{"id":1642,"date":"2024-03-03T17:18:12","date_gmt":"2024-03-03T20:18:12","guid":{"rendered":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/?page_id=1642"},"modified":"2024-11-11T20:46:20","modified_gmt":"2024-11-11T23:46:20","slug":"pagina-17-gestante-sem-exposicao-previa-a-tarv","status":"publish","type":"page","link":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/pagina-17-gestante-sem-exposicao-previa-a-tarv","title":{"rendered":"P\u00e1gina 17 – GESTANTE SEM EXPOSI\u00c7\u00c3O PR\u00c9VIA \u00c0 TARV"},"content":{"rendered":"\t\t
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GESTANTE SEM EXPOSI\u00c7\u00c3O PR\u00c9VIA \u00c0 TARV<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Gestantes vivendo com HIV (GVHIV) em in\u00edcio de TARV durante a gesta\u00e7\u00e3o, sem hist\u00f3rico de exposi\u00e7\u00e3o pr\u00e9via \u00e0 TARV, independentemente da idade gestacional:<\/span><\/span><\/p>

O esquema inicial preferencial de TARV deve incluir a combina\u00e7\u00e3o de dois inibidores da transcriptase reversa an\u00e1logos de nucleos\u00eddeos (ITRN) e um terceiro ARV.<\/span><\/p>

A recomenda\u00e7\u00e3o da dupla de ITRN \u00e9 a coformula\u00e7\u00e3o de tenofovir e lamivudina (TDF 300mg + 3TC 300mg).<\/span><\/p>

\u00c9 importante que as escolhas terap\u00eauticas sejam feitas de forma compartilhada com a equipe de sa\u00fade, a fim de proporcionar a essas mulheres op\u00e7\u00f5es individualizadas e informa\u00e7\u00f5es a respeito do seu esquema terap\u00eautico.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Genotipagem pr\u00e9-tratamento: <\/b>\u00e9\u00a0<\/b>indicada a todas gestantes vivendo com HIV em in\u00edcio de TARV, de forma a\u00a0orientar o esquema terap\u00eautico<\/b>. A realiza\u00e7\u00e3o de genotipagem para gestantes deve ser considerada uma prioridade na rede de assist\u00eancia, uma vez que a escolha de um esquema antirretroviral eficaz tem impacto direto na TV do HIV. Contudo, ressalta-se que\u00a0o in\u00edcio do tratamento n\u00e3o deve ser adiado pela espera do resultado desse exame<\/b>.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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<\/span><\/span><\/span><\/p>

Quando h\u00e1 falha na supress\u00e3o viral relacionada a m\u00e1 ades\u00e3o, intoler\u00e2ncia ou sensibilidade aos ARVs, h\u00e1 indica\u00e7\u00e3o de inclus\u00e3o do 3\u00ba ARV no esquema terap\u00eautico. As recomenda\u00e7\u00f5es de escolha do 3\u00ba ARV, com esquemas preferenciais e alternativos, a serem discutidas e decididas de forma compartilhada entre a equipe de sa\u00fade e a paciente,s\u00e3o:<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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<\/span><\/span><\/p>

S\u00e3o contraindica\u00e7\u00f5es ao DTG:<\/span><\/span><\/p>

\u203a Uso concomitante dos seguintes anticonvulsivantes: oxicarbamazepina, dofetilida ou pilsicainida;<\/span><\/p>

\u203a Efeito adverso ou intoler\u00e2ncia ao medicamento.<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Quadro 12 – Esquemas de TARV para in\u00edcio de tratamento em gestantes com HIV\/aids<\/span><\/h6>\n

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Esquema Preferencial para in\u00edcio de TARV na gestante<\/strong><\/span><\/td>\nConsidera\u00e7\u00f5es<\/strong><\/span><\/td>\n<\/tr>\n
 <\/td>\nContraindica\u00e7\u00e3o ao DTG: RAL ou ATV\/r ou DRV\/r<\/span><\/td>\n<\/tr>\n
TDF + 3TC + DTG<\/strong><\/span><\/td>\nContraindica\u00e7\u00e3o ao TDF: AZT<\/span><\/td>\n<\/tr>\n
 <\/td>\nContraindica\u00e7\u00e3o ao TDF e AZT: ABC (a)<\/sup><\/span><\/td>\n<\/tr>\n
ESQUEMAS ALTERNATIVOS PARA IN\u00cdCIO DE TARV NA GESTANTE<\/strong><\/span><\/td>\nCONSIDERA\u00c7\u00d5ES<\/strong><\/span><\/td>\n<\/tr>\n
TDF + 3TC + RAL<\/span><\/td>\nDeve ser programada ainda no pr\u00e9-natal a troca do RAL para o DTG ap\u00f3s o parto<\/span><\/td>\n<\/tr>\n
TDF + 3TC + ATV\/r<\/span><\/td>\nRefor\u00e7ar contraindica\u00e7\u00e3o do uso concomitante de ATV e medicamentos da classe dos inibidores de bomba de pr\u00f3tons (por exemplo: omeprazol)<\/span><\/td>\n<\/tr>\n
TDF + 3TC + DRV\/r<\/span><\/td>\nContraindicada formula\u00e7\u00e3o de DRV 800mg durante gesta\u00e7\u00e3o<\/span><\/td>\n<\/tr>\n
TDF + 3TC + EFV<\/span><\/td>\nPara uso do EFZ, \u00e9 mandat\u00f3ria a demonstra\u00e7\u00e3o de sensibilidade na genotipagem pr\u00e9-tratamento<\/strong><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Fonte: DCCI\/SVS\/MS\n<\/sup>(a) Autorizada apenas se HLA-B*5701 negativo.<\/sup><\/span>
(BRASIL, 2022 p. 85)<\/sup><\/span><\/pre>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t<\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\tTabela de Siglas e Abreviaturas<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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GESTANTE SEM EXPOSI\u00c7\u00c3O PR\u00c9VIA \u00c0 TARV Gestantes vivendo com HIV (GVHIV) em in\u00edcio de TARV durante a gesta\u00e7\u00e3o, sem hist\u00f3rico de exposi\u00e7\u00e3o pr\u00e9via \u00e0 TARV, independentemente da idade gestacional: O esquema inicial preferencial de TARV deve incluir a combina\u00e7\u00e3o de dois inibidores da transcriptase reversa an\u00e1logos de nucleos\u00eddeos (ITRN) e um terceiro ARV. A recomenda\u00e7\u00e3o […]<\/p>\n","protected":false},"author":7780,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[92],"tags":[],"class_list":["post-1642","page","type-page","status-publish","hentry","category-hiv-novo"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/pages\/1642","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/users\/7780"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/comments?post=1642"}],"version-history":[{"count":0,"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/pages\/1642\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/media?parent=1642"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/categories?post=1642"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ufsm.br\/pet\/ciencia-da-computacao\/wp-json\/wp\/v2\/tags?post=1642"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}