ó ‚Ò‡Ò˚‚‡ÌË ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó ÔÂÔ‡‡Ú‡ Û‚Â΢˂‡ÂÚÒfl ̇ 50%) ãÛ˜¯Â ÔËÌËχڸ ÔÂ‰ ÒÌÓÏ, ÓÒÓ·ÂÌÌÓ ‚ Ú˜ÂÌË ÔÂ‚˚ı 2 ̉Âθ ‰Îfl ÛÏÂ̸¯ÂÌËfl ÔÓ·Ó˜ÌÓÈ ‡͈ËË Ì‡ ñçë ÇÓÁÏÓÊÌ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl

57

àÌ„Ë·ËÚÓ˚ ÔÓÚ‡Á˚ çÂÎÙË̇‚Ë (çîÇ) èÓÓ¯ÓÍ ‰Îfl ÔÂÓ‡Î¸ÌÓÈ ÒÛÒÔÂÌÁËË, ÍÓÚÓ˚È Òϯ˂‡ÂÚÒfl Ò ‚Ó‰ÓÈ: 200 Ï„ ‚ ÔÓÎÌÓÈ ˜‡ÈÌÓÈ ÎÓÊÍ ·ÂÁ „ÓÍË (50 Ï„ ‚ ÏÂÌÓÈ ÎÓʘ͠ӷ˙ÂÏÓÏ 1, 25 ÏÎ): 5 ÏΠ퇷ÎÂÚÍË: 250 Ï„ (Ú‡·ÎÂÚÍË ÏÓÊÌÓ ‰ÂÎËÚ¸ ÔÓÔÓ·Ï, ‡ Ú‡ÍÊ ËÁÏÂθ˜‡Ú¸ Ë Òϯ˂‡Ú¸ Ò ÔˢÂÈ ËÎË ‡ÒÚ‚ÓflÚ¸ ‚ ‚Ó‰Â) ÇÒ ‚ÓÁ‡ÒÚÌ˚ „ÛÔÔ˚; Ӊ̇ÍÓ, ËÁ-Á‡ ¯ËÓÍÓÈ ‚‡ˇ·ÂθÌÓÒÚË Ù‡χÍÓÍËÌÂÚËÍË ‚ ‡ÌÌÂÏ ‚ÓÁ‡ÒÚ ‰ÂÚflÏ Ï·‰¯Â 1 „Ó‰‡ ÚÂ·Û˛ÚÒfl Ó˜Â̸ ‚˚ÒÓÍË ‰ÓÁ˚

ãÓÔË̇‚Ë/ËÚÓ̇‚Ë (ãèÇ/)

èÂÓ‡Î¸Ì˚È ‡ÒÚ‚Ó: 80 Ï„/ÏÎ ÎÓÔË̇‚Ë‡ ÔÎ˛Ò 20 Ï„/ÏÎ ËÚÓ̇‚Ë‡ ä‡ÔÒÛÎ˚: 1 33,3 Ï„ ÎÓÔË̇‚Ë‡ ÔÎ˛Ò 33,3 Ï„ ËÚÓ̇‚Ë‡

6 ÏÂÒflˆÂ‚ Ë ÒÚ‡¯Â

58

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

å·‰¯Â 1 „Ó‰‡: ‰ÓÁ‡ 50 Ï„/Í„ 3 ‡Á‡ ‚ ÒÛÚÍË ËÎË 75 Ï„/Í„ 2 ‡Á‡ ‚ ‰Â̸ ÓÚ >1 „Ó‰‡ ‰Ó <1 3 ÎÂÚ: ÓÚ 55 ‰Ó 65 Ï„/Í„ 2 ‡Á‡ ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: ≥1 3 ÎÂÚ: 1 250 Ï„ 2 ‡Á‡ ‚ ‰Â̸

èÓÓ¯ÓÍ Ó·Î‡‰‡ÂÚ ÔËflÚÌ˚Ï Ò·‰ÍÓ‚‡Ú˚Ï ‚ÍÛÒÓÏ Ò Â‰‚‡ ÛÎÓ‚ËÏ˚Ï ÔË‚ÍÛÒÓÏ „Ó˜Ë, ÌÓ ËÏÂÂÚ ÍÛÔ˜‡ÚÛ˛ ÍÓÌÒËÒÚÂÌˆË˛ Ë Ò ÚÛ‰ÓÏ ‡ÒÚ‚ÓflÂÚÒfl ‚ ‚Ó‰Â; ÌÂÔÓÒ‰ÒÚ‚ÂÌÌÓ ÔÂ‰ ÔËÂÏÓÏ ÔÓÓ¯ÓÍ Ì‡‰Ó ‚ÓÒÒڇ̇‚ÎË‚‡Ú¸ ‚ ‚Ó‰Â, ÏÓÎÓÍÂ, ÏÓÎÓ˜ÌÓÈ ÒÏÂÒË, ÔÛ‰ËÌ„Â Ë Ú.‰. (Ì ÒΉÛÂÚ ËÒÔÓθÁÓ‚‡Ú¸ ‚ ˝ÚËı ˆÂÎflı ÍËÒÎ˚ ·Î˛‰‡ Ë ÒÓÍË, ÔÓÒÍÓθÍÛ ÓÌË ÛÒËÎË‚‡˛Ú „Ó¸ÍËÈ ÔË‚ÍÛÒ ÎÂ͇ÒÚ‚ÂÌÌÓ„Ó ÔÂÔ‡‡Ú‡). ê‡ÒÚ‚Ó ÒÚ‡·ËÎÂÌ ‚ Ú˜ÂÌË 6 ˜‡ÒÓ‚ àÁ-Á‡ ÚÛ‰ÌÓÒÚÂÈ ‚ Ó·‡˘ÂÌËË Ò ÔÓÓ¯ÍÓÏ Ô‰ÔÓ˜ÚËÚÂθÌ ËÒÔÓθÁÓ‚‡Ú¸ ËÁÏÂθ˜ÂÌÌ˚ ڇ·ÎÂÚÍË (‰‡Ê ‰Îfl ‰ÂÚÂÈ „Û‰ÌÓ„Ó ‚ÓÁ‡ÒÚ‡), ÂÒÎË ÏÓÊÌÓ Ó·ÂÒÔ˜ËÚ¸ ÌÛÊÌÛ˛ ‰ÓÁËÓ‚ÍÛ èÓÓ¯ÓÍ Ë Ú‡·ÎÂÚÍË ÏÓÊÌÓ ı‡ÌËÚ¸ ÔË ÍÓÏ̇ÚÌÓÈ ÚÂÏÔÂ‡ÚÛ êÂÍÓÏẨÛÂÚÒfl ÔËÌËχڸ Ò ÔˢÂÈ ÇÓÁÏÓÊÌ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl (ÏÂÌ ‚˚‡ÊÂÌÌ˚ ÔÓ Ò‡‚ÌÂÌ˲ Ò Ú‡ÍÓ‚˚ÏË Û ËÌ„Ë·ËÚÓÓ‚ ÔÓÚ‡Á˚, ÒÓ‰Âʇ˘Ëı ËÚÓ̇‚Ë)

ÓÚ >6 ÏÂÒflˆÂ‚ ‰Ó1 3 ÎÂÚ: 225 Ï„/Ï2 ãèÇ/57,5 Ï„/Ï2 êíÇ 2 ‡Á‡ ‚ ‰Â̸a ãË·Ó ‰ÓÁËӂ͇ ÔÓ Ï‡ÒÒ Ú·: 7-1 5 Í„: 1 2 Ï„/Í„ ãèÇ/3 Ï„/Í„ êíÇ 2 ‡Á‡ ‚ ‰Â̸ 1 5–40 Í„: 10 Ï„/Í„ ãèÇ/2,5 Ï„/Í„ êíÇ 2 ‡Á‡ ‚ ‰Â̸ å‡ÍÒËχθ̇fl ‰ÓÁ‡: >40 Í„: 400 Ï„ ãèÇ/100 Ï„ êíÇ (3 ͇ÔÒÛÎ˚ ËÎË 5 ÏÎ) 2 ‡Á‡ ‚ ‰Â̸

èÂÓ‡Î¸Ì˚È ‡ÒÚ‚Ó Ë Í‡ÔÒÛÎ˚ ÎÛ˜¯Â ‚ÒÂ„Ó ı‡ÌËÚ¸ ‚ ıÓÎÓ‰ËθÌËÍÂ, Ӊ̇ÍÓ ‰ÓÔÛÒ͇ÂÚÒfl ı‡ÌÂÌËÂ Ë ÔË ÍÓÏ̇ÚÌÓÈ ÚÂÏÔÂ‡ÚÛ ‰Ó 25o C (77o F) Ì ·ÓΠ‰‚Ûı ÏÂÒflˆÂ‚; ÔË ÚÂÏÔÂ‡ÚÛ >25o C (77o F) ÎÂ͇ÒÚ‚Ó ÔÓÚËÚÒfl ·˚ÒÚ Üˉ͇fl ÙÓχ ÔÂÔ‡‡Ú‡ ËÏÂÂÚ ÏÂ̸¯ËÈ Ó·˙ÂÏ, ÌÓ Ó·Î‡‰‡ÂÚ ·ÓΠ„Ó¸ÍËÏ ‚ÍÛÒÓÏ ä‡ÔÒÛÎ˚ ·Óθ¯Ó„Ó ‡ÁÏÂ‡ ä‡ÔÒÛÎ˚ ÌÂθÁfl ‰Ó·ËÚ¸ ËÎË ÓÚÍ˚‚‡Ú¸. ëΉÛÂÚ „ÎÓÚ‡Ú¸ ˆÂÎËÍÓÏ. çÂÓ·ıÓ‰ËÏÓ ÔËÌËχڸ Ò ÔˢÂÈ ÇÓÁÏÓÊÌ˚ ÎÂ͇ÒÚ‚ÂÌÌ˚ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl

a

ê‡Ò˜ÂÚ ÔÎÓ˘‡‰Ë ÔÓ‚ÂıÌÓÒÚË Ú· ‚ Ï2: ÍÓÂ̸ Í‚‡‰‡ÚÌ˚È ËÁ ÒÎÂ‰Û˛˘ÂÈ ‚Â΢ËÌ˚ (ÓÒÚ ‚ Ò‡ÌÚËÏÂÚ‡ı, ÛÏÌÓÊÂÌÌ˚È Ì‡ χÒÒÛ Ú· ‚ ÍËÎÓ„‡Ïχı Ë ‰ÂÎÂÌÌ˚È Ì‡ 3600).

59

èêàãéÜÖçàÖ D. äéåÅàçÄñàà ÄêÇ-èêÖèÄêÄíéÇ Ç îàäëàêéÇÄççõï ÑéáÄï èé ëéëíéüçàû çÄ 1 ÑÖäÄÅêü 2003 ÉéÑÄ d4T (40 Ï„) + 3íë (1 50 Ï„) + çÇè (200 Ï„) äÓÏ·Ë̇ˆËË ËÁ ÚÂı ÔÂÔ‡‡ÚÓ‚ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁ‡ı äÓÏ·Ë̇ˆËË ËÁ ‰‚Ûı ÔÂÔ‡‡ÚÓ‚ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁ‡ı d4T (30 Ï„) + 3íë (1 50 Ï„) + çÇè (200 Ï„) áÑÇ (300 Ï„) + 3íë (1 50 Ï„) + ÄÅä (1 50 Ï„) áÑÇ (300 Ï„) + 3íë (1 50 Ï„) + çÇè (200 Ï„) d4T (30 Ï„) + 3íë (1 50 Ï„) d4T (40 Ï„) + 3íë (1 50 Ï„) áÑÇ (300 Ï„) + 3íë (1 50 Ï„)

èËϘ‡ÌËÂ: Çéá ÔÓ‰‰ÂÊË‚‡ÂÚ ÔËÏÂÌÂÌË ÍÓÏ·Ë̇ˆËÈ ÔÂÔ‡‡ÚÓ‚ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁ‡ı, ÍÓ„‰‡ ͇˜ÂÒÚ‚Ó Ëı ÒÓÒÚ‡‚‡ „‡‡ÌÚËÓ‚‡ÌÓ, ‡ Ëı ·Ëӽ͂˂‡ÎÂÌÚÌÓÒÚ¸ ‰Ó͇Á‡Ì‡, ˜ÚÓ Ó·ÂÒÔ˜˂‡ÂÚ ÓÔ‰ÂÎÂÌÌ˚ ÔÂËÏÛ˘ÂÒÚ‚‡ ‚ ‡·ÓÚÂ. ç ‚Ò ÍÓÏ·Ë̇ˆËË ÔÂÔ‡‡ÚÓ‚ ‚ ÙËÍÒËÓ‚‡ÌÌ˚ı ‰ÓÁ‡ı ÔÓ¯ÎË Ô‰‚‡ËÚÂθÌÛ˛ ÓˆÂÌÍÛ Çéá ̇ ÒÓÓÚ‚ÂÚÒÚ‚Ë ÚÂıÌ˘ÂÒÍËÏ ÛÒÎÓ‚ËflÏ. Çéá ‚Â‰ÂÚ ‰Ó·Ó‚ÓθÌÛ˛ ÒËÒÚÂÏÛ Ô‰‚‡ËÚÂθÌÓ„Ó ÎˈÂÌÁËÓ‚‡ÌËfl, ‚ ÒÓÓÚ‚ÂÚÒÚ‚ËË Ò ÍÓÚÓÓÈ Ì‡ 1 ‰Â͇·fl 2003 „Ó‰‡ ÚË ÔÓËÁ‚Ó‰ËÚÂÎfl ÔÓÎÛ˜ËÎË Ô‰‚‡ËÚÂθÌÛ˛ ÎˈÂÌÁ˲ ̇ ÍÓÏ·Ë̇ˆËË áÑÇ/3íë, ‰‚‡ – ̇ ÍÓÏ·Ë̇ˆËË d4T/3íë/çÇè Ë Ó‰ËÌ – ̇ ÍÓÏ·Ë̇ˆËË áÑÇ/3íë/ÄÅä. ëÔËÒÓÍ ÔÓËÁ‚Ó‰ËÚÂÎÂÈ, ÔÓÎۘ˂¯Ëı Ô‰‚‡ËÚÂθÌÛ˛ ÎˈÂÌÁ˲ Çéá, ÔÓÒÚÓflÌÌÓ Ó·ÌÓ‚ÎflÂÚÒfl. ë ÌËÏ ÏÓÊÌÓ ÓÁ̇ÍÓÏËÚ¸Òfl ÔÓ ‡‰ÂÒÛ: http://www.who.int/medicines

60

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

èêàãéÜÖçàÖ E. ëàëíÖåÄ éèêÖÑÖãÖçàü ëíÄÑàâ Çàó-àçîÖäñàà à áÄÅéãÖÇÄçàü ì Çáêéëãõï à èéÑêéëíäéÇ èé äãÄëëàîàäÄñàà Çéá äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl I 1. ÅÂÒÒËÏÔÚÓÏ̇fl 2. É ÂÌÂ‡ÎËÁÓ‚‡Ì̇fl ÎËÏÙ‡‰ÂÌÓÔ‡ÚËfl ëÚÂÔÂ̸ ÔÓÚÂË ÚÛ‰ÓÒÔÓÒÓ·ÌÓÒÚË 1: ·ÂÒÒËÏÔÚÓÏ̇fl, ÌÓχθ̇fl ‡ÍÚË‚ÌÓÒÚ¸ äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl II 3. èÓÚÂfl χÒÒ˚ Ú· <10% 4. å‡Î˚ ÔÓfl‚ÎÂÌËfl ÔÓ‡ÊÂÌËfl ÍÓÊË Ë ÒÎËÁËÒÚ˚ı Ó·ÓÎÓ˜ÂÍ (Ò·ÓÂÈÌ˚È ‰ÂχÚËÚ, ÔÓ˜ÂÒÛı‡, „Ë·ÍÓ‚˚ ËÌÙÂ͈ËË ÌÓ„ÚÂÈ, ˆˉ˂ËÛ˛˘Ë flÁ‚˚ ‚ ÔÓÎÓÒÚË Ú‡, ‡Ì„ÛÎflÌ˚È ıÂÈÎËÚ) 5. éÔÓflÒ˚‚‡˛˘ËÈ Î˯‡È ‚ Ú˜ÂÌË ÔÓÒΉÌËı ÔflÚË ÎÂÚ 6. èÓ‚ÚÓÌ˚ ËÌÙÂ͈ËË ‚ÂıÌËı ‰˚ı‡ÚÂθÌ˚ı ÔÛÚÂÈ (Ú.Â. ·‡ÍÚÂˇθÌ˚È ÒËÌÛÒËÚ) à/ËÎË ÒÚÂÔÂ̸ ÔÓÚÂË ÚÛ‰ÓÒÔÓÒÓ·ÌÓÒÚË 2: ÒËÏÔÚÓχÚ˘ÂÒ͇fl, ÌÓχθ̇fl ‡ÍÚË‚ÌÓÒÚ¸ äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl III 7. èÓÚÂfl χÒÒ˚ Ú· >10% 8. ïÓÌ˘ÂÒ͇fl ‰Ë‡Âfl ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË >1 ÏÂÒflˆ‡ 9. ÑÎËÚÂθÌÓ ÔÓ‚˚¯ÂÌË ÚÂÏÔÂ‡ÚÛ˚ Ú· ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË (ÔÂËӉ˘ÂÒÍÓ ËÎË ÔÓÒÚÓflÌÌÓÂ) >1 ÏÂÒflˆ‡ 10. ä‡Ì‰Ë‰ÓÁÌ˚È ÒÚÓχÚËÚ (ÏÓÎÓ˜Ìˈ‡) 1 1. ÇÓÎÓÒËÒÚ‡fl ÎÂÈÍÓÔ·ÍËfl Ú‡ 1 2. ã„Ә̇fl ÙÓχ ÚÛ·ÂÍÛÎÂÁ‡ 1 3. íflÊÂÎ˚ ·‡ÍÚÂˇθÌ˚ ËÌÙÂ͈ËË (Ú.Â. ÔÌ‚ÏÓÌËfl, ÔËÓÏËÓÁËÚ) à/ËÎË ÒÚÂÔÂ̸ ÔÓÚÂË ÚÛ‰ÓÒÔÓÒÓ·ÌÓÒÚË 3: ÔÓÒÚÂθÌ˚È ÂÊËÏ <50% ‰ÌÂÈ ‚ Ú˜ÂÌË ÔÓ¯ÎÓ„Ó ÏÂÒflˆ‡ äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl IV: 1 4. ëË̉ÓÏ ËÒÚÓ˘ÂÌËfl ÔË Çàó-ËÌÙÂ͈ËË a 1 5. èÌ‚ÏÓˆËÒÚ̇fl ÔÌ‚ÏÓÌËfl 16. íÓÍÒÓÔ·ÁÏÓÁ „ÓÎÓ‚ÌÓ„Ó ÏÓÁ„‡ 17. äËÔÚÓÒÔÓˉËÓÁ Ò ‰Ë‡ÂÂÈ >1 ÏÂÒflˆ‡ 1 8. äËÔÚÓÍÓÍÍÓÁ ‚ÌÂ΄ӘÌ˚È 1 9. ñËÚÓÏ„‡ÎÓ‚ËÛÒ̇fl ËÌÙÂ͈Ëfl Ò ÔÓ‡ÊÂÌËÂÏ ‰Û„Ëı Ó„‡ÌÓ‚ ÔÓÏËÏÓ Ô˜ÂÌË, ÒÂÎÂÁÂÌÍË Ë ÎËÏÙ‡Ú˘ÂÒÍËı ÛÁÎÓ‚ (̇ÔËÏÂ, ÂÚËÌËÚ) 20. àÌÙÂ͈Ëfl, ‚˚Á‚‡Ì̇fl ‚ËÛÒÓÏ ÔÓÒÚÓ„Ó „ÂÔÂÒ‡, Ò ÔÓ‡ÊÂÌËÂÏ ÍÓÊË Ë ÒÎËÁËÒÚ˚ı Ó·ÓÎÓ˜ÂÍ ( >1 ÏÂÒflˆ‡) ËÎË ‚ÌÛÚÂÌÌËı Ó„‡ÌÓ‚ 2 1. èÓ„ÂÒÒËÛ˛˘‡fl ÏÛθÚËÙÓ͇θ̇fl ÎÂÈÍÓ˝ÌˆÂÙ‡ÎÓÔ‡ÚËfl 22. ã˛·ÓÈ ÒËÒÚÂÏÌ˚È ˝Ì‰ÂÏ˘ÂÒÍËÈ ÏËÍÓÁ 23. ä‡Ì‰Ë‰‡ÏËÍÓÁ Ò ÔÓ‡ÊÂÌËÂÏ Ôˢ‚Ӊ‡, Ú‡ıÂË, ·ÓÌıÓ‚ ËÎË Î„ÍËı 24. ÄÚËÔ˘Ì˚È ÏËÍÓ·‡ÍÚÂËÓÁ, ÒËÒÚÂÏÌ˚È ËÎË Î„ӘÌ˚È 25. çÂÚËÙÓˉ̇fl ҇θÏÓÌÂÎÎÂÁ̇fl ÒÂÔÚˈÂÏËfl 26. ÇÌÂ΄ӘÌ˚È ÚÛ·ÂÍÛÎÂÁ 27. ãËÏÙÓχ 28. ë‡ÍÓχ ä‡ÔÓ¯Ë 29. ù̈ÂÙ‡ÎÓÔ‡ÚËfl ÔË Çàó-ËÌÙÂ͈ËË b à/ËÎË ÒÚÂÔÂ̸ ÔÓÚÂË ÚÛ‰ÓÒÔÓÒÓ·ÌÓÒÚË 4: ÔÓÒÚÂθÌ˚È ÂÊËÏ >50% ‰ÌÂÈ ‚ Ú˜ÂÌË ÔÓ¯ÎÓ„Ó ÏÂÒflˆ‡ a ëË̉ÓÏ ËÒÚÓ˘ÂÌËfl ÔË Çàó-ËÌÙÂ͈ËË: ÔÓÚÂfl χÒÒ˚ Ú· >10% ‚ ÒÓ˜ÂÚ‡ÌËË ÎË·Ó Ò ıÓÌ˘ÂÒÍÓÈ ‰Ë‡ÂÂÈ ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË (>1 ÏÂÒflˆ‡), ÎË·Ó Ò ıÓÌ˘ÂÒÍÓÈ Ò··ÓÒÚ¸˛ Ë ‰ÎËÚÂθÌ˚Ï ÔÓ‚˚¯ÂÌËÂÏ ÚÂÏÔÂ‡ÚÛ˚ Ú· ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË (>1 ÏÂÒflˆ‡). b

ù̈ÂÙ‡ÎÓÔ‡ÚËfl ÔË Çàó-ËÌÙÂ͈ËË: ÍÎËÌ˘ÂÒÍË ÔËÁ̇ÍË ÍÓ„ÌËÚË‚Ì˚ı Ë/ËÎË ‰‚Ë„‡ÚÂθÌ˚ı ‡ÒÒÚÓÈÒÚ‚, ÒÓÁ‰‡˛˘Ëı ÚÛ‰ÌÓÒÚË ‚ Ôӂ҉̂ÌÓÈ ÊËÁÌË Ë ÔÓ„ÂÒÒËÛ˛˘Ëı ‚ Ú˜ÂÌË ÌÂÒÍÓθÍËı ̉Âθ ËÎË ÏÂÒflˆÂ‚, ‚ ÓÚÒÛÚÒÚ‚Ë ÒÓÔÛÚÒÚ‚Û˛˘Ëı Á‡·Ó΂‡ÌËÈ ËÎË ‰Û„Ëı Ô˘ËÌ, ÍÓÏ ÇàóËÌÙÂ͈ËË, ÍÓÚÓ˚ ÏÓ„ÎË ·˚ Ó·˙flÒÌËÚ¸ ˝ÚË ÍÎËÌ˘ÂÒÍË ÔËÁ̇ÍË.

61

èêàãéÜÖçàÖ F. ëàëíÖåÄ éèêÖÑÖãÖçàü ëíÄÑàâ Çàó-àçîÖäñàà à áÄÅéãÖÇÄçàü ì ÑÖíÖâ èé äãÄëëàîàäÄñàà Çéá äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl I: 1 ÅÂÒÒËÏÔÚÓÏ̇fl 2. É ÂÌÂ‡ÎËÁÓ‚‡Ì̇fl ÎËÏÙ‡‰ÂÌÓÔ‡ÚËfl äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl II: 3. ïÓÌ˘ÂÒ͇fl ‰Ë‡Âfl ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË ‰ÎËÚÂθÌÓÒÚ¸˛ ·ÓΠ30 ‰ÌÂÈ 4. íflÊÂÎ˚È ÔÂÒËÒÚËÛ˛˘ËÈ ËÎË ˆˉ˂ËÛ˛˘ËÈ Í‡Ì‰Ë‰‡ÏËÍÓÁ ‚Ì ÔÂËÓ‰‡ ÌÓ‚ÓÓʉÂÌÌÓÒÚË 5. èÓÚÂfl χÒÒ˚ Ú· ËÎË ÓÚÒÚ‡‚‡ÌË ‚ ÙËÁ˘ÂÒÍÓÏ ‡Á‚ËÚËË ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË 6. ìÒÚÓȘ˂˚È Ê‡ ‚ Ú˜ÂÌË ·ÓΠ30 ‰ÌÂÈ ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËË 7. èÓ‚ÚÓÌ˚ ÚflÊÂÎ˚ ·‡ÍÚÂˇθÌ˚ ËÌÙÂ͈ËË, ÔÓÏËÏÓ ÒÂÔÚˈÂÏËË Ë ÏÂÌËÌ„ËÚ‡ (̇ÔËÏÂ ÓÒÚÂÓÏËÂÎËÚ, ·‡ÍÚÂˇθ̇fl (Ì íÅ) ÔÌ‚ÏÓÌËfl, ‡·ÒˆÂÒÒ˚) äÎËÌ˘ÂÒ͇fl ÒÚ‡‰Ëfl III: 8. éÔÔÛÚÛÌËÒÚ˘ÂÒÍË ËÌÙÂ͈ËË, Ó·ÛÒÎÓ‚ÎÂÌÌ˚ ëèàÑÓÏ 9. êÂÁÍÓ ÓÚÒÚ‡‚‡ÌË (Ô‡ÛÁ˚)‚ ÙËÁ˘ÂÒÍÓÏ ‡Á‚ËÚËË ÌÂflÒÌÓÈ ˝ÚËÓÎÓ„ËËa 10. èÓ„ÂÒÒËÛ˛˘‡fl ˝ÌˆÂÙ‡ÎÓÔ‡ÚËfl 1 1. áÎÓ͇˜ÂÒÚ‚ÂÌÌ˚ Á‡·Ó΂‡ÌËfl 1 2. èÓ‚ÚÓ̇fl ÒÂÔÚˈÂÏËfl ËÎË ÏÂÌËÌ„ËÚ

a

èÂÒËÒÚËÛ˛˘‡fl ÔÓÚÂfl ‚ÂÒ‡ >10% ÓÚ ÌÓχθÌÓ„Ó ËÎË ÏÂ̸¯Â 5-„Ó ÔÓˆÂÌÚËÎfl ÔÓ ‚ÂÒÛ ‰Îfl ‰Ë‡„‡ÏÏ˚ ÓÒÚ‡ ÔÓ 2 ÔÓÒΉӂ‡ÚÂθÌ˚Ï ËÁÏÂÂÌËflÏ Ò ÔÂÂ˚‚ÓÏ ‚ 1 ÏÂÒflˆ ÔË ÓÚÒÛÚÒÚ‚ËË ‰Û„ÓÈ ˝ÚËÓÎÓ„ËË ËÎË ÒÓÔÛÚÒÚ‚Û˛˘ÂÈ ·ÓÎÂÁÌË.

62

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

ÅàÅãàéÉêÄîàü 1. Palella FJ, Jr., Deloria-Knoll M, Chmiel JS, et al. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med 2003;1 38(8):620-626. 2. é·˙‰ËÌÂÌ̇fl ÔÓ„‡Ïχ ééç ÔÓ Çàó/ëèàÑÛ (ûçùâÑë) Ë ÇÒÂÏË̇fl Ó„‡ÌËÁ‡ˆËfl Á‰‡‚ÓÓı‡ÌÂÌËfl (Çéá). ê‡Á‚ËÚË ˝ÔˉÂÏËË ëèàч: 2003. ÜÂÌ‚‡, ûçùâÑë. ëÏ.: URL: http://www.who.int/ hiv/pub/epidemiology/epi2003/en/ 3. Yeni PG, Hammer SM, Carpenter CC, et al. Antiretroviral treatment for adult HIV infection in 2002: updated recommendations of the International AIDS SocietyUSA Panel. JAMA 2002;288(2):222-235. 4. DHHS. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Available from: URL: http://AIDSInfo.nih.gov/guidelines 5. Badri M, Wood R. Usefulness of total lymphocyte count in monitoring highly active antiretroviral therapy in resource-limited settings. AIDS 2003;17(4):541-545. 6. Kumarasamy N, Mahajan AP , Flanigan TP , et al. Total lymphocyte count (TLC) is a useful tool for the timing of opportunistic infection prophylaxis in India and other resource-constrained countries. J Acquir Immune Defic Syndr 2002;3 1(4):378-383. 7. van der Ryst E, Kotze M, Joubert G, et al. Correlation among total lymphocyte count, absolute CD4+ count, and CD4+ percentage in a group of HIV-1-infected South African patients. J Acquir Immune Defic Syndr Hum Retrovirol 1 998;1 9(3): 238-244. 8. Brettle RP . Correlation between total and CD4 lymphocyte counts in HIV infection. Int J STD AIDS. 1 997; 8(9):597. 9. Beck EJ, Kupek EJ, Gompels MM, et al. Correlation between total and CD4 lymphocyte counts in HIV infection: not making the good an enemy of the not so perfect. Int J STD AIDS 1 996;7(6): 422-428. 10. Fournier AM, Sosenko JM. The relationship of total lymphocyte count to CD4 lymphocyte counts in patients infected with human immunodeficiency virus. Am J Med Sci. 1 992;304(2):79-82. 1 1. Bang LM, Scott LJ. Emtricitabine: an antiretroviral agent for HIV infection. Drugs 2003;63(22):241 3-2424; discussion 24252426. 1 2. Boubaker K, Flepp M, Sudre P , et al. Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study. Clin Infect Dis 200 1;33(1 1):1 93 1-1 937. 1 3. Pollard RB, Tierney C, Havlir D, et al. A phase II randomized study of the virologic and immunologic effect of zidovudine + stavudine versus stavudine alone and zidovudine + lamivudine in patients with >300 CD4 cells who were antiretroviral naive (ACTG 298). AIDS Res Hum Retroviruses 2002;1 8(10):699-704. 1 4. Staszewski SGJ, Pozniak AL, Suleiman JMAH, et al. Efficacy and safety of tenofovir DF versus stavudine when used in combination with lamivudine and efavirenz in antiretroviral naive patients: 96-week preliminary interim results. 10th Conference on Retroviruses and Opportunistic Infections; 2003 Feb 10-1 4; Boston, Massachusetts. 1 5. Gallant JE, Deresinski S. Tenofovir disoproxil fumarate. Clin Infect Dis 2003;37(7):944-950.

63

16. Karras A, Lafaurie M, Furco A, et al. Tenofovir-related nephrotoxicity in human immunodeficiency virus-infected patients: three cases of renal failure, Fanconi syndrome, and nephrogenic diabetes insipidus. Clin Infect Dis 2003;36(8): 1070-1073. 17. Schaaf B, Aries SP , Kramme E, et al. Acute renal failure associated with tenofovir treatment in a patient with acquired immunodeficiency syndrome. Clin Infect Dis 2003;37(3):41-43. 1 8. Verhelst D, Monge M, Meynard JL, et al. Fanconi syndrome and renal failure induced by tenofovir: a first case report. Am J Kidney Dis 2002;40(6):1 33 1-1 333. 1 9. Ena J, Amador C, Benito C, et al. Risk and determinants of developing severe liver toxicity during therapy with nevirapine- and efavirenz-containing regimens in HIVinfected patients. Int J STD AIDS 2003;1 4(1 1):776-78 1. 20. Keiser P , Nassar N, White C, et al. Comparison of nevirapine- and efavirenzcontaining antiretroviral regimens in antiretroviral-naive patients: a cohort study. HIV Clin Trials 2002;3(4):296-303. 2 1. Keiser P , Nassar N, Yazdani B, et al. Comparison of efficacy of efavirenz and nevirapine: lessons learned for cohort analysis in light of the 2NN Study. HIV Clin Trials 2003;4(5):358-360. 22. Law WP , Dore GJ, Duncombe CJ, et al. Risk of severe hepatotoxicity associated with antiretroviral therapy in the HIV-NAT Cohort, Thailand, 1 996-200 1. AIDS 2003; 17(1 5):2 1 9 1-2 1 99. 23. Martin-Carbonero L, Nunez M, Gonzalez-Lahoz J, et al. Incidence of liver injury after beginning antiretroviral therapy with efavirenz or nevirapine. HIV Clin Trials 2003;4(2):1 1 5-1 20.

24. Moyle GJ. NNRTI choice: has 2NN changed our practice? AIDS Read 2003;1 3(7):325-328. 25. van Leth FHE, Phanuphak P , Miller S, et al. Results of the 2NN study: a randomized comparative trial of first-line antiretroviral therapy with regimens containing either nevirapine alone, efavirenz alone, or both drugs combined, together with stavudine and lamivudine. 10th Conference on Retroviruses and Opportunistic Infections; 2003 Feb 10-1 4; Boston, Massachusetts. 26. Hirsch MS, Brun-Vezinet F, Clotet B, et al. Antiretroviral drug resistance testing in adults infected with human immunodeficiency virus type 1: 2003 recommendations of an International AIDS Society-USA Panel. Clin Infect Dis 2003; 37(1):1 1 3-1 28. 27. Walmsley S, Bernstein B, King M, et al. Lopinavir-ritonavir versus nelfinavir for the initial treatment of HIV infection. N Engl J Med 2002;346(26):2039-2046. 28. Adje-Toure CA, Cheingsong R, GarciaLerma JG, et al. Antiretroviral therapy in HIV-2-infected patients: changes in plasma viral load, CD4+ cell counts, and drug resistance profiles of patients treated in Abidjan, Côte d’Ivoire. AIDS 2003; 17(Suppl 3):S49-S54. 29. Van der Ende ME, Prins JM, Brinkman K, et al. Clinical, immunological and virological response to different antiretroviral regimens in a cohort of HIV-2-infected patients. AIDS 2003;17(Suppl 3):S55-S6 1. 30. Smith NA, Shaw T, Berry N, et al. Antiretroviral therapy for HIV-2-infected patients. J Infect Dis 200 1;42:1 26-1 33. 3 1. Sanne I, Piliero P , Squires K, et al. Results of a phase 2 clinical trial at 48 weeks (AI424-007): a dose-ranging, safety, and efficacy comparative trial of atazanavir at three doses in combination with didanosine

64

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

and stavudine in antiretroviral-naive subjects. J Acquir Immune Defic Syndr 2003;32(1): 1 8-29. 32. Haas DW, Zala C, Schrader S, et al. Therapy with atazanavir plus saquinavir in patients failing highly active antiretroviral therapy: a randomized comparative pilot trial. AIDS 2003;17(9):1 339-1 349. 33. Piliero PJ. Atazanavir: a novel HIV-1 protease inhibitor. Expert Opin Investig Drugs 2002;1 1(9):1 295-1 30 1. 34. Gulick RMRH, Shikuma CM, Lustgarten S, et al. ACTG 5095: a comparative study of 3 protease inhibitor-sparing antiretroviral regimens for the initial treatment of HIV infection. 2nd IAS Conference on HIV Pathogenesis and Treatment; 2003 Jul 1 3-16; Paris. 35. Staszewski S, Keiser P , Montaner J, et al. Abacavir-lamivudine-zidovudine vs indinavir-lamivudine-zidovudine in antiretroviral-naive HIV-infected adults: A randomized equivalence trial. JAMA. 200 1; 285 (9):1 1 55-1 163. 36. Ibbotson T, Perry CM. Lamivudine/ zidovudine/abacavir: triple combination tablet. Drugs 2003; 63(1 1):1089-1098; discussion 1099-1 100. 37. Kityo C. A randomised trial of monitoring practice and structured treatment interruptions in the management of antiretroviral therapy in adults with HIV infection in Africa: The DART trial. 1 3th International Conference on AIDS and STIs in Africa (ICASA); 2003; Nairobi (Abstract 1098933). 38. Gallant JERA, Weinberg W, Young B, et al. Early non-response to tenofovir DF and abacavir and lamivudine in a randomized trial compared to efavirenz + ABC and 3TC: ESS30009 unplanned interim analysis. 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy; 2003 Sep 1 4-17; Chicago, Illinois.

39. Gilead. High rate of virologic failure in patients with HIV infection treated with once daily triple NRTI regimen containing didanosine, lamivudine, and tenofovir; 2003 (Letter). 40. Gerstoft J, Kirk O, Obel N, et al. Low efficacy and high frequency of adverse events in a randomized trial of the triple nucleoside regimen abacavir, stavudine and didanosine. AIDS 2003;17(1 4): 2045-2052. 41. Stern JO, Love JT, Robinson, PA, et al. Hepatic safety of nevirapine: Results of the Boehringer Ingelheim Viramune Hepatic Safety Project. 1 4th International Conference on AIDS; 2002 Jul 7-1 2; Barcelona (Abstract LBOr1 5). 42. Imperiale SM, Stern JO, Love JT, et al. The VIRAMUNE (nevirapine) hepatic safety project: analysis of symptomatic hepatic events. 4th International Workshop on Adverse Events and Lipodystrophy in HIV; 2002 Sep 22-25; San Diego, California (Abstract 87). 43. Stern JO, Robinson PA, Love JT, et al. A comprehensive hepatic safety analysis of nevirapine in different populations of HIV infected patients. J Acquired Immune Defic Syndr 2003;34, Supll 1:S2 1-S33. 44. Boehringer-Ingelheim Pharmaceuticals, Inc. Viramune drug label. Revised 20 June 2003. 45. Lyons F, Hopkins S, McGeary A, et al. Nevirapine tolerability in HIV infected women in pregnancy – A word of caution (late breaker). 2nd IAS Conference on HIV Pathogenesis and Treatment; 2003 Jul 1 3-16; Paris. 46. Langlet P , Guillaume M-P , Devriendt J, et al. Fatal liver failure associated with nevirapine in a pregnant HIV patient: the first reported case. Gastroenterol 2000;1 1 8(Suppl 2):Abstract 6623 (10 1st Annual Meeting of the American

65

Gastroenterological Association; 2000 May 2 1-24; San Diego, California). 47. Eshleman SH, Mracna M, Guay LA, et al. Selection and fading of resistance mutations in women and infants receiving nevirapine to prevent HIV-1 vertical transmission (HIVNET 0 1 2). AIDS 200 1;1 84:9 1 4-9 17. 48. Sullivan J. South African Intrapartum Nevirapine Trial: selection of resistance mutations. 1 4th International Conference on AIDS; 2002 Jul 7-1 2; Barcelona (Abstract LbPeB9024). 49. Cunningham CK, Chaix ML, Rackacewicz C, et al. Development of resistance mutations in women receiving standard antiretroviral therapy who received intrapartum nevirapine to prevent perinatal human immunodeficiency virus type 1 transmission: a substudy of Pediatric AIDS Clinical Trials Group protocol 3 16. J Infect Dis 2002;1 86:1 8 1-1 88. 50. Chaowanachan T, Chotpitayasunondh T, Vanprapar N, et al. Resistance mutations following a single-dose intrapartum administration of nevirapine to HIV-infected Thai women and their infants receiving short-course zidovudine. 10th Conference on Retroviruses and Opportunistic Infections; 2003 Feb 10-1 4; Boston, Massachusetts (Abstract 855). 51. Mandelbrot L, Landreau-Mascaro A, Rekacewicz C, et al. Lamivudine-zidovudine combinatin for prevention of maternal-infant transmission of HIV-1. JAMA 200 1;285:2083-2093. 52. Giuliano M, Palmisano L, Galluzzo CM, et al. Selection of resistance mutations in pregnant women receiving zidovudine and lamivudine to prevent HIV perinatal transmission. AIDS 2003;17:1 570-1 571. 53. Wade AM, Ades AE. Age-related reference ranges: significance tests for

models and confidence intervals for centiles. Stat Med 1 994;1 3:2359-2367. 54. Shearer WT, Rosenblatt HM, Gelman RS, et al. Lymphocyte subsets in healthy children from birth through 1 8 years of age: the Pediatric AIDS Clinical Trials Group P1009 Study. J Allergy Clin Immunol 2003; 1 1 2(5):973-980. 55. Embree J, Bwayo J, Nagelkerke N, et al. Lymphocyte subsets in human immunodeficiency virus type 1-infected and uninfected children in Nairobi. Pediatr Infect Dis J 200 1;20:397-403. 56. Mofenson LM, Harris DR, Moye J, et al. Alternatives to HIV-1 RNA concentration and CD4 count to predict mortality in HIV1-infected children in resource-poor settings. Lancet 2003; 362 (9396):1625-1627. 57. European Collaborative Study. Gender and race do not alter early-life determinants of clinical disease progression in HIV-1 vertically infected children. AIDS 2004 (in press). 58. Gortmaker SL, Hughes M, Cervia J, et al. Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV1. N Engl J Med 200 1;345:1 522-1 528. 59. De Martino M, Tovo P-A, Balducci M, et al. Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. JAMA 2000;284:1 90-1 97. 60. Lindsey JC, Hughes MD, McKinney RE, et al. Treatment mediated changes in human immunodeficiency virus (HIV) type 1 RNA and CD4 cell counts as predictors of weight growth failure, cognitive decline, and survival in HIV-infected children. J Infect Dis 2000;1 82:1 385-1 393. 6 1. Verweel G, van Rossum AMC, Hartwig NG, et al. Treatment with highly active

66

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ

antiretroviral therapy in human immunodeficiency virus type 1-infected children is associated with a sustained effect on growth. Pediatrics 2002;109(2):E25 Available from: URL: http://www.pediatrics.org/cgi/content/ full/109/2/e25 62. Saulsbury FT. Resolution of organ-specific complications of human immunodeficiency virus infection in children with use of highly active antiretroviral therapy. Clin Infect Dis 200 1;32:464-468. 63. McCoig C, Castrejon MM, Castano E, et al. Effect of combination antiretroviral therapy on cerebrospinal fluid HIV RNA, HIV resistance, and clinical manifestations of encephalopathy. J Pediatr 2002;1 41:36-44. 64. Santoro-Lopes G, de Pinho AM, Harrison LH, et al. Reduced risk of tuberculosis among Brazilian patients with advanced human immunodeficiency virus infection treated with highly active antiretroviral therapy. Clin Infect Dis 2002;34(4):543-546. 65. Giarardi E, Antonucci G, Vanacore P , et al. Impact of combination antireteroviral therapy on the risk of tuberculosis among persons with HIV infection. AIDS 2000;1 4:1 985-1 99 1. 66. Badri M, Wilson D, Wood R. Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study. Lancet 2002;359: 2059-2064. 67. Harvard University. Consensus statement on antiretroviral treatment for AIDS in poor countries. Boston: Harvard University; 200 1. 68. Burman WJ, Jones BE. Treatment of HIVrelated tuberculosis in the era of effective antiretroviral therapy. Am J Respir Crit Care Med 200 1; 164(1):7-1 2. 69. Wagner KR, Bishai WR. Issues in the treatment of Mycobacterium tuberculosis in

patients with human immunodeficiency virus infection. AIDS 200 1;1 5(Suppl 5):S203-S2 1 2. 70. Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. N Eng J Med 1 999;340(5): 367-373. 71. Dean GL, Edwards SG, Ives NJ, et al. Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. AIDS 2002; 16(1): 75-83. 72. Lopez-Cortes L, Ruiz-Valderas R, Viciana P , et al. Pharmacokinetic interactions between efavirenz and rifampin in HIVinfected patients with tuberculosis. Clin Pharmacokinet 2002;41:68 1-690. 73. Patel A, Patel K, Patel J, et al. To study the safety and antiretroviral efficacy of rifampicin and efavirenz in antiretroviralna?ve tuberculosis co-infected HIV-1 patients in India. X Conference on Retroviruses and Opportunistic Infections; 2003; Boston, Massachusetts (Abstract 1 38). 7 4. Pedral-Samapio D, Alves C, Netto E, et al. Efficacy of efavirenz 600 mg dose in the ARV therapy regimen for HIV patients receiving rifampicin in the treatment of tuberculosis. 10th Conference on Retroviruses and Opportunistic Infections; 2003 Feb 10-1 4; Boston, Massachusetts (Abstract 784). 75. Dean G, Back D, de Ruiter A. Effect of tuberculosis therapy on nevirapine trough plasma concentration. AIDS 1 999;1 3:24892490. 76. Ribera E, Pou L, Lopez RM, et al. Pharmacokinetic interaction between nevaripine and rifampicin in HIV-infected patients with tuberculosis. J Acquir Immune Defic Syndr 200 1;28:450-453. 77. Olivia J, Moreno S, Sanz J, et al. Coadministration of rifampin and nevirapine in

67

HIV-infected patients with tuberculosis. AIDS 2003;17:637-642. 78. Ribera E, Azuaje C, Montero F. Saquinavir, ritonavir, didanosine, and lamivudine in a once daily regimen for HIV infection in patients with rifampin-containing antituberculosis treatment. 1 4th International Conference on AIDS; 2002 Jul 7-1 2; Barcelona (Abstract ThPeB7280). 79. la Porte C, Colbers E, Bertz R, et al. Pharmacokinetics of two adjusted dose regimens of lopinavir/ritonavir in combination with rifampin in healthy volunteers. 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy; 2002; San Diego, California (Abstract A-1 823). 80. Narita M, Ashkin D, Hollander E, et al. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med 1 998;1 58:1 57-16 1.

8 1. Harries AD, Hargreaves NJ, Kemp J, et al. Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1. Lancet 200 1;357(9267):1 51 9-1 523. 82. Havlir D, Vella S, Hammer S. The Global HIV Drug Resistance Surveillance Program: a partnership between WHO and IAS. AIDS 2002;16(10):7-9. 83. Desclaux A, Ciss M, Taverne B, et al. Access to antiretroviral drugs and AIDS management in Senegal. AIDS 2003;17(Suppl 3):S95-S10 1. 84. Laniece I, Ciss M, Desclaux A, et al.Adherence to HAART and its principal determinants in a cohort of Senegalese adults. AIDS 2003; 17(Suppl 3):S103-S108.

68

êÄëòàêÖçàÖ åÄëòíÄÅéÇ ÄçíàêÖíêéÇàêìëçéâ íÖêÄèàà Ç ìëãéÇàüï éÉêÄçàóÖççõï êÖëìêëéÇ