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Basic Questions on AIDS & Field Level Research

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GBWm& welqK gwjK ck I gvV chvqi MelYv Wv. Gg G nvmvb c_g cKvk : deqvwi eBgjv 2007 DrmM mgq 579 cKvkK dwi` Avng` mgq cKvkb 38/2K evsjvevRvi, XvKv cQ` ae Gl KvR mgq KwDUvm 38/2K evsjvevRvi, XvKv gy`Y mvjgvbx wcUvm bqvevRvi, XvKv g~j : 175.00 UvKv gv
AIDS BISHAYK MOULIK PROSHNO O MATH PORJAYER GOBESHENA (Basic Question on AIDS & Field Level Research) by Dr. M A Hasan. First Published Book Fair 2007 by Farid Ahmed, Somoy Prakashan, 38/2ka Banglabazar, Dhaka. Web : www.somoy.com Price : Tk. 175.00 Only ISBN 984-458-579-1 Code : 579 E-mail : f.ahmed@somoy.com

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Aavq GK fvBivm, GBPAvBwf I GBWm
1.1.1 GBWm Kx? 17 1.1.2 GBWmi bvgKiY Ggb nj Kb? 17 1.1.3 GBPAvBwf fvBivm Kx? 17 1.1.4 fvBivm Kx? 18

1.1.5 fvBivm I evwiqvi ga cv_K Kx? 19

1.2.1 GBPAvBwf fvBivm kixii Kv_vq AvNvZ Ki? 19 1.2.2 iMci m GBPAvBwf msgYi mK 19 1.2.3 GBPAvBwf fvBivm Kx cwqvq kZKwYKvK AvgY Ki? 20 1.3.1 GBPAvBwf fvBivm KiKg nq _vK? 20 1.3.2 GBPAvBwf-1 Ges GBPAvBwf-2 Gi ga Zdvr Kx? 20 1.4.1 GBPAvBwfi wgDUkb (wefvRb ev cwieZb) 21 1.4.2 GBPAvBwf P 21 1.4.3 GK bRi GBPAvBwf P 24 1.4.5 HIV evwos G cvwUqm Gi f~wgKv 25 1.4.6 Kvl K`vwfgyLx fvBivj cvwUbi cwZiva 25 1.5.1 GBPAvBwf Ges GBWmi ga Zdvr Kx? 26 1.6.1 wewfb NvZK fvBivmi Pwii Zzjbvg~jK wek-lY 26 1.6.2 Abvb iUvfvBivmi mv_ GBPAvBwf-Gi mK 27 1.6.3 HILV-1 Ges HTLV-2 Gi Zdvr 27 1.7.1 GBPAvBwf fvBivm wK cwieZbkxj? 28 1.7.2 GBPAvBwf fvBivmwU KZw`b ci Ges wKfve kixi cwZwqv NUvq 29 1.8.1 msgYi ci kixi GBPAvBwfi bxie Aev 29 1.8.2 GBPAvBwf jvUw (Latency) 29 1.8.3 GBPAvBwf Kvwiqvi (Carrier) Aev 29 1.9.1 GBPAvBwfZ Avv nevi ci KLb GBWm nq bv? 29 1.9.2 GBPAvBwf Avv GKRbi Rxeb KZUzKz `xNvwqZ nZ cvi? 30 1.10.1 GBWmi kYxwefvM 30 1.11.1 GBPAvBwf jvUw 31 1.12.1 GBPAvBwf ivMi bZzb msv 32 1.13.1 GBWm ebvg GBPAvBwf ivM 32 1.14. BwgDb eev 33 1.14.1 GBWm msgYi mv_ BwgDb eevi mK Kx? 33 1.15.1 wU-njcvi Kvl msv wKQy K_v 36 1.15.2 wU-Kvli kYx wefvM 36 1.15.3 wU-mvcmi Kvl 36 1.15.4 mvBUvUwK-wU Kvl 36 1.15.5 wU-njcvi Kvl 37

Aavq `yB GBWmi De I wevi

2.1.1 GBWmi BwZnvm Ges wevi (GBWm GwcWwgK I cvbWwgK) 39 2.2.1 GBWmi iUv Kv_vq Ges KLb? 39 2.3.1 AvwdKv I mve-mvnviv Aj GBWmi wevi 41 2.4.1 GBWm ivMi De mK wKQy gZev` 44 2.5.1 RxeR _K gvbyli ga GBWm msgYi cPwjZ aviYv KZUzKz evemZ 45 2.6.1 GBPAvBwf fvBivmi gZ h BwgDbvWwdwmqw fvBivmjv RxeRMZ _vKZ cvi: 45 2.7.1 hyivi GBWm msv wKQy cwimsLvb 46 2.7.2 bvix I cyil`i ga Kviv ewk Avv? 47 2.8.1 GBWm ivMi De mK jLKi gZev` 48

5.11.1 GK bRi h ivM I jYmg~n `L GBWmi K_v fveZ ne 80 5.11.2 mvaviYZ Kx Kx xivM I hbivM wbq GBPAvBwf Avviv wPwKrmKi wbKU Avm? 80 5.11.3 Wvqwiqvi mv_ GBPAvBwf msgYi mK Kx? 82

Aavq Qq GBPAvBwf kbvKiY I cqvRbxq cv_jwRKvj U

6.1.1 GBWm kbv KiZ h mg U KiZ nq 83 6.2.1 GBPAvBwf wwbs I Abvb U 83 6.3.1 Iqvb e-U U 84 6.4.1 cwjgvim PBb wiAvKkb: 85 6.5.1 wc-24 GwURb cixvwU Kx? 86 6.6.1 GBWm kbvKiYi mnR Kvb cwZ AvQ wK bv 86 6.6.2 mvaviY vb GBPAvBwf Avv`i kbv Kiv hvq wK? 89 6.6.3 AbygvbwfwK GBWm wbYq: wKwbKvj Bfvjyqkb 89 6.7.1 Kxfve kbv Kiv hve h GKwU wk GBPAvBwf Avv nqQ? 91 6.8.1 KLb cixv KiZ ne, Kxfve cixv KiZ ne? 91 6.9.1 GBPAvBwf U msv wKQy AvBbMZ I Gw_Kvj evaevaKZv: 91

Aavq wZb evsjv`k GBWmi wevi

3.1.1 evsjv`k GBWmi wevi 49 3.2.1 evsjv`ki Avv bvix`i msLv wbYq mgmvUv Kv_vq? 56 3.3.1 evsjv`ki fvmgvb hbKgx`i Aev: 57

Aavq Pvi GBWmi jY

4.1.1 GBPAvBwf msgYi wewfb i 61 4.2.1 gvUv`vM GBWmi jYjv Kx Kx? 63 4.2.2 GBPAvBwf Avv ewi kixi cv_wgK jY 63 4.2.3 KbwwUDkbvj jY 64 4.3.1 GBWm ivMwU `Lv `qvi cvvj jY I DcmMjv Kgb nq _vK? 64 4.4.1 jwmKvMw dyj hvevi aib 65 4.5.1 GBPAvBwf Iq wmbWgi AMZ KqKwU jY I DcmM 66 4.5.2 w-g wWwRR (Slim disease) Kx? 66 4.6.1 wk`i ga GBWm-Gi jYjv Kx aibi? 67 4.7.1 Avvi ZK hmg jY `Lv `q 67 4.8.1 GBWm ivM PvLi mgmv 68 4.9.1 gw Kxfve GBPAvBwf mswgZ nq? 68 4.10.1 hme ivM nj GBPAvBwf-Gi K_v fveZ ne 69

Aavq mvZ GBWmi Kv-dvi

7.1 GBWmi Kv-dvi 93

7.1.1 hbivM Avv`i GBPAvBwf msgYi mvebv wK ewk? 94 7.2.1 ngvdvBwjqv ivMx 94 7.3.1 bvix`i ga h KviY GBPAvBwf mswgZ nq 95 7.4.1 hmg fvBivm GBPAvBwf msgYK Zivw^Z Ki 96 7.5.1 GBWm ivMi ii m dzi Kvb mK AvQ? 96

Aavq AvU GBPAvBwf msgY SuzwKc~Y Rxeb hvcb

8.1 UvMU Mc 97 8.1.1 KvUvMwi-1: kxl SuywKZ hviv 97 8.1.2 KvUvMwi-2: hv`i Avv nevi mvebv AvQ 98 8.1.3 KvUvMwi-3: Avv nevi hviv bvRyK Aevq AvQ 98 8.2 wewfb ckv, kYx I eqmi jvKi ga GBWmi mvebv 99 8.2.1 Kv`i Rb GBPAvBwf wwbs evaZvg~jK? 99 8.2.2 Kvb eqwm`i ga GBWm msgYi mvebv ewk? 99 8.3 hb AvPiYi m GBWmi mK: 100 8.3.1 mgKvgx`i ga GBWm msgYi SuywK KZUzKz? 100 8.3.2 Iivj m 101 8.3.3 jmweqvb`i SuywK 101 8.3.4 nUivmyqvj`i ga DP nvi GBWm msgYi KviY 102 8.3.5 GKKMvgx : Mvcb mKi gvag GBWm msgY 102 8.3.6 `xNKvji GKK mxi KvQ _K Kxfve GBPAvBwf msgY nZ cvi? GBWm cwZiva hbmxK KZUzKzb Rvbv cqvRb? 103 8.4.1 eMvgx: eMvgx`i GBPAvBwf msgYi mvebv ewk Kb? 103 8.5.1 hbKgx`i Rxeb: G`i GBPAvBwf msgYi mvebv ewk Kb? 103

Aavq cuvP GBPAvBwf Avv`i ga hme ivM `Lv `q

5.1.1 GBWm Avv nj cwZwqv wnmve h mg ivM nq 71 5.2.1 GBWm ivM Avviv mvaviYZ wbwjwLZ AYyRxe I ciRxex msv ivM Avv nq 71 5.3.1 cvUvRvqv RvZxq BbdKkb: wbDgvwmmwUm Kvwiwb 72 5.4.1 evwiqv RvZxq msgY 75 5.5.1 ivPvjwgqv 76 5.6.1 mvjgvbjv 76 5.7.1 gvBKvevwiqvg BbdKkb 77 5.8.1 QvK RvZxq msgY 78 5.9.1 vqy msv RwUjZv 79 5.10.1 `ivM msv RwUjZv 79

8.5.2 h me hvwbc_ fvBivmhy exh we`gvb _vK: 104 8.6.1 hbmshvM: cvqyc_ wgjb 105 8.6.2 cvqyc_ wgjb AvKwUf I mnhvMx (Passive) mx`i Suwy K KZUzKz ? 106 8.6.3 bvixi cvqyc_ cyili wgjb 106 8.6.4 cvqyc_ wgwjZ njB GKRb GBWm Avv ne wK bv 107 8.6.5 cvqyc_ ev hvwbc_ exh wbMZ bv njI GBPAvBwf msgY NUe? 107 8.7.1 BbRKkbi m~uPi gvag GBPAvBwf mswgZ nZ cvi? 108 8.7.2 bvix`i ga BbRKkbi gvag GBWm Qovevi SuywK KZUzKz? 108 8.7.3 bvixi GB SuzwKi KviY Kx? 108 8.8.1 Kvb wekl Ilya BbRKkbi gvag bkv`e MnYKvix`i (IDUs) GBWm msgYi SzuwK evovq wK bv? 109 8.9.1 gq`i Lvrbv GBPAvBwf msgYi c_ mnR Ki `q? 109 8.10.1 gyLi jvjvi (mvjvBfv) gvag GBPAvBwf Qovq wK bv 109 8.10.2 a~gcvb Ges g`cvb GBPAvBwf msgY KZUzKz f~wgKv ivL? 110 8.11.1 h me KviY g` Ges Abvb bkvRvZxq c`v_ GBPAvBwf msgYi mvebv evwoq `q 111 8.12.1 gwnjv`i gvwmKKvjxb GBPAvBwf msgYi mvebv KZUzKz? 111 8.13.1 GBPAvBwf cwZiva RbwbqYi Lvevi ewoi f~wgKv wKiKg? 111 8.14.1 `kgvbfve GBWmi Kvb jY bB, A_P GBPAvBwf cwRwUfGgb ew GBWm Qovq wK? 112 8.14.2 GBWmi jYwenxb GKRb cyil Zvi mxK Avv KiZ cvi wK? 112 8.14.3 GKevi gv hbmshvM njB GBPAvBwf mswgZ ne? 112 8.14.4 GBPAvBwf Avvi m wgwjZ njB wbwZfve ivM mswgZ ne? 112 8.14.5 Rxebi c_g wgjbB GKRb GBPAvBwf Avv nZ cvi wK? 113 8.15.1 AvZ dvi 113 8.16.1 alY, cvPvi Ges bvix `vmZi m GBWmi mK 114 8.17.1 Abvb SuywK 114

9.7.1 WwU`i wbKU _K GBPAvBwf ivMi msgY nZ cvi Kx? 119 9.8.1 Abvb SzuwK : 119 9.9 Abvb mevKgx`i Avv nevi Szwu K 120 9.9.1 hviv mjyb I cvjvi KvR Ki GBWm _K euvPZ Zviv Kx Kie? 120

Aavq `k GBWm cwZiva

10.1.1 wbivc` hbRxeb: KbWg eenvi I Abvb cwZiv 121 10.1.2 Kv`i Rb KbWg eenvi evaZvg~jK? 121 10.1.3 KbWg eenvi h wbqgjv gb Pjv DwPZ 122 10.1.4 KbWg eenvi msv cPvi KZUzKz mv_K nq? 122 10.2.1 GBPAvBwf msgY cwZiva fvBwimvBWvj cqvM 124 10.2.2 wdgj KbWg I mswk- fvBwimvBWvj KZUzKz KvhKi? 125 10.3.1 aZKiY 126 10.4.1 Qj`i Lvrbv GBPAvBwf msgYi SzuwK Kgvq? 127 10.5.1 BbRKkbi gvag WvM MnY ceYZv cwZiva Kiv hve Kxfve? 127 10.5.2 wbW&j GP cvMvg KZUzKz KvhKi nZ cvi? 127 10.6.1 GBWm msgY _K euvPvi Rb wK aibi Kgm~wP MnY KiZ ne? 128 10.6.2 mvgvwRK Av`vjb Mo Zvjv 128 10.6.3 kbvKiY Kgm~wP 129

Aavq GMviv GBWm ivM wk I MfeZx gv

11.1.1 GBPAvBwf Avv`i MfaviY wK aibi RwUjZv `Lv `q? 131 11.2.1 gv _K wki ga wKfve AvBPAvBwf msgY NU? 131 11.3.1 GBPAvBwf cwRwUf wk`i RbMZ Amyweavjv Kx Kx? 132 11.4.1 beRvZK I wk`i GBPAvBwf msgY 133 11.4.2 wbivc` wki Rb`vb wK me? 134 11.4.3 gv _K wki ga GBPAvBwf msgY Kxfve cwZiva Kiv hve? 135 11.5.1 eyKi `ya GBPAvBwf wbtmZ nq wK bv 136 11.5.2 GBPAvBwf Avv gvqi `ya wK wki Rb wbivc`? 136 11.6.1 bi euvUv _K GBPAvBwf msgY nZ cvi? 136 11.7.1 MfeZx gv wK GBPAvBwf Avv nZ cvi? 136

Aavq bq wPwKrmK I ^vKgx`i SuywK

9.1.1 ckvMZ KviY GBPAvBwf msgYi mvebv KZUzKz? 115 9.2.1 mswgZ i wPwKrmvKgx`i ZKi msk Avmj Kx nZ cvi? 115 9.2.2 GBPAvBwf Avvi i ^vKgxi PvL, gyL, bvK jM Mj Kx KiZ ne? 115 9.2.3 GwUmcwUK w`j A_ev i Swiq djj GBPAvBwf msgY cwZiva Kiv hve wK? 116 9.3.1 fyj ev `yNUbvg Kvb GBWm Avvi m mshvM NU Mj wKQy Kivi AvQ wK? 116 9.3.2 G aibi `yNUbv NUj Avi Kx KiZ ne? 116 9.4.1 ncvUvBwUm-wm (HCV) msgYi mvebv KZUzKz? 116 9.5.1 G aibi ckvMZ `yNUbv Govevi c_ Kx? 117 9.6.1 `yNUbv _K cwZivi Rb cv GcvRvi wUUgU ev wcBwc 117 9.6.2 cv GcvRvi wUUgU ev wcBwc-G Avi Kx Kiv hvq? 117 9.6.3 hv`i ga GBPAvBwf msgYi mvebv Zwi nq Zv`i `yNUbvi ci Kx Kx Ilya w`Z ne? 118 9.6.4 cv GcvRvi wUUgU bevi mgqmxgv KZUzKz? 118 9.6.5 cv GcvRvi wUUgU eeZ Ilyajv Kx Kx cvkcwZwqv Zwi KiZ cvi? 118 9.6.6 G Aevq gvqiv Kx Kie? 119

Aavq eviv ewZi mv_ GBPAvBwf msgYi

mvebv Ges Avvi gbvivM I weKvi
12.1 ewZi mv_ GBPAvBwfi mK : 137 12.1.1 GBPAvBwf Avvi gvbwmK ceYZv Kgb? 137 12.2.1 GBPAvBwf msgY ewZ Kx aibi cfve ivL? 138 12.2.2 ewngLx`i PvwiwK ewk Kgb nq _vK? 138 y 12.2.3 AgyLx`i PvwiwK ewk Kgb nq _vK? 139 12.3.1 wigwZ I AwigwZ ew`i ewk Kgb nq _vK? 139 12.3.2 AwigwZ ewngyLx (Instable Extrovert) Mc 140 12.3.3 mywigwZ ewngyLx (Stable extrovert) Mc 141 12.3.4 AwigwZ AgLx (Instable Introvert ) Mc 141 y

12.3.5 mywigwZ AgLx (Stable Introvert ) Mc 141 y 12.4 GBWm ivMvv`i gvbwmK ^v, gbvivM I weKvi 142 12.4.1 Wwjwiqvg Kx? 143 12.4.2 wWgbwkqv Kx? 143 12.4.3 gvwbqvK wmbWg Kx? 143 12.4.4 weqvM e_v 145 12.4.5 AvZnZvi ceYZv 145 12.4.6 GvsRvBwU Bbmvgwbqv 145 12.4.7 wb`vnxbZv 146

13.16.3 Avvi ivMi welqwU Mvcb Kivi cqvRb AvQ wK? 156 13.16.4 wKkvi Aciva mskvabx K`jvZ wK aibi mgmv nZ cvi? 156

Aavq P GBWmi wPwKrmv

14.1.1 GBPAvBwf fvBivm webvkx GwU-fvBivj _ivwc Zwii Kkj 157 14.2.1 wifvm Uvwckb-Gi cwZeKZv 158 14.2.2 wbDwKqvmvBW GbvjM 158 14.2.3 GbGbAviwUAvB (NNRTI): 159 14.3.1 Abvb: wifvm Uvwckb BbwnweUim 159 14.3.2 RNASE H Inhibitor : 159 14.3.3 fvBivj wWGbGi BwUMkb cwZeK 160 14.3.4 fvBivj wRb Gckb cwZeKZv 160 14.3.5 wUDgvi bvwmm dvi Ae`gb 161 14.3.6 BwgDbv mvcwmf GRU 161 14.3.7 GwU-AwWvU 161 14.3.8 AviBwf (REV) 161 14.3.9 fvBivj ivBevmvgvj dgwkdwUs 161 14.3.10 GBPAvBwf fvBwiqbjvi mgeZ nIqv I cwiYZ nIqvi c_ evav mw 161 14.3.11 mvBKvmcvwib (cyclosporin) Ae`gb Ges mvBKvdvBwjb (Cyclophilin) Avtwewqvq cwZeKZv mw 163 14.4.1 UwK c`v_ cqvM Ki Amy Kvljv gi djvi Kkj 163 14.4.2 KvcwmW cvwUbi mv_ fvBwiqb AviGbG-Gi cwZeKZv 163 14.4.3 cvwUqvm BbwnweUi 164 14.4.4 wRb _ivwci mgmv 164 14.5.1 GwU iUvfvBivj Ilyajvi cvkcw Zwqv 165 14.5.2 wbDwKqvmvBW wifvm UvwcUm BbwnweUii cvkcwZwqv 165 14.5.3 bb-wbDwKqvmvBW wifvm Uvwckb BbwnweUii cvkcwZwqv 166 14.5.4 cvwUqvm BbwnweUii cvkcwZwqv 166 14.6.1 GBPAvBwf Avviv Kx cwqvq my _vKe Ges Kx Kij ivMwU Lvivc chvq hve bv? 166 14.7 GBWm mvcvU Mc 167 14.7.1 Bbdigkbvj mvcvU 167 14.7.2 Bgvkbvj mvcvU 167 14.7.3 wjwfs mvcvU 168 14.8.1 GBWm Avv ivMxi wPwKrmvi cwiek Kgb nIqv DwPZ? 168 14.9 GBPAvBwf ivM cwZla 171 14.9.1 fvBivm cek wbeviK cqvM I cwZivag~jK wPwKrmvq 171 14.9.2 cPwjZ AvaywbK wPwKrmv 171 14.9.3 weK wPwKrmv 171 14.10.1 hme wPwKrmv cwieZb KiZ ne 173 14.11.1 h aibi cwieZb Kvg 174 Dj-Lcw 175

Aavq Ziv - cvwievwiK I mvgvwRK Rxebi mv_ GBWmi bvbv mK

13.1.1 GBPAvBwf Avv`i cvwievwiK Rxeb Kgb ne? 147 13.2.1 Avv`i msk Avmj GBPAvBwf QovZ cvi? 147 13.2.2 GKB Kvc, M-vm kqvi Kij GBPAvBwf msgYi mvebv KZUzKz? 147 13.2.3 fyjg Avvi Uz_evk eenvi Kij Kx nZ cvi? 148 13.3.1 GBPAvBwf Avvi eeZ UqjU _K ivM QovZ cvi? 148 13.4.1 GBPAvBwf Avvi Nievwo cwivi KiZ Mj Avv nevi mvebv KZUzKz? 149 13.5.1 GBPAvBwf Avvi nuvwP-Kvwk wK msvgK? 149 13.5.2 Avvi g~ Mvq jvMj wK GBPAvBwf mswgZ nZ cvi? 149 13.5.3 gjg~ fvBivm KZUv _vK? 149 13.5.4 GBPAvBwf Avvi `n we`gvb Nv ev Z Quyj GBPAvBwf ne wK? 149 13.6.1 GBWm Avv ew wK ivbvNi hZ cvie? 150 13.7.1 Avv ivMx`i Rb Lvevi `vevi msv Kx aibi mZKZv cqvRb? 150 13.8.1 GBWm ivMvv`i cvb Ges Avnvi cyw gvb 150 13.9.1 Lvevi nvUj I iziU _K GBPAvBwf Qovevi mvebv KZUzKz? 151 13.9.2 nvUj eeZ weQvbvi Pv`i, Zvqvj BZvw` wK GBPAvBwf QovZ cvi? 151 13.10.1 iwdRviUi wK ivM QovZ cvi? 151 13.11.1 GBPAvBwf msgY evmvb Kvb cfve wevi Ki? 152 13.12.1 gkv viv GBPAvBwf msgY nZ cvi? 152 13.12.2 cvlv cvYx I Abvb RxeR KZK GBWm msgYi mvebv KZUzKz? 152 13.13.1 GBPAvBwf AvvK Pzgy Lj ivM mswgZ nZ cvi? 153 13.13.2 GBWm Avv bZKxi mvwba Gj A_ev bZmx GBWm Avv nj ivMvv nevi mvebv KZUzKz? 153 13.13.3 myBwgs cyj muvZvi KvUj GBPAvBwf QovZ cvi? 154 13.13.4 wRgbwkqvg evqvg KiZ wMq GBWm msgY nZ cvi? 154 13.13.5 wmbgv, wUwf I AvWdvgi wewfb nvDmi gKvc igjvZ A_ev ckv`vi gKvcgvb`i eeZ KxU gvidZ GBWm Qovevi mvebv KZUzKy? 154 13.14.1 wmMviU kqvwis-Gi gvag GBPAvBwf mswgZ nZ cvi? 154 13.15.1 ng_yb wK GBWm Qovq? 154 13.15.2 GBPAvBwf Avv`i exh mivmwi Mvq jvMj Kx nZ cvi? 155 13.16 GBPAvBwf Avv wk`i wkv Rxeb: 155 13.16.1 GBPAvBwf Avviv zj-KjR Mj Kvb mgmv ne wK? 155 13.16.2 GBPAvBwf Avv wkv_xiv Zv`i mncvVx`i Rb KZUv SuywK Zwi Kie? 155

Aavq GK
fvBivm, GBPAvBwf I GBWm
1.1.1 GBWm Kx? GBWm Kvb wekl GKwU ivM bq, AbKjv ivMi GKwZ cKvk| GZ wmwW-4 wjvmvBUi msLv `yki wbP bg hvq Ges jve cixvq i GBPAvBwf cwRwUf nq| Gi m AvbylvwK h mg ivM `Lv w`Z cvi ZviI jve wfwK cgvY _vKvUv evbxq| 1.1.2 GBWmi bvgKiY Ggb nj Kb? GBWm K_vwU Acquired Immunedeficiency Syndrome -Gi msw AvKvi| Acquired K_vwUi A_ nj GB h, GBWm eskvbyg nq bv wKsev Avcbv _KB kixii ga Rbvq bv| hbmshvMi mgq hvwbc_ I cvqyc_i ewniveiY ev gyLMnii ggebi mv_ hbvi mski gvag A_ev Ab Kvbfve GBPAvBwf fvBivmhy hvwbim ev jvjv GKRbi _K Aci Rbi ga Qwoq coj GB ivM nq _vK| h Kvb `~wlZ i A_ev `~wlZ ii Kbv KYv MnYi gvagI G ivM kixi Qovq| kixii ivM cwZiva eevi bvg nj BwgDb wmg| wewfb ivM GUvK wZM KiZ cvi| GBPAvBwfi cavb jB nj GB cwZiva eevwU| GBPAvBwf Avv nevi dj kixi wU-njcvi Kvl Kg hvq| GUvK BwgDbvWwdwmqw ej| wmbWg (syndrome) GKwU GKK ivM bq, GwU AbKjv ivM Ges Zvi jYi mg^q| Avi GB mejv welq GK msw AvKvi Acquired Immunedeficiency Syndrome ev AIDS ivMi GKwU msw eYbv `q| 1.1.3 GBPAvBwf fvBivm Kx? GBPAvBwf fvBivm Dci ewYZ Dcvq Qwoq cov Ggb GKwU wekl fvBivm hv kixii ivM cwZiva eevK wZM Ki| GBPAvBwf kwUi c~Yic nj, Human Immunodeficiency Virus| A_vr gvbylK AvgY Ki

kixii cwZiva eev fO `q h fvBivm ZvKB ejv nq GBPAvBwf fvBivm| GwU jbwU fvBivm Mvfy iUvfvBivmjviB GKwU| jbwU K_vwUi A_ axi| GB fvBivmi viv GBPAvBwf msgY I ivMi cKvkI NU axi axi| cavbZ kixii cwZiva eev A_vr BwgDb eevKB GUv AvgY Ki| ZvB Gi wei kixi cwZiva Mo DVZ cvi bv| GBPAvBwf fvBwiqbi ga wbDwKqvcvwUb RvZxq K`ei Pvicvk w-i nRvZxq c`v_i Zwi AviY iqQ| GwUK wRwc-120 ej| Avi h wRwbmwU c`v ev Kvcmyj AvKvi AveiY Zwi Ki GB nRvZxq c`v_ I wbDwKwqK AvwmWK aviY Ki ZvK ejv nq Uvggeb Gbfjc (Transmembrane env) cvwUb ev wRwc-41| GB wRwc-41-B wkKoi gZ AvUK ivL nRvZxq c`v_i AveiYwUi mv_ ewniveiYK| Gevi Avmv hvK K`| wbDwKqvcvwUbhy K` `yB Kwc fvBivj RbvwgK AviGbG Ges Uvdvi AviGbG AYyi mv_ MvM cvwUb (gag protein) I cvjcvwUb (pol protein) bvgK `yaibi cvwUb RvZxq e we`gvb _vK| GB MvM cvwUbjv eb mwKvix wmgU RvZxq c`v_i gZ hv fvBivmi AMZ wbDwKwqK AvwmW I nRvZxq c`v_mn fvBivmi K`wUK ai ivL| wZb aibi MvM cvwUb iqQ; h_v gvwU MvM cvwUb ev MA, KvcwmW MvM cvwUb ev CA Ges wbDwKqvKvcwmW MvM cvwUb ev NC| GgG MvM cvwUb nRvZxq c`v_i fZii w`KUvq GgG MvM cvwUb jM _vK Ges ciii ga eb Zwi Ki| wmG MvM cvwUbwU Aevb bq K`| Gbwm MvM cvwUb fvBivmi RbvwgK AviGbGi mv_ eb Zwi Ki mvwRq wQq GK K` ivL| I IN bvgK GbRvBgjv mswk- _vK cvjcvwUbi mv_| G`iK ai ivLv cvjcvwUbi KvR|
PR, RT

bZzb fvBivmi Drcw nq Ges fvBivmi ew NU| Gme KviY Dw` I Rxe`ni evBi fvBivm wUK _vKZ cvi bv| 1.1.5 fvBivm I evwiqvi ga cv_K Kx? evwiqv Ggb GKwU c~Y Kvl hvi Kvl cvPxi iqQ Ges Kvlvfi wWGbG AviGbGmn ivBevRvgi DcwwZ iqQ| evwiqvi GKwU gUvewjK GbRvBg iqQ Ges GUv gvbyli kixii Kvli ga Ges Kvli evBi `yfveB wUK _vKZ cvi| evwiqvK mvaviY gvBvmKvci mvnvh `Lv hvq Ges GUv 300 bvbvwgUvii Pq eo nq _vK| Aciw`K fvBivm evwiqvi Pq AbK QvU, Rxe Kvli ewkwenxb Ggb GKwU jvBcvcvwUb Kvcmyj hvi Kvb cvPxi bB| Gi ga Kvb gUvewjK GbRvBg ev ivBevRvg _vK bv| nv Kvli ga mnvqK cwiek Qvov GUv wbR _K euP _vKZ cvi bv Ges GUv wWGbG AviGbG bvgK fvBivm bqZv AviGbG fvBivm bvg AwfwnZ Kiv nq| fvBivmjv mvaviYZ 20300 GbGg nq _vK| c fvBivm nj mKj fvBivmi ga eo| GUvK mvaviY gvBvmKvc `Lv hvq| 1.2.1 GBPAvBwf fvBivm kixii Kv_vq AvNvZ Ki? kixii kZKwYKvjvB fvBivmi AvgYi wkKvi nq, wekl Ki wUwjvmvBU A_ev wU-njcvi Kvljv| GB wU-njcvi Kvljv kixii cwZivai cavb Kvvwi wnmve KvR Ki| 1.2.2 iMci m GBPAvBwf msgYi mK : AbK ck Kib, Kvb wekl Mci ii GBPAvBwf enbi gZv ev cwZiva Movi gZv iqQ wK bv| cZK gvbyli kixi BwgDb Kvljvi ga wmwW-4 bvgK vb iqQ| AvgYi Rb GB wmwW-4 vbB eQ bq GBPAvBwf| hnZz GBPAvBwf gvbyli BwgDb Kvljv, wekl Ki wU-njcvi gbvmvBU I gvvdRK AvgY Ki GjvZ Aevb bq Ges G`i ga fvBivm cvwUKj Qwoq `q, ZvB i evwnZ nq Gjv kixii wewfb Zij c`v_ Rgv nq| Gi ga exh Ges hvwbim AMZ| GKviYB hvwbim Ges exhi gvag GB fvBivm AwaK nvi Qwoq _vK| Avv ewi jvjv Ges PvLi cvwbZI GBPAvBwf _vK| Ze exhi Zzjbvq jvjvZ fvBivmi cwigvY AbK Kg _vK| Zvi Pq AviI Kg _vK PvLi cvwbZ|

1.1.4 fvBivm Kx? fvBivm evwiqvi Pq eY QvU Ggb GK wRwbm hv mvaviY AYyexYh `Lv hvq bv; Rxe Kvli AZvekKxq Askjv GwU aviY Ki bv ej GUvK Rxe KvlI ejv hvq bv| Rxe Kvl I Roc`v_i gaeZx vb Aevb bqv fvBivm Ggb GKwU Kvcmyj ev evM hvi ga _vK mvgvb cwigvY wWGbG A_ev AviGbG e Ges evMwU nq Zvi AveiY| Rxe Kvli evBi fvBivmi wbR^ Kvb Rxeb bB| Rxe KvlK AvgYi gvag Kvli wbR^ Dcv`vbjvK wbRi myweavgZ mg^q Ki

1.2.3 GBPAvBwf fvBivm Kx cwqvq kZKwYKvK AvgY Ki? GBPAvBwf g~jZ wU-njcvi wjvmvBU A_ev wU-njcvi KvlK AvgY Ki| wU-njcvi Kvljv BwgDb eevi bvbv w`K wbqY Ki| Zv`i mwq f~wgKvZB Avgv`i kixi wewfb ivMi AvgY _K iv cvq| wU-njcvi Kvli f~wgKvwU AbKUv GKwU `ji bZvi gZ| Gi wb`kB bvbvwea cwZiva eev Mo IV| GBPAvBwf fvBivm ii kZKwYKvi wUwjvmvBU I wU-njcvi KvljvK AvgYi gvag gvbyli BwgDb eevK Ggbfve AKvhKi Ki `q hvZ mjv ivM cwZivai gZv nvwiq dj| GUv c_gB AvgY Ki wU-njcvii AMZ wmwW-4 K| wmwW-4 vb mshvM NwUq cwZiva gZv bmvZi gvag GUv kixii Afi cek Ki| GB wU-njcvi BwgDb Kvljv Avv nevi KviY Abvb ivMi weiI cwZiva Kg hvq| wU-njcvi Kvl Qvov kZKwYKvi AMZ gbvmvBU I gvvdRKI fvBivm AvgY Ki| GZ cwZiva mwbK gbvmvBU I gvvdRjv wVKfve KvR Ki bv| BwgDb cwZiva eevq Zwi GwUewWjv wKQy fvBivm wbab KvhKi _vKjI BwgDb eevi gv^q wechqi KviY Gi msLv I gZv w`b w`b Kg Avm| Giv wbwq nq hvq Ges ivMi wei joevi gZv nvwiq dj| GK mgq Gjv wbw nq co| kixii BwgDb eev GwUewW Zwi Ki GBPAvBwfi wei joevi Pv Ki| GZ cv_wgKfve fvBivmi AvgY wKQyUv wbqwZ njI cieZxZ Gjv bZzb ic I gZv wbq BwgDb eevK cybivq AvNvZ Ki Ges GK mgq cyiv BwgDb eevKB wbwq Ki `q| 1.3.1 GBPAvBwf fvBivm KiKg nq _vK? `yaibi GBPAvBwf fvBivm nq _vK| GKwU GBPAvBwf-1, AbwU GBPAvBwf-2| mvgwMK GBWm ivMx`i AaKB Avv nq GKB mv_ `yB aibi fvBivm viv| Ze GBPAvBwf-1 nj GBWm ivMi cavbZg KviY| hyivmn cw_exi AwaKvsk `k GBWm ivM NU _vK GB GBPAvBwf-1 Gi KviY| c~e, `wY I ga AvwdKvZ GBPAvBwf-1 msgY ewk NU _vK| GBPAvBwf-2K kbv Kiv nq 1986 mb| AvwdKv, wekl Ki cwg AvwdKvZ GUv mePq ewk ivM msgY NwUq _vK| Di AvgwiKv, BDivc Ges Gwkqvq A wKQy jvK GBPAvBwf-2 Z Avv nq| GKKfve kZKiv 4 fvM Avv nq GBPAvBwf-2 viv| 1.3.2 GBPAvBwf-1 Ges GBPAvBwf-2 Gi ga Zdvr Kx? GBPAvBwf-1 Ges GBPAvBwf-2 `yUvB iUvfvBivm; `yUvB GBWm Zwi Ki| Ze GBPAvBwf-1-Gi wevi AcvKZ Kg Ges GUv cavbZ c~e AvwdKvmn KqKwU `k mxgve|

GBPAvBwf-2 _K GBPAvBwf-1 AbK ewk fqi| GBPAvBwf-2 m fvBiwgqv Zzjbvg~jKfve Kg nq _vK| GBPAvBwf-2-Gi msgYI AvbycvwZKfve Kg gvvq Ges `yej cKwZi nq _vK| GBPAvBwf-2-Gi wbwq Aev ev Nyg mgq A_vr msgYi ci _K ivMi jY cKvki ga eeavbwU GBPAvBwf-1-Gi Pq AbK ewk nq _vK| GgbI cgvY iqQ h, GBPAvBwf-2 `~wlZ i MnYi ciI cvq P eQi KU MQ jYwenxb fve| 1.4.1 GBPAvBwfi wgDUkb (wefvRb ev cwieZb) : GBPAvBwfi wgDUkb GKwU iZc~Y welq| Kbbv fvBivmwUi PwiB nj Gi gvMZ cwieZb ev wgDUkb| GZ bZzb bZzb h mg fvBivm Zwi nq, Zv`i GwUewWi gaI wKQzUv cv_K _vK| G cwqvq Zwi Kvb Kvb fvBivm ivM msgY NUvq AwZ `Z, KvbwU Avevi AwZ axi| Ze wgDUkbi ciI GBPAvBwf Zvi gwjK Pwi AyY ivL Ges KLbB GUv Ggb Kvb wfb fvBivm cwiYZ nq bv hvZ GUv bZzb Kvb cwqvq gvbyli ga Qwoq coZ cvi ev Ab ivM NUvZ cvi| 1.4.2 GBPAvBwf P (HIV Cycle): h mg RxevYy ev ciRxex Ges QvK gvbylK Avv Ki Zv`i cZKi RxebP AvQ| fvBivmiI Ggb GKwU P AvQ, Ze ZvK RxebP ejv hvq bv| Kbbv fvBivmi wbR^ Rxeb bB| mvaviYZ fvBivm Gi wWGbG I AviGbG RvZxq wbDwKwqK AvwmWjv Kvli ga cek Ki Kvli msMnkvjvq we`gvb wbR^ m`jvK eenvi Ki bZzb fvBivm Zwi Ki| GBPAvBwf fvBivmi GwU AviI RwUj| GBPAvBwf fvBivm kixi cek Kivi ci AYy chvq wKQy cwieZb NU Ges cwikl GKwU fvBivmi m`k AbKjv fvBivm Zwi nq| G cwqvq chvqg h cwieZbjv NU Zv nj

GBPAvBwf fvBivmi mv_ wmwW-4 wimii eb ggeb wdDkbi gvag fvBivmi Abycek wifvm Uvwckb (Reverse Transcription) BwUMkb (Integration) cvfvBivj Uvwckb (Proviral transcription) wRb Gckb (Gene expression) Avm^wj (Assembly) evwWs (Budding) gvPzikb (Maturation)

Kvl fvBivm ceki ci hv nq GBPAvBwf P

G chvq GwU-wmwW-4 GwUewW mywbw`fve fvBivmK AvgY Ki cwZiva KiZ cvi| wmwW-4 RvZxq GB M-vBKvcvwUb fvBivmi wRwc-120 RvZxq AviYi mv_ k eb Zwi Ki m~Y fvBivmwUKB APj Ki w`Z cvi| GKvR KiZ hq wmwW-4 Kvl wbRI Avv nq fvBivm viv| ggeb wdDkbi ci hv NU Zv nj Kvli mvBUvc-vRgi fZi wifvm Uvwckb| GB cwqvq Avv Kvli mvBUvc-vRg fvBivmi AviGbG Rbvgi GKwU wWGbG Kwc Zwi nq| GB wWGbG Kvli wbDwKqvm cek Ki vgvRvgvj wWGbGi mv_ mshy nq cvfvBivm Zwi Ki| Kvli ga hv NU Zv nj BwUMkb, cvfvBivj Uvwckb Ges cybivq wbDwKqvm _K mvBUvc-vRg wdi Avmv ev mvBUvc-vRwgK Gckb| cvfvBivj Uvwckb-Gi ci cvfvBwiqb `ywU cwqvq Kvli mvBUvc-vRg wdi Avm| G cwqvi bvg mvBUvc-vRwgK Gckb| Gici fvBwiqbjv mvBUvc-vRgi gmvi AviGbG eenvi Ki Kvl cvPxii fZi mgeZ nq| Gici NU Kvli evBi evwWs Ges cybtfvBivm ZwiKiY| wifvm Uvwckb cwqvq fvBivm Zvi Kvi AviGbG (fvBivmi K` AewZ AviI GKwU RbwUK nvwZqvi) Ges wifvm Uvwckb GbRvBg Ggbfve cqvM Ki hvZ fvBivmi AviGbG Kvi wWGbGZ icvwiZ nq| GB wWGbGwU `ywU j^v myZvi gZ| GK wjwbqvi Wvej vbWW wWGbG (Linear double stranded DNA) ej| GB wWGbG ev icvwiZ GBPAvBwf Kvli wbDwKqvmi fZi cek Ki| G cwqvwUKB BwUMkb ej| G chvq fvBivmi wWGbG Kgc-wU Zvi fvvii BwUMm cvwUb bvgK GbRvBgi mnhvwMZvq Avv Kvli vgvRvgvj wWGbG-Gi mv_ mshy nq| BwUMkbi ci cvfvBivj Uvwckb cwqvwU i nq| fvBivmi wbDwKwqK AvwmW ev RbwUK ejv Avv Kvli wWGbG-Gi mv_ hy nq wbR^ msKZevnx h wbqK wWGbG Zwi Ki ZvK cv-fvBivm ej| G cwqvq icvwiZ Kvli ga c~Y`N wWGbG PBb ev kLj GKB mv_ fvBivmi asmvZK wWGbG msKZ Ges Kvli AMZ wWGbG msKZ DcwZ _vK| Kbbv iUvfvBivj wWGbGjv Avv Kvli wWGbG-Gi wekl wekl vb mshvM vcb Ki| Kvb Kvb vbi cwZ GB mshvM NUvevi ceYZv ewk _vK| Ze h Kvl GB cwiewZZ wWGbG GKB m Kvl I fvBivmi bvbv ewk aviY Ki, ZvK GKwU Amy Kvl ejv hvq| Kbbv GB Kvl msNefve wbRivB bZzb fvBivm Zwii wb`k `q| AviKUz wevwiZ ejZ Mj, G cwqvq hv NU Zv nj G cwqvq fvBivj wbDwKqvcvwUb Ges wifvm Uvwckb (RT) bvgK GbRvBg Kvli mvBUvc-vRg Aevb bq| GB wifvm Uvwckb GbRvBg

GBPAvBwf fvBivmK wbqY KiZ nj fvBivm wevii GB avcjv fvj Ki Rvbv _vKZ nq| G cwqvq c_g hv NU Zv nj fvBivmi AveiYi mv_ mswk- Gbfjvc cvwUb wRwc-120 Gi mv_ BwgDb Kvli ewniveiY wmwW-4 wiwmii mv_ mshvM vcb| GUvK GBPAvBwf Gbfjc-wmwW-4 evBws (HIV env-CD4 Binding) ej| Gici NU Kvl AveiY ev mj ggebi mv_ fvBivmi wdDkb| GUvK ggeb wdDkb ej| GB ggeb wdDkbK mdj Kivi fvBivmi Gbfjvc M-vBKvcvwUb wRwc-41 Gi f~wgKv AZv iZcY| GUv HIV-1 ~ K` ei mv_ Kvli mvBUvc-vRgi mshvM NwUq _vK| GB ggeb wdDkbi gvag fvBivm Kvli Afi cek Ki| Ze GB ggeb wdDkbi c~eB wmwW-4 bvgK M-vBKvcvwUbwU gvvdR I wmwW-4+ wUwjvmvBUi ewniveiY AvUK djZ cvi|

Avv Kvli Afi wbDwKqvcvwUb Kgc- wmb_wmm Ki fvBivj AviGbG Rbvgi GKwU wWGbG Kwc Zwi Ki| Gici fvBivj wWGbG Kgc-wU wbDwKqvm cek Ki| mv_ wbq hvq fvBivm mswk- GbRvBgjvKI| GB KvlK`B BwUMm cvwUb bvgK GbRvBgwU fvBivj wWGbG-K nv vgvRgi wWGbG-Gi mv_ mshy Ki cvfvBivm Zwi Ki| GB BwUMUW cvfvBivm `yaibi fvBivj AviGbG Uvw Zwi Ki| Gi ga -vBmW GgAviGbG (Spliced mRNAs) Ges Avb-vBmW AviGbG (Unspliced RNA) wbR^ msKZ eenvi Ki `yaibi fvBivj cvwUb Zwi Ki, hjvi GKwU nj gvwU MvM cvwUb, AbwU KvcwmW MvM cvwUb| ciiwU fvBivj KvW Zwi KiZ AZvekK| Gici Ni MvQvbv| MvM Ges MvM-cvj fvBivj cwjcvwUbi mv_ RbvwgK fvBivj wWGbG GKwZ nq nv Kvli Mvq bZzb fvBivm Zwi Ki| Gici Gjv hLb nv Kvli ewniveiY ev ggeb Vj dzU eiZ Pvq ZLb w-i wewk cvZjv Pwei AveiYwU (Gbfjc) msMn Ki bq| GB dzU eibvK ej evwWs| G cwqv PjvKvj fvBivj cvwUqm GbRvBg MvM Ges MvM cvj wcKvimi ev AM`~Z (gag-pol precursor) cvwUbjvK eenvi Ki cwiYZ fvBivm Zwi Ki| mB mv_ ivM msgY NUvZ KiZ cvi Ggb AmsL fvBwiqb Qwoq `q| GB fvBivm AviI bZzb KvlK AvgY Ki| AvgYi GK chvq GB cv-fvBivj wWGbG Avv Kvli ga h c~Y`N wWGbG kLj Zwi Ki Zvi ga Avv Kvli wWGbG msKZI we`gvb _vK| GB bZzb wWGbGi ga fvBivmi Abvb ewk we`gvb _vK| Gjv Abvb KvlK GKwZ Ki AviI bZzb fvBivm Zwii wb`k `q| GBme fvBivm bZzb bZzb KvlK AvgY Ki Ges AviI AviI fvBivm Zwi nq| GUvB GBPAvBwf P| 1.4.3 GK bRi GBPAvBwf P: fvBivmi Pew mb Kivi Rb c_gB Gbfjc cvwUbi mv_ nv KvlMvi mshvM mvwaZ nq| GB mshvMi dj fvBivm Ges Kvli AveiYi ga Ggb aibi eb ev wdDkb NU hvZ fvBivmi wbDwKqvcvwUb Kgc-wU UvMU Kvli mvBUvc-vRgi ga XyK co| GB RwUj ebi ga wifvm UvwcUm bvgK GbRvBg (R.T) fvBivmi RNA Rbvgi DNA Kwc Zwi Ki| GB DNA mg fvBivm Kgc-wU Kvli wbDwKqvm cQ| GB wbDwKqvmi ga BwUMm cvwUb (IN) fvBivm DNA I nv
HIV-1

gvRvgvj DNA Gi ga GKxfeb mvwaZ Ki cvfvBivm Zwi Ki| Gici GB GKxf~Z cvfvBivm LwZ (spliced) Ges ALwZ (unspliced) gvmvi mRNA Zwi Ki| gvmvi RNA Gi msKZ h_vg MvM I MvM cvj cvwUb Gi gZ AeKvVvgvMZ cvwUb I wbqK fvBivm cvwUb Zwi Ki| fvBivj cvwUKji ga vb bIqv fvBivj RNA MvM I MvM cvj cvwUbjv nv Kvl ev Avkq `vZv Kvli Mv Aevb bq| KvlMv _K Kzuwoi gZ ewiq coevi mgq fvBivm cvwUKjjv wi mnwewk GKwU Gbfjc wbq ei nq| bZzb fvBivm wbMgb ev evwWs Gi mgq fvBivj cvwUqm (Viral protease) MvM I MvM cvj wcKvimi cvwUbK cwiYZ fvBivmi Mv mshvRb Ki gviYgZv mb BbdKkvm fvBwiqvbm Zwi Ki| 1.4.5 HIV evwWs G cvwUqm Gi f~wgKv: Avv Kvl _K bZzb fvBivm evwWs Gi mgq wKsev evwWs cieZx Aevq hLb MvM I MvM cvj cwjcvwUbjv cwiYZ cvwUbi mv_ mshy nq ZLbB iUvfvBivm cvwUKjjv cwiYZ fvBivm ic bq| MvM I MvM cvj cvwUbi mv_ GB eb mb Ki fvBivj cvwUqm| PR (Viral protease) Ggb GKwU GmcviUvBj cvwUqm hvi ga `ywU mg`k GgvBbv AvwmWi (99) BDwbU _vK| cvwUqm Gi GB eb iUvfvBivm cvwUKjjv cwiYZ Kivi wcQb GKwU iZc~Y f~wgKv ivL| fvBivj cvwUqmi wgDUkb ev cwieZb Ggb aibi msgY gZvnxb fvBivm Zwi Ki hvZ Kvi cvwUbwU enxb Aevq _vK| cvwUqmi KviYB cwiYZ fvBwiqbjv Kvl _K wbMZ nq bZzb Kvl AviI fvBivmi cwZwjLb wbwZ Ki| 1.4.6 Kvl K`vwfgyLx fvBivj cvwUbi cwZiva : Kvli AveiYi mv_ wdDkbi ci fvBivj wbDwKqvcvwUb Kvl Afi cek Ki Ges Kvl K` ev wbDwKqvmi w`K GMvq| gvbe kixii h mg Kvli wefvRb nqbv Zvi gaI GBPAvBwf I Abvb jbwU fvBivm wbR`i ew NUvZ cvi| Gi mve KviY nj, GBPAvBwf-1-Gi ga gwU cvwUbi gvag Kvl K` kbv Ki mLvb cuQvevi gZ gZv aviY| GKviY Ggb GKwU ccUvBW (Peptide)-Gi K_v wPv Kiv nj hv wK bv mvBUvc-vRg _K fvBivmi K`vwfgyLx cwigYK evwZj Ki GK mvBUvc-vRgi gaB asm KiZ cvi| Gfve gbvmvBU RvZxq UvMU Kvli ga GBPAvBwf AKvhKi nevi K_v| G KvR mgmv Zwi neviI K_v| GB mgmv Zwi Ki fvBivm we`gvb H mg cvwUb, hv fvBivmi wc-BwUMkb Kgc- (Pre-integration

complex) -K K` wbq hvq| G cwqvq GBPAvBwf-1-Gi wfAvBGd

cvwUb evavM bv nIqvq Zv fvBivj wWGbG wmb_wmm mv`b KiZ cvi| 1.5.1 GBPAvBwf Ges GBWmi ga Zdvr Kx?

GBPAvBwf nj fvBivmwUi bvg, hvi m~Y bvg nj Human Immunodeficiency Virus | Avi GB fvBivmwU gvbe`ni i ceki ci kZKwYKvK AKvhKi Ki w`q h ivMwU Zwi Ki Zvi bvg GBWm| GBWm Kvb GKwU wekl ivM bq| GwU AbKjv ivMi mwwjZ cKvk| G ivMjv nq _vK kixii BwgDb eevi wechqi KviY| GBPAvBwf kixi cek KijB kZfvM msgY ne GgbUvI wVK bv| Ze kZKiv 90 fvM ivMi jY `Lv `q, hw`I ivM msgYi c_gw`K AbKB my _vK| AbK mgq ivMi jY cKvk cZ eQii ci eQi jM hvq| 1.6.1 wewfb NvZK fvBivmi Pwii Zzjbvg~jK wek-lY : ncvUvBwUm G fvBivm gyLi jvjv, ewg, gjg~ BZvw` eRi gvag Qwoq _vK| GB fvBivm cwiek AbK w`b wUK _vK| ncvUvBwUm we fvBivm mvaviYZ icwimvjb I hbmshvMi gvag Qwoq _vK| ncvUvBUm we fvBivm wekl jvjv I gji gvag QovZ cvi| AbK MelK G gyLi wgDKvmvi ZK ivM msgYi kZ wnmve MY Ki _vKb| ncvUvBwUm wm fvBivm icwimvjb I BbRKkbi gvag Qwoq _vK| ncvUvBwUm G I we fvBivmi fvKwmb _vKjI wm fvBivmi fvKwmb GLbI Zwi nqwb| GBPAvBwf fvBivmwU `Z cwieZkxj iUvfvBivm| GwU g~jZ: hbmshvM, icwimvjb I BbRKkbi gvag Qwoq _vK| GBPAvBwf Avv gvq`i `n _K wbMZ fvBivm beRvZK enb KiZ cvi Ges gvqi `ya _K wki `n fvBivm QovZ cvi| hvwbim, exhmn `ni mKj Zij wbtmiY GB fvBivm _vK| GBPAvBwf evZvm DoZ cvi bv, wK Kivbv fvBivm I dz fvBivm WcjU AvKvi A_vr nuvwP, Kvwk, bvKi cvwb BZvw` _K wbtmZ nq QovZ cvi| GBPAvBwf fvBivm jveiUwiZ we cvwbZ KqKw`b wUK _vKZ cvi| wK cvKwZK cwiek cvwbZ GUv Lye `Z gviv hvq, wekl Ki Kvwibhy cvwb Ges wWUviRUi msk Gm| Kvwib cvq ZvrwYKfve GBPAvBwfK gi djZ cvi| jveiUwi Kwkb A_vr wekl cwiek Uwej, Pqvi, gS BZvw`i Ici GBPAvBwf wKQzYi Rb njI wUK _vKZ cvi| wK ^vfvweK cvKwZK

cwiek Uweji Ici, Avmeveci Ici, gSi Ici wUK _vKv GBPAvBwfi Rb AbKUv Ame| Kbv Aevq wWUviRU Ges KwgKvjmGi msk Zv GwU gviv coB, mvgvb DPZvc Ges cwiwgwZ AvvfvqvjU i-ZI GUv wbw nq| 56 wWMx mjwmqvm Zvcgvvq GBPAvBwf wbw nq hvq| G KviY G Zvcgvvq iK cvivBRW Kiv nq Ges evqvjwRKvj cvWvjv eenvi Kiv nq| Ze ngvdvBwjqv ivMx`iK dvi-9 `qvi c~e Zv 680 Zvcgvvq 72 NUvi Rb WvB wnU Kiv nq| mvaviYfve dyUvj fvBivm `Z z gviv hvq| ZvB AbK wijvBRkbi Rb GUv Lye mnR cwZ| Ze Gi ciI GKwU K_v gb ivLv cqvRb h, GBPAvBwf AbK mgq Kbv i euP _vKZ cvi| ZvB Avvi i Zv ZvRv nvK, wKsev Kbv nvK Gwoq PjZ ne Ges G`i iwm eenvhjv wWUviRU, we-wPs cvDWvi ev Kvwib w`q ayq djZ ne| Gjv avqvi mgq ivevi M-vfm eenvi KiZ ne| GBPAvBwf evZvmi mshvM Avmj Avi euvPZ cvi bv| Kvli ga Ges kixii Zij c`v_ Aevb MnY Ki wbR^ AveiYi gaB Giv euP _vK| gvbyli kixii evBi i A_ev vg evsK iwZ exh Qvov GBPAvBwf ewkY wUK _vKZ cvi bv| 1.6.2 Abvb iUvfvBivmi mv_ GBPAvBwf-Gi mK : GBPAvBwf, GBPwUGjwf-1, GBPwUGjwf-2 G`i mejvB AviGbG wbfi iUvfvBivm Ges G`i mevi ga wifvm Uvwmi bvgK GK iKg GbRvBg iqQ| G wZbwU fvBivm i Ges kixii Zij Ask Aevb bq| G`i AvgYi je nj kixii kZKwYKv| Ze G`i ga Awgj nj, GBPAvBwf viv h ivM Zwi nq Zvi bvg GBWm Ges GBPwUGjwf-1 viv h ivM NU Zvi bvg wjDKvwgqv ev ii Kvvi| GBPwUGjwf-2I GK RvZxq wjDKvwgqv Zwi Ki| GBPAvBwf Ges GBPwUGjwf DfqB ii kZKwYKvK AvgY KijI G`i AvgY cwZwU wfb, hgb wfb fvBivm D~Z ivM `ywU| wjDKvwgqvi KviY `Z kZKwYKvi ew nq Ges AmsL AcwiYZ kZKwYKv Zwi nq| Ze BwgDb Kvli wmwW-4 vbwU Gi j bq| Abw`K GBPAvBwf BwgDb eev I kZKwYKvK asm Ki| Ze GBPwUGjwf hgb GBWm Zwi Ki bv, GBPAvBwfI Zgwb wjDKvwgqv Zwi Ki bv|

GBPAvBwfK Avgiv kbv KiwQ 50 eQi AvM| wK ii Kvvi ev wjDKvwgqv hv wK bv GBPwUGjwfi KviY NU _vK Zvi Drcw NUQ KqKk eQi AvM| 1.6.3 HILV-1 Ges HTLV-2 Gi Zdvr GBPAvBwf-1 I GBPAvBwf-2 Qvov Abvb h mg iUvfvBivm viv gvbyl Avv nq mjv nj wnDgvb wU-Kvl wjDKvwgqv fvBivm (Human T-cell Leukaemia virus Type-1, 2) ev HTLV1 Ges HTLV2 | AviKwU nj BwWqvcvw_K wmwW-4+ wU-wjvmvBUvcwbqv (Idiopathic CD4 +T Lymphocytopenia) ev ICL fvBivm|
Human T-cell leukaemia A_ev T-lymphotropic virus type-1 (HTLV1):

1.7.1 GBPAvBwf fvBivm wK cwieZbkxj? nuv, GwU AZ cwieZbkxj Ges Gi wbqwgZ wgDUkb NU _vK| wgDUkb K_vwUi A_ nj wRb msv cwieZb| bZzb fvBivm Zwii mgq Mvjgj wWGbG wbq h fvBivm Zwi nq Zv`iK GBPAvBwf wgDUUm ejv nq| GBPAvBwf wgDUkb wbqwgZ nq _vK Ges bZzb bZzb Bbi fvBivm Zwi nq| Kvb Kvb fvBivm axiMwZ mb A_vr mgq wbq ivM Zwi Ki| Kvb KvbwU Avevi AZ fqi| fqi cKw Zi GBPAvBwf BbjvK wfijU Bb ej| GB Bbi fvBivm viv ivM `Z Qovq| ivMi jYI `Z cKvk cvq Ges wechqI ewk nq| GUv wbqY Kiv wPwKrmKi Rb KwVb nq co| 1.7.2 GBPAvBwf fvBivmwU KZw`b ci Ges Kxfve kixi cwZwqv NUvq KD GBPAvBwf mswgZ nj mvaviYZ 2 _K 8 mvn ci mivKbfvikb (Seroconversion) nq| GBPAvBwf msgYi my Aev _K ivMi jY cKvki mgqwU GK _K P eQi ch nZ cvi| Kvb Kvb ewi ga GKhyM ciI ivMi jY `Lv `qwb, Ggb D`vniYI iqQ| GB `xN mgq ivMi jY kixi Pvcv _vKZ cvi| GUvK BbwKDwekb wcwiqWI ej| 1.8.1 msgYi ci kixi GBPAvBwfi bxie Aev : GBPAvBwf Avv-cieZx cv_wgK cwZwqvi ciI GKRb `xNmgq my _vKZ cvi| G mgq fvBivm Lye axi axi `ni BwgDb eevK asm KiZ _vK, wK evBi Gi Kvb jY _vK bv| G AevK AbK jYwenxb GBPAvBwf msgY ej| 1.8.2 GBPAvBwf jvUw (Latency): GBPAvBwf fvBivm AbKmgq Kvli ga Aevb wbq Nyg Aevq _vK wK Zvi Kvb ew NU bv| G AevK GBPAvBwf jvUw ej| GB my msgY ZLbB NU hLb Kvl AMZ wRbi mv_ GBPAvBwf wRb bxie eb Ki Aevb Ki| GB msgYwU kixii BwgDb eevI AbK mgq kbv KiZ cvi bv| jvUwi mv_ jYwenxb msgYi Zdvr nj GB h, jYwenxb msgY fvBivm ew NU, wK jvUwZ Zv NU bv| AbK mgq ivMi jY _vKv AevZB fvBivm GB my Aevq Pj hZ cvi| jYwenxb Aevq GBPAvBwf Avv ew wbRi kixi _K Abi kixi fvBivm QovZ cvi|

GwU Ggb GK aibi iUvfvBivm hv kixi bxie ev Kvwiqvi U _vKZ cvi A_ev bvbvwea wgk ivM ev wKwbKvj wmbWgi cKvk NUvZ cvi| G ivM vqy mwKZ AmyL Tropical Spastic Paraparesis and Myelopathy, nZ cvi| GZ wekl aiYi PgivM (cutaneous lesions), eo`i T-cell leukaemia ev ii Kvvi Ges wjvgv nZ cvi| GZ wjM-vjv dzjZ cvi, hKZ I c-xnv evoZ cvi, i Kvjwmqvg ew cZ cvi| ZK wekl aibi Z mw nZ cvi A_ev G fvBivm kixi bxie _vKZ cvi| bxie _vKv AevK jYwenxb Kvwiqvi U (carrier state) ej| G fvBivmwU hbmshvM, i cwimvjb I BbRKkbi gvag GKRbi _K AbRbi kixi Ges gvqi `n _K Lye mnRB Mf mvbi ga Qwoq co| BbdKkb nevi ci ivM cKvki eeavb 6 _K 10 eQi ch nZ cvi|
HTLV2 :

Ggb GK aibi iUvfvBivm hv wK bv HTLV1 -Gi mgMvxq Ges D fvBivmi mv_ BwgDbvjwRKvwj m wiqvKwUf| GRb HTLV2 mvaviY wwbs-Gi gvag kbv Kiv KwVb| GBPwUGjwf-2 Gi mv_ Kvvii Kvb mK LuR cvIqv hvqwb| `~wlZ m~P I i mvjbi gvag G fvBivm GKRb y u _K AviKRb Qwoq co|
Idiopathic CD4 +T-lymphocytopenia (ICL) :

Ggb GKwU ivMK eySvq hv AvcvZfve `LZ GBWmi gZ| GZ ivMxi `n GBPAvBwf mswk- ivMjv `Lv `q| mB mv_ wmwW-4 Kvli msLv bg hvq wZbki wbP| G ivMwU GBPAvBwfi mv_ mwKZ bv njI Gi mv_ ievwnZ GKwU wfbagx iUvfvBivmi mK iqQ| i mvjbi gvag G ivM QovQ| Ze GwU wbq GLbI cixv-wbixv PjQ|
ICL

1.8.3 GBPAvBwf Kvwiqvi (Carrier) Aev : hme GBPAvBwf `xN mgq A_vr `k eQii ewk mgq kixi _vK wK jYi cKvk NUvq bv ZLb ZvK ivMi Kvwiqvi Aev ejv nq| GBPAvBwf Avv`i ga cvq 10 fvM GiKg Aevq Rxeb hvcb KiZ cvi| GBPAvBwfi Kvwiqvii welqwU GmwUGjwf-1, wmGgwf Ges nvicm wmgc- fvBivmi Kvwiqvi Aevi KvQvKvwQ| 1.9.1 GBPAvBwfZ Avv nevi ci KLb GBWm nq bv? mvaviYZ fvBivm AvgYi ci Kvb bv Kvb mgq GBWm `Lv `q| KviI KviI (cwimsLvb Abyhvqx cvq 10 fvM ) kixi fvBivm cek Kivi ciI Zv eQii ci eQi Nyg Aevq _vK| `k eQi ciI `Lv hvq h, G`i ga GBWm `Lv `qwb| Avevi AbKi `n AvhRbK cwZiva eev _vKvi KviY mivcwRwUf ewi m hbgjvgkvi ciI GBPAvBwf fvBivm kixi cek Ki bv Ges cixvq Zv`i i mivbMwUf _vK| GBme fvMevb`i ga GKRb njb gvwRK Rbmbi x| GiKg ek wKQy ew iqQ hv`i ^vgx ev x GBPAvBwf mswgZ nevi ciI hKvb GKRb mx AZvhRbKfve my iqQ| 1.9.2 GBPAvBwf Avv GKRbi Rxeb KZUzKz `xNvwqZ nZ cvi? GBPAvBwfZ Avv nevi ci Ges GBWm ivMi jYjv `Lv `qvi ci K KZw`b euvPZ cvie ev euvPe m mK mywbw` Abygvb Kiv bv MjI MelKiv `LQb, hviv `~wlZ i MnYi KviY GBWm ivM Avv nqQ, Zv`i ga `Z Aevi AebwZ NUQ| ngvdvBwjqvK`i (Haemophiliacs) ga ivMi `Z AebwZi welqwU cKUfve `kgvb nq| GQvov BbRKkbi gvag gv`Kmex`i gaI bvbv KviY ivMwU wecbK MwZZ GMvq| wewea ivMi KviY `yej kvixwiK Aev Ges mB mv_ AwaK gvvq fvBivmi Abycek Gi Rb `vqx| Zzjbvg~jKfve hbmshvMi gvag GBPAvBwf msgYi Pq ii gvag GBPAvBwf msgYi nvi AbK ewk| Ze `yNUbvg KviI hw` wfijU fvBivmi mv_ mshvM NU mI hbmshvMi ci `Z Aevi AebwZ NUZ cvi| GBPAvBwf msgYi ci GKK Rbi BwgDb eev GKK fve cwZwqv e Ki| G KviY GKK Rbi `n ivMi cwZwqv, cwZiva Ges wevi GKK iKg nq _vK| GBPAvBwf Avv`i cwiYwZ Ab AvjvwPZ nqQ| G cm gb ivLv cqvRb h, G ivM Avv ivMxi ZvrwYK gZz NU bv|

GBPAvBwf fvBivmi msgYi Rb h aibi cwiek I ivMi DcwwZ mnvqK f~wgKv cvjb Ki mjvK fvBivm msgYi Kv-dvi wnmve wPwZ Kiv nq| hgb, jve wekl gvvq AvjUvfvqvjU jvBU GBPAvBwfK DxweZ Ki| Abvb Kv-dvii welqjv GB Mi Ab Aavq AvjvwPZ nqQ| 1.10.1 GBWmi kYxwefvM: 80-Gi `kK GBWm ivMK fvM Kiv nqwQj PviwU Mc Mc 1. kxl chvqi BbdKkb ev Acute infection Mc 2. jYwenxb BbdKkb Mc 3. mg kixii wjM-v ev jwmKv Mwjv dzj hvIqv Ges Mc 4. vqyweK wechqi mv_ ivMi DcwwZ| 1993 mb A, B Ges C- GB wZb KvUvMwiZ fvM Kiv nq GBWm ivMK KvUvMwi A : jYwenxb Ges cv_wgK Aevq AvwKDU msgY (Acute infection) | hgb, jwmKv Mwjv dzj hvIqvK A KvUvMwii Afy Kiv nqQ| KvUvMwi B : GB KvUvMwii Afy nj mB me ivMx hv`i ga jYi cKvk NUQ| KvUvMwi C : hLb GBWmi mnhvx (Associated) ivMjvi cKvk NU| wmwW-4 I wU-Kvl-Gi msLv Abyhvqx cwZ KvUvMwiK Avevi wZbfvM wefvRb Kiv nqQ; h_v C1, C2, C3 BZvw`| hgbwmwW-4 Kvl (cwZ Nb wgwjwjUvi) 500-Gi Ici nj Zv nq C1 KvUvMwii AMZ, 200-499 Gi ga nj C2 , 200-Gi wbP nj C3 - GiKg| 1.11.1 GBPAvBwf jvUw: GBPAvBwf jvUw ev GBPAvBwf fvBivmi Nyg Aevi evcvi AbKjv gZ I msv iqQ| wKwbKvj g~jvqbi cvcU `kgvb jYjvi AbycwwZi mgqK GBPAvBwf jvUw ej| GB mgq Immunodeficiency cwijwZ bv njI A wKQz Kvl fvBivmK aviY Ki ivL Ges AwZ axi MwZZ fvBivm Qwoq _vK| mcwZ wbweo MelYvq `Lv MQ HIV replication Ges virus expression me mgqB mPj _vK, Zvi gvb HIV infection Gi avivwU KLbB _g _vK bv| i Ges jwmKMwZ we`gvb GBPAvBwf Avv Kvljv wek-lY Ki, fvBivm DNA cvwUb wmb_wmm cwigvc Ki `Lv MQ h, AbK Avv KvlB wbYq Kiv hvq Ggb cwigvb

GBPAvBwf wRb Zwi Ki bv| mvcwZK MelYvq AviI `Lv MQ h, GBPAvBwf aviY KiQ Ggb AbK Kvl, AwZ bMY gvvq fvBivm RNA Ges cvwUb wmb_wmm KiZ cviQ| G KviYB GBPAvBwf jvUw msv weZKi De nqQ| g~jZ: GBPAvBwf fvBivmi cvwUKjjv ev fvBivm evWb i wkivq Aevb bv Ki jwmKvMwi ga AvcwKfve wbzc Aevq _vK| ii ga fvBivm cvwUKj ev fvBivm evWb bv _vKvq ivM kbv Kiv hvq bv| GZ Ggb gvZK aviYv nq h fvBivm ew Av` NUQ bv| A_vr GBPAvBwf fvBivmi Nyg Aev, jvUw BZvw` welqjv Avmj jYnxb cvhvq fvBivm ewi KqKwU i gv| 1.12.1 GBPAvBwf ivMi bZzb msv: 1986 mb hyivi mUvi di WvM KUvj ev wmwWwm GBPAvBwf ivMK mywbw`fve kbv Kivi Rb Gi msv I kYxwefvM wbaviY Ki| GBPAvBwf BbdKkbi eo cgvY nj Avv gvbyli kixi Kvl _K GBPAvBwf fvBivm AvBmvjkb I fvBivm kbvKiY| Ze GB cwqvwU RwUj nIqvq Ges GwU AbK mgq me bv nIqvq, GBPAvBwf wwbs I IqvY e-U Ui Dci Rvi `qv nq| mivmwi ev civ jeiUwi cixvi gvag fvBivmi DcwwZ kbvKiYi mv_ mv_ GBPAvBwf ivMi wKwbKvj cKvkK ivMi k cgvY wnme weePbv Kiv nqQ| h mg ivM I jYi cKvkK wmwWwm GBWm ivMi msvi ga Af~ KiQ Zv AbK cixvi AvM ivMi DcwwZi AvMvg msKZ `q| iZ wmwW-4 Kvli msLv 500-Z bg Gj ZvK GBWm ej ai wbjI 1993 mbi bZzb msvq ivM wbbqK wbf~j Kievi Rb cwZ wgwjwjUvi i wmwW-4 Kvmi msLv 200-K ivM wbYqi m~PK wnmve wbaviY Ki| Gi dj `Lv hvq h, wmwW-4 Kvl 200-Z bg Avmvi AvMB kZKiv 10 fvM ivMx GBWm ivM Avv nqQ| Ze G cwqvq ivM kbv nevi AvM gviv MQ Ggb GKRbKI cvIqv hvqwb| G cwqvq ivMi jY `Lv `evi ci ivM wbYqi Rb Mo 12-18 gvm mgq cvIqv hvq|

GBPAvBwf ivMi msv Gfve wbaviY Kivq mvgwqKfve GBWm Avv`i cwimsLvbi evcvi wKQzUv wevwi mw nZ cvi| GZ cv_wgK wnmve GBPAvBwf Avvi msLv Kg AvmjI ivMi jYmn GBPAvBwf cwRwUf ivMxi msLv AcwiewZZ _vKe| ivM wbYq fyjjv GovZ GwU GKwU KvhKi cwZ| 1.13.1 GBWm ebvg GBPAvBwf ivM: GUv GLb cwivi h, GBPAvBwf ivMi KviY BwgDwbwU ev kixii cwZiva eev f covq bvbv ivMi msgYmn h RwUjZvi mw nq ZvK GBWm ejv nq| G ivMi msvwU c_g cKvwkZ nq 1982 mb| H mgq wmwWwm (mUvi di WvM KUvj) G msvwU Zwi Ki Ges cieZxZ bZzb wKQz wmbWgK G msvi Af~ Ki| wK eve `Lv hvQ hviv GBPAvBwf fvBivm Avv nq jYwenxb Aevq bxie mgvR emevm KiQ Ges hv`i Kvb cixv-wbixv nqwb Zviv G msvi evBi _K hvQ| G ZvivB GBWmi msvf~ nQ hviv ivMi kl chvq iqQ Ges hv`i ga ivMi jYjv cwizwUZ nqQ| G KviY jYmn GBWm ivMK AvWfvW ev cwiYZ GBPAvBwf wWwRR ejv DwPZ| cv_wgK Aevq fvBivm Avv nIqvq ci ivMwUK GBWm bv ej GBPAvBwf ivM (HIV diseases) ejZ ne| wmwWwm-Gi msv hvB nvKbv Kvb ivMxi `n fvBivm kbv nIqvi ci Zvi wPwKrmv wbR^ MwZZ PjZ ne| g~jZ: PGL
Persistent generalized lymphadenopathy) , ARC (AIDS related complex) Ges AIDS GBPAvBwf ivMi wewfb Aavq gv| G KviY ARC

I PGL bvg `yUv cwiZvM Kiv DwPZ| ivMi bvg ne GKwU Ges Zv nj GBPAvBwf ivM (HIV diseases)| 1.14. BwgDb eev (Immune System) : 1.14.1 GBWm msgYi mv_ BwgDb eevi mK Kx?

GBPAvBwf fvBivmi jB nj gvbe`ni BwgDb eev| GB BwgDb eevi wechqi gvagB GBWm gvbe`n AvwacZ MnY Ki| BwgDb eevi cwZiv `vbKvix wU-mji Mv wmwW-4 GwURbi mv_B GBPAvBwf fvBivmi c_g eb NU| gvbe`ni BwgDb wmgi Dci GBPAvBwf fvBivmi AvgY cwZwU ek RwUj| G cm weUbi Bwiqvj KjR Ae mvq-Gi AavcK dvwm ejb, The T-cell surface antigen CD4 is the principle binding site
for the HIV virus, but alone it is insufficient to allow entry of virus

into the cell. Now, however, HIV coreceptors have been identified as seven transmembrane G-protein coupled receptors.

RvZxq Kv-wiwmijv (Co-receptor) mnR fvBivmK MnY Ki| wekl Ki msgYi iZ gvvdRUwcK (Macrophage trophic) fvBivmjvK| msgYi kl chvq wU-Kvl GB fvBivmK c_ Ki `q CXCR4 RvZxq wiwmijvi mv_ mshvM NUvbvi | GB Kvwiwmii c_jvK e Ki `qv me nq KgvKvBbm (Chemokines) viv| wmwmAvi-5 Kv-wiwmii c_ e Kiv hvq GgAvBwc-1 Avjdv (MIP1 alpha), GgAvBwc weUv (MIP beta) A_ev ibwUm (RENTES) viv|
CCR2b CCR3 CCR5

kixi Qwoq co; cwZivq wbqvwRZ NvZK ev wKjvi KvljvI nq IV KvhKi| G chvq mvBUvKvBbm bvgK ivmvqwbK gwWqUii wbtmiY NU| Acquired immunity: GwURbi kbvKiYi cvcU mywbw` asmkw mb wbDUvjvBwRs GwUewW Zwi nq wnDgvivj (Humoral) cwZwqvi cvcU| mywbw` Kvli cwZwqvi mv_ mv_ wU-wjvmvBU-Gi gvag Zwi nq cwZiva| cv_wgK AvgYi 5 _K 10 w`b ci G cwqvi gvag Drcb mvBUvUwK wU-wjvmvBU (Cytotoxic T-lymphocyte) ev wmwUGj Avv KvljvK asm Ki| wU-Kvl wiwmi AYyjv fvBivmi Aevb I ebjv (epitope) kbv KiZ cvi| GB wU-Kvl I gvvdRjv GgAvBwc-1 Avjdv, GgAvBwc weUv I ibwUm RvZxq Ggb wKQy KgvKvBbm (chemokines) Zwi KiZ cvi hv fvBivm KZK wmwW-4 Kvl AvgYi c_ i KiZ cvi| ivMi Nyg Aevq bxie cvnviv`vi : GBPAvBwf msgYi jYjv nevi AvM gvbe`ni BwgDb cwZwqv wnDgvivj I mjyjvi (Humoral and cellular) chvq KvR Ki fvBivm ew iva wbijm f~wgKv ivL| GZ wmwW-4 Kvli msLv DP _vK Ges fvBivm mewb chvq Aevb Ki| GiciI mKj cwZiva fO fvBivmi ew NU wbewYZ Dcvq cvfvBivj wWGbG chvqg Avv Kvli Rbvgi mv_ mshy nq bZzb fvBivm Zwi Ki| wgDUkbi gvag Pnviv cvwq BwgDb cwZwqvi j _K mi hq bZzb fvBivm Zwi Ki| GB BwgDbvmvcwmf fvBivm BwgDb eevK wbwq Ki bZzb fvBivm Zwi nq| GZ wmwW-4 wU-Kvli mv_ m mvBUvKvBbmjv AvcwKfve KvhKvwiZv nvivq| AwZgvvq fvBivm msgYi mgq Kvli evBi Ggb GK aibi Uwb Zwi nq hv wK bv BwgDb eevK wbRxe Ki Zvj| Gici ivMi MfxiZv evovi mv_ mv_ GBPAvBwf fvBivm Zvi Pwi I AvgYi aviv e`wjq Ggb AvKvi (Syncitium-inducing ev SI) aviY Ki

GB cvcU wRb chywi gvag GBWm cwZivai welqwU Dj nq DVQ| wmwmAvi-5 bvgK Kv-wiwmi-Gi 32Zg AevbwU gyQ dj h bb-dvskbvj wiwmiwU Zwi nq Zv GBPAvBwf msgY cwZiva mg| G cm cdmi dvwm ejb, A 32 basepair deletion from the coding
region of CCR5 results in a frame shift, and the gene product is a non-functional receptor. Individuals who are homozygous for this deletion have been shown to be resistant to infection with HIV, and individuals heterozygous for the mutation, progress to AIDS more slowly than patients without the mutation. The protective allele is absent in black populations and in populations from Japan.

G _K Kvjv`i ga GBWm msgY ceYZvi GKwU KviY cwivi nq IV| Dj-L, cvUvb-2 `kjvZ cwZ cuvPRb GKRb GBWm Avv nq| GBPAvBwf msgYi ciciB 106 AviGbG Kwc fvBivm Zwi nq ivMxi cwZ wgwjwjUvi i| GB fvBiwgqv ivMi ii ci nZ Pvi _K AvU mvn ch PjZ cvi| Gici GB fvBivmi msLv egvvq bg Avm Kvb wPwKrmv QvovB| G mgq ivMxi mivKbfvikb ev ivMi cKvk evwnK cixvi gvag cgvwYZ nq| G chvq hw` fvBivmi AviGbG gvv ewk _vK Zvnj eySZ ne ivM `Z wevi jvf KiZ hvQ| GZ G evSv hve h, ivMxi BwgDb eev -I mwVKfve KvR KiQ bv, hv wK bv RbwUK dvii KviY nZ cvi| A_ev mswgZ fvBivmwU AwZ kwkvjx nevi KviYI Ggb nZ cvi| GBPAvBwf msgYi ci BwgDb eevi ga h NUbvjv NU Zv nj KqK Nvi ga ^vfvweK cwZiva ev BwgDb eev fvBivmi AvgYi cwZwqv e Ki c`vn mwi msKZjv Qwoq `q| Awbw` gvvdRjv (Non specific macrophage) kK kbv bv KiB

hvZ wU-Kvl DxcK KgvKvBbmjv fvBivmi AvgY nZ wmwW-4 Kvli cZb iLZ Ag nq co| GZ i wmwW-4 Kvli msLv cwZ Nb wgwjwjUvi `yki wbP bg Avm| Gi ciciB cwZQwe fvBivm ev wiwc-KUW (replicated) fvBivmi msLv Ggb AYb chvq Pj hvq h BwgDb cwZwqv Zvi m cvj-v w`q DVZ cvi bv| GB BwgDb cwZwqvi wechqi mv_ mv_B bvbv aibi myhvM mvbx RxevYyi msgY Ges bvbv aibi wUDgvii Drcw NU| Gme KviYB GBWm ivMxi gZz NU| BwgDb ivi GB wPi cvcUB ejv hvq h, GKwU ^vKi cwZiva eevB GBPAvBwfK cwZiva Kievi Rb mePq eo A| GBPAvBwfK civ Kivi j hme Ilya cqvM Kiv nQ Ges fwelZ cqvM Kiv ne Zvi j ne GB BwgDb cwZwqvK kwkvjx Kiv| G cvcU hv KiZ ne Zv nj gv^q i I wU-Kvli msLv evwoq Avbv| GBPAvBwf fvBivmK wPwZ Ki cwZivg~jK asm eev Mo Zvjv| wmwW-4 K evwoq Zvjv| myhvM mvbx msgYjvK cwZnZ Kiv| 1.15.1 wU-njcvi Kvl msv wKQy K_v : wU-njcvi Kvljv wewfb iKg kZKwYKviB Ask| GB Kvljv ivM cwZivai K`xq kw wnmve KvR Ki| wU-njcvi Kvljv Zwi nq nvoi gvq Ges Zvici cwiYZ nq _vBgvm (Thymus) bvgK MwZ| _vBgvm MwwU Mjvq _vK| GKviYB G RvZxq Kvljvi bvg wU-njcvi Kvl| T AiwU Thymus _KB GmQ| 1.15.2 wU-Kvli kYx wefvM : wU-Kvljv wZb iKg nq _vK; h_v wU-mvcmi (T-Suppressor) Kvl, mvBUvUwK-wU (Cytotoxic-T) Kvl Ges wU-njcvi Kvl| 1.15.3 wU-mvcmi Kvl

wU-mvcmi Kvljv BwgDb wmgi cwZiva msKZ cvV Ki cwZiva Kvli wbqYK Kv Ki wdWevK gKvwbRgi gvag| 1.15.4 mvBUvUwK-wU Kvl mvBUvUwK-wU Kvljv ivMvv A_ev Kvvi Avv KvljvK AvgY Ki Ges asm Ki| 1.15.5 wU-njcvi Kvl wU-njcvi Kvljv kixii wewfb cwZiva eevi ga hvMvhvM vcb Ki Ges cKZ ivM-cwZiva eev ev BwgDwbwUK Kvhg ivL| wZb aibi wU-Kvl ev _vBgvm Kvli ga GKgv wU-njcvi Kvli gaB wmwW-4 bvgK GKwU mywPwZ vb iqQ hLvbUvq GBPAvBwf AvgY KiZ cvi| G KviY G RvZxq KvlB Kej GBPAvBwf viv Avv nq Ges kixi wUnjcvi Kvl Kg Mj eySZ ne fvBivmi AvgY evcK I weZZ nqQ| GB wU-njcvi Kvli msLv Avi wmwW-4 Gi msLv MYbv GKB evcvi| wU-njcvi KvDU, wmwW-4 KvDU, wU-Kvl KvDU BZvw` cixvjv Avmj GKB cixvi wewfb bvg| wU-njcvi Kvl cwigvc KiZ nq cwZ wKDweK wgwjwjUvi i Gi msLv MYbv Ki| Ze AvRKvj wPwKrmKiv cwZiva eevi Aevb Rvbevi Rb hmg wb`kKi (indicator) Ici Rvi w`q _vKb Zvi ga AbZg nj wU-njcvi Kvli AbycvZ wU-mvcmi Kvli msLv| wU-mvcmi Kvljv cwZivaK KvljvK gi djvi gvag BwgDb eevK wbqY Ki ej wU-njcvii mv_ mv_ wU-mvcmii msLvI wbqYi ga ivLv cqvRb| my cwZiva eev ivi Rb wU-mvcmi Kvli msLvi evcvi aviYv _vKv `iKvi| my wbivM `n wU-njcvi Kvli msLv wU-mvcmi Kvli wY| wK GBPAvBwf Avv nevi ciB G AbycvZ f wU-mvcmi Kvli msLv evoZ _vK Ges GKmgq Gi msLv wU-njcvi Kvli PqI eo hZ cvi| Avi hLb wU-njcvi I mvcmi Kvli AbycvZwU Dv nq 1:2-G `uvovq ZLb kixii cwZiva eevi iZi AebwZi K_v fveZ ne| Gme KviY ivMi Aevb wbYq wU-Kvljvi ga wU-njcvii AbycvZ GKwU iZcY w`K| ~ GKRb my ^vfvweK gvbyli kixi Qk _K evivk ch wU-njcvi Kvl _vKZ cvi cwZ wKDweK wgwjwjUvi i| wU-njcvi Kvli msLv Kg

hvevi welqwU GKKRbi kixi GKKiKg ivMi ev kvixwiK cwZiva eevi BwZ enb Ki| GUv ew wekl Abe` BwgDb eevi DcwwZZ wewfb ivMi AvMvmbi mv_ mKhy| Ze wU-njcvi Kvl `yki wbP bg Mj eySZ ne ivMx GBWm Avv nqQ| wU-njcvi Kvljv hLb GKki wbP bg hvq, ZLb Avv ew GKvwaK ivMi mnR AvgYi wkKvi nq co| MocoZv jvKi wU-njcvi Kvl msLv GK nvRvii gZ nq _vK Ges GBPAvBwf AvgYi cv_wgK Aevq Gi msLv cuvPki IciB _vK| ivMwU hLb ga chvq, ZLb Gi msLv cuvPk _K bg `yki chvq Pj Avm| GB mgq Avvi `n bvbvwea AmyZv `Lv w`Z i Ki| Gici Gi msLv hLb `ykiI wbP Pj hvq ZLb GBWmi AMZ wewfb ivMi jY `Lv `q| iZi Aevq GB msLv GKki wbP bg Avm| BwgDb eev Gmgq AvgYKvix fvBivm, evwiqv, wewfb ciRxex I Kvvi KvlK kbv KiZ e_ nq| wU-njcvi Kvli msLv AbK mgq DVvbvgv Ki| AbKmgq w`evivwi ga cv_K nZ cvi `ok _K wZbki gZ| Aek AbKmgq jveiUwi cwqvi KviY MYbvq wfb djvdjI AvmZ cvi| mvaviYZ GB wU-njcvi Kvli msLv ivMxi wbR^ wPvi KviY nq ej cixvwU cwZevi GKB mgq, GKB jve Kiv cqvRb| GK GKwU bZzb msgYi ci wZb mvn Acv Kiv DwPZ bZzb Ki cixv Kievi Rb| GQvov wU-njcvi Kvljvi DVvbvgvi mv_ mv_ wU-mvcmii AbycvZwU ivMxi Aev wbYqi Rb weePbvq Avbv DwPZ| wU-njcvi Kvljv hLb GKki wbP bg Avm ZLb Kvvi Kvlmn bvbviKg msgYi KviY ivMxi ^v Aevi gvivZK AebwZ NU| Gi gvSI `ywU ivMi AvgYi gaeZx mgq wU-njcvi Kvli msLv cvk wbqI ivMx my eva KiZ cvi Ges AvhRbKfve Kvb Kvb wUnjcvii msLv `k _K k~b Aev wbqI gvUvgywU my Aevq GKRb wKQyw`b euP _vKZ cvi| wekl Ki GBWmi bZzb Ilyajv cqvMi ci GgbUv AbK ewk me nQ| Ze cwZiva eevi wechqi KviY GgwbZB Avv ew `yej I Kv nq co| AbK gvivZK IRb nvmi mv_ mv_ GBPAvBwfRwbZ Abvb mgmvq Avv nq|

Aavq `yB
GBWmi De I wevi
2.1.1 GBWmi BwZnvm Ges wevi (GBWm GwcWwgK I cvbWwgK) GBWm GwcWwgKi c_g hyM GBWm msgYi iUv `kgvb nq Di AvgwiKv, AvwdKv, BDivc Ges jvwZb AvgwiKvi KqKwU `k| cieZxZ GKhyM ci Zv Qwoq co Gwkqvi bvbv vb| mB mv_ AvwdKvi knijv _K Mvgvj Qwoq co GBWm gnvgvwi| AvR AvwdKvi Kvb Kvb vb cwZ cuvPRbi ga GKRb GBWm Avv| 1992 mbi GK cwimsLvb `Lv hvq h, m mgq mgM cw_exZ 12.9 wgwjqb jvK GBWm Avv wQj| Gi ga AaKB wQj AvwdKvq| ZLb aviYv Kiv nqwQj 2000 mb bvMv` GB msLv 110 wgwjqb wMq `uvove| GK cwimsLvb Rvbv hvq, 90-Gi `kK fviZi gy^vB kni hbKgx`i kZKiv 30 fvMB GBWm-G Avv wQj| H mgq _vBjvi wPqvsgvB c`k GBWm -G Avv wQj 10 fvM hbKgx| 20-22 eqmmxgvi _vB mbv wizU`i ga kZKiv `yfvMB GBPAvBwf Avv wQj| wek ^v msvi (WHO) GK cwZe`b AvksKv Kiv nqwQj 2000 mbi ci GwkqvZ cwZ eQi bZzb Ki `k j jvK GBWm Avv ne| Ze weki `k `k GBWm cwZiva wKQy wKQy D`vM MnY Kivq RbmPZbZv wKQyUv njI ew cqQ| 2004 mb AbywZ evsKK GBWm mjbi Z_ Abyhvqx mB mgq wek GBWm Avv ivMxi msLv wQj wZb KvwU Avwk jvL| 2.2.1 GBWmi iUv Kv_vq Ges KLb? mfZvwebvkx GBWm cvbWwgKi iUv Kv_vq nqwQj Zv wbq bvbv weZK _vKjI MelKiv ejQb h, 60 _K 70-Gi `kK ek wKQy GBWm ivMxK `Lv MQ BDivc| GB ivM Zv`i gaB `Lv wMqwQj hviv GKmgq AvwdKvZ KvR KiQ| GQvov h mg Kv BDivc Awfevmx nq GmwQj Zv`i KviI KviI `n GBWmi jY `Lv wMqwQj H mgq| BDivcB GBWm Avv c_g ewK kbv Kiv nq| m wQj cuwPk eQi eq GKRb bvweK| bvbv `k gYi ci 1958 mb m Amy nq Ges

1959 mb wbDgvwmmwUm Kvwiwb wbDgvwbqv (Pneumocystis carinii pneumonia ev PCP) I mvBUvgMvjv fvBivm (CMV) Avv nq gviv hvq| cieZxZ cwjgvim PBb wiqvKkb Kkj (Polymerase Chain reaction ev PCR) cqvMi viv H bvweKi wUmy mvj cixv Ki welqwU wbwZ Kiv nq| hyivi miKvwi bw_fy `wjj GBPAvBwf cwRwUf wUmyi AwZi cgvY cvIqv hvq 1968 mb, cbiv eQi eq GK Kv evjKi `n| H evjK AvgwiKvi mU jyB knii evwm`v wQj| m kixigq Kvdvwmm mviKvgvq fyMwQj| Western Blot (WB) Test-G Zvi wUmy I mivg GBPAvBwf GwUewW aiv co| GjvBRv UI Zvi GBPAvBwf GwURb aiv co| Gici AvgwiKvZ ek wKQy GBWm ivMx kbv nq 80Gi `kK| Rvqvii wKbmvmvq cwiPvwjZ MelYvq `Lv MQ h, mLvb c_g GBWm ivMxwU cvIqv wMqwQj 1959 mb| 70-Gi `kK DMvvq ivMwU eo AvKvi Qwoq co| 1981 mb hyiv GBWm kbv nevi ci BDivc cevmx ek wKQy AvwdKvbi `n GBWm kbv Kiv nq| Zv`i AwaKvskB wQj Rvqvii Awaevmx| iqvv Ges Rvqvi cwiPvwjZ MelYvq `Lv hvq, 1962 mb ga AvwdKvZ GBWm RvZxq ivM we`gvb wQj| 1976 mb Rvqvi emevmiZ GKRb Wwbk mvRb Ges 1977 mb ejwRqvg emevmiZ Rvqvii GK bvMwiK GBWm ivM Avv nqwQj ej aviYv Kiv nq| ga AvwdKvq KgiZ wPwKrmKiv 60-Gi `kK GBWm m`k Ggb wKQy ivMi K_v Dj-L KiQb hv hyivwfwK mUvi di wWwRR KUvj (CDC) c` GBWmi msvi mv_ wgj hvq| H mgq GKwU bZzb ivM kbv Kiv nq hvi bvg wQj w-g wWwRR (Slim disease)| GB w-g wWwRRi jY wQj weivgnxb Wvqwiqv| 70 I 80-Gi `kK wPwKrmKiv AvwdKvq hme ivMi Dvb `Ljb Zvi ga Dj-LhvM wQj gvivZK AvKvi Kvdvwmm mviKvgv, Lv`bvjxZ QvKi msgY Ges wvKvwmm| i cixv bv Ki h mg jY I ivMi cKvk `L GBWm kbv Kiv nq, G aibi AmyLjv ZviB AMZ| hw`I GBWm ivM 70-Gi `kKi AvMB wewQbfve AvwdKvi KqKwU vb `Lv wMqwQj, Ze cKZ GwcWwgK `Lv `q 70 `kKi kl _K 80 `kKi c_g fvM ch mgq, hgbUv `Lv wMqwQj hyiv Ges nvBwZZ| 2.3.1 AvwdKv I mve-mvnviv Aj GBWmi wevi: AvwdKv Ges mve-mvnviv Aj GB ivMi evcK wevii GKwU KviY nj RvZxq Dbqb I bMivqbi mv_ mv_ kniKw`K kwgK kYx I hbKgx`i msLv ew| GB mg kwgKiv cwievi _K wewQb nIqvZ GKw`K hgb hbKgx`i mv_ wecbK hbmshvM NUvq, Zgwb hvZvqvZ eev DbZ
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nevi Rb hbKgx I Avv kwgK `ki me Qwoq co| Gici `yej ^v eev, ivRbwZK msNvZ, hy BZvw`i KviY ivMi wevi NUQ| Kbbv, hy I ivRbwZK AwiZvK bvbv aibi hbivM wevii GKwU AbZg KviY wnmve aiv nq| AvwdKvi h cvuPwU `k mevP chvq GBPAvBwf ivMi msgY NUQ mjv nj Zvvwbqv, DMvv, Kwbqv, gvjvwe I Rvqvi| hme `k GBWmi wevi evoQ mjv nj gvbymvi gvjvwe, DMvv, wR^veyq, iqvv Ges Zvvwbqv| hyiv I BDivc hLvb 90 fvM GBPAvBwf msgY NU mgKvgx, BbRKkbi gvag WvM mebKvix (IDUs) I Zv`i mx Ges ngvdvBwjqvK`i ga, mLvb AvwdKvZ ivMi msgY nq egyLx hbwgjb, i cwimvjb Ges MfKvjxb Aevq ivM msgYi KviY| AvwdKvb mve mvnviv Aj 80 fvM GBPAvBwf msgY nq nUivmyqvj`i hbwgjbi gvag cavbZ cyil _K bvix`n msgY NU| GZ bvixivB ewk Avv nQ AvwdKvZ| Avv bvix I cyili GB AbycvZwU 14:1| Zzjbvg~jKfve AvgwiKvZ bvix-cyil Avvi AbycvZwU 1:19| AvwdKvZ hbmwqZv ii mv_ mv_ ivMi msgY NU| 20-24 eqmmxgvi ga mevP msLK bvix G ivM Avv nQ| cyil`i ga 2529 eqmmxgvi ga ivMi Aev mevP chvq cuQQ| cyil I bvixi mshvMi gvag GBPAvBwf msgY ewZ h KviYjv evcK f~wgKv ivLQ Zv nj Nb Nb hbwgjb, GKvwaK hbmx, hbKgx`i mv_ mK Ges hbivM cyl ivLv| GQvov hbmyivq KbWg eenvi bv Kivi welqwU Zv iqQB| Kwbqvq GK MelYvq `Lv MQ h, Lvrbv Qvov cyil`i gaB GBPAvBwf1-Gi msgY ewk NUQ| gq`i ga hviv RbwbqY ewo eenvi KiQ Zv`i gaI GBPAvBwf-1 msgY ewk NUQ| AvwdKvZ GBPAvBwf msgYi GKwU cavb KviY hbevwnZ ivM| MelYvq `Lv MQ, GBPAvBwf Avvi ga 50 fvMB Abvb hbivM Avv| Abvv`i ga 14 fvM hbivM cvIqv MQ| 1985 mb MelKiv mbMvji hbKgx`i ga Ggb GK aibi GBPAvBwf kbv Kib hv wmwgqvb BwgDbvWwdwmqw fvBivm (Simian immunodeficiency virus ev SIV) -Gi mv_ m wiqv KiQ| GKB aibi fvBivm cvIqv wMqwQj 1980 mb wMwb wemvDZ| 1966 mb AvBfwi Kv Ges 1967 mb Mveb I bvBRwiqvZ cvIqv wMqwQj| gRvi evcvi nj, GB fvBivmwU (GBPAvBwf-2) ek wKQy cZzMxR ivMx`i `nI cvIqv wMqwQj| Zviv meZ 60-Gi `kK AvwdKv _K G ivM wbq wMqwQj|
41

GBPAvBwf-2 msgY cavbZ cwg AvwdKvq `Lv MQ| mbMvj, wMwb, wMwb wemvD, Mvw^qvi knivj GB GBPAvBwf-2-Gi cvavb `Lv MQ| cwg AvwdKvi knivj hbKgx`i ga 15 _K 64 fvMB GBPAvBwf-2Z Avv| mePq ewk Avv nj wMwb wemvDZ| GLvbKvi 8.9 fvM cveqB GBPAvBwf-2 mivcwRwUf| GBPAvBwf-1-Gi gZ GBPAvBwf-2I nUivmyqvj mKi gvag Qwoq _vK| hbevwnZ ivMvv Ges hbKgx`i ga Gi cvavb ewk| wMwb wemvDZ `Lv MQ, GBPAvBwf-2-Z Avv 40 fvM ewi xivI GKB ivM Avv| gv _KI mvb`i ga GBPAvBwf-2-Gi msgY NU _vK| Ze GBPAvBwf-2-Gi fviwUKvj Uvwgkb GBPAvBwf-1-Gi Pq AbK Kg nq _vK| GBPAvBwf-2-Gi AviKwU Dj-LhvM w`K nj eqm evovi mv_ mv_ GB fvBivmi msgYi nviI ew cq _vK| Gi mve KviY axi MwZZ Gi msgY Ges mB mv_ Gi `xNgqv`x GbWwgK Pwi| AvwdKvq hbKgx`i 27 _K 88 fvM GBPAvBwf cwRwUf| AbK AvMi GKUv wicvUB `Lv MQ iqvvi cvq 43 fvM hbKgx GBPAvBwf Avv| 1984 mbi AvMB G msLv wQj cvq 33 fvM| cieZxZ GUv cvq 88 fvM DbxZ nqQ ej MelKiv RvwbqQb| bvBivweZ 1981 mb 4 fvM hbKgx GBPAvBwf cwRwUf wQj| 1985 mb Zv 61 fvM Gm `uvovq| 1986 mb cKvwkZ GK wicvU `Lv hvQ, bvBivwei wbkYxi hbKgx`i 66 fvM Ges GKUy DuP ii hbKgx`i ga 31 fvM GBPAvBwf Avv| ga z AvwdKvZ GB hbKgx`i m gjvgkv GBWm wevii GKwU eo KviY| hbKgx`i ga GBWm ivM ewk nevi KviYjvi ga ay myivi AfveB bq, mB mv_ AwaK nvi hbwgjb I hvwbc_ Nv AbZg KviY| wmwdwjm, Mbvwiqv, kvsqW, KvgvBwWqvmn, hbv bvbv aibi Nv GBPAvBwf msgYi Dj-LhvM KviY| Rb wbqYi ewoI AbK GBPAvBwf msgY mnvqK cwiek Zwi KiQ| Gme GjvKvq GBPAvBwf Avv`i ga 81 fvM cyil weMZ `yeQii ga gvm AZ GKevi hbKgx`i mv_ wgwjZ nqwQj| Gme Aj Avv gvq`i msLvI Dj-LhvM| mve-mvnviv Aj GBPAvBwf Avv`i ga 10 fvMB Avv nq Rbm~ gvqi Mf _K| iqvvi wKMvwjZ cvq 20 fvM gv GBPAvBwf Avv| DMvvZ cvq 30 fvM gv GBPAvBwf cwRwUf ej cgvwYZ nqQ| Gme Aj gv _K wk`i ga GBPAvBwf fvBivm msgYi nvi 30 _K 39 fvM| wKbmvmvZ 6 fvM MfeZxK GBPAvBwf cwRwUf wnmve kbv Kiv nqQ Ges GB me gvq`i Mf Rb bqv 21 fvM wk GBPAvBwf Avv nevi KviY GK eQii ga gviv MQ| Rvw^qvZ GBPAvBwf Avv wk`i ga 45 fvM gviv MQ Rbi `yeQii ga| mve-mvnviv Aj 10 fvM wkB Avv nqQ i
42

cwimvjbi KviY| RvqviI GBPAvBwf Avv wk`i ga 25 fvM Avv nq _vK i cwimvjbi KviY| cvvZ GBWm wwbs Kivi KviY G aibi wechq AbK Kg| GBWm wevii mekl wekcwiwwZ: wekevcx GBWm Avv bvixi msLv gv^q ew cvQ| 2003 mbi wWm^i cKvwkZ GK cwimsLvb Rvbv hvq h, wekevcx GBWm ivM Avv `i 50 fvMB bvix| AvwdKvi mve-mvnviv Aj GBWm Avv`i 57 fvMB bvix| (m~: 2004 Report on the Global AIDS Epidemic: Executive
Summery)

bZzb Ki hviv GBPAvBwfZ Avv nQ Zv`i 50 fvMi eqmmxgv 15-24 eQii ga| wewfb gnv`k GBWm wevii cvcU chvjvPbv Ki `Lv hvQ, AvwdKvi AevB mePq fqven| GwkqvZ GBWm GwcWwgKi AevI Kg fxwZKi bq| Pxb, B`vbwkqv, wfqZbvg GBWm Avvi msLv `Z ew cvQ| eZgvb G Aj cvq 7.4 wgwjqb jvK GBPAvBwf Avv iqQ| G`i ga 2003 mbB Avv nqQ 1.1 wgwjqb jvK| `wY AvwdKvi ci mevP msLK GBPAvBwf Avv ew emevm KiQ fviZ| eZgvb mLvb GBPAvBwf Avvi msLv 5.1 wgwjqbi KvQvKvwQ|Ze ^wi welq nj GB h, _vBjv I K^vwWqv GBWm wbqY wKQyUv njI mdjZvi gyL `LQ| mekl wnmve gZ, AvwdKvb mve-mvnviv Aj GBPAvBwf Avv iqQ 25 wgwjqb jvK| GLvb GBWmi KviY gZnviI AbK ewk| Kej 2003 z mbB G Aj bZzb Ki Avv nqQ cvq wZb wgwjqb jvK| Gmgq GBWmRwbZ KviY gZzeiY KiQ 2.2 wgwjqb jvK| AvwdKvi gv`vMvvi, mvqvwRjvi gZ `k mcwZ GBWm Avvi nvi evojI Avkvi K_v nj, DMvvZ GB nvi wKQyUv KgQ| AvwdKvi `wYvji mvZwU `k GBWm Avvi nvi Zv`i gvU RbmsLvi 17 fvM| eZmvqvbv I mvqvwRjv GBPAvBwf Avvi nvi cvq 35 fvM| AvwdKvi Abvb `kjvZ GBPAvBwf Avv iqQ 2 _K 20 fvM RbMvx| Di AvwdKv Ges gacvP GBWm Avvi msLv 4 jvL 80 nvRvi| c~e BDivc I ga Gwkqvq eZgvb cvq 1.3 wgwjqb jvK GBPAvBwf Avv| A_P 1995 mb G Aj Avvi msLv wQj gv 1 jvL 60 nvRvi| cwg BDivc eZgvb GBPAvBwf Avvi msLv 5 jvL 80 nvRvi| jvwZb AvgwiKvq eZgvb 1.6 wgwjqb jvK GBPAvBwf Avv| evwRji Kvb Kvb kni gv`Kmex`i 60 fvMiI ewk GBPAvBwf Avv|
43

Kvwiweqvb Aj 3 fvM jvK GBPAvBwf Avv| ay evnvgv, nvBwZ I wwb`v`-UvevMvZ 4 jvL 30 nvRvi GBPAvBwf Avv iqQ| Kvwiweqvb Aji ga mePq Lvivc Aev nvBwZi| mLvb 5.6 fvM jvK GBPAvBwf Avv| AvgwiKv hyiv eZgvb cvq 9 jvL 50 nvRvi jvK GBPAvBwf Avv| mLvb bZzb Ki hviv Avv nQ Zv`i AvwaKvskB AvwdKvb eskv~Z AvgwiKvb| (m~: 2004 Report on the Global AIDS Epidemic:
Executive Summery)

kl ch `Lv Mj h, wZbwU fvBivmB GKB fvBivmi wewfb ic| G cvcU 1986 mb GB fvBivmjvi mwwjZ bvg `qv nq Human
Immunodeficiency Virus type -I (HIV1 )|

2.5.1. RxeR _K gvbyli ga GBWm msgYi cPwjZ aviYv KZUzKz evemZ RxeR _K gvbyli ga GBWm msgYi mvebv wbq mvaviYi ga GKwU cPwjZ Rbv Kbv iqQ| G cvcU MelKiv `LQb h, GBPAvBwf wkvwi ga GBWm NUvZ cvijI Zv Zzjbvg~jKfve Kg mv_K nq| wkvwi hvvwbc_ fvBivj mvqve cek Kwiq `Lv MQ wkvwI GBPAvBwf fvBivm viv Avv nQ| Ze gyLi wgDKvmvi gvag cixvg~jK msgY mv_K nqwb| h mg cyil wkvwK wmwgqvb BwgDbvWwdwmqw fvBivm (GmAvBwf) viv mswgZ Kiv me nqQ Zv chvqg cyil _K gq wkvwZ Ges gq _K cyil wkvwZ mswgZ nqQ| Ici Dwj-wLZ GB cixv gvbe kixii evBi fvBivmi DcwwZ cmwUK wKQyUv cki gyLvgywL Ki w`qQ| Ze GUv wVK h, cKwZZ Kvb RxeRi ga GBPAvBwf fvBivm cvIqv hvqwb| ZvB KzKzi, weovj, wkqvj BZvw` viv mvaviYfve GBPAvBwf msgYi mvebv Aeve| 2.6.1. GBPAvBwf fvBivmi gZ h BwgDbvWwdwmqw fvBivmjv RxeRMZ _vKZ cvi: wmwgqvb BwgDbvWwdwmqw fvBivm (GmAvBwf) bvgK fvBivm GK RvZxq cvYxi ga `Lv wMqQ| GUv wkvw RvZxq cvYx`i ga BwgDbvWwdwmqw wmbWgi gZ ivM NwUq _vK| GiKg GKwU fvBivm iqQ hvi bvg wfmbv (Visna)| GUv QvMj-fovi ga `Lv hvq| GUvI GBWmi gZ ivM NUvq QvMj-fovi ga| djvBb (Feline) BwgDbvWwdwmqw fvBivm ev FIV weovji ga GBWm RvZxq AmyL NUvq| GdAvBwf GBPAvBwfi gZB GKwU iUvfvBivm Ges ivMi msgY GBPAvBwfi gZB| Ze GdAvBwf viv gvbyl Avv nqbv| Gwfqvb mviKvgv fvBivm bvgK GKiKg BwgDbvWwdwmqw fvBivm gyiMxi ga BwgDbvWwdwmqw ivM NUvq| bb-wnDgvb Kivbv fvBivm wgDUkbi ci hgb gvbylK Avv KiZ cvi, Zgwb RxeRi BwgDbvWwdwmqw fvBivm wekl Ki iUv fvBivm wgDUkbi ci Kx chvq hZ cvi wKsev Zv gvbylK Avv KiZ cvi wK bv m evcvi Kvb hyMvn wevbwbfi cgvY cvIqv hvq bv| gvbyli ga we`gvb iUvfvBivmjvi wgDUkb NUI GBPAvBwf fvBivmi De nZ cvi|
45

2.4.1. GBWm ivMi De mK wKQy gZev`: 1981 mbi em GBWmK GKwU bZzb ivM wnmve wbeb Kiv nq gvwKb hyiv| AvgwiKvi wmwWwm H eQii 5 Ryb jmGjmi Ggb cuvPRb k mg_ mgKvgxK kbv Ki hviv wekl aibi bDgvwbqvq Avv nq w nvmcvZvj khvkvqx wQj| Zviv wcwmwcZ fyMwQj| GKgvm ci RyjvB-Gi 3 ZvwiL AviI 10 Rb jvKK kbv Kiv nq GKB aibi wbDgvwbqv Avv Aevq| Gici 26 Rb cyilK kbv Kiv nq Kvdvwmm mviKvgv bvgK GK aibi ZKi Kvvi Avv Aevq| wcwmwc GK aibi cvUvRvqv| GUv Avgv`i cwiekB _vK Ges mvaviYZ my gvbylK Avv Ki bv| ZeyI G aibi msgYjv cici NUZ _vKj wbDBqK, mvbdvwmKv, jmGjmmn wewfb Aj, my-mej mgKvgx`i ga| wKQyw`bi gaB AvgwiKvq GUv GwcWwgK AvKvi Qwoq coj| BDivc I Di AvgwiKvq Ke, KLb G ivM Abycek Kij Ges Zv Kxfve NUj Zv wbq i nj bvbv MelYv| c_g ivM msgYi gvagwU kbv bv nIqvq bvbv Rbv-Kbv PjwQj| GgbI Kbv Kiv nwQj h, G ivMi RxevYy evZvm ev Ab Kvb gvag evwnZ nq gvbe`n Abycek KiQ| cwikl wbwZ nIqv hvq h, GwU mswgZ nQ hbmshvMi gvag, wekl Ki mgKvgx`i ga Ges Kvb Kvb BbRKkbi gvag gv`Kmex`i ga| Gici i nq ivM-RxevYy kbv Kivi cPv| G cwqvq wevbxiv MelYvi gvag cgvY Kib h, Kvb RxevYy ev ciRxex bq, GKiKg fvBivm viv G ivM msgY NUQ| 1983 Ges 1984 mb hyivwfwK wZbwU jveiUwi cvq mgmvgwqK mgq GBWm fvBivm ev h fvBivm GBWm ivM mw KiwQj ZvK kbv Ki| GKB mv_ fvBivm kbv nIqvq wewfb MelYvMvi bZzbfve kbv Kiv wZbwU fvBivmK wZbiKg bvg `q| cv_wgKfve wbevwPZ bvg wZbwU wQj
Lymphadenopathy associated virus (LAV) Human T-cell lymphotropic virus type- III (HTLV-III) AIDS associated retrovirus (ARV)
44

hvB nvK, RxeR _K gvbe`n fvBivmi Pj AvmvwU bZzb wKQy bq| mvcwZKKvj RxeRi kixi _K AvMZ Kivbv fvBivmi msgYi djB mvmi Avwefve nqQ| mxwgZ njI GB Kivbv fvBivm AZxZ ccvwLi kixi _K gvbe kixi mswgZ nq Ri, GbKdvjvBwUm, gvBjvBwUm BZvw` NwUqwQj| Rxe`n _K gvbe`n G fvBivmwUi msgYi bvg Rybvwmm (Zoonosis)| RybvwmmK AMnYhvM Z wnmve gb Kiv hvQ bv bvbv KviY| Kbbv GBPAvBwf AvwdKvi evbii `n we`gvb GKaibi fvBivmi mgMvxq Ges H AjB GBPAvBwf-1 I 2 Gi iUv nq| GiciI G Z MnxZ nQ bv mKj wevbxi KvQ| Ze hv wekwevbxiv gb wbQb Zv nj GB h, GBPAvBwf-1 Gi Drcw mvcwZKKvjB ga AvwdKvZ nqQ| mLvb _K Di AvgwiKv I BDivc QwoqQ, Mvg _K kni gvbyli hvMvhvM I PjvPj ewi Rb| meZ ivMwU ga AvwdKvi cZ ebvj I cvovMvu _K kni, mLvb _K AvwdKvi wewfb `k Ges cieZxZ wewfb gnv`k Qwoq coQ| gvbe kixi Avv wU-njcvi Kvl Ges Avv BwgDb Kvljvi ga j KvwU fvBivm cvwUKj _vK| fvBivm Qovevi Rb Avv ewi i Ges kixii im ev Zij c`v_ GK`n _K AviK `n QovZ nq| GB fvBivm Avv i, exh, hvwbim BZvw` GK`n _K AviK `n cek bv Kij KvbfveB GBWm QovZ cvi bv| 2.7.1. hyivi GBWm msv wKQy cwimsLvb: 1983 mb nUivmyqvj mKi KviY hyiv 6.9 fvM bvix GBWm Avv nqQ| 1986 mb GB nvi wQj 7 fvM Ges 1990 mb 11.5 fvM| 1992 mb GB nvi 13.5 fvM wMq cuQvq| 1984 mb hyiv cwiPvwjZ MelYvq RvwZMZfve GBWm wevii cwimsLvb wbgic GBPAvBwf Avv`i ga kZKiv 59 fvM wQj kZv| 25 fvM Avv wQj Kvjv`i AMZ, 14 fvM wQj wnvwb| wK g GBPAvBwf msgYwU Kvjv I wnvwb`i ga evoZ _vK| 1992 mbi GK cwimsLvb `Lv hvq GBPAvBwf Avv`i ga kZKiv 48 fvM kZv, 33 fvM Kvjv Ges 17.5 fvM wnvwb| eqmwfwK Avv`i 20-29 eqmmxgvi ga 1986 mb Avv wQj 21 fvM, 30-39 eqmmxgvi ga 47 fvM, 40-49 eqmmxgvi 21 fvM, 49+ eqmx`i ga 10 fvM| 1992 mb 20-29 eqmmxgvi ga Avvi msLv bg Avm 19 fvM| 30-39 eqm mxgvi ga GB nvi wQj 46 fvM Ges 49+ eqmx`i ga 10 fvM| (m~: wmwWwm mvwfj wicvU, 1986 Ges 1993)|
46

weMZ eQijvZ hyiv GBPAvBwfi jY wnmve we`gvb AmyL wevii ceYZvi gaI evcK cwieZb NUQ| GBWm GwcWwgKi ii w`K 90 fvM ivMx wcwmwc wbq wPwKrmKi kiYvcb nqQ| 1982 mb 58 fvM GBWm ivMxi wcwmwc, 30 fvMi Kvdvwmm mviKvgv Ges 12 fvMi Abvb ivMi msgY cwijwZ nq| 1992-G Gm wcwmwci msgYi nvi bg Avm 42 fvM Ges Kvdvwmm mviKvgv bg Avm gv 9 fvM| 1992-Gi cavb jY wnmve cwijwZ nq GBPAvBwf Iqws wmbWg (wasting syndrome) hv gvU ivMxi 20 fvMi ga `Lv hvq| A_P GB jYwU c~e GBPAvBwfi msvi Af wQj bv| y 1992-Gi ci Abvb h jYjvi ga cwieZb NU Zv nj BmvdvwRBj KvwwWqvwmm ev Lv`bvjxZ QvKi msgY| GUv Avv`i 15 fvMi `Lv hvq| mvBUvgMvjvfvBivm msgY 9 fvM Ges gvBKvevwiqvg Gwfqvg Kgc- 7 fvM cwijwZ nq| GQvovI cwijwZ nq GBPAvBwf GbKdvjvcvw_ 6 fvM , wvKvwmm 5 fvM , Uvc-vRgvwmm 5 fvM Ges bvbv vb Qwoq cov nvicm wmgc- 5 fvM | ivM msgYi GB cwieZbi avivwUi cQbi KviY Abymvb Ki `Lv hvq h, Kvdvwmm mviKvgvi cvavb wQj mgKvgx`i ga| mgKvgx`i hbAvPiY cwieZbi KviY Ges myiv cvevi KviY Kvdvwmm mviKvgv Kg GmQ| Gi _K aviYv Kiv nq h, GKwU hbevwnZ GRU Kvdvwmm mviKvgvi msgY NUvwQj mvaviY mgKvgx Ges gv`Kmex mgKvgx`i ga| 2.7.2. bvix I cyil`i ga Kviv ewk Avv? mUvi di wWwRR KUvj (wmwWwm) Dj-L Ki h, 1981 mb hyiv c_g GBWm Avv bvixK kbv Kiv nqwQj| 1992 mbi AvM GB msLv eo `uvovq 24 nvRvi 323 Rb hv wK bv H Aji mvgwMK GBWm Avv `i 10.5 fvM| eZgvb AvgwiKvq emevmiZ AvwdKvb I AvgwiKvb`i ga gZzi KviY wnmve GBWmi vb cg| hme `k (cvUvb-2 `kmg~n) egyLx hbmKi KviY GBWm QovQ mLvb bvix`i Aev AviI Lvivc| AvwdKvb mve-mvnviv Aj gvU GBPAvBwf Avvi 50 fvMB bvix| Lye kxNB GB bvix`i ga GBWmRwbZ ivM gZz Abvb AmyL wemyLi KviY mwwjZ gZi nviK Qvwoq hve| z 2.8.1. GBWm ivMi De mK jLKi gZev`: wVK Kxfve GBWmi i nqQ Zv Avgv`i Rvbv bB| Ze GBWmi De ev i wbq bvbv aibi Z cPwjZ iqQ|
47

GKwU Z njivMwU kZ kZ eQi aiB wQj Ges cw_exi Kvb wewQb Aj mxgve wQj hv wK bv cieZxZ bvbv `k Qwoq coQ| G ZwU Lye GKUv MnYhvM nqwb G KviY h, wek hvMvhvM, gY, AvMvmb, bZzb `k Awfhvb, Avtgnv`kxq evwYR BZvw` AbK AvM i njI ivMwU 1950 mbi AvM `Lv hvqwb| G cvcU GBWm Dei wZxq ZwUi cwZ gbvhvM `qv nq hvZ gb Kiv nq, gvbylK mPivPi AvgY Ki h mg fvBivm, ZviB GKwUi wgDUkb NUvi KviY GBPAvBwf fvBivm Zwi nqQ| Ze gvbe`n hmg fvBivm AvgY Ki GBPAvBwf fvBivmi mv_ Zvi mvgvbZg wgj bv cvIqvq GB ZwUI cvq bvKP nq hvq| GBPAvBwf-Gi Drcw msv ZZxq Ges evcKfve AvjvwPZ ZwU nj, GwU AvwdKvi GK cRvwZi evbii `n we`gvb fvBivm _K gvbe`n QwoqQ| G jLK gb Kib, GB fvBivm evbi RvZxq cvYx _K QovjI Gi GKwU AvZ BUviwgwWqU nv iqQ hv _K gvbe`n GB fvBivmi msgY nqQ wKQy Kv-dvii KviY| `yNUbv Qvov fvBivm wgDUkb I weKvki cQb B I wekl aibi BKvjvB-Gi f~wgKvi Ici Rvi w`Qb jLK| RxeRZ we`gvb GBPAvBwf RvZxq BwgDbvWwdwmqw fvBivmi weeZbi welqwUi Dci iZ Avivc Ki jLK Zuvi GK MelYvq Dj-L KibProbably the retrovirus that was transmitted from Chimp to Human being was HIV2 , which has longer incubation period and less virulence. Later it may have mutated and evolved HIV1 . An intermediate host that has made this zoonosis successful is still missing.

Aavq wZb
evsjv`k GBWmi wevi
3.1.1. evsjv`k GBWmi wevi: MZ GK `kK ai wekevcx GBWm ivMi wevi wecbKfve Qwoq coQ| evsjv`k Gi gvv GLbI AvkvRbK bv njI bvbv KviY evsjv`k GBWm msgYi AbZg cavb SzuwKc~Y `k| G`ki 14 KvwU gvbylK GBWmi fqvenZv _K iv Kievi Rb GLbB evcK Kgm~wP MnY Kiv cqvRb| miKvwi wnmve 2001 mb evsjv`k GBPAvBwf cwRwUf ivMxi msLv wQj 188 Rb| 2002 mb GB msLv eo nqQ 248 Rb| 2002 mb AviI 59 Rb cyil Ges AvURb bvixK GBPAvBwf cwRwUf wnmve kbv KiQ GKwU emiKvwi Dbqb msv| 2002 mb Avv gvU 315 Rbi ga cwiPq cvIqv MQ 286 Rbi| G`i 235 Rb cyil Ges 51 Rb gwnjv| miKvii `qv Z_vbyhvqx, GBWm Avv`i ga G ch gviv MQ 20 Rb| evcK cevmx AaywlZ eni wmjUB GLb `ki ga mevwaK GBWm SzuwKc~Y Aj cwiYZ nqQ| GB Aj 83 Rbi gZv GBWm Avv ivMxi mvb cvIqv MQ| 1989 mb wmjU RjvZB mec_g GBWm ivMxi mvb cvIqv hvq| ivMx wQjb gacvP diZ GK ew| wKQy w`b AvM wZwb gviv MQb| Zvi xI GKB ivM gviv MQb| GQvov 1991 mbi AvM gvm KvbvBNvU DcRjvq GKB m wZbRb GBWm ivMxi mvb cvIqv hvq| `yevBq wPwKrmvKvj Zv`i kixi GBWmi RxevYy aiv co| ay wmjUB bq, we`k cZvMZ ewi gvag MvUv cwievi GBWm Avv nIqvi NUbv cvebvZI NUQ| G KgiZ emiKvwi wekl`i gZ, wecyj msLK GBPAvBwf cwRwUf kbvi evBi iq MQ, hv LyeB DMi welq|
49

wZwb AviI ejb HIV has certain relation with global warming, execs
carbon dioxide emission, UV radiation and ecological changes.

wmwgb BwgDbvWwdwmqw fvBivm _K wgDUkbi gvag GBPAvBwf-2 RvZxq fvBivmi weeZbi welqwUi Dci wZwb iZ Avivc Kib| jLK gb Kib, AvwdKv gnv`k GBWm ivMi i I Zvi evcK wevii cQb cwiek wechq Qvov `vwi`, Kgmsvbi Afve, ^v mevi Afve I `Z bMivqb Ges bvMwiK myweavi AfveK GBWm ivMi evcK wevii cQb Dj-LhvM KviY wnmve weePbv KiQb jLK| GQvov wewfb RvwZ, Mvxi gvbwmK MVb I evwZK SzuwKc~Y hb AvPiYi KviY wnmve wPwZ Kib jLK| Avevi GB gvbwmK MVbi cQb Rxbi cfvewU AZ iZcY| ~
48

eQi wfwK GBPAvBwf Avvi cwimsLvb : mb

2000 2001 2002

Avv 248 Rbi eqm wfwK cwimsLvb|

eQi wfwK ewi nvi 0 22.88 % 67.55 %

Avvi msLv
153 Rb 188 Rb 315 Rb

GK eQi ew
0 35 Rb 127 Rb

eqm mxgv

2002 mb Avv 315 Rbi ga cwiPq cvIqv MQ 286 Rbi| G`i ga cyil 235 Rb, gwnjv 51 Rb| Avvi KvUvMwi cyil bvix AvZ gvU msLv 235 51 29 315 Avvi nvi 74.60 16.19 9.21 100

wk 15-19 20-24 25-29 30-34 AvZ

Avvi msLv 17 Rb 17 Rb 82 Rb 55 Rb 45 Rb 32 Rb gvU 248 Rb

Avvi nvi 7 fvM 7 fvM 33 fvM 22 fvM 18 fvM 13 fvM

cwimsLvb `Lv hvQ ZiY eqmxivB GBPAvBwfZ Avv nQ mevwaK| 2002 mb Avv 315 Rbi ga RjvwfwK cwimsLvb: Rjv XvKv wmjU PMvg Lyjbv ivRkvnx ewikvj we`kx AvZ Avvi msLv 70 Rb 43 Rb 51 Rb 8 Rb 3 Rb 3 Rb 7 Rb 130 Rb 315 Rb

miKvwi wnmve i cixvi gvag `k h 248 Rbi `n GBPAvBwf fvBivm cvIqv MQ ej Dj-L Kiv nqQ Zv`i cwimsLvb: ckv/cwiPq we`k cZvMZ Mnea~ wk ckv`vi hbKgx UvK WvBfvi Qv eemvqx Kvivew` AvZ gvU wj cyil gwnjv msLv 111 Rb 25 Rb 17 Rb 7 Rb 2 Rb 1 Rb 3 Rb 2 Rb 78 Rb 248 Rb Avvi nvi 45 fvM 10 fvM 7 fvM 3 fvM 1 fvM 0.4 fvM 1 fvM 1 fvM 31 fvM

gvU

(m~: RvZxq GBPAvBwf Ges AvPiYMZ mvwfjvi ZZxq chvq Rwici Z_vewj; 2000-2001)| GB cwimsLvb `Lv hvQ, hviv GBWm SuzwKc~Y AvPiYi m mswk- bq ZvivI GBPAvBwf fvBivm Avv nQ| GBWm Avv`i msk GmB Zv`i cwievii m`miv G ivM Avv nqQ| cv_wgKfve hviv SzuwKc~Y hbRxeb hvcb KiQ A_ev we`k hbeemvq m nqQ, ZvivB GB ivM Avv nqQ| `ki ga Ges `ki evBi G mg jvK`i SuywKc~Y AvPiY AevnZ _vKj GKmgq evsjv`k NvZK evwa GBWm msgY gnvgvwi chvq hve ej AvksKv Kiv hvQ| evsjv`k ivMwU Qovbvi mevwaK SuywKc~Y RbMvx nj wmwii gvag wkivq gv`K MnYKvix| G`i kZKiv 4 fvM GBPAvBwf Avv ej aiv coQ| wkivq gv`K MnYKvix Qvov GBWm Qovbvi Suwy Kc~Y wnme wPwZ wewfb chvqi hbKgx, UvK PvjK, wivPvjK, wnRov cfwZ RbMvxi ga c~eeZx Rwici Zzjbvq GBPAvBwf msgY Zgb evowb|
51

Avv 248 Rbi ga bvix 50 Ges cyil 198 Rb| Avvi msLv 198 Rb 50 Rb gvU 248 Rb
50

Avvi nvi 80 fvM 20 fvM

2002 mvji wWm^i ch miKvwi wnmve G `k GBPAvBwf fvBivm enbKvixi msLv wQj 248 Rb Ges G`i ga GBWm Avvi msLv 26 Rb ejv nqwQj| miKvii GB wnmve GLb wekvm Ki bv G welq m`n iqQ| wek ^v msv Ges BD Gb GBWmi gZ, eZgvb G msLv cvq 13 nvRvi ej Dj-L Kiv nq | emiKvix GK wnmve (2006) Abyhvqx `k GBPAvBwf cRwUf ivMxi msLv 658Rb| GZ 2004 mvji wWm^i ^v I cwievi KjvY gYvjqi kl NvlYv Abyhvqx `k 465 Rb GBPAvBwf cwRwUf ivMxi mv_ 193 Rb bZzb ivMxK mshy Kiv nqQ| Dj-L Kiv cqvRb h 2004 mvj 102 Rb GBPAvBwf cwRwUf bZzbfve cyibv wnmvei mv_ mshy Kiv nqwQj| H mgqi cwimsLvb Abyhvqx `ki 465 Rb GBPAvBwf cwRwUfi ga 87 Rb GBWm Avv nqwQj| G`i ga 44 Rb BwZga gviv MQ| 2003 mbi gvP kxjvq wekevsK AvqvwRZ GBWm cwZiva welqK GK Kgkvjvi Z_ Abyqvqx GBWm wevii SzuwKc~Y AvPiYi evsjv`k Gwkqvi ga kxl iqQ| eQi wfwK GBPAvBwf Avvi nvjbvMv` cwimsLvb (evsjv`k): mb
2000 2001 2002 2003 2004 2005

eveZvi wbixL GB wnmvewUK AZ dzjvbv dvcvbv ej gb nQ| G welq mvi K_v nj h, evsjv`k GBWm msv wevbmZ Kvb cwimsLvb bB| GgbwK we`k cZvMZ`i ga KZRb GBPAvBwf cwRwUf Aevq `k wdiQ Zv hvPvB I Rwici Kvb eev wbZ `ki ^v wefvM e_ nqQ| evcK GBPAvBwf wwbs Qvov G aibi Z_fvvi Zwi me bq| AvRvwZK msvI `vZv Mvx cwiPvwjZ GK Rixc `Lv hvq h- wmwii gvag wkivq gv`K MnYKvix`i kZKiv 71 fvMB GK Abi m Zv`i wmwi fvMvfvwM Ki| Rwic GBPAvBwf msgY QvovI `ki Aj f` wkivq gv`K MnYKvix`i ga kZKiv 9 `kwgK 4 _K 19 `kwgK 4 fvM, fvmgvb hbKgx`i ga kZKiv 12 `kwgK 1 fvM _K 29 `kwgK 8 fvM, cwZZvjq AevbKvix hbKgx`i ga kZKiv 17 `kwgK 4 _K 40 `kwgK 1 fvM, cyil hbKgx`i ga kZKiv 14 `kwgK 2 fvM, UvKPvjK I njcvi`i ga kZKiv 7 fvM bvbv iKg hbivM Avv nqQ ej Dj-L Kiv nq| Suwy Kc~Y AvPiYKvix RbMvxi ga wmwdwjmi gZv hbivMi DPnvi GBPAvBwf msgYK e Y evwoq w`qQ| AvimwK& cwiPvwjZ GK Rixc `Lv hvq h, `ki kxl wPwKrmv cwZvbjvi ewnwefvM wPwKrmv mev MnYKvix hbivMx`i ga kxl iqQ wivPvjK, UvK WvBfvi, njcvi, Qv I cywjk I wewfb wbivcv Kgxiv| GBWm SuywKi evcvi `ki wewfb KjR-wekwe`vjqi AvevwmK Qv`i mK mekl Rwic AvkvRbK Z_ cvIqv MQ| Rwic Zv`i ga GLbI Kvb GBPAvBwf cwRwUf cvIqv hvqwb| Ze `Lv MQ, `ki K`xq Aj (XvKv) KjR-wekwe`vjqi kZKiv 18 `kwgK 2 fvM AvevwmK Qv bvix hbKgxi wbKU Ges 2 `kwgK 7 fvM wnRov hbKgxi KvQ wMqwQj| G`i ga kZKiv 64 `kwgK 7 fvMB KbWg eenvi Kiwb| GB AvevwmK Qv`i ga `kwgK 4 kZvsk wmwii gvag wkivq gv`K MnY Ki| Ghver GKvwaK Rwic SuywKc~Y hbKg Af AwaKvsk weevwnZ cyil RvwbqQ, Zviv gwnjv hbKgx, wnRov A_ev Ab cyili m KbWg Qvov wgjb Af Ges G`i KD KD BbRKkbi gvag wkivq gv`K MnYI Af| Zv`i cvq mevB Zv`i x`i m KbWg Qvov wgwjZ nq| ^vgx`i GB SzuwKc~Y AvPiYi KviY x`i `yB -ZZxqvsk GBPAvBwf, ncvUvBwUm Ges Avbvb hbevwnZ ivM Avv nIqvi SzuwKi ga iqQ| G`i AbvMZ mvbivI NvZK ivM Avv nZ cvi| AvRvwZK msv, `vZvMvx I `ki wKQz GbwRI cwiPvwjZ I cwimsLvbwU mevZfve mZ bq Ges wekl AZ gvZK|
53

Avvi msLv
153 Rb 188 Rb 315 Rb 363 Rb 465 Rb 658 Rb

GK eQi ew
35 Rb 127 Rb 48 Rb 102 Rb 193 Rb

eQi wfwK ewi nvi 22.87 % 67.55 % 15.23% 28.09% 41.50%

Dcivwj-wLZ QK Abyhvqx `Lv hvQ, 2003 mb evsjv`ki gvwUZ GBWm ivMxi ewi nvi wQj 15.23%, 2004 mb 28.09% Ges 2005 mb ewi nvi wQj 41.50%| eQi cwZ GBWm ivMxi msLv ewi nvi nj Mo 35%| emiKvix wnmve Abyhvqx 2002 mb evsjv`k DcwZ 13 nvRvi GBPAvBwf enbKvix ivMxi K_v gb wbj 2010 mvj Gi msLv `vove 143413 Rb| Avi 2005 mvj `k we`gvb GBPAvBwf ivMxi msLvwU 13 nvRvi ej gb wbj 2010 mvj Gi msLv `vove 58290 Rb| miKvix wnmve Abyhvqx H mgq ivMxi msLv `vove 2948 Rb| nVvr Ki we`k cZvMZ GBPAvBwf cwRwUf`i msLv ew bv cj 2010 mvji wPwU GgbB ne| emiKvix wnmve Abyhvqx eZgvb `k AevbKvix GBPAvBwf cwRwUf ivMxi msLv 30-40 nvRvi gb Kij 2010 mvj G msLv `uvove 99645-132868 Rb|
52

RvwZmsNi GBWm welqK msv BDGbGBWm-Gi Z_ Abymvi Kej 2002 mbB mviv wek 50 jvL jvK GBWm ivM Avv nqQ Ges 31 jvL gviv MQ| GB msvi gZ, m~Y Z_ bv _vKjI evsjv`k GBPAvBwf cwRwUfi msLv 30 _K 40 nvRvi| wVK GKB aibi Z_ w`qQ evsjv`k KgiZ GKwU we`kx `vZv msv| Zv`i GK cwZe`b Abyhvqx, eZgvb ek KqK nvRvi evsjv`kx GBPAvBwf RxevYy enb KiQ| AvimwK&i MelYvq `Lv hvQ h we`k KgiZ cyil`i mv_ GBWm Avv GjvKvi mvaviY gvbylmn hbKgx`i wgjbi KviY, we`k cZvMZ`i ga GBWm SuzwK mePq ewk| ZvB we`k cZvMZ cZKi GBPAvBwf wwbs evaZvg~jKfve Kiv cqvRb| cv Z_ Abyhvqx cwZ eQi G`k _K cvPvi nq hvIqv bvixi msLv cvq `yB jvL Ges ea Dcvq MncwiPvwiKvmn SuzwKc~Y ckvq we`kMvgx bvixi msLvI Kg bq| G`i mevi GBPAvBwf wwbs Kiv cqvRb| GQvov `ki mKj hbKgxi wbebmn Zv`i wbqwgZ GBPAvBwf wwbs Kiv cqvRb| AvimwK& cwiPvwjZ ckvwfwK GK cwimsLvb `Lv hvq h, evsjv`k kZKiv 46 fvM wivPvjK, evm I UvK WvBfviiv ckv`vi hbKgx`i mv_ wgwjZ nq _vK| ZvB wiv, UvK, evmi mKj PvjKi jvBm bevqbi mv_ wbqwgZ GBPAvBwf wwbs Kiv cqvRb| Kbbv, welqwU ay Zv`i ewMZ wbivcvi evcvi bq, Gi m wewfb kYx I ckvi gvbyl Ges Zv`i cwievi cwiRbi wbivcvi welqwU RwoZ| RvwZmsN kvwiv wgkbi KvR kl h mg mbv I cywjk m`m `k wdiQ Zv`iI GBPAvBwf cixv Kiv cqvRb| wekl Ki AvwdKvi `kjvZ hviv KgiZ AvQ Zv`i Avv nIqvi mvebv mevwaK| wKQyw`b AvM mbvevwnbxi GK mwgbvi wZbRb GBPAvBwf cwRwUf mbvm`mK wPwZ Kivi welqwU ^xKvi Kiv nq| GKviY wbqwgZ evwnbxi mbv, Avbmvi, wewWAvi I cywjk m`m`i wbqwgZ GBPAvBwf wwbs evaZvg~jK nIqv cqvRb| GQvov wewfb Kvivew``i ga GBPAvBwfmn wewfb hbivMi cixv-wbixv I wPwKrmv Kiv Rb^v_B cqvRb| wegvbc_ cwZw`b hme we`kx ev evsjv`kx bvMwiK `k cek KiQ Zv`i KD GBWm ivMi RxevYy enb Ki AvbQ wK bv Zv cixvi Kvb eev GLb evsjv`ki Kvb wegvbe`iB bB| 1987 mb XvKv wegvbe`i we`k _K Avmv hvx`i nj_ PwKs KvDUviwU e nq hvq| fviZi GBWmcxwoZ gNvjq ivRi mxgv Nulv evsjv`kx Pv wki cvq Qq jvL kwgK RbMvxi gvSI mnRB GBWm msgYi Avkv `Lv w`qQ| wmjU Aji Pv evMvbjvmn mxgv GjvKvi KvQvKvwQ hviv evm Ki Zv`i GBPAvBwf wwbs Kiv `iKvi| Giv SuywKc~Y cwiek emevm KiQ|
54

GBPAvBwf Avvi ga AwaKvskB (cvq 45 fvM) gacvP I BDivci `kjv _K cZvMZ| gawe I DPwe`i ga GBWm msgYi cavb KviY nj fviZi wewfb eo kni hgb KjKvZv, gy^vB Ges _vBjvi evsKKi ckv`vi hbKgx`i mv_ gjvgkv| GivB `ki ga cavbZ AwbqwgZ hbKgx, fvmgvb hbmx I Mnea~`i ga GBWm QovQ| evsjv`k cevmx kwgK`i msLv ewi dj ^vgx wewQb Mnea~`i ga eMvwgZv ev Aea mK ew cvIqvi mv_ mv_ GKw`K hgb mvaviY hbivMjv QovQ, Zgwb GBPAvBwf msgYi SuywKI evoQ| Gaibi ki Mnea~`i ga hviv gqwj ivM f~MQ Zv`i 38 fvMB hbevwnZ ivM Avv Ges 33 fvM weevn ewnfZ hbmK wj| (AvimwK& MelYv) ~ Dj-L Kiv cqvRb h, evsjv`ki AweevwnZ wKkvi-wKkvix I ZiYZiYx`i ga (13-23 eqmmxgvi) 40 fvMB hb-mwq Ges G`i weevn ewnf~Z GK ev GKvwaKevi hbgjvgkvi AwfZv iqQ| Ze AwaKvski ga mKi aiYwU nUivmyqvj| G`i ga mgKvgx`i msLv AwZ bMb njI BbRKkbi gvag bkvMnYKvix`i msLv ewi dj GBPAvBwf msgYi mvebv ew cvQ| mvcwZK mgq cvvZ wek wKkvi-wKkvix I ZiY-ZiYx`i ga cvqyc_ hbwgjbi nvi ew cjI evsjv`k G ceYZvwU GLbI Dj-LhvM nvi evowb| KzgvixZi aviYvwU hvwbc_ gjvgkvi mv_ mwKZ Kievi KviY Ges bkv`ei mv_ ewi mKi weeZbi KviYB cvqyc_ wgjbi nviwU cvvZ Zzjbvg~jKfve ewk| agxq g~jeva, mvswZK wewfbZvi KviY fviZmn `wY Gwkqvi Abvb `k cvqyc_ wgjb Af cyili msLv evsjv`ki Pq ewk| G aibi ewiv Zv`i xmn wewfb KvRyqvj hbmx I hbKgx`i mv_ gjvgkvi gvag GBPAvBwf fvBivm msgYi SuywK evovQ| 3.2.1. evsjv`ki Avv bvix`i msLv wbYq mgmvUv Kv_vq? mvgvwRK KviY bvixiv Avovj _vKvq Ges cyilZvwK mgvR bvixiv mivmwi K_v bv ejvq ivMi wevi msv Z_jv mwVKfve Rvbv hvQ bv| hw`I Abvb `ki gZ evsjv`kI dvwgwj c-vwbs wKwbK, cvwievwiK wPwKrmv K`, wUKv`vb Kgm~wP BZvw`i gvag bvixi m ^vKgx`i hvMvhvM nQ, ZeyI GUv GBWmi DcwwZ wbYq Lye KvhKi cwZ ej weewPZ nQ bv| hbivMi wPwKrmvi welqwU G mg wKwbK I mvwfmi AMZ nj Ges
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fvjbviej Mci Rb GBPAvBwf wwbs evaZvg~jK Kiv nj mgmvi wKQyUv mgvavb ne| evsjv`ki cvcU bvix`i ga GBWm welqK mPZbZvi AviKwU cwZeKZv nj mgvR Zv`i Ae`wgZ vb Ges Zv`i Ici mvgvwRKfve AvivwcZ BgR| GKRb MwnYx wbtmsKvP Zvi hbivM cKvk wKsev ivM msv AvjvPbvq AskMnY wavw^Z _vK| Kbbv bvix `ni AbK ivMKB Zvi e_Zv I wU ej MY Kiv nq| GQvov `wi` cwievii bvixiv AmyL wemyLi K_v cKvk Ki cwievii KZvi Avw_K evSv evovZ AwbQyK _vK| Zvi Ici hbivMi welqwU mKj kvixwiK mgmvi ga AcvKZ MY welq wnmve weewPZ nq| GQvov kKvZiZvi KviY welqwU AcKvwkZ _vK cwievi cwiRb I wPwKrmKi wbKU| GBPAvBwf Avv AbK bvixB Zv`i hbmx`i ga ivMi msgYi evcvi gvivZK DrKvq fvMb| AbK wbR`i kvixwiK Aev Zv`i mxK Rvbvb, Avevi AbK Zv Mvcb Kib| KD KD hbmshvM GKeviB cwinvi Kib| Avevi KD KD ^vfvweK hbRxeb hvcb Kib| Ze ^vfvweK KviY mevB MfaviYK Gwoq PjZ Pvb| G cvcU ivM cwZivai Dk GBPAvBwf cRwUf ew`i wbivc` hbRxeb msv wkv`vb Kgmw~ P cwiPvjbv Kiv cqvRb| mvgwMKfve hbivMi msgY _K euvPevi Rb bvixK ay wbR`i `wfx, cvi`kxZv Ges AvPiYi Ici wbfi KijB ne bv, mB mv_ Zv`i hb mx`iK KbWg eenvi ivwR Kivbvi evcvi Rvi w`Z ne| ZvK Zvi Aevb, mvgvwRK ixwZbxwZ I cyil kwi `vcUi wei joZ ne| 3.3.1 evsjv`ki fvmgvb hbKgx`i Aev: XvKv AvjvwR AvRgv G GbfvqibgUvj wimvP BbwwUDU (Avim&wK) 2002-2003 mb cwiPvwjZ GK MelYvq Dj-L Ki h, XvKv knii fvmgvb hbKgx`i ga cvq kZKiv 89 fvM mvaviY hbivMjv mK gvUvgywU mPZb| 95 fvM hbKgx GBWm ivMwUi bvg bQ| Ze G ivMi msgY I fqvenZv mK Zv`i aviYvjv Am~Y, KzmsvivQb I fyj-vwZ fiv| GB hbKgx`i AbK gb Ki GBWm ivMwU wmwdwjm, Mbvwiqv, KvgvBwWqvi gZ GKwU mvaviY hbevwnZ ivM| Zviv GUvI gb Ki h, G ivMi wPwKrmv AvQ Ges BbRKkb wbj ivMwU mi hvq| MelYvq Dj-L Kiv nq h, kZKiv 17 fvM hbKgx gb Ki GBWm GKwU mvaviY QuvqvP ivM| 5 fvM hbKgx GBWmi bvgB kvbwb Ges 21% hbKgx G ivMi fqvenZv mK GKevi A|
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Zviv gb Ki, Abi Kvco-Pvco civ, Abi eeZ e-W eenvi, Acwivi-AcwiQb _vKv, GuUv Lvevi LvIqv, GuUv M-vm c-U cvbvnvi Kiv _K GBWm mswgZ nZ cvi| hbKgx`i AbK gb Ki, GBWm Avvi wbKU msk Gm A_ev Zv`i mv_ q _K wKsev kvixwiK msk _K GBWm mswgZ nq _vK| KD KD GUvK evZvm evwnZ ivMi gZ QuvqvP gb Ki| hb AbvPvi, Awbqg _K i Ki eeZ KbWgi msk, GgbwK KbWg cvq gvovbv _KI GBWm Qwoq co Ggb aviYv AbKB cvlY Ki| GB MelYvq cZxqgvb nq h, msLvMwi hbKgxiv cjwfK BbdvgUwi wWwRR, fvRvBbvj KvwwWqvwmm mn bvbvwea hbevwnZ ivM fyMQ| hbivMjvi ga fvRvBbvj UvBKvgvwbqvwmm, Mbvwiqv I bb-wmwdK fvRvBbvBwUm ivM Avvi msLv mePq ewk| Gici wmwdwjm, RwbUvj Avjmvi (nvicm fvRvBbvBwUm ev GBPGmwf-2), Rwm ev ncvUvBwUm-we I KvgvBwWqv ivMi Aevb| KvgvBwWqv I UvBKvgvwbqvwmmK AwaKvsk hbKgx mvaviY mv`v mve ej gb Ki| hviv fvRvBbvwUm fyMQ Zv`i cvq kZfvMB cv_RwbK BKvjvB KZK mswgZ| G`i 90% Gi ga B ev QvKi msgY iqQ| GB MelYv cwZe`b _K AviI Rvbv hvq, kZKiv 23 fvM hbKgx KLbB wPwKrmKi KvQ hvqwb Ges 46% KLbI GBPAvBwf U Kiwb| GQvov 38% hbKgx gvUv`vM Amy AevZB KvR Ki PjQ| evsjv`k fvmgvb hbKgx`i ga `wbK MvnKi msLv DP chvq iqQ ej Avim&wK cwiPvwjZ MelYvq Dj-L Kiv nqQ| GKRb hbKgx `wbK 7 _K mevP 40 Rbi mv_ wgwjZ nq| GB cwimsLvb GK K_vq fqven| fvmgvb hbKgx`i Li`i ewkifvMB wivIqvjv kYxi jvK| KjRwekwe`vjqi Aeqmx QvivI Avm evcK msLvq| wewfb evmvevwo I Awdmi bkcnixivI Zv`i eo MvnK| GQvov cywjk Zv AvQB| j UvwgbvjjvZ AevbiZ hbKgx`i cavb MvnK j-wgvii kwgKPvjKiv| gvS gvS wKQy hvxI Zv`i KvQ Avm| evm UvwgbvjjvZI GKB wP| mLvb hbKgx`i cavb MvnK cwienY kwgKiv| evm, UvKi njcvi I WvBfvi`i ga kZKiv 80 fvMB fvmgvb hbKgxmn vqx hbcj-xjvZ wbqwgZ hvZvqvZ Ki| Avim&wKi MelYv _K AviI Rvbv hvq, Lii Avcwi KviY fvmgvb hbKgxiv cvqB KbWg eenvi KiZ cvi bv| Ges Zv`i hbmx`i KbWg eenvi ivwR KivZ cvi bv| kZKiv 20 fvM hbKgx klevi wgjbi mgq KbWg eenvi Kiwb| GQvov 10% hbKgx KLbB KbWg eenvi Ki bv|
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hbKgx`i AbK c_g w`K KbWg eenvi KiZ bv| cieZxZ hbivM msgYi welqwU RvbZ ci KbWg eenvi i KiQ| KD KD Avevi Li`i m KbWg eenvi KijI ^vgx ev vqx mxi mv_ gjvgkvi Kvb myiv wbQ bv| kZKiv 68 fvM hbKgx Rvbvq, KbWg eenvi Liiv Avcw KiQ| G AvcwKvix`i ga QvivB cavb| Li`i KD KD KbWg Qvov gjvgkv Kivi Rb ewk A_ `qvi c ve `q| wivIqvjv, evm UvKi WvBfvi-njcvi Ges _vbv, duvwo I ijIq cywjk`i ga kZKiv 80 fvMB hbwgjbi KbWg eenvi KiZ Pvq bv| GB MelYvq bZzb h welqwU Rvbv hvq Zv nj, 4% hbKgx wdgj KbWg eenvi Ki| Ze `vg ewk ej KD KD GKwU wdgj KbWg wZb-Pvi evi Ki eenvi Ki| wdgj KbWg eenvi hbv e_v nq ej Zviv Gjv eenvi Drmvnx nQ bv| GB MelYvq Kvb hbKgxi `n GBPAvBwfi AwZ LyuR cvIqv bv MjI mcwZ `yRb hbKgx GBWm Avv nq gviv MQ ej Rvbv hvq| 2002-2003 mb AvimwK& cwiPvwjZ gvV cvhq MelYv `Lv hvq h, fvmgvb hbKgx`i ga gv 9.84 fvM KbWg eenvi Ki bv| hviv KbWg eenvi Ki Zv`i ga kZKiv 76.52 fvM wbqwgZ KbWg eenvi Ki Ges kZKiv 13.64 fvM Lii Avcwi KviY gvS gvS KbWg eenvi Ki bv| `wbK eeZ KbWgi msLv- 50.76 fvM fvmgvb hbKgx `wbK 2 _K 6wU KbWg eenvi Ki| `wbK 7-10wU KbWg eenvi Ki 21.21% hbKgx, 11-20wU KbWg eenvi Ki 8.33%, 20-30wU eenvi Ki 6.07%| gv 1.51% hbKgx w`b 1wU Ki KbWg eenvi Ki| w`b 30wUi ewk KbWg jvM 0.76% hbKgxi| GQvov 3.79% hbKgx KZwU KbWg jvM Zv wbw` Ki ejZ cviwb| GLvb weklfve Dj-L h, fvmgvb hbKgxiv KbWg eenvi KijI Zv`i ga 4% hbKgx wdgj KbWgI eenvi Ki| G`i ga KD KD GKwU wdgj KbWg 3/4 evi Ki eenvi Ki| wdgj KbWg eenvi Kij hbv e_v cvq ej KD KD cieZxZ Avi Zv eenvi Kiwb| kl evi wgjbi mgq KbWg eenvi klevi wgjbi mgq KbWg eenvi KiQ 80.30 fvM, eenvi Kiwb 18.94%| KbWg eenvi Li`i gbvfve:- KbWg eenvi Liiv Avcw Ki Ggb Z_ w`qQ 14.39% hbKgx; 9.09% hbKgx ejQ h G evcvi Li`i Avcw bB| KD KD Avcw Ki ejQ 68.18% Aewk 8.34% hbKgx ^Qvq KbWg eenvi weiZ _vK ej ^xKvi KiQ|
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Aavq Pvi
GBWmi jY
4.1.1. GBPAvBwf msgYi wewfb i : GBPAvBwf AvgYi ci ivMi i _K cwiYwZ ch mgqKvjK KqKwU fvM fvM Kiv hvq| c_g i nj, AbmU (Onset) ev ivMi i chvq, wZxq iwU nj, ivMi jYwenxb Aev, ZZxq iwU nj, `xNgqv`x wewea jYi cKvk Ges PZz_ ev kl i nj iZi AmyLi Aev| fvBivm kixi cek Kivi ci `yB _K AvU mvn mgq jM hvq kixi GwUewW Zwi nZ| GwUewW Zwi nevi cwqvwUK mivKbfvikb ej| GB GwUewW Zwi nevi AvM ch i GBPAvBwf mivbMwUf _vK| GwUewW Zwi nevi ciB i mivcwRwUf nq| G cwqvq mvaviYZ `yB _K AvU mvn mgq jvM| wekl GwUewW Zwii welqwU Qq gvm chI `wi nZ cvi| msgYi mgq _K mivKbfvikb ch mgqK GwUewW Zwii DBv wcwiqW (window period) ejv nq| mvaviYZ msgYi `yB gvm ciB GBPAvBwf GwUewW Zwi nq Ges cvq mevi B Qq gvmi ga GwUewW Zwi nq hvq| Ze GKfvM Qq gvmi ewk mgq cqvRb nq GwUewW Zwi nZ| 0.01 fvM GBPAvBwf Avv ewi `yB _K wZb eQi ciI mivKbfvikb nZ cvi| GBPAvBwf fvBivm BwgDb eevi wekl vbmn BwgDb Kvl Ges mB mv_ wgDKvm AveiY I vqyZi wekl Kvli mv_ mshy nq Gi bxie AMhvv Pvjy ivLZ cvi|
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Gme KviY `yNUbvRwbZ GBPAvBwf msgYi `yB mvn _K Qq gvm ch mgq evi evi i cixv KiZ nq| wekl Zv `yB _K wZb eQi ciI Kiv cqvRb| GBPAvBwf GwUewW Zwi nevi ciB cixv wbixvq ivMi DcwwZ aiv co| Ze fvBivmwU kixii ga bxieI AbKw`b _vKZ cvi| G KviY GBPAvBwf bMwUf nIqv gvbB GB bq h, GKRb fvBivm viv Avv nqwb| wek ^v msv (WHO) GBWmi msv wbaviY KiZ hq Gi criteria -K `yfvM fvM KiQ| cavb jY ev major criteria: IRb nvm (kvixwiK IRbi cvq `k kZvsk), wbK Wvqwiqv (GKgvmi AwaK mgq vqx), `xNvqx Ri (GKgvmi AwaK mgq ai)| MY jY ev minor criteria: fvj nQ bv Ggb Kvwk (GKgvmi AwaK mgq ai), mvaviYfve mg kixigq ZKi c`vn ev civBwUK WvgvUvBwUm, iKviU ev GKvwaKevi nvicm Rvvii msgY, Lv`bvjx I kvmbvjxZ QvKi msgY, kixii wewfb A-cZ Qwoq cov `xNgqv`x nvicm fvBivmi msgY, mg kixievcx jwmKvMwjv dzj hvIqv| cixv-wbixvi AvM ivMxi jYjv g~jvqb Ki cvq 74 fvM GBPAvBwf Avv ivMx kbv Kiv me| cvq 90 fvM wKwbKvj Km Wwdwbkb ev ivMx`i ivM kbvKiYi welqwU weZKi Ea _vK| Dj-L Kiv cqvRb h, Kvdvwmm mviKvgv, BmvdvRvBj KvwwWqvwmm, wvKvwmm I w-gwWwRRi mv_ hv ivMK ga AvwdKvq GBWm mswk- ivM wnmve kbv Kiv nq| wek ^v msvi Criteria cqvM Ki AvwdKvi hv nvmcvZvjjvi ivMx`i ga cvq 58 fvM GBPAvBwf msgY kbv Kiv hvq| AvwdKvb`i ga Qwoq cov Kvdvwmm mviKvgv Ges wvKvj gwbbRvBwUmK GBWm ivMi AbZg jY wnmve weePbv Kiv nq| GBPAvBwf Avv
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AvwdKvb`i cvq 50 fvMB Kvb bv Kvb mgq hbivM Avv nqQ| GB Aj hbv Nv GBPAvBwf msgYi GKwU AbZg Kv-dvi| mvgwMKfve AvwdKv gnv`k hbKgx`i ga GBWm msgYi hjvK wi dvi ev AbZg cavb SuywK wnmve weePbv Kiv nq Zv nj wmwdwjm, Mbvwiqv, kvsqW, hbv Nv, KvgvBwWqv, UvBKvgvwbqvwmmi KviY mvwf Nv ev mvifvBKvj BbdKkb Ges Iivj KUvmcwUf eenvi| 4.2.1. gvUv`vM GBWmi jYjv Kx Kx? GBWm ivM Avv nj ivMxi kixi h jYjv `Lv hvq Zv nj: GK gvmi ewk vqx Ri, Kvwk, `yejZv, Mvq e_v I jvj jvj PvKv ei nIqv, gv_v e_v, jwmKv Mw dzj hvIqv, wMivq wMivq e_v, kixii IRb 10 fvMi AwaK nvm cvIqv, GKgvmi AwaK vqx cvZjv cvqLvbv, GKvwaKevi nvicm Rvvi (Herpes zoster)-Gi msgY, `xN mgq gyL I Mjvq QvK msgY BZvw`|

4.2.2. GBPAvBwf Avv ewi kixi cv_wgK jY : GBPAvBwf fvBivm kixi ceki ci h cv_wgK jYjv `Lv `q Zv nj Ri, `yejZv, ckxi `yejZv, gv_v e_v, gwi c`vn, PvL Ges PvLi Pvicvk e_v, AwZwi AvjvK mse`bkxjZv, Mjv em hvIqv, Mjv e_v, Mvq jvj jvj `vM, jwmKvMwjv dyj hvIqv BZvw`| AbK ivMi iUv nq mvaviY dzi gZ| KLbI KLbI G jYjvi mv_ BbdKkvm gbvwbDwKqvwmm (infectious mononucleosis)-Gi jY wgj hvq| Kbbv gbvwbDwKqvwmm ivMI Ri, M-v dzj hvIqv BZvw` NU| gbvwbDwKqvwmm NU GcBb evi fvBivm viv| Avi GB fvBivmwU KLbI KLbI GBPAvBwfi DxcK wnmve KvR Ki, Avevi KLbI GBWm Avv`iK ewk Ki AvgY Ki| AwaKvsk B Avv nevi ci wewfb M-vjv dzj hvq Ges KqK mvni ga ivMx my nq IV| Gici `xN mgq AbKiB Kvb ivMi jY _vK bv|
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4.2.3. KbwwUDkbvj jY (constitutional symptoms): GBPAvBwf msgYi cv_wgK jYjvK KbwwUDkbvj jY ej| Gi ga Ri, jwmKvMw dzj hvIqv, `yejZv BZvw` Dj-LhvM| mB mv_ wUnjcvi Kvli msLv cuvPki wbP bg Avm| mivKbfvikb chvqwU AwZv nq Mj Gme kvixwiK mgmvjv Avevi ^vfvweK nq Avm| Gici cuvP _K `k eQi Lye A wKQy jY kixii ga `Lv `q| 4.3.1 GBWm ivMwU `Lv `qvi cvvj jY I DcmMjv Kgb nq _vK? Rb ncwK wekwe`vjqi MelYv djvdj gZ, GBPAvBwf msgYi KviY hLb GBWm ivMwU `Lv `q ZLb ivMx hmg jY I DcmM wbq nvwRi nq Zv nj dzj hvIqv jwmKvMw, mB mv_ i `yki wbP wU-njcvi Kvl, Gi mv_ _vK Ri, Wvqwiqv, IRb nvm BZvw` DcmM| GB kvixwiK DcmMjv GBPAvBwf msgYi cv_wgK AevZI GKevi `Lv w`q _vK| Ze ivMxi kvixwiK Aevi AebwZi ci hLb G mgmvjv cybivq `Lv `q ZLb Gi ga KqK eQi AwZv nq hvq| GB wZxq chvqi bZzb Ki `Lv `qv DcmMjvi mv_ Avi h mg mgmv `Lv `q Zv nj dzmdzm bvbv Amyweav| dzmdzmi Amyweavjvi ga wbDgvwmmwUm Kvwiwb wbDgvwbqv ev wcwmwcB c_g `Lv `q| wbDgvwmmwUm Kvwiwb GKRvZxq QvK| Gmgq Abvb QvKi msgYI NU _vK| GZ wbDgvwbqv Qvov MjvZI QvKi msgY `Lv `q| evwiqvRwbZ bvbv msgY, hv, hbevwnZ ivMmn vqy msv bvbv mgmvI `Lv `q Gmgq| GBWmi KviY gvBKvevwiqvg Gwfqvg Kgc-mn gvBKvevwiqvg wUDeviwKDjvwmmiI msgY NU| GZ ivMxi hv ivM `Lv `q| nuvwP, Kvwki gvag WcjU BbdKkbi KviY hv ivMxi kixi _K RxevYy Avv ewi kixi cek KiZ cvi| GQvov c~e _KB kixii fZi my Aevq _vKv hvi RxevYy Gmgq KvhKi nq DVZ cvi| ivM cwZiva eevi wechq NUvq GUv Kej dzmdzmKB AvgY Ki bv, mB mv_ kixii cvq mKj eevKB AvgY Ki| GBWm ivMxiv hLb hvZ Avv nq ZLb Zv kbv Kiv I wPwKrmv Kiv nq AZ KwVb| c~e ivM cwZiva gZv asmi KviY wewfb ivMi msgYKB GBWmi AbZg ewk wnmve weePbv Kiv nZ| G fveB wPwKrmKiv ivM kbv KiZb| eZgvb BwgDb cwZiva eevi Aevb Ges wU-njcvi Kvli msLvi Ici wfw KiB GBWmK kbv Kiv nq| AbK GBPAvBwf msgYi ci cvq cbiv eQi ch ek myfve euP _vK| Gici GK mgq nVvr KiB GBWmi jY `Lv `q| Gici nqZv
62

eQi `yqK euP _vK| Avevi AbKi ga GBWmi jY AvM `Lv `q Ges ivM wbq Giv cvq `k eQi euP _vK| GBWm mswk- Kvb AmyLjv ivMxK AvgY KiQ Zvi IciB ivMxi Avqy wbfi Ki| hgb, hv`i ga Kvdvwmm mviKvgv `Lv `q, Zviv wcwmwc Mci Pq ewk euvP| Ze GBWmi kl chvq ivMx AZ `yej nq khvkvqx nq co Ges mKj ivM cwZiva nvwiq dj| GBmgq Kvb wPwKrmvB G`i Ici KvR Ki bv Ges G AevZB G`i gZz nq| 4.4.1. jwmKvMw dyj hvevi aib : cvMwmf RbvivjvBRW wjvWbvcvw_ (progressive generalized lymphadenopathy) A_ev wjvWbvcvw_ wmbWgwU GBPAvBwf msgYi

cv_wgK jYjvi ga AbZg| GZ jwmKvMwjv Ggbfve dzj hvq h nvZ w`q Pvgovi wbP dvjv MwjvK Abyfe Kiv hvq| mvaviYZ Mjvi `ycvk mycviwdwkqvj mvifvBKvj Mc (superficial cervical group) , eMji wbP Avwjvwi Mc Ges KzPuwKZ BbBbvj Mc Mwjv dzj _vK| cvq 70 fvM ivMxi ga GB jYwU `Lv `q| AbKi ga GB jwmKvMw dzj bv, wKsev dzjjI `xNgqv`x nq bv| jwmKvMwjv dzj hvIqv gvbB GB bq h, KD GBWm Avv nqQ| Gi mv_ BwgDb eevi iZi AebwZiI Zgb mK bB| AbK kixi Ab Kvb jYi AvM GwUB c_g `Lv `q Ges hLb Gjv dzj hvq ZLb Zv KqKgvm evcx vqx nq| GBPAvBwf msgYi Avi hme jY mePq AvM `Lv `q Zv nj `xN mgqevcx wbgvvq Ri, weivgnxb `yejZv, `ymvnevcx cvZjv cvqLvbv, Mvq jvj jvj `vM, jYxq IRb nvm; IRb nvm cuvP KwRi Ici Qvwoq hvq| Gi mv_ iv iv Nvg nq, KLbI Mjvi ga mv`v mv`v AveiY co ev QvKi msgY nq| GB jYjvK AbKmgq GBWm wijUW Kgc- ev ARC ej AwfwnZ Kiv nq| GLb Aek GAviwm K_vUv eeZ nq bv| Kbbv, GB jYjv Ggb bq h, Gi cwiYwZZ memgq GBWm ivM NUe| kixii ivM cwZiva eevq wKQyUv NvUwZ njI wewfb aibi fvBivm, evwiqv, QvK, ciRxex msgYi KviY GB jYjv `Lv w`Z cvi| GBPAvBwf msgYi GB jYjv `Lv `evi ci hw` i cixv Ki `Lv hvq h GBPAvBwf bMwUf, m cici KqKevi cixv KivZ ne| Abvb hme ivMi KviY Gme jY `Lv w`Z cvi Zvi ga Dj-LhvM nj BbdKkvm gbvwbDwKqvwmm, wbK dvwUM wmbWg (Infectious mononucleosis chronic fatigue syndrome)|
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4.5.1. GBPAvBwf Iq wmbWgi AMZ KqKwU jY I DcmM `k fvMi ewk IRb Kg hvIqvi mv_ cvZjv cvqLvbv (Kgc `wbK `yevi Ki 30 w`b) A_ev IRb nvmi mv_ gvMZ `yejZv Ges 30 w`bi ewk Ri (memgq _vK ev Qo Qo hvq Ggb) BZvw` jY I DcmMK Iqws wmbWg ej| G Rii mv_ kixi hv, Kvvi, wvvwiwWqvwmm A_ev mywbw` KviY Qvov GUivBwUm (enteritis)-Gi DcwwZ GBWmi jY ej weewPZ nq| GBWmi jYjvi ga mvwf (cervix) fZi Qwoq cov KvviI AMZ| evievi wbDgvwbqvi msgYI GBWmi jY| Ze eQi GKvwaKevi wbDgvwbqv njB Zv GBWmi GKwU jY ej weewPZ ne| wbDgvwbqv AekB cv_jwRKvj cixv wbixv, Kdi KvjPvi I Gi cixvi gvag kbv nZ ne| Gme cixv wbixv Qvov ivM wbYqK AbygvbwfwK ej wPwZ Kiv ne| 4.5.2. w-g wWwRR (Slim disease) Kx? AvwdKvevmx`i ga `xNvqx Wvqwiqv Ges IRb Kg hvIqv GBPAvBwf-Gi GKwU eo jY ej aiv nq| GBPAvBwf Avv`i ga 40 fvMB GKgvmi AwaKKvj Wvqwiqvq fyM _vK| bvbvwea evwiqv, cvUvRvqv, Kwgmn wewfb ciRxex Gme ivMxi gj cvIqv hvq| AbK ivMxi gj wvvwiwWqvg (cryptosporidium) Ges AvBmvmcviv (isospora) cvIqv MjI GBPAvBwf Avv`i AaKi gj Kvb RxevYyB kbv Kiv me nq bv| Giv AbK mgq RxevYy I ciRxex webvkx wPwKrmvZI fvj nqbv| Ze GBPAvBwf bMwUf`i ga KwwWqvb BbdKkb Lye Kg nq _vK| GBWmi mv_ hv I wbDgvwbqv mK : hv I evwiqvj wbDgvwbqv GBPAvBwf Avv`i ga ewk nq _vK| AvwdKvi gZ fviZxq GBWm ivMx`i gaI hv ivMi nvi DPgvvq we`gvb| AvwdKv gnv`ki KwbqvZ evcKfve cwiPvwjZ GK MelYvq `Lv MQ h, GBPAvBwf mivcwRwUf`i ga kZKiv 28.4 fvM ivMx nvmcvZvj fwZ nqQ dzmdzm bvbv aiYi msgY wbq| eyiwi nvmcvZvj dzmdzmi bvbv ivM wbq fwZ nIqv 302 Rb ivMxi ga 222Rb A_vr kZKiv 73.5 fvM GBPAvBwf cRwUf nqQ| GBPAvBwf Avv`i ga h me dzmdzmi ivM cvavb wevi KiQ Zv nj hv I wbDgvwbqv| GB me ivMx`i ga kZKiv 5 fvM wcwmwc-Z Avv nqQ| wbDgvwbqvq Avv`i evcK Ask evKUwiqv viv mswgZ nqQ| hyivi GBPAvBwf Avv`i ga wcwmwc GKwU cavb ivM njI
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AvwdKvb`i ga GwU Kg NU _vK| Gi cavb KviY meZ AvcwKfve AvwdKvi AvenvIqvq Gi wbg DcwwZ Ges ivMxi mv_ RxevYyi wbggvvq mshvM| c~e AvwdKvi GKwU `k cwZ 4Rb GBPAvBwf ivMxi ga GKRb wbDgvwbqvZ f~MQ| Gi ga kZKiv 17 fvMB nQ community based pneumonia | AvwdKv gnv`k GBPAvBwf Avv`i ga gZzi AbZg KviY nj hv| GBPAvBwf ivMx`i cwZ 3 Rbi ga GKRb hvq Avv nQ| mve-mvnviv Aji 26 _K 67 fvM hv ivMx GBPAvBwf cwRwUf ej cgvwYZ nqQ| 4.6.1. wk`i ga GBWm-Gi jYjv Kx aibi? AwaKvsk wk`i ivMi jYi mv_ eo`i jYi h_ wgj iqQ| Ze wk`i ga bvbv iKg ivMi Nb Nb msgYB ivMi cavb ewk wnmve aiv `q| Giv GZ ivMv Ges bvbvwea RwUj msgY giYvcb _vK h G`iK euvPvbvB KwVb ej gb nq| Lye mnRB G`i vqyZ Avv nq GBPAvBwf fvBivm viv| Avv wk`i QuvqvP bvbv NvZK ewa cwZiva BwgDbvBRkb cwZwU Kx ne Zv wbq AbK wPwKrmKiB ck _vK| ck _vK GB KviY h, GB mgq wk`i cwZiva eev GKevi wb chvq _vK| ZvZ AbK gb Kib h, fvKwmbRwbZ KviYB wk ivMvv nq coQ| Avmj Zv bq| hw`I gb Kiv nQ h, wkivM wekl G welq mywbw` wmv beb, Zey mvweK weePbvq `Lv hvQ h, wWc_wiqv, cvUzwmm, cvwjI, gvm, wUUbvm, hv BZvw`i fvKwmb bv w`jB eis wZi cwigvY gvivZK nq `Lv `e| 4.7.1. Avvi ZK h mg jY `Lv `q hyivi Zzjbvq AvwdKvZ PgivMi mgmvjv ewk NU _vK| Rvw^qvZ GBPAvBwf Avv`i ga 98 fvMB wewfb PgivM fyM _vK| Kvdvwmm mviKvgv, nvicm Rvvi, mevwiK WvgvUvBwUm, civBwUK gvKzjv cvcyjvi ivkjv mvaviYfve G Aji GBPAvBwf Avv`i ga `Lv hvq| GBPAvBwf Avv AvwdKvb`i gyL h mg jY `Lv hvq Zvi ga Dj-LhvM nj, QvKRwbZ AveiY (thrush) , gvwoi GK aibi Nv hvi bvg Avjmviv-bvUvBwRs wRbwRfvBwUm (ulcero-necrotizing gingivitis)| G`i ga Kvdvwmm mvijvgv AbK mgq gyLMniB c_g `Lv `q| Ze gyL wjDKvc-vwKqv Zgb `Lv `qbv|
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gvUvgywUfve GBWm Avv`i kixii Pvgovq hmg jY `Lv `q, mjv nj: civBwUK WvgvUvBwUm civBwUK gvKzjv cvcyjvi ivk| GB jYwU AvwdKvZ ewk `Lv hvq| Rvqvi GBWm Avv`i ga G ivM msgYi nvi 20 fvM| nvicm Rvvi| AvwdKvZ 10 _K 15 fvM GBWm ivMxi G ivM msgY nq _vK| nvicm wmgc- Kvdvwmm mviKvgv mevwiK WvgvUvBwUm gvw WvgvUvgvj bvwUK nvicm Rvvi| GB jYwU AvwdKvZ ewk `Lv hvq| 4.8.1. GBWm ivM PvLi mgmv : GBWm ivM PvLi mgmv mvaviYZ PvLi BbdKkbi KviYB nq _vK| Ze Giga mPivPi NU Ggb ivM nj mvBUvgMvjv fvBivmi KviY wmGgwf iwUbvBwUm (retinitis)| wekl Ki hLb wU-njcvi Kvli msLv cvki wbP bg hvq, ZLb G aibi fvBivm PvLi iwUbvK AvgY Ki wmGgwf iwUbvBwUm Zwi Ki| GZ `wkw Kg hvq| dj ivMx AbK mgq PvLi mvgb w`q Ggb wKQy fm hZ `L hv wK bv A fvmgvb gqjv ev Qvqvi gZ gb nq| GZ PvLi KvYvi w`K `wgZv ev cwidivj wfkbI (peripheral vision) Kg hvq| Uvc-vRgvwmm bvgK AviKwU ivM PvL I gwK AvgY KiZ cvi| GZI `wkw Kg hvq| Gme ivM kixii AcwieZbxq wZ mvwaZ nq| Ze wPwKrmv Kij wZUv mvgb GMvq bv| 4.9.1. gw Kxfve GBPAvBwf mswgZ nq? gv_vi KvljvK hv myiv Ges wbivcv `q ZvZ iqQ wmwW-4 mvidm| GBPAvBwf msgYi ci ZvB Gme GjvKv Avv nq| Gfve vqyZ Avv nevi dj mswgZ Kvljv Ggb wKQy KwgKvj Zwi Ki hv gMRi Kvli KvRjv enZ Ki| Gi dj ivMxi wPv kw `yej Ges axiMwZmb nq IV| wKQy wZI nvwiq hvq| iZifve GBPAvBwf Avv ivMxivB G aibi RwUjZvq fvM| GB RwUjZvi bvg GBWm wWgbwkqv Kgc- (Dementia complex)| GBPAvBwf msgYi KviY h mg myhvM mvbx BbdKkbjv NU, mjv gvS gvS gwI RwUjZv Zwi Ki| Gi ga Uvc-vRgvwmm Ges wjvgvi bvg weklfve Dj-LhvM|
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GBPAvBwf wbqY cqvMKZ IlyaI AbK mgq wZkw b Ki, mB mv_ b Ki GKvMZv I gbvhvM| AbKmgq Ilyai KviY DRbv, DM I gvbwmK Aemv` Zwi nq| 4.10.1. hme ivM nj GBPAvBwf-Gi K_v fveZ ne wbwjwLZ ivMjv nj GBWm msgYK m`n KiZ ne GKvwaKevi wbDgvwbqv wbDgvwmmwUm Kvwiwb wbDgvwbqv (Pneumocystitis carinii pneumonia ev
PCP)

wUDeviKyjvwmm (Tuberculosis) dzmdzm Ges dzmdzmi evBi| evisevi KvwWv BmvdvRvBwUm (Candida oesophagitis) GbKdvjvcvw_ (Encephalopathy) GevwaKevi nvicm Rvvi, GK gvmi ewk mgq ai nvicm wmgc-RwbZ Nv| `xNvqx Wvqwiqv wvKvwmm (Cryptococcosis), hLb dzmdzmi evBi aiv co| Uvc-vRgvwmm (Toxoplasmosis), hLb gw mswgZ nq| mvBUvgMvjv fvBivmi msgY: hKr, c-xnv Ges jwmKvMwi evBi| Kvdvwmm mviKvgv (Kaposis Sarcoma (Ks) Iqws wmbWg ev IRb nvm (Wasting syndrome) Zzjbvg~jKfve nUivmyqvj bvix I cyil`i ga IRb nvm cvq mgvb mgvb NUjI (h_vg 20 fvM I 19 fvM) mgKvgx`i ga AcvKZ Kg IRb nvm NU (15 fvM)| mePq ewk NU wbDgvwmmwUm Kvwiwb wbDgvwbqv ev wcwmwc Avv`i ga (m~- hyivi mUvi di wWwRR KUvj ev wmwWwm, 1990)| 53 fvM GBPAvBwf cwRwUf bvix`i ga wcwmwci msgY NU _vK| nUivmyqvj cyil`i ga GB nvi 50 fvM Ges mgKvgx cyil`i ga 57 fvM| GKviY hKvb wKwbK ev nvmcvZvj ivMxi `n wbDgvwmmwUm kbv nevi ci ciB GBPAvBwf wwbs evaZvg~jK nIqv cqvRb| 1993 mb hyiv wfwK wmwWwm Ziv eQii ewk eqmx ivMx`i GBWmi msv wbaviYi Rb jve wfwK cgvYi mv_ mv_ wbewYZ GK ev GKvwaK ivMi cKvkK BwgDbvWwdwmqw wmbWgi jY ej wbYq KiQ| ivMjv nj
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 KvwwWqvwmm (Candidiasis); kvmbvjx, dzmdzm A_ev Lv`bvjxZ Qwoq co| hLvbB Gi msgY nvK bv Kb, gvBvmKwc I mvBUvjwR Ki G ivMwUK kbv KiZ ne| mivmwi GvmKwc A_ev evmKwci gvag bgybv msMn Ki GwUi cixv KiZ ne| wbDgvwmmwUm Kvwiwb wbDgvwbqv (PCP) gvBKvevwiqvg Gwfqvg Kgc- ev Gg Kvbmvwm (Mycobacterium avium complex or M. kansasii) hLb dzmdzmi evBi aiv co ev Qwoq co| gvBKvevwiqvg wUDeviKzjvwmm (Mycobacterium tuberculosis) hLb dzmdzm ev dzmdzmi evBi nq| gvBKvevwiqvg (Mycobacterium); Abvb aibi ev kbv Kiv hvq bv Ggb aibi hLb dzmdzmi evBi aiv co| wvKvwmm (Extra pulmonary); hLb dzmdzmi evBi Qovq| wvvwiwWqvwmm (Cryptosporidiosis) hLb AK AvgY Ki Ges ivM gvmvwaKvj ai _vK| mvBUvgMvjvfvBivm (wmGgwf) hLb hKr I wc-nvi evBi ivMi msgY NUvq| Uvc-vRgvwmm (Toxoplasmosis); hLb gw Qovq| AvBmvmcvwiqvwmm (Isosporiasis); `xNvqx AvwK, GK gvmi ewk mgq ai vqx| wnvc-vRgvwmm (Histoplasmosis); dzmdzmi evBi hLb Qwoq co| Kvdvwmm mviKvgv (Kaposis Sarcoma) KwwWqBWvgvBKvwmm (Coccidioidomycosis), hLb Qwoq co, wekl Ki dzmdzmi evBi| nvicm wmgc- fvBivm- Gi Nv hLb GK gvmi ewk vqx nq| wjvgv (Lymphoma) hLb gMR ev eBb cv_wgKfve AvgY Ki| cvMwmf gvwdvKvj wjDKvGbKdvjvcvw_ (Progressive multifocal
leukoencephalopathy) mvwfKvj Kvvi (Invasive)

Aavq cuvP
GBPAvBwf Avv`i ga hme ivM `Lv `q
5.1.1. GBWm Avv nj cwZwqv wnmve h mg ivM nq wbDgvwmmwUm Kvwiwb wbDgvwbqv ev wcwmwc, wvKvwmm (Cryptoccosis), Uvc-vRgvwmm (Toxoplasmosis), mvBUvgMvjvfvBivm (wmGgwf) msgY Ges KvwwWqvwmm (Candidiasis)-mn wewfb QvKi msgY| Giga Dj-L Kivi gZv iqQ gvBvvwiwWqv (Microsporidia) Ges wvvwiwWqvg (Cryptosporidiam)-Gi msgY| GBPAvBwf msgYi mv_ mv_ nvicm Mc Ae fvBivm Ges Avc_vm AvjmviiI msgY NU _vK| hv, nvcvUvBwUm-we I wmi msgYI nq evcKfve| 5.2.1. GBWm ivM Avviv mvaviYZ wbwjwLZ AYyRxe I ciRxex msv ivM Avv nq QvK RvZxq : KvwwWqvwmm (Candidiasis) wvKvwmm (Cryptococcosis) AvmcviwRjvwmm (Aspergillosis) wnmUvc-vRgvwmm (Histoplasmosis) KwwWqBWvgvBKvwmm (Coccidioidomycosis) cvUvRvqv RvZxq : wbDgvwmmwUm Kvwiwb wvvwiwWqvwmm (Cryptosporidiosis) Uvc-vRgvwmm (Toxoplasmosis)
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mvjgvbjv mcwUmwgqv Iqws wmbWg (Wasting syndrome) Gjv wbYq gvBvmKwc, wnmUvjwR, mvBUvjwR BZvw` cixv KiZ ne| Gjv KvjPvi Ki A_ev mivmwi Gi wmgb _K GwURb wbYq Ki ivM wbYq Kiv me|
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AvBmvmcvwiqwmm (Isosporiasis) fvBivm RvZxq : nvicm wmgc- fwimjv-Rvvi (Vericella Zoster) mvBUvgMvjvfvBivm (Cytomegalovirus) evwiqv RvZxq : cUvKvm wbDgvwbqv (Streptococcus pneumoniae) ngvdvBjvm Bbdyqv (Haemophilus influenzae) bBmwiqv gwbbRvBwUwWm (Neisseria meningitidis) gvivjv KvUviwjm (Moraxella catarrhalis) (GB PviwU GKRvZxq GbKvcmyjUW evwiqv|) GQvovI iqQ mvjgvbjv (Salmonella) ivPvwjwgqv (Rochalimaea) gvBKvevwiqvg (Mycobacterium) BbdKkb : gvBKvevwiqvg Gwfqvg Kgc- gvBKvevwiqvg wUDeviKyjvwmm GbKvcmyjUW evwiqv :

GBWm Avv`i dzmdzm bvbv aibi AYyRxe wbDgvwbqv bvgK ivM Zwi Ki| G`i ga vKvm wbDgvwbqv Ges ngvdvBjvm Bbdzqv mevP msLK KwgDwbwU eRW& wbDgvwbqvi KviY nq _vK| GB aibi wbDgvwbqvjv ivMi hKvb Aevq nq _vK| Kvb Kvb `k eq`i ga h KviI Nb Nb wbDgvwbqv NUj GBPAvBwf wwbs Kwiq bqv nq| Ze GBWm Avv`i ga h wbDgvwbqv ewk NU Zvi KviY wbDgvwmmwUm Kvwiwb bvgK GKaibi cvUvRvqv| wbDgvwmmwUm Kvwiwb mK wKQy K_v : wbDgvwmmwUm Kvwiwb bvgK GB cvUvRvqvK c_g kbv Kiv nq 1909 mb| PvMvm bvg GK wevbx evwRji mvIcvIjvZ GK c_g kbv Kib| c_g wZwb fewQjb GwU H Aj cv wUcvbvmvg (Trypanosome) RvZxq ciRxexi GKwU Ask| ci `Lv Mj, wUcvbvmvg viv Avv bq Ggb Bu`yi, wMwbwcMI GUv cvIqv hvQ| (Dj-L, wUcvbvmvg RvZxq ciRxexZ Avv nq ivMxiv ay Nygvq)| AviI cixv wbixvi ci GUv AvweZ nq cw_exi me Bu`yi, eovj, evbi, KzKi, QvMj, fov, kqvj, z gvbyl mevi ga| AwaKvsk gvbyli kixii ga we`gvb wbDgvwmmwUm Kvwiwbi jvewfwK DcwwZ GUvB cgvY Ki h, cvq mevB Rxebi Kvb bv Kvb mgq GB RxevYy viv Avv nq| Ze ivMwU PovI nq BwgDb eevq wechq NUj| mvaviYZ my jvKK GwU hLb AvgY Ki ZLb ivMi Zgb Kvb jY cwizU nqbv GB cvUvRvqvi AvgYi avi Ges gZv Kg _vKvi KviY| G KviYB 24 eQi eqmmxgvi cvq 65 _K 100 fvM wk cixv wbixvq wbDgvwmmwUm Kvwiwb wbDgvwbqvq Avv cgvwYZ njI mvaviYfve my wkiv ivMvv nqbv| Kej wc-gvwPDiW& (Prematured) Ges AZ ivMvv wk`i gaB G ivMi jY wKQyUv `Lv `q| wk`i ga hviv RbMZfveB BwgDbvWwdwmqw wmbWg A_ev wU-Kvli `yejZv wbq Rbvq Zv`i gaB G ivMi jY mnR cKvk nq _vK| GQvov wjDKvwgqv, nRwKb wWwRRmn wewfb wjvgv Ges Kvvi RvZxq AmyL wbDgvwmmwUm Kvwiwb NwUq _vK| AbK mgq eyov`i gaI wbDgvwmmwUm Kvwiwb wbDgvwbqv ivMwU Kvb KviY QvovB NU _vK| Aek mcwZ wbDgvwmmwUm Kvwiwb wbDgvwbqvi AviGbG wek-lY Ki GUvK QvK Mvfy Kiv nqQ| GUvK wm AvKvi A_ev wmewnf~Z vivRqW AvKvi cvIqv hZ cvi| wmjv nq Mvj A_ev wW^vKwZ, cuvP _K AvU gvBb Wvqvhy| GKKUv wmi ga Pvi _K AvUUv
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GB RxevYyjv h aibi ivM NUvq Zv nj

wbDgvwbqv gwbbRvBwUm cwiKviWvBwUm (Pericarditis) gwWqvwbvBwUm (Mediastinitis) mcwUK Av_vivBwUm mvBbvmvBwUm (Sinusitis) AUvBwUm wgwWqv (Otitis Media) cvBgvwi eviwgqv vBivwKU RvZxq (Spirochetal Infections) : wmwdwjm 5.3.1. cvUvRvqv RvZxq BbdKkb: wbDgvwmmwUm Kvwiwb

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vivRqW _vKZ cvi| Gjv wRgmv (Giemsa), Mvg (Gram) I ivBU Bb (Wright Stain) ev wekl aibi iK viv kbv Kiv hZ cvi| G RvZxq wbDgvwmmwUm Kvwiwb wbDgvwbqvZ cv_wgK AevZ ivMi Kvb jY _vKbv| dzmdzmi GjwfqvjvB (alveoli)-Gi ga Giv evmv eua _vKv AevZI mvaviYfve Kvb c`vni mw nq bv| Ze hLb Gi ew GKwU wekl gvvq cuQ ZLb ivMxi Ri, Kuvcywb, Nvg, Kvwk BZvw` jY `Lv `q Ges Pjvdivq kvmK i nq| mvaviYZ Kvwkjv ek cvZjv I Zij nq _vK| Kvwki gvv evovi mv_ mv_ kvmK nq| GBPAvBwf Avv bq Ggb ivMx`i ga cavb jY GB kvmKB| GBPAvBwf GwcWwgK i nevi AvM 194 Rb wcwmwc Avv ivMxi Ici cwiPvwjZ GK MelYvq `Lv hvq, Zv`i 91 fvMiB wQj kvmK Ges 46 _K 48 fvMi wQj Ri I Kvwk| Avi GBPAvBwf Avv`i ga wcwmwc hv hv NUvq Zv gv^q nj Kvw, `yejZv, Ri, kxZeva, Ng hvIqv Ges cwikl kvmK| nuvUvPjv KijB kvmK eo IV| dzmdzmi evBiI wcwmwc mgmv Zwi KiZ cvi| GUvK ej GUv-cvjgvbvwi msgY (Extra Pulmonary Infection) | GBPAvBwf Avv`i ga G aibi msgY NU ZK, PvL, Kvb, _vBiqW, wcUzBUvwimn wewfb M-v| Gi msgY nZ cvi `wc, hKZ, c-xnv, e, Lv`bvjx, dzmdzmi AveiY, gyLi UvKiv, gv I wjbvWI| wcwmwcZ i cixvq mvaviYfve Kvb Zvrchc~Y cwieZb aiv co bv| Ze Avvi ga GjwWGBP (LDH) bvgK GK iKg GbRvBgi gvv evo Ges wPwKrmvi GK mvn ci GUv bg AvmZ _vK| ii GjvBRvmn wewfb cixvZI GUv kbv Kiv hvq| GQvov eyKi GiZI cwieZb aiv co| UvBg_vwcg mvjdvg_vvRj (Trimethoprim Sulfamethoxazole ev TMP-SMX) bvgK mnRcvc Ilya wcwmwci wPwKrmvq Ges cwZiva eeZ nq _vK| Avv`i ga cwZw`b cwZ KwR IRb 20 wgwjMvg wUGgwc Ges 100 wgwjMvg GmGgG gyL ev wkivq `qv nq| Gfve wPwKrmv Pj 14 _K 21 w`b| wcwmwc Avv`i wPwKrmvq eeZ AviKwU Ilya cUvwgwWb (Pentamidine) hv`i ga wUGgwc-GmGgG KvR KiQ bv Zv`i cUvwgwWb `qv nq| c~e GBPAvBwf Avv`i ga cwZw`b cwZ KwRZ Pvi wgwjMvg
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cUvwgwWb wkivq `qv nZ| GLb `Lv hvQ, GUv bvwgq cwZ KwRZ wZb wgwjMvg w`jI fvj KvR nq| GB wPwKrmv Pj 14 _K 21 w`b| GQvov Abvb hmg Ilya wcwmwc Avv`i wPwKrmvq cqvM Kiv nq Zvi ga Wvcmvb (Dapsone) Dj-LhvM| GwU Kz ivMi wPwKrmvZI eeZ nq| Abvb bZzb Ilyai ga iqQ wKbWvgvBwmb (Clindamycin) Ges cvBgvKzBb (Primaquine)| cvBgvKzBb `qv nq gyL, 30 wgwjMvg Ki cwZw`b GKevi Ges wKbWvgvBwmb `qv nq 600 wgwjMvg cwZ QNUv Ai| wKbWvgvBwmb wkivZI cqvM Kiv hZ cvi| m 900 wgwjMvg Ki 8 NUv Ai wkivq cqvM KiZ nq| iZ wkivq wKvgvBwmbi mv_ gyL cvBgvKzBb `qv nq| Aevi DbwZi ci `yUv IlyaB gyL `qv hvq| me wgwjq wPwKrmv 21 w`b PvjvZ nq| cvBwiUwg (Piritrexim) bvgK GKwU bZzb Ilya ewiqQ hv wK bv wcwmwc Ges Uvc-vRgv MvbvwW (Toxoplasma gondii) msgY wbqY eenvi Kiv nq| GUvi myweav nj GB h, GwU Lvevi Ilya wnmve eeZ nq| Gi KvhKvwiZv wUGgwc _K GK nvRvi Y ewk| wUGgwci gZ AviKwU Ilya UvBgUU (Trimetrexate)| G `yUv IlyaB WvB-nvBWvdjU wiWvm BbwnweUi| Ilya `yUv cqvM Kiv nq wjDKvfvwib (Leucovorin) bvgK Ab GKwU Ilyai m| 5.4.1. evwiqv RvZxq msgY GBPAvBwf Avv`i ga evwiqvj wbDgvwbqvi msgYi jYjv mvaviY wbDgvwbqvi gZB nVvr Ri, Kvwk, Nb Nb kvm, eyK e_v, KLbI Kvwki mv_ i, dzmdzm PvKv nevi Rb jYxq cwieZb| jveiUwiZ cixv wbixv Kij GBPAvBwf Avv`i ga kZKwYKv 15 nvRvii ewk cvIqv hvq bv| GjwWGBP (LDH) bvgK GKwU GbRvBg ew cvq wcwmwc Ges ngvdvBjvm BbdzqvZ| eyKi GiZ `kgvb cwieZb aiv co dzmdzm wewfb `vM, PvKv evav BZvw` kbvKiYi gvag| dzmdzm dzUv ev cvwb Rgv Lye KgB NU GBPAvBwf Avv`i ga| Ze GBPAvBwf mivbMwUf`i ga GbKvcmyjUW evwiqvRwbZ wbDgvwbqvi (wbgvKvm wbDgvwbqv) KviY 15 fvM ivMxi dzmdzm cvwb RgZ cvi| gvBvvci wbP Kvwk cixv Ki wbDgvwbqvi aib wbYq Kiv hvq| Mvg Bbi gZ mvaviY iK eenvi Ki wbgvKvm wbDgvwbqv kbv Kiv hZ cvi| wbgvKvm wbDgvwbqv nj wkivq cwbwmwjb A_ev Bwi_vgvBwmb `qv nq| ngvdvBwjqv msgY wZxq cRbi mdvjvmcvwib
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(Cephalosporin), hgb mdziwg (Cefuroxime) `qv nq| weUvjvKUvgm (Betalactamase) bMwUf BbdzqvZ Ggwcwmwjb A_ev Gvgvvwmwjb

`qv nq| ivM kbv KiZ Amyweav nj UvBg_vwcg mvjdvg_vvRj (wUGgwc-GmGgG) `qv nq| Ze hnZz GUv GBPAvBwf Avv`i ga iZi cvkcwZwqv NUvq, ZvB GwU cwinvi KivB fvj| 5.5.1. ivPvjwgqv ivPvjwgqv (Rochalimaea) GKaibi z`vKvi Mvg bMwUf RxevYy| GUv ii wkivq evwmjvwi GvbwRqvgvUvwmm (Bacillary angiomatosis) bvgK GKaibi ivM Zwi Ki _vK| GB evwmjvwi GvbwRqvgvUvwmm NUZ cvi ZK _K i Ki kixii Afi me| GUv Avv KiZ cvi vqy, nvo, nvoi gv, dymdzm, A, hKZ, c-xnv, `wc Ges wjbvWK| 5.6.1. mvjgvbjv (Salmonella) mvjgvbjv RxevYywU UvBdqW ivMi KviY| Ze UvBdqWi jY bv NwUqI mvjgvbjv RxevYy wevi jvf KiZ cvi GBWm Avv`i ga| evi evi GB aibi mvjgvbjv Avv nevi welqwUK wmwWwm GBWm ivMi GKwU jY wnmve kbv KiQ| GBPAvBwf Avv`i ga hme ivMi msgY `Lv hvq Zvi ga mvjgvbjvi vb GKfvMiI wbP| Zey cixv wbixvq `Lv hvQ, my ewi Zzjbvq GBPAvBwf Avv`i ga mvjgvbjvi AvgYi nvi GKk Y ewk| ZvB Nb Nb mvjgvbjv evwiqvg BbdKkbK GBPAvBwf Kvm-3 ej kbv KiQ wmwWwm| GZ mvjgvbjv Mci h mg RxevYyi msgY NU _vK Zv`i ga Dj-LhvM njmvjgvbjv UvBwdwgDwiqvg (S. Typhimurium), mvjgvbjv GUvivBwUwWm (S. Enteritidis), mvjgvbjv AvwiRvwbqv (S. Arizonea), mvjgvbjv Wvewjb (S. Dublin)| G`i ga mvaviYfve mvjgvbjv UvBwdwgDwiqvg ay gvbylKB Avv Ki _vK ev gvbyli kixiB we`gvb _vK| Avi bb-UvBwdwgDwiqvg mvjgvbjvjv _vK RxeRZ| RxeR _K Lvevii gvag Gjv gvbyli kixi cek KiZ cvi wekl Ki KuvPv wWg, m Kiv nqwb Ggb gvsm, Abvb Lvevi `vevi Ges cvivBRkb Kiv nqwb Ggb `ya _K| Lvevi QvovI gvwiRyqvbvi gvag UvBdqWi msgY NUZ cvi| mvjgvbjv UvBwdwgDwiqvg mgKvgx`i ga hbevwnZI nZ cvi|

mvaviYZ GBPAvBwf Avv`i ga bb-UvBwdwgDwiqvg mvjgvbjvi jY `kgvb nq ewg I cvZjv cvqLvbv NUevi ga w`q| Gjv GKaibi MvmUv GUvivBwUm Zwi Ki| 5 fvM Gme RxevYy A _K i Pj hZ cvi| i mvjgvbjv cevwnZ nq hKvb RvqMvq duvov Zwi KiZ cvi ev cuyR Rwgq djZ cvi| Gfve cuyR RgZ cvi `wc, dzmdzm, cmvei _wjZ, A, nvo Ges gvUv wkivq| GBPAvBwf Avv`i ga hviv G aibi msgYi wkKvi nq Zv`i ga Kvb Kvb Ai cPb ev mcwmmi jY cKvk cvq| Giga cavb jY nj Ri, mv_ Nvg, Kvucwy b, IRb nvm Ges yavg`v| ii KvjPvi Ki bb-UvBwdwgDwiqvg mvjgvbjv ivM wbYq KiZ nq| GQvov gji KvjPvi KivI cqvRb| ivM wbYq ii Abvb cixv Zgb mnvqK bq| wPwKrmvi Rb eQ bqv nq ZZxq cRbi mdvjvmcwib, wUGgwc, GmGgG, Ggwcwmwjb, KvivgdwbKj BZvw`| 14 w`b wPwKrmv PvjvZ nq| c_g w`K IlyawU wkivq `qv cqvRb, wekl Ki hZw`b ivMi cavb jYjv we`gvb _vK| mdUvqvb (Ceftriaxone) GK _K `yB Mvg wkivq cwZ 24 Nv Ai cqvM KiZ nq 14 w`b, A_ev wUGgwc-GmGgG cuvP _K cbiv wgwjMvg cwZ KwRZ, cwZ QNv Ai wkivq A_ev Ggwcwmwjb 500 wgwjMvg cwZ QNv Ai wkivq A_ev KvivgdwbKj cwZ QNv Ai wkivq w`Z nq| AbK mgq GBWm Avv`i ga KvivgdwbKji mv_ 300 wgwjMvg widvgwcwmb `qv nq gyL| 5.7.1. gvBKvevwiqvg BbdKkb gvBKvevwiqvg Gwfqvg Kgc- (MAC) mvaviYfve cwiek we`gvb _vK| Gjv bvbv aibi nq _vK Ges my `n Kvb ivM NUvq bv| GBPAvBwf Avv`i ga GwU eo aibi ivM wnmve `Lv w`Z cvi, wekl Ki hv`i wmwW-4 Kvli msLv cwZ wmwmZ cvki wbP| GBPAvBwf Avvi ivM iZi chvq bv cuQvjI GgGwm AvMvmb NwUq Avvbv MvoZ cvi dzmdzm I A, AbKUv bxieB| G chvq iZi Amyweav `Lv bv w`jI GUv GKUv wechqi msKZ enb Ki| i KvjPvi Ki GgGwm mnRB kbv Kiv hvq| GgGwm Avv`i wPwKrmvq GvwR_vgvBwmb I Kvwi_vgvBwmb (Clarithromycin) cqvM Kiv cqvRb| mePq fvj nq Gi GKwUK B_vgeyUj (Ethambutol) I widvgwcwmb (Rifampicin) wKsev wmcvdvwmbi
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mv_ cqvM Kij| wmcvdvwmb 750 wgwjMvg w`b `yevi Ki `qv hZ cvi GgGwm Avv`i wbivgqi Rb| Aek Zv w`Z ne GvwR_vgvBwmb I B_vgeyUji mv_| GgGwm msgY wbivgq GvwR_vgvBwmb cqvM KiZ ne 500 wgwjMvg gyL w`b GKevi A_ev Kvwi_vgvBwmb 500 _K 1000 wgwjMvg gyL w`b `yevi Ki| B_vgeyUj I widvgwcwmb (Rifampicin) hLb GvwR_vgvBwmbi mv_ cqvM Kiv ne ZLb Zvi gvv neB_vgeyUj `wbK cwZ KwRZ 15 wgwjMvg, widvgwcwmb 10 _K 20 wgwjMvg cwZ KwRZ| 5.8.1. QvK RvZxq msgY AvmcviwRjvwmm: AvmcviwRjvm Ggb GK aibi QvK hv wK bv cPbkxj flR e I gvwUZ we`gvb _vK| GB QvKi vijv bvK w`q kixi cek Ki| cvq wZbk cRvwZi AvmcviwRjvm iqQ| Giga A KqKwU gvbyli `n ivM msgY NUvq| gvbyli Rb hv wecbK Zv nj AvmviwRjvm wdDwgMUvm (Fumigatus)| Avi `yaibi AvmcviwRjvm gvbyli ivM NUvq G`i GKwU nj AvmviwRjvm bvBRvi (A. Niger), AbUv AvmcviwRjvm dvfvm (A. Flavus)| mvaviYZ AvmcviwRjvm `yej kixi A_vr kixii ivM cwZiva Kg MjB AvgY KiZ cvi| wekl Ki wewfb Ilya cqvMi ci, `xN ivM wech kvixwiK Aevq A_ev Kvvi Avv Aevq| GUv Kvb A mshvRbi ci A_ev wjDKvwgqv I wjvgv bvgK ivM NUevi ciI nZ cvi| GBPAvBwf Avv nevi ci wU-Kvli KvhKvwiZv Kg Mj GUv kixi PovI nq| GB z`vKvq evZvmevwnZ AvmcviwRjvm vijv c_g dzmdzmi kvmbvjxZ cek Ki, Zvici GjwfqvjvB-G Qwoq co| mLvb ew cq GwU ii wkivK AvgY Ki Z mw Ki Ges icvZ NUvq| KLbI KLbI AvmcviwRjvm GKwU eji gZb AvKvi wbq Aevb bq dzmdzm| wekl Ki hvRwbZ Z ev dzUvq Avvbv Mvo| BwgDwbwU wbg gvvq cuQ Mj GwU ievwnZ nq kixi evcKfve Qwoq coZ cvi| G Aevi bvg Bbfwmf AvmcviwRjvwmm (Invasive aspergillosis )| G Aevq DPgvvq Ri nZ cvi Ges dzmdzm PvKv (Consolidation) nZ cvi| AvmcviwRjvwmm Qwoq coZ cvi `wc, Lv`bvjxZ, nvo, gv_vi gMR, ZKmn bvbv vb| GZ hme ivM NUZ cvi Zv nj BmvdvRvBwUm, GvKviWvBwUm, gwbbRvBwUm, mvBbvmvBwUm, AwIgvBjvBwUm, eb
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Avemm Ges ZK Nv| Ze GUv dzmdzmi evBi ievwnZ nq mePq ewk AvgY Ki gwK| dzmdzm AvmcviwRjvm msgY NUj hmg jY `Lv `q Zv nj Ri, Kvwk, kvmK, eyK e_v, K`vwPr Kvwki mv_ icvZ| hv`i ivMi jY AvQ Zv`i Kvwk A_ev bvKi k-v KvjPvi Ki ivM wbYq Kiv me| Gimn Abvb cixvZI ivM kbv Kiv me| GB ivMi wPwKrmvq eenvi Kiv nq GvUwiwmb-we| GUv cwZw`b cwZ KwRZ 0.5 _K 0.8 wgwjMvg Ki cqvM KiZ nq| Kvb Kvb GvUwiwmb-we Gi mv_ widvgwcwmb (Rifampicin) `qv nq| GwU GvUwiwmbi KvRK kwkvjx Kivi mv_ mv_ wbRI BwZevPK f~wgKv ivL| GUv cwZw`b 600 wgwj Mvg Ki gyL w`Z nq| AviKwU weK iqQBUvKvbvRj (Itraconazole) bvgK QvKbvkK Ilya cqvM| GwU `wbK 100 _K 400 wgwjMvg Ki cqvM Kij 80 fvM wbivgq `q| Ze GBPAvBwf Avv`i ga BvKvbvRji KvhKvwiZv Kg _vK| 5.9.1. vqy msv RwUjZv Zvvwbqvq GK MelYvq `Lv MQ mLvbKvi GBPAvBwf Avv`i ga 10.5 fvM vqy msv RwUjZvq fyMQ| Gi ga cavb h Amyweavjv NUQ Zv nj cvNvZ, kixii Ask wekl Aek nq hvIqv Ges wewfb vqyi wechq| mePq ewk hv NU Zv nj GBPAvBwf wWgbwkqv iwUbvcvw_ Gvwidwqv (Areflexia) wcivwgWvj UvK mvBb Ugvi (Tremor) Bb-KvAwWbkb BZvw`| H MelYvq `Lv hvq h, wvKvm wbIdigv RwbZ KviY gwbbRvBwUm nqQ Qq _K eviv fvM ivMxi | Uvc-vRgvwmm UvBUvi cwRwUf nqQ 11 fvM | 5.10.1. `ivM msv RwUjZv : `ivM msv RwUjZv ev cwiKviWvBwUm `Lv `q 28 _K 39 fvM GBPAvBwf Avv ivMx`i ga| Kvdvwmm mviKvgv ivMwU ga AvwdKvZ GgwbZB GbWwgK AvKvi NU _vK| Rvqvi, iqvv, eyiw, DMvv, gvjvwe, Zvvwbqv, Rvw^qv, wR^veyq, Kwbqv BZvw` GjvKvq Kvdvwmm mviKvgvi DcwwZ wQj ek eo gvvqGBWm GwcWwgK Qwoq coevi AvM _KB|
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Avh welq, G GjvKvjvZB eZgvb GBPAvBwf msgY mePq ewk NUQ| Kvdvwmm mviKvgvi evcK msgYmn c_g GBWm ivMxwU aiv co 1984 mb| Rvqvii 22 Rb GBWm ivMxi ga wZbRbiB wQj Kvdvwmm mviKvgv| AvwdKvi wewfb vb GBPAvBwf Avv`i cuvP _K cbiv fvMi Kvdvwmm mviKvgv `Lv hvQ| hyiv I BDivci DbZ `kjvi m AvwdKvi GBWm ivMx`i AviKwU cv_K nj gvBKvevwiqvg Gwfqvg Kgc-i Zzjbvg~jK AbycwwZ| 5.11.1. GK bRi h ivM I jYmg~n `L GBWmi K_v fveZ ne: gyL QvK msgY hbv QvKi msgY GK gvmi AwaK cvZjv cvqLvbv wUwe, hv I wbDgvwbqvi msgY hbivM wekl Ki wmwdwjm-Mbvwiqvi BwZnvm iqQ, Ggb ivMxi `n QvKi msgY wekl aibi PgivMi DcwwZ; hgb Kvdvwmm mviKvgv| G aibi jY Aek Avgv`i `k `Lv hvq bv| AvwdKvb I Abvb Kv`i GwU ewk `Lv hvq| wmGgwf 5.11.2. mvaviYZ Kx Kx xivM I hbivM wbq GBPAvBwf Avviv wPwKrmKi wbKU Avm? gvwmKi mgmv| Amgq gvwmK e, AwbqwgZ gvwmK A_ev Kg gvwmK nIqv BZvw`| gvwmKi G mgmvi KviY nj wicvWvwf nigvbi Ici GBPAvBwf fvBivmi cwZwqv| QvKi KviY hvwbc_ c`vn I mB mv_ mve| GBPGmwf-2 msgY ev hvwbc_ nvicm wmgc- fvBivm msgY AviKwU jY| hyivi mUvi di wWwRR KUvj (wmwWwm)-Gi MelYvq 18 fvM ivMxi nvicm wmgc-i DcwwZ cvIqv MQ| wmwdwjm| G mg ivMxiv hvwbc_ Nv wbq DcwZ nq| G ivMi mv_ GBWmi RwUj mK iqQ| GBPAvBwf Avvi ga G ivMi ZxeZv `Z ew cvq|
78

cjwfK BbdvgUwi wWwRR (wcAvBwW)| G ivMi jY nj Rivqy, wW^vkq, wW^bvjx, ZjcUmn hvwbc_ c`vn Ges wUDev Ifvwiqvb Avemm| GZ ZjcU cuyR Rg| mvaviY wcAvBwW Ges GBWmi wcAvBwW-Gi Zdvr nj GB h, GBWm ivM mvaviYZ GB BbdKkb ev cyR Rgvi KviY kZKwYKvi msLv 10 nvRvii wbP _vK| hw`I u RxevYy msgYi aiY Ges RxevYy UvBc Dfq GKB iKg nq _vK| wnDgvb cvwcjvgv fvBivm (HPV)| GwU GKwU hbevwnZ fvBivm hv hvwbc_ I cvqyc_ QvU QvU AvOyii gZ MvUv ev AvbvRbvBUvj KvBjvgvUv (anogenital condylomata) ev IqvUm Zwi Ki| AvbvRbvBUvj IqvUmjv AbKmgq wKQyUv em hvIqv, big, fRv, Mvjvcx _K jvj iOi nZ cvi Ges mvaviYfve bvix hbvi jvweqv, mvwf I gjvii cvk nq _vK| AbK mgq Gjv wmwdwjmRwbZ KvBjvgvUvi gZ nZ cvi| mvifvBKvj IqvUmi Pap smear ewZiK wPwKrmv i Kiv DwPZ bq| mvifvBKvj BbUvGwc_wjqvj wbqvc-vwmqv (cervieal interaepithelial neoplasia) ev wmAvBGb| GBPAvBwf-Gi m wnDgvb cvwcjvgv fvBivm (HPV) RbvUvBc 16, 18, Ges 31-Gi mv_ wmAvBGb Ges Bbfwmf mvifvBKvj Kvvii mK iqQ| GUv GvbvRbvBUvj wbqvc-vwmqviI KviY| mvaviYZ: hv`i ga BwgDwbwU Kg hvq Zv`i ncvUvBwUm-we msgY ewk nq _vK| GBWm Avvi gaI wmAvBGb-Gi nvi my jvKi Zzjbvq cvq 49 Y ewk Ges ncvUvBwUm-we-Gi nvi cvq 9 Y ewk| ZvB my jvKi ga wmAvBGb-Gi DcwwZi mv_ mv_ GBPAvBwf wwbs Kwiq bqv cqvRb| KvwwWqvwmm Ggb GKwU ivM hv `L GBPAvBwf msgYi K_v gb ivLZ ne| wmwWwm-Gi wnmve Abyhvqx bvix`i ga 19 fvM, nUivmyqvj cyil`i ga 14 fvM Ges mgKvgx cyil`i ga 11 fvM GBPAvBwf Avv ivMx Lv`bvjxZ KvwWvi msgY wbq wPwKrmKi wbKU DcwZ nq| wmwWwm KZK ivW AvBjv (road island) cwiPvwjZ AviKwU MelYvq `Lv MQ GBPAvBwf Avvi ga KvwWvZ Avv nqQ 34 fvM, Abw`K wcwmwcZ 20 fvM|

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 Gme MelYvi cvcU wmwWwm GBWmi msv evLv KiZ wMq ejQ, mB mg miv cwRwUfKB GBWm Avv ejv hve hv`i mvifvBKvj Kvvi, dzmdzm evisevi evwiqvRwbZ wbDgvwbqv I hvi jY `Lv hve A_ev hv`i ga wmwW-4 Kvli msLv `yki wbP ne| Icii Z_i AvjvK ejv cqvRb, GBWm Avvi m gjvgkvi mv_ mv_B KD GBWm Avv ne GUv wbwZ Ki ejv hvq bv| Ze GUv Kvb fimviI K_v bq| GBPAvBwf AbKw`b `ni ga my Aevq _vKZ cvi| Avi mivcwRwUf njI ZrYvr GBWmi jY cKvk cve GgbI K_v bB| jY cKvk cZ cvq mZiv eQi jMQ, Ggb D`vniYI iqQ| GBWmi Ilya wRWvfywWb cqvMKvjI cyil _K bvixi ga GBWm msgYi mvebv ew cvq| AviI hmg hbivM gq`i ga GBWm msgYi mvebv eo hvq Zvi ga Dj-LhvM njv cjwfK BbdvgUwi wWwRR| 5.11.3. Wvqwiqvi mv_ GBPAvBwf msgYi mK Kx? GBPAvBwf msgYi ciB h cv_wgK jYjv kixi `Lv `q Zvi ga AbZg nj Wvqwiqv| cvq 50 fvM Avvi gaB GB jYwU `Lv hvq| fvBivmi cv_wgK AvgYi ci ciB mvgwqKfve BwgDb cwZiva eevq dvUj aij ek wKQy evwiqv, fvBivm I ciRxex AvwK MvjhvMi mw Ki| Kvb Kvb mgq GB Wvqwiqv GZUv gvivZK nq h, Rxebi Avkv `Lv `q| Kvb Kvb z`vI GBPAvBwf msgY NU| m `xNgqv`x Wvqwiqv nq Ges gvivZK IRb nvm NU| cv_wgK AvgYi cvcU ZK h jvj jvj `vM `Lv `q mjv wewfb iKg RxevYy, fvBivm, QvK, ciRxex viv NUZ cvi| GgbwK AbK GBPAvBwf msgY bv NUjI Gme AYyRxei KviY G aibi mgmv nZ cvi| AbK mgq KvviI kixi G aibi jvj jvj `vM Zwi Ki| GBPAvBwf msgY nj h `vMjv nq mjv nq QvU QvU, GKUz DuPz I jvjP| Gjv mvaviYZ gyL, evmn kixii Eav Ges cvq nq _vK|

Aavq Qq
GBPAvBwf kbvKiY I cqvRbxq cv_jwRKvj U
6.1.1. GBWm kbv KiZ h mg U KiZ nq: GBPAvBwf GwUewW U (HIV antibody test) GBPAvBwf GwURb U (HIV antigen test) fvBivm AvBmvjkb (isolation) Ges cwigvY wbYq wcwmAvi-Gi gvag fvBivmi cwigvY wbYq BZvw`| dzmdzm I dzmdzmi evBi hvmn mvjgvbjv (Salmonella) RvZxq ivMjv msgY wbYqi Rb KvjPviB MnYhvM| GBPAvBwf GbKdvjvcvw_-Gi Rb wKwbKvj cixv wbixv QvovI wmGmGd-Gi (CSF)-Gi cixv Ges eb vb Kiv Acwinvh| 6.2.1. GBPAvBwf wwbs I Abvb U jve h me cwZZ GBPAvBwf kbv Kiv nq Zvi ga c_gB Dj-L KiZ nq GBPAvBwf wwbs-Gi K_v| evi evi GBPAvBwf wwbs cwRwUf nj ZvK GBPAvBwf Avv ejB ai wbZ ne, wKQy wKQy ewZg Qvov| Kbbv GB U AbK mgq fyj cwRwUf (False positive) nZ cvi| GRb BwgDbvdzim Gvm (immunofluorescence assay) ev GBPAvBwf e-U U Kwiq wbZ ne| Ze mivmwi fvBivm kbvKiY I AvBmvjkb KivI me| wwbs Ui gvag GBPAvBwf GwUewWwU cwigvc Kiv nq| h me `k cixv wbixvi myhvM bB mLvb wek ^v msvi MvBWjvBb Abyhvqx wKwbKvwj GBPAvBwf kbv Kiv nq| Ze i cixv Qvov mywbw`fve wKQyZB kbv Kiv me bq h GKRb GBPAvBwf Avv wK bv| 1985 mb GBPAvBwf wbYqi Ujv cPwjZ nq|
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GBPAvBwf wwbs, GjvBRv (Enzyme Linked Immunosorbent Assay ev ELISA) I e-U Ui mv_ ivM wbYq I ivMxi Aev wbYqi Rb AviI h mg cixv Kiv nq Zv njwmwW-4 Kvl wbYq I wU-njcvi wjvmvBU Kvl wbYq| GQvov wc-24 bvgK GK aibi fvBivj GwURbI cwigvc Kiv nq| fvBivj GwURb cwigvc Ki fvBivj jvW wbYq Kiv me| cixv Ki hv wbYq Kiv nq Zv nj kixi GBPAvBwf fvBivm cek KiQ wK bv Ges cek Ki _vKj kixi Zv KZUv iqQ| mivmwi fvBivm kbv Kivi welqwU ek k Ges eq ej| BwgDb eev Avv nevi ci kixi h GBPAvBwf GwUewW Zwi nq Zv `L ivM wbYq AcvKZ mnR| 6.3.1. Iqvb e-U U (Western Blot Test)
Immunoelectrophoresis A_ev immunoblot cwZZ GBPAvBwf confirmation test-K ejv nq western blot test| fvBivmi AMZ wekl cvwUbi

Ges cwjgvim GbRvBgi m mshy cvwUbjv gvbe`n h wZb aibi GwUewW Zwi Ki Zv`i `yUv kbv bv nj IqvY e-U UK cwRwUf aiv nq bv| Gme KviY GBPAvBwf e-U U GjvBRv Ui Pq AbK ewk mywbw`| hLvb GjvBRv Ui gvag ay GwUewW kbv Kiv nq, mLvb e-U Ui gvag mywbw` GwURb Ges fvBivmi Ask hvi wei GwUewW Zwi nq Zv kbv Kiv me| Zzjbvg~jKfve IqvY e-U U GjvBRvi Pq wKQyUv Svgjvhy I eqej cixv| Iw`K GjvBRv I wwbs AwZ `Z Ges Kg LiP mv`b Kiv me| AviI wKQy cixv wbixv AvQ hvi gvag GBPAvBwfi DcwwZ cwigvc Kiv me| Gjvi ga iqQ fvBivmi cvwUb I GbRvBg wbYq| wifvm Uvwm bvgK fvBivmi GbRvBgwU wbYqi gvag iUvfvBivmi DcwwZ wbYq Kiv me| cwZwU iUvfvBivm GB GbRvBg _vK| jveiUwiZ Avv ewi mivg my Kvl cek KwiqI cixv wbixvi gvag GBPAvBwfi DcwwZ cgvY Kiv me| ivMxi Aev wbYqi Rb kixi cevngvb fvBivm wbYq Kiv me, wekl Ki ivMi iZ Ges kl chvq| mivmwi GBWm fvBivm kbvKiYi gvag m`RvZ wki `n GBWmi DcwwZ cgvY Kiv me| Kbbv Gme wki Rbi ek wKQyw`b ci ch Zvi `n GBPAvBwf GwUewW we`gvb _vK| wkwU wbivM njI c-vmUv gvidZ mvwiZ gvqi GwUewW aviY KiZ cvi Qq gvm _K `k eQi ch| 6.4.1. cwjgvim PBb wiAvKkb: cwjgvim PBb wiAvKkb (Polymerase Chain Reaction ev PCR) ej GKwU U iqQ GBPAvBwf kbvKiYi Rb| GB Ui gvag fvBivmi RbwUK gvUwiqvjjv Avgwc-wdKkb Ki ivM kbv Kiv nq| hnZz RbwUK gvUwiqvji GKwU fMvsk _KI G cwZZ fvBivm wbYq me, ZvB GwU GBPAvBwf wbYq AwZ KvhKi| cwjgvim PBb wiAvKkb (wcwmAvi) U cwZwU 80-Gi `kK _K wekevcx bvbv ivM kbvi Rb eeZ nQ| wWGbGi RbwUK Aski h Kvb KYvi msKZK hi mvnvh cwieab (amplify) Ki wekl aibi fvBivmK kbv Kiv nq GB cixvi mvnvh| Gfve RwUj evwiqvmn gvbe kixii wewfb KvlI kbv Kiv nq|
83

AvwaKi KviY BwgDbvjwRKvj cwieZbi welqwU cixvi gvag wbbq Ki mywbwZfve GBWm ivM wbYq Kiv hvq| GBWm wbYqi cixvwU AZ KvhKi| G cwZZ GBPAvBwf GwURbi DcwwZZ GwUewW cwigvc Kiv MjI GUv gb ivLv cqvRb h, GBWm ivMi iZ I kl fvBivmi mKj GwURb mggvvq DcwZ _vK bv| G Rb GBWm ivMx`i Aev Rvbvi Rb WB cwRwUf evm ev wiAvKwUf evmwU mK Rvbv cqvRb| wmwWwm cv_wgKfve P24 A_ev GP41 evi DcwwZK mevwaK iZ w`q G `yUv cixvK GBPAvBwf cwRwUfi mgv_K ej MY KiQ| GBPAvBwf gy mivgi ga we`gvb MvM cvwUbjv wekl Ki P 24 , P17 , P 55 Gi DcwwZZ KLbI KLbI Non Specific Reaction nIqvZ Abvb evjvi DcwwZ `Lvi Dci Rvi `qv nQ| Ze mvaviYfve P 24 GwUewWi DcwwZZ cv_wgKfve cvq mywbwZfve GBWmi DcwwZ kbv Kiv nq| GB GwUewWwUB ivMi cv_wgK AevZ aiv co| evi evi GjvBRv bMwUf nIqv gvb ivMi AbycwwZ| Ze GwU cwRwUf nj GKkfvM ivMi wbqZvi K_v ejv hvq bv| Kbbv GBPAvBwf GwUewW GjvBRv U aiv co| GRb Iqvb e-U U KiZ nq| Iqvb e-U U Ggb GK cixv hLvb GBPAvBwf mywbw` GwURbK kbv Kiv me, hvi wei GwUewWwU Zwi nqQ| GB cixvi gvag GBPAvBwf fvBivmi wZbwU GwURbi ga AZ `yUvi weiI GwUewW Zwi nj Zv e-U Ui gvag wbYq Kiv me| Ze fvBivmi AveiY K`
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6.5.1. wc-24 GwURb cixvwU Kx?

HIV1 P 24 Core protein ev P 24 antigen wbYq Kiv nq Antigen Capture Enzyme Linked Immunosorbent Assay (ELISA) cwZi gvag| A_vr

Ki wPwKrmv cieZx Aevq g~j cixvjv Kwiq wbZ cvij GKwU MnYhvM wPwKrmv eev ceZb Kiv me| Kvb Kvb MelK gvbyqvwj wmwW-4 Kvli cwigvci Ici Rvi w`qQb| cqvRbi cvcU weK eev I Dvebx Kkj cqvM ewZiK wekevcx GBWm gnvgvwi Govbv me bq| hLvb Iqvb e-U U I GjvBRv di GBPAvBwf U Kiv me ne bv mLvb GBPAvBwf wwbs-Gi mv_ mv_ ivMxi wKQy kvixwiK jY wgwjq `LZ ne| G cwZZ GBPAvBwf kbv Kivi Rb ivMxi cavb wZbwU jY nj kZKiv `kfvMi ewk IRb nvm, GK gvmi AwaK Wvqwiqv, gvmvwaK mgq ai Ri me mgqi Rb wKsev Qo Qo| GQvov wKQy Acavb jYi IciI iZ Avivc KiZ ne; hgb GK gvmi ewk Kvwk, gyL I Mjvq QvKi msgY, wjbvWjv dzj hvIqv, evi evi nvicm Rvvi nIqv, mg kixii Pvgovq PzjKvwbmn c`vn `Lv `qv, kixii bvbv vb nvicm wmgc-i `xNvqx msgY BZvw`| GBWm wbYqi Rb k jY wnmve weewPZ nq kixii me Qovbv Kvdvwmm mviKvgv Ges wvKvj gwbbRvBwUmi msgY| AvwdKv gnv`ki Kvb Kvb vb Kvbic cixv ewZiK Kejgv jYjv `LB GBWm kbv Kiv nq| AvwdKvi ga Kej AvBfwiKvB i cixvi Ici ev GBPAvBwf cwRwUf Ui Ici Rvi `qv nq| Rvqvi G cwZ cqvM Ki 59 _K 79 fvM mdjZv cvIqv MjI hv ivMi cv`yfvei KviY i cixvi welqwUK Acwinvh Ki ZzjQ| mvaviYZ hv msgY I ivMi cKvkjv GBPAvBwf msgYi iZB cKU nq _vK| Ze Avgv`i gZ `kjvZ GKgvmi ewk KvwkK GBPAvBwf msgYi jY wnmve MY bv Ki `xNvqx Wvqwiqv I cvZjv cvqLvbv, Ri, IRb nvm, wjbvWjv dzj hvIqv Ges evcK QvKi msgYK cavb jY wnmve ai bqv DwPZ| GZ Ki GBWm kbvKiY AbK mnR nq DVe| GB mv_ weklfve weePbvq AvbZ ne hbivMjvi mn-Aevb Ges ivMxi wecbK hbRxebi BwZnvm| GBWm ivMi jYjv wbfi Ki kixii ivM cwZivai e_Zv ev BwgDbvmvckbi mv_ mv_ GjvKvwfwK myweavev`x ivM I RxevYyi cv`yfvei Ici| hgb- BDivc GBWm ivMxiv Avv nZ cvi
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wc-24 GwURb UwU AbKUv GjvBRv Ui gZ| Ze G GBPAvBwfi GwUewW U bv Ki GBPAvBwf Kvi we`gvb cvwUb wc24K kbv Kiv nq| wc-24-Gi gZ cvwUbjv GBPAvBwf msgYi AeewnZ ci _K memgq i we`gvb _vK| G ivMxi ii c-vRgv wKsev kixi wbtmZ hKvb im _K wc-24 kbv Kiv me| ivMi mKj i wc-24 wbYq Kiv me| ivM msgYi c_g mvn Ges kl w`K hLb i cevngvb fvBivmi cwigvY ewk _vK ZLb GwU wbYq Kiv mnR| wwbs Ujv AbK mgq nvg U KxU eeZ nq| Ze bvbv KviY evwoZ G aibi cixv bv KivB fvj|
CD4 +T-cell levels :

wU-mji msLv MYbv ay ivM wbYqi RbB bq, ivMi Aev I cwiYwZ Rvbevi RbI AZ Riwi| wPwKrmvi cvcU ivMi DbwZ ev AebwZ wbYqi Rb Gi g~jvqb AwZ iZcY| wRWvfywWb Ges didanosine RvZxq ~ Ilya cqvM Kij c_g AvU mvn CD4 -Gi msLv ew cvq| wK Gi ci msLvwU Avevi wbP bg Avmvq c-vmev wUUgUi KvhKvwiZvi mv_ bvbvwea anti-retroviral drug-Gi KvhKvwiZv Zzjbv Kiv KwVb nq coQ| G KviY bvbv cwqvq fvBivj jvW cwigvc Kiv nq ivMxi cwidivj (Peripheral) i cixv Ki| 6.6.1. GBWm kbvKiYi mnR Kvb cwZ AvQ wK bv: hme vb jve myweav bB mLvb mnRfve GBWm kbv Kivi Rb wKQy jY I DcmMK wPwZ Kiv nqQ| Gme jY I DcmMwfwK ivMi msv wbaviY KiQ wek ^v msv, 1986 mb| wmwWwm-I G welq KvR KiQ| Ze Zv`i ivM kbvKiY cwZwU cqvM Kiv me Kej jve myweavcv DbZ `kjvZ| hLvb GBPAvBwf kbvKiYmn wmwW-4 wjvmvBU, wc24 GwURb wbYq Ges Abvb DbZ cixv mnRjf mLvbB GUv KvhKi nZ cvi| AbybZ weki AbK vb jve myweav bv _vKvi KviY jLK wbRI ivM wbYq I wPwKrmvi evcvi jY I DcmM wfwK wPwKrmvi Ici Rvi w`Qb| G aibi cwZZ GBPAvBwf wwbs-Gi ci ivMxi mvgwMK kvixwiK Aev, ivMi DbwZ I AebwZ msv cvivwgUvijv chvjvPbv Ki ivM wbYqi mv_ mv_ wPwKrmv Pvjvbv me| Ze GjvBRv di GBPAvBwf cixvwU mb
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Uvc-vRgvwmm, wvKvwmm, Lv`bvjxi QvKRwbZ mgmv, hv, wcwmwc, wvvwiwWqvwmm (Cryptosporidiosis) BZvw` viv| DMvv, Zvvwbqv, Rvqvimn AvwdKvi AbK `k GBWmi cavb jYjv nj fqfifve IRb nvm, cP `yejZv, Ri, Wvqwiqv, Kvwk BZvw`| GKgvmi AwaK Wvqwiqv Qvov Abvb jYjvi cKvk Ab Kvb ivMi KviYI nvZ cvi| ZvB `xN mgqevcx Wvqwiqv Qvov Ab jYjvK `yej jY ej weePbv Kiv nq| Ze Gmei mv_ gyL I Mjvq QvKi msgY Ges Mvq civBwUK cvcyjvi Bivckb (Pruritic papular eruption) _vKj cvq 77 fvM GBWm ivM ej m`n Kiv hvq| Gme jY `Lv `evi ci `Z GBPAvBwf wwbs QvovI h mg cixv Kiv cqvRb Zv nj
HIV antibody confirmatory test Full blood count Urea and electrolytes Liver function tests Hepatitis, A, B and C serology Syphilis serology HIV viral load Immune profile Toxoplasma and cytomegalovirus serology cixv|

6.6.2. mvaviY vb GBPAvBwf Avv`i kbv Kiv hvq wK? GBPAvBwfZ Avv nevi ci GKRb AvcvZt`wZ my _vKZ cvi j^v mgq| hLb ivMi jY `Lv `q ZLb Zv Abvb AbK mvaviY ivMi gZB nq _vK| Ze GB GBWmi jY `Lv w`Z mvaviYZ cuvP _K `k eQi KU hvq| Lye A msLK Avvi gaB Pvi-cuvP eQii ga jY `Lv `q| 50 fvM GBPAvBwf Avvi `k eQii ga GBWmi jY `Lv `q| Avvi `ni jY `L GKRb ` wPwKrmK GBPAvBwf U KivjB ivM kbv KiZ cvieb| Ze mvaviYZ GBPAvBwf Avv nevi `yB _K AvU mvni ga kixii ga GK aibi cwZwqv `Lv `q| GUvK GBPAvBwf msgYi AvwKDU (acute) ev kxl jY ej| GQvov GBWmi mnhvMx AmyLjv `LI ivM kbv Kiv hvq| AbKmgq cwZiva gZvi wewfbZvi KviY cv_wgKfve h ew fvBivm Qovq Zvi AvMB Zvi _K h ivM cvq m iZifve Amy nq coZ cvi| D`vniY^ic aiv hvK, K ew _K L ew Avv nj| A_P K-Gi c~e L-B iZifve Amy nq coj| wekl wekl ivMi mnvevb GBWmi weZwZ `Z NwUq _vK| GBPAvBwf AbK mgq BwgDb Kvl Nyg Aevq _vK ev jywKq _vK| G mgq wekl wekl ivMi AvgYi cvcU hLb wU-njcvi wjvmvBU Kvljv cwZiva Zwii Pv Ki ZLb cvq Nyg GBPAvBwf fvBivmjv DxweZ nq co Ges `Z wbR`i ew NUvq| G aibi h mg fvBivm GBPAvBwfK DxweZ Ki Zvi ga Dj-LhvM mvBUvgMvjvfvBivm ev wmGgwf GcBb evi fvBivm ncvUvBwUm-we fvBivm KvwWv gvBvmcvwiwWqv Ges wvmcvwiwWqvg nvicm fvBivm BZvw`| 6.6.3. AbygvbwfwK GBWm wbYq : wKwbKvj Bfvjyqkb AbygvbwfwK GBWm wbYqi Rb h ivMjv weePbvq Avbv `iKvi Zvi ga AbZg nj Lv`bvjxZ QvKi msgY| hLvb cixv wbixvi myweav bB mLvb PvL `L Ges jY I DcmMjv Abyaveb Ki ivM wbYq KiZ nq|
87

ivMi Aev wbYqi Rb gvcZ ne wmwW-4 Kvl msLv, wmwW-4 : wmwW-8, wc-24 GwURb Ges fvBivj jvW| ivMxi Aev weePbv Ki nvU (HAART) _ivwc w`Z ne| _ivwc `evi ci cixv KiZ ne

Full blood count

Urea and electrolytes Liver function tests Lipid profile Glucose HIV viral load Immune profile Weight

cv_jwRKvj cixv wbixv Ges RbvUvBwcK Gvm (Genotypic assay) Gi gvag wPwKrmvi mdjZv g~jvqb KiZ ne|
86

G cwqvq GBWmRwbZ KviY Lv`bvjxZ QvKi msgY wbYq KiZ nj hme welqi Ici iZ w`Z ne Zv nj XvK wMjZ Amyweav Ges XvK Mjvi mgq eyK e_v| mB mv_ gyL mv`v mv`v `vM, `kgvb QvK, jvjvf wgDKvmvi DcwwZ BZvw`| G gvBvvci mvnvh dvsMvj wdjvgU kbv Kiv DwPZ| mvBUvgMvjvfvBivm iwUbvBwUm: PvLi (Opthalmoscopic) cixv Ki iwUbvi ga mywbw` mv`v `vM wPwZ Kivi mv_ mv_ K` _K Qwoq co Ggb wKQy kZ wP i wkivi cvk `LZ cj Zv ivMi jY wnmve aiZ ne| GUv gvmi ci gvm evoZ _vK| GZ iwUbvi wkivjv dzj IV c`vni KviY| iwUbvZ icvZ Ges Nv-Gi wP _vK| kl iwUbvZ wPivqx wQUwQU `vM I Z nq Ges iwUbv wKq Avm (Atrophy)| gvBKvevwiqvwmm (Mycobacteriosis) : gj A_ev kixii Kvb Zij c`v_ cixv Ki AvwmW dv evwmjvB (AFB) kbv Ki GUv wbYq KiZ nq | Kvdvwmm mviKvgv (Kaposis sarcoma) : Kvdvwmm mviKvgv Ggb GKwU hbevwnZ ivM hv wK bv ZK, wgDKvm AveiY Ges kixii AfixY A Amyweav mw Ki| GUv `L kbv Kiv ek KwVb| Ze Awf wPwKrmK ZK I wgDKvm AveiY jvjvf ewb Z `L ivM wbYq KiZ cvib| GwU ZK I wgDKvm AveiYi Ici GwU GKwU AviYi gZ `kgvb nq| jvjvf ewb Zjv `Lv `q dmv MveYi ew`i ZK| Kvjv`i KvjP A_ev Lqwi `vM nq| cieZxZ ZK Ges AfixY A PvKv nZ cvi| wbDgvwmmwUm Kvwiwb wbDgvwbqv (wcwmwc) : bovPov I nuvUvnuvwUZ kvmK ew Ges k-vwenxb Kvwk G ivMi jY| wZb gvmi ewk G aibi jY _vKj Gii gvag ivM kbv Kiv nq| G ivM ii AwRbi cwigvY 70 wgwjwgUvi gvKvwii (Hg) wbP bg Avm| gwi Uvc-vRgvwmm : gMRi wekl vb A_ev bvfi wechq ev dvKvj AvebigvwjwU (Focal abnormality) wbYqi mv_ mv_ PZbvi i bg hvIqv `L G ivM
88

wbYq KiZ nq| gwi GiwmwU, GgAviAvB (CT, MRI) KiI ivM mK aviYv Kiv hvq| i Uvc-vRgvwmm GwUewW wbYqi gvag A_ev Ilya cqvMi gvag ivM wbivgqi mvdj weePbv Ki ivM wbYq Kiv me| 6.7.1. Kxfve kbv Kiv hve h GKwU wk GBPAvBwf Avv nqQ? ay GBPAvBwf wwbs Ki A_ev GBPAvBwf GwUewW kbv KiB ejv hve bv h GKwU wk GBWm ivM Avv nqQ| Kbbv, GBPAvBwf Avv gvqi Mf _K Rb bqvi ci ciB cvq me wkB GBPAvBwf cwRwUf wnmve wPwZ nq| Gi KviY c-vmUv ev Mfdzji gvag gvqi GwUewW wki ga Qwoq cov| Rbi wZb _K Qgvm ci wki kixi _K gvqi GwUewW mi Mj `Lv hve 50 fvMi ewk wk GBPAvBwf cwRwUf _vKQ bv| hviv mwZKvi A_ GBPAvBwf Avv ne Zv`i kixi bZzb Ki Zwi ne GBPAvBwf GwUewW| ZvB Qgvmi AvM GBPAvBwf msv mvaviY cixvjvK iZ `qv nq bv| Aek wc-24 bvgK GKaibi GwURb kbvKiYi gvag wki Rbi ci ciB ivM kbv Kiv hvq| Zey mvaviYfve `kgvm eqmi ci h mg wk wewfb cixvq bxivM cgvwYZ ne ZvKB GBPAvBwf gy ejv hve| 6.8.1. KLb cixv KiZ ne, Kxfve cixv KiZ ne? GBPAvBwf msgYi mvebv `Lv w`j ev AbvKvwZ Kvb hbmshvM NUj A_ev alY ev Kvb `yNUbvRwbZ KviY msgY NUj mv_ mv_B GKwU cv_wgK (Base line) cixv Kwiq bqv cqvRb| Ze GBPAvBwf GwUewW Zwi nZ Kgc Qmvn mgqi cqvRb nq| Gme ivMi msgY NUj mvaviYZ Qmvn _K Qgvmi ga cixvi djvdj cwRwUf nq _vK| 6.9.1. GBPAvBwf U msv wKQy AvBbMZ I Gw_Kvj evaevaKZv: h KvDK cixv Kievi c~e Zvi mv_ Lvjvgjv K_v ejv cqvRb Ges mwZiI cqvRb| U iRv mvaviYZ Ab KvDK Rvbvbv nq bv| GgbwK wbKURbi U djvdj RvbZ njI mwZi cqvRb nq; KLbI KLbI Av`vjZi Av`kiI cqvRb nq| Ze wekl Gme wewa-wblai eZq iqQ; hgb Byi Kvvwb, PvKzwii wbqvM`vZvmn Kvb Kvb miKvwi msvi GUv Rvbevi AwaKvi iqQ| Kvb Kvb `k mbvevwnbx, cywjk, RjLvbvq KZeiZ Kgxmn Riwi ^vmevq wbqvwRZ eweMi evaZvg~jK GBPAvBwf wwbs Kiv nq| GQvov Acvikbi c~e ivMxK, 89

i`vbi c~e i`vZvi, Riwi ^vmev MnYKvix ivMx Ges hbKgx`iK evaZvg~jKfve GBPAvBwf wwbs Kiv nq| evsjv`k hviv we`k cZvMZ, wekl Ki `k wdi Avmv cvPviKZ bvix`i GBPAvBwf wwbs Kiv evaZvg~jK nIqv cqvRb| Avgv`i gZ `wi` `k PvKwi evKwii ^v cixv Ges wivPvjK I gUihvbi WvBfvi`i jvBm c`vbi GBPAvBwf wwbs Kwiq bqv cqvRb| Kvb Kvb `k weqi c~e GBPAvBwf wwbs Kwiq bqvUv evaZvg~jK Ki AvBb cYqb Kiv nqQ| wmwdwjmi gZ Abvb hbivMi cixv Ges ii cc cixv evaZvg~jK Kiv nqQ AvgwiKvi AbK UI| Avgv`i `k cwZwU wi McK GBPAvBwf wwbs Kwiq wbZ gvwUfkb Kiv cqvRb Ges wekl evaZvg~jK Kiv cqvRb RvwZK GB gnvwechqi nvZ _K iv Kivi RbB| hviv GKK hbmK eRvq iLQ Kej Zv`i B cixvi cqvRbxqZv Zgb bB| GKwb mK I hbvPviB GBWmi wei mePq eo myiv|

Aavq mvZ
GBWmi Kv-dvi
wKQy ivM iqQ hjvZ Avv nj h KviI GBPAvBwf msgYi mvebv eY eo hvq| AbK GBWmi m Gme ivMi mnvevb _vK| Gjv GBWm msgYi Kv-dvi| 7.1 fvBivj Kv-dvi: hmg fvBivm GBWm fvBivmjvK Dx KiZ Ges Qwoq coZ mvnvh Ki Zvi ga AbZg nj ncvUvBwUm-we fvBivm (HBV) ncvUvBwUm-wm fvBivm; GUvi mv_ GBWm ivMi mswk-Zv cgvwYZ nqQ| wnDgvb-wU wjvUwcK fvBivm UvBc-1 (Human T-lymphotropic

virus type-1 ev HTLV-1) mvBUvgMvjvfvBivm (Cytomegalovirus ev CMV) GcBb evi fvBivm (Epstein Barr virus ev EBV) nvicm wmgc- fvBivm UvBc-2 (Herpes simplex virus type-2 ev HSV-2) nvicm Rvvi fvBivm (Herpes zoster virus ev HZV)

CMV, EBV, HSV 2 Ges HZV GB PviwU fvBivm GBWm ivMi iZc~Y

cfveK ev Kv-dvi wnmve KvR Ki A_vr Gme ivMi msgY nj GBWm ivM Avv nevi mvebv eo hvq| Abvb Kv-dvi : wmwdwjm, Mbvwiqv, KvgvBwWqv, RbvBUvj nvicmmn Abvb h mg hbevwnZ ivM, hbv Nv (Jenaital ulcer) I c`vn mw Ki| Gme ivM GBWm msgY mnvqK f~wgKv cvjb Ki| VvuU, Mjv, hbv, cvqyc_ I gyL-Mnii Z| gq`i Lvrbv, Kbv wgjb, NbNb wgjb I A^vfvweK hb AvPiYi KviY Gme Zi mw nq _vK| iZi hv I `xNvqx wbDgvwbqv ivM| wekl Ki wcwmwc ivM Avv ew`i ga GBWm msgYi mvebv ewk _vK|
90 91

7.1.1. hbivM Avv`i GBPAvBwf msgYi mvebv wK ewk? hbevwnZ ivMjv GBPAvBwf msgYi mvebv evwoq Kej hvwbc_ NvB Zwi Ki bv, mB mv_ GBPAvBwf UvMU Kvli msLvI evwoq `q| G aibi h Kvb msgY hvwbc_ GKwUfUW ev mwq wjvmvBU I gbvmvBUi msLv AbK Y evwoq `q| Gjv mnR GBPAvBwf viv Avv nq| Gi DcwwZZ hvwbc_ cwe fvBivm AvgYi mnR je cq hvq| wmwdwjm, nvicm, ngvdvBwjqv (Haemophilia), Wyw (Ducreye) Ges KvgvBwWqv msgYi KviY hvwbc_ Nv njI wmGgwf msgY, GcBb evi fvBivm msgY Kvb Z Zwi nq bv| Ze Gjv GBPAvBwf UvMU Kvli msLv evwoq `q| Gme KviY GB hbevwnZ ivMjv GBPAvBwf msgY iZc~Y Kv-dvi wnmve weewPZ nq| hbivMvv mgKvgx`i ga wmwdwjm I MbvwiqvRwbZ Nv I KvgvBwWqvRwbZ c`vn GBPAvBwf msgY mnR Ki `q| Gi Ici cvwmf mgKvgx`i ga AbKi ngviqW (cvBjm) ivMi Z, Gbvjwdkvi ev dU hvIqv gjvi I Gbvj IqvUm GBWm msgY wekl f~wgKv ivL| Nv ev Z `yfve GBWm msgY mnvqZv Ki| Zi KviY GBPAvBwf RxevYy mivmwi i mswgZ nZ cvi; AbwU BwgDwbwU msv hv civ mnvqK f~wgKv ivL UvMU Kvl mwi gvag| VvuU I gyLMnii Z GBPAvBwf msgY mnvqK f~wgKv ivL| G KviY hbwgjb KbWg eenvii mv_ mv_ ARvbv APbv KviI mv_ wgjbi Iivj m cwinvi Kivi Dci Rvi `qv hvQ| cqvRb WUvj Wvg ev GK aibi jvU evwiqvi eenvi KiZ ne| Rvbv _vKv cqvRb, VvuU I gyLi gvag GBPAvBwf msgY Kg njI GUv Ame bq| GQvovI G c_ Mbvwiqv, wmwdwjm I nvicmi gZ hbivMi msgY nq _vK| 7.2.1. ngvdvBwjqv ivMx (Haemophilia patients) : ngvdvBwjqv Avv`i Rb KwUs dvi eenvii AvM Zv GBPAvBwf wwbs Kiv cqvRb| 1980 mbi c~e GLbKvi gZ Zvc cqvMi gvag i weKiY eevi cPjb wQj bv| ZLb Kej i cwimvjb I wPwKrmvi KviY AvgwiKvq h_vg 80 fvM I 50 fvM GBWm ivM Avv nqwQj| AvRK m cwiwwZ bv _vKjI ngvdvBwjqv ivMvv`i ga GBWm msgYi NUbv kl nq hvqwb| mivcwRwUf ngvdvBwjqv (Haemophiliacs)-`i hbmxiv `k _K wek fvM GBPAvBwf Avv nq| nvgvdvBwjqvK`i kixi dvi-9 `evi c~e Zv wbqggvwdK wijvBRkb Ki wbj iZB GBPAvBwf cwZiva Kiv me| hvwbc_ `yMhy mve : KviI hvwbc_ `yMhy mve nj Aenjv bv Ki `Z Wvvii civgk wbZ ne| KD hbivM Avv nj H ivMi cixvi mv_ mv_ GBPAvBwf,
92

wmwdwjm, Mbvwiqv, KvgvBwWqv, ncvUvBwUm-we I ncvUvBwUm-wm, mve nvicm ivMi DcwwZ cixv Kwiq wbZ ne, wekl Ki hLb Kvb hbivM mvaviY wPwKrmvq wbivgq nQ bv| hviv ncvUvBwUmwe ivM Avv Zv`i ga GBWm msgYi mvebv ewk| ZvB ncvUvBwUmwe wwbs Kiv Ges mevBK fvKwmb `qv AwZ Riwi| 7.3.1. bvix`i ga h KviY GBPAvBwf mswgZ nq : bvix`i ga GBPAvBwf msgYi GKwU cavb KviY nj BbRKkbi gvag bkv MnY Ges bkv MnYKvix`i m wgjb| hyiv 41 fvM bvix BbRKkbi gvag gv`K MnY Kivi KviY GBPAvBwf Avv nq _vK| 38 fvM bvix GBPAvBwf Avv nq bkvM `i m hbwgjbi KviY A_ev GBPAvBwf Avv cyil ev bvixi m hbwgjbi cvcU| bvix `ni `yej w`K nj GKwU weZ wgDKvmv AveZ hvwbc_| Gi ga cPzi ievnx wkiv Ges UvMU Kvl we`gvb _vKvq bvixiv mnRB GBPAvBwf Avv nq| gq`i hbivMi mv_ h jYjv GBWm msgYi mvebvi K_v gb Kwiq `q Zv nj vqx `yMhy mve, hvwbc_ evievi Zxe A^vfvweK QvKi msgY (KvwwWqvwmm), mBmv_ wjGvWvbvcvw_, wewfb evwiqvRwbZ ivMi Nb Nb msgY, mB mv_ Ri, Kvwk, IRb nvm BZvw`| G hbivMi KviY wbYqmn mvifvBKvj cvcwqvi (Pap smear) Kiv cqvRb, wekl Ki mvifvBKvj wWmc-wkqv I vqvgvm mj Kvwmbvgv (Squamous cell carcinoma ) wbYqi Rb| GBWm ivMi mv_ mvifvBKvj wWmc-wkqv, mvifvBKvj BUvBwc_wjqvj wbqvc-vwmqv (Intraepithalial neoplasia) A_ev vqvgvm mj Kvwmbvgv nq _vK| Gme ivMi KviY GBWm msgYi cwiekI Zwi nq _vK| hvwbc_ wKQy wKQy QvKi msgY I `xNgqv`x msgYi KviYI GB aibi ivMjv nZ cvi| jLKi MelYvq cgvwYZ nqQ fvRvBbvj B-Gi msgY, KvwwWqvwmm Ges wekl aibi BKvjvB msgY hvwbc_ hgb GBPAvBwf msgYi mnvqK cwiek Zwi Ki, Zgwb mvifvBKvj Kvvi I Kvdvwmm mviKvgv ZwiZI wekl f~wgKv ivL| bvix I nUivmyqvj cyil`i ga Kvdvwmm mviKvgvi nvi AwZ bMY| mgKvgx`i ga DPnvi cvIqv hvq Kvdvwmm mviKvgv| hv`i Gvbvj IqvUm iqQ Zv`i gaB Kvdvwmm mviKvgv iqQ|
93

G cvcU Kvb Kvb MelK mgKvgx`i ga sexually transmitted agent-Gi GKwU wekl f~wgKvi K_v gb Kib| m~- Beral V. Peterman,
TA, Berkelman RI, et al Kaposis Sarcoma among persons with AIDS a sexully transmitted infection; Lancet 1990, 335; 123-8|

7.4.1. hmg fvBivm GBPAvBwf msgYK Zivw^Z Ki : hmg fvBivm BbdKkb GBPAvBwf msgYK Zivw^Z Ki Zvi ga Dj-LhvM nj ncvUvBwUm-we fvBivm Ges wnDgvb wU-wjvUwcK fvBivm (HTLV1 )| Abvb h fvBivmjv Kv-dvi wnmve KvR Ki mjv nj mvBUvgMvjvfvBivm, nvicm wmgc- fvBivm, nvicm Rvvi fvBivm BZvw`| mgKvgx`i ga mvBUvgMvjvfvBivmi DcwwZ GBWm msgYi mvebv evwoq `q| Ggwb Ki BbRKkbi gvag gv`Kmex`i ga GBPwUGjwf-1 GBPAvBwf msgYi mvebv evwoq `q| AbK MelKB gb Kib, mvaviYfve hvi DcwwZ Ges mgKvgx`i ga GUwiK ciRxex (Enteric parasite) GBPAvBwf msgYi mnvqK cwiek Zwi Ki| Ze hv msv GB c~evbygvbwU mK AbK mskq cKvk KiQb|
mvBUvgMvjvfvBivm msgYi mv_ Kvdvwmm mviKvgvi GKwU mK

Aavq AvU
GBPAvBwf msgY SuzwKc~Y Rxeb hvcb
8.1 UvMU Mc mve GBPAvBwf Avv`iK wec`i gvv Abyhvqx wZbwU Avjv`v KvUvMwiZ fvM Kiv hZ cvi; h_v 8.1.1. KvUvMwi-1 : kxl Suwy KZ hviv (High Risk Group) mKj aibi hbKgx; hgb gwnjv hbKgx cyil mgKvgx/hbKgx BbRKkbi gvag hviv WvM MnY Ki (Injectable Drug Users ev IDUs) fvmgvb hbKgx (FSWs)| Giv wbewZ bq, G`i wbw` Kvb evmvbI bB| eo knijvi ivv I cvK G`i Avevmj| eMvgx bvix I cyil| GBWm Avv MfeZx gvqi mvbiv| AvtRjv I AfixY evm-UvKi WvBfvi, njcvi, Kvi Ges Zv`i cwievi I AvZxq^Rb| GB kYxi k Rxexiv mvaviYZ wewfb aibi g cwZZv`i mv_ wgwjZ nq| j e`ijvZ Avg`vwb ivwb I cwienb KvR wbqvwRZ ewnivMZ jvKRb, kwgK I WvBfviiv| GQvov mgy` e`ijvZ AvMZ RvnvwR I we`kx bvweK| Giv G`k Gm wewfb hbKgx`i mv_ gjvgkv Ki| wivPvjK I wewfb aibi w`bgRyi| Giv fvmgvb cwZZv`i mv_ wgwjZ nq| we`k cvPvi nq hvIqv bvix hv`iK ci Dvi Ki `k diZ Avbv nq| cywjk, bvBU MvW, `vivqvb kYxi jvK hviv wewfb fvmgvb cwZZv`i m wgwjZ nq|
95

iqQ| Kvdvwmm mviKvgvi Dei cQb gyL I cvqyc_ wbtmZ GKwU DxcK ei K_v wPv Kiv hvQ| GUvi bvg `Iqv nqQ myqvwj UvwgUW KGm GRU wnmve| MelKiv GUvI gb KiQb h, GUv AvgwiKv _K eUb mswgZ nqQ| (m~ : Beral-V, Bull-D,
Jaffe-H, etal Is risk KS in AIDS patients in Britain in sexual partnars came from US or Africa; BMJ 1991; 302 : 624-5)

jLK wbRI Gbvivj GRUK ay KGm-B bq, GBWm msgYiI GKwU AbZg KviY wnmve weePbv Kib| 7.5.1. GBWm ivMi ii m dzi Kvb mK AvQ? mvwZK mgq nsKs, Pxb, KvbvWvmn bvbv `k mvm fvBivmi AvNvZ Ges Avv`i ga cvq 15 fvMi gZz wekevcx fxwZ mw KiQ| Ze GBPAvBwfi mv_ G ivMi mK GLbI Rvbv hvqwb| GBWm Avv`i ga Kv fvBivm ev dzi msgY wbq MelYv Ki `Lv MQ GBPAvBwf AvgYi iZ Gme cwZiva wKQyUv me njI cieZxZ GUv gvivZK AvKvi aviY Ki| G KviY fvKwmb w`q cwZiva Kiv hvq Ggb AmyLjv cwZivai Rb h_vh_ eev MnYi mycvwik KiQ wmwWwm| dz fvKwmb cqvM GBPAvBwf Avv`i ga Zgb Kvb mgmv nq bv| mvaviYfve fvKwmb cqvMi mgmvi Pq bZzb ivM msgYi fqvenZv I wec` AbK ewk _vK|
94

 GBPAvBwf Avv`i cwievi I wbKU AvZxq^Rb| mnR Avv nZ cvi Ggb eweM Zv`i cwieviI AvZxq^Rb| ckv`vi i`vZv| 8.1.2. KvUvMwi-2: hv`i Avv nevi mvebv AvQ (Potential Threat
Group)

8.2. wewfb ckv, kYx I eqmi jvKi ga GBWmi mvebv : 8.2.1. Kv`i Rb GBPAvBwf wwbs evaZvg~jK? hv`i ga ivMi jY `Lv MQ Zv`i Zv wwbs KiZB ne, GQvovI hviv mcwZ I AZxZ BbRKkbi gvag bkv`e MnY KiQ| mcwZ I AZxZ hv`i hbmx BbRKkbi gvag gv`K meb KiQ| cvUvb-2 `kjvi bvix A_ev cyil`i m hv`i hbmshvM NUQ| ngvdvBwjqvZ Avv`i mv_ hviv gjvgkv KiQ|

hviv ninvgkv we`k hvIqv Avmv Ki| hviv we`k wewfb aibi PvKwi Ki Ges `xNw`b ci ci `k di| mbvevwnbxi h mKj m`m we`k wewfb kvwiv wgkb KvR KiQ| we`kx h me Ljvqvi evsjv`k LjZ AvmQ ev wbqwgZfve vbxq jxM LjQ, wekl Ki AvwdKvi `kjvi Ljvqvie`| hme we`kx evsjv`k hvIqv Avmv KiQ, _vKQ Ges wewfb KvR wbqvwRZ iqQ| mxgv GjvKvq PvivPvjvbi KvR wbqvwRZ bvix I cyil| Giv wewfbfve eeZ nq| mxgv ivq wbqvwRZ wewWAvi m`miv| 8.1.3. KvUvMwi-3: Avv nevi hviv bvRyK Aevq AvQ (Vulnerable
Group)

hviv hyiv 1978-1985 mbi ga i MnY KiQ Ges Abvb

`k hviv wwbs wenxb i MnY KiQ|

hviv eZgvb I AZxZ GKvwaK jvKi m gjvgkv KiQ|

Kvwiweqvb Ges AvwdKvi mve-mvnviv Aj emevmiZ A_ev H Aj _K Awfevmx bvix-cyil| h mg bvixK Kwg Dcvq exh mvjb Kiv nqQ| 8.2.2. Kvb eqwm`i ga GBWm msgYi mvebv ewk? AvgwiKvi GK cwimsLvb `Lv hvQ, 14-21 eqm mxgvi ga 63 fvMB wewea hb mK wj| GB eqwm`i ga bvbvwea hbmK wj iqQ evsjv`ki wKkvi, wKkvix, ZiY I ZiYxivI| G`i ga GBWmmn Abvb hbivM msgYi mvebv ewk| ivg cwimsLvb `Lv hvq, GB eqmmxgvi gaB cvq 33 fvM evsjv`kx hb AwfZvcv nq A_ev hb wbhvZbi wkKvi nq| Ze GwU Kvb RvZxq chvqi Rwic djvdj bq| Aci c, GBPAvBwf Avv bvix`i 88 fvMB 15-44 eqmmxgvi ga Ges mevP chvq Avv nQ 30-39 eqm mxgvi bvixiv| GB eqmx`i ga Aea hbmshvMi NUbv ewk nIqvq G`i ga GBPAvBwf Qwoq covi weivU mvebv iqQ| ZvB KbWg eenvii wkvUv Ges GBPAvBwf msv Z_ GB eqmmxgvi gaB Qwoq w`Z ne| GZ `ki ZiY mc`vq ay GBPAvBwf _KB iv cve bv, wewfb hbivM _KI myiv cZ cvie| RvwZmsNi gnvmwPei wekl cwZwbwa W. bvwdm mvw`K MZ 16 Rvbyqvwi 2003 Dj-L Kib h, Despite low prevalence of HIV/AIDS, less than
97

mgKvgx bvix I cyil hviv hvwbc_ I cvqyc_ Dfq c_B gjvgkv Ki| BbRKkbi gvag hviv WvM MnY Ki| nvmcvZvji wPwKrmK, bvm I Abvb Kgx, cv_jwR I i mvjb wefvMi Kgxmn mswk-iv| `wi` KgRxex bvix kwgK, weklZ MvgUm I Abvb Kg hviv KvwqK kg `q| `vwi`i KviY Giv eeZ nq| wegvbe`i, mgy`e`i, je`i wKsev Gme e`ii Avkcvk wewfb Kg I eemv evwYR wbqvwRZ jvKRb Ges Zv`i cwievi I AvZxq^Rb| wewfb hbivM (STD) Avv bvix I cyil|
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one percent among sex workers, Bangladesh is a high-risk country for many reasons.

wZwb AviI Rvbvb, There are thirty million people below the age of
twenty years, and there is evidence that young people are experimenting with commercial sex and multiple partners. Only 19 percent of ever-married women and 33 percent of currently married men had ever heard of AIDS. High infection rates among the drug users and unsafe blood transfusion are among the basic modes of HIV transmission.

mgKvgx`i cyili Pq bvixi ga GBWm msgYi nvi ewk| G welq jLK gb Kib h, GBWm msgYi mnvqK cwiek Zwi KiZ cvi Ggb aibi evwiqv I QvK iqQ gjvkq| GwU x hbv cwe nj GBWm msgYi mnvqK cwiek Zwi nq Ges cyil hbvi Pvgovi wbPI Abyic f~wgKv ivL| mgKvgx`i gvS gvS GBPAvBwf wwbs KivZ ne| G`i hbv I Gi Avkcvk, Mjvq hme Z I Nv nq mjv Aenjv Kij GBWm msgYi mvebv eo hve| GRb cqvRbxq wPwKrmv MnY Ki Z ev Nvjv mvwiq ZzjZ ne| 8.3.2. Iivj m: myivmn Iivj m, Pz^b, Avwjb, Av`i, gvmR BZvw` GBPAvBwf msgYi mvebv LyeB Kg| GBPAvBwf Avv ewi mv_ Iivj m GKevi wec`gy Kvb welq bq| Avi KbWg Qvov cvqyc_ wKsev hvwbc_ wgjb Zv fqi wecbK| cvqyc_, hvwbc_ Ges cyil hbv jnbi gZ hbwqvZ fvBivm msgYi nvi Zzjbvg~jKfve Kg njI Zv Av` wbivc` bq| hvwbc_ I cvqyc_ jnbi AviI wecw nj GB, G cwqvq ncvUvBwUm-we, nvicm wmgc-, wmGgwf, wmwdwjm, Mbvwiqvmn bvbv aibi ciRxex I hbivM msgYi mvebv iqQ| G KviY GUvK AvcwKfve wecbK hb AvPiY wnmve wPwZ KiQb jLK| G cwqvq GBPAvBwf msgYi mvebv _vKvq wPwKrmKMY jvU evwiqvi I WUvj Wvg eenvii civgk `b| 8.3.3. jmweqvb`i Suwy K bvixi m bvixi hbmshvM A_vr jmweqvb`i ga GBPAvBwf msgYi mvebv Zzjbvg~jKfve AbK Kg| Ze G`i ga VuvU I hvwbc_i mshvMi gvag GBWm QovZ cvi| AvgwiKvq cwiPvwjZ GK MelYv wicvU _K Rvbv hvq, GKnvRvi GBPAvBwf Avvi ga gv GKRb bvix Ab bvixi m hbmshvM wj nqwQj| jmweqvb`i ga hviv GBPAvBwf Avv nqQ Zv`i AwaKvskB Ab cyili mv_ hbmshvMi dj ev BbRKkbi gvag bkv`e MnYi KviY GBPAvBwfZ Avv nqQ| h me cwqvq jmweqvb`i ga GBPAvBwf msgY NUZ cvi Zvi ga Dj-LhvM njcvqyc_ I hvwbc_ jnb Ges GKvwaK bvix KZK GKB hb 99

8.3 hb AvPiYi m GBWmi mK: 8.3.1. mgKvgx`i ga GBWm msgYi SuywK KZUzKz? mgKvwgZv GBWm msgYi AbZg KviY| ZvB G Afvm cwinvi KiZ ne| Ze GKevi cwiZvM Kiv bv Mj Zv`i Rb wekl KZjv ^vwewa gb PjZ ne| cvqyc_ I hvwbc_ wbqwgZ cwivi cwiQb ivLZ ne Ges wgjbi c~e AekB KbWg eenvi KiZ ne| mgKvgx`i cvqyc_ wgjb (Insertid) Qvov Avi hfve GBWm QovZ cvi Zv nj Ggb me hbwqvq AskMnY hvZ gjvi I gyLi ZK Ges wgDKvmvq Z mw nq| nvZ, Avyj ev KwVb Kvb ei eenvi G aibi Z mw KiZ cvi| gjvkqK Wyk viv cwivi KivKI GBPAvBwf msgYi GKwU mnvqK KviY ej gb Kiv nq GB KviY h, GZ gjvkqi wgDKvmv wKq hvq Ges mnR dU hvIqvi mvebv Zwi Ki| viwgmvBW (Sparmicides) AbK mgq hvwbc_ c`vn Zwi Ki wec` evwoq w`Z cvi| hvwbc_ jnbi (Kvwbwjvm) KviY fvBivm msgYi mvebv djvwmI ev cyil hbv jnbi Pq Kg| Kbbv exhi Pq hvwbc_ fvBivmi cwigvY Zzjbvg~jKfve Kg _vK| mgKvgxiv GKmgq GgvjbvBUU I eyUvjbvBUU eenvii gvag GBPAvBwf msgYi mvebv evwoqwQj hyiv| GK mgq AbK MelK GjvK Etiologic agent wnmve gb KiQb| Gjv eenvii gvag GKRb hgb wecbK hb mK wj nq, Zgwb Gme e ii wkivjvK cmviY Ki ivM cwZiva gZv Kwgq (Immune suppressive) GBPAvBwf msgY mnvqK cwiek mw Ki|
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Ljbv eenvi| Ze GwU GKwU MY mvebv| ZZxq wek bvix`i ga GBPAvBwf msgYi cavb KviY GBPAvBwf Avvi mv_ hvwbc_ ev cvqyc_ wgjb| hv`i GKvwaK hbmx iqQ Ges hviv cvqyc_ I hvwbc_ Dfq w`KB gjvgkv Ki Zv`i ga GBPAvBwf msgYi nvi ewk| ZvB Gme ^vfvweK cwZiv eevi mv_ mv_ hvwbc_ I cvqyc_i cwiQbZvi Ici Rvi `qv hvQ| w`b `yevi Gme vb cwivi cvwb, cUvk wgwkZ cvwb, Kvwib hy cvwb, AvqvwWb BZvw` w`q ayq djZ ne| gjvgkvi ci hvwbZ AewZ Zij wbtmiY I exh fvjfve ayq djZ ne| 8.3.4. nUivmyqvj`i ga DP nvi GBWm msgYi KviY hyivI nUivmyqvj mKi KviY GBWm msgYi mvebvwU geagvb| 1989 _K 1995 mb ch QeQii ga G msLvwU PZzY nqQ| Gi KviY nUivmyqvj`i ga hb myiv MnY Kievi ceYZv Lye Kg| bvbv ARynvZ Zviv KbWg eenvi Avcw Rvbvq Ges Zviv GiKg wekvm KiZ Pvq h, GBWm Kej mgKvgx Ges bkvMnYKvix`i gaB NU _vK| GQvovI wKQy GBPAvBwf Avv ew wPwZ bv nevi KviY bxie GBWm Qwoq hvQ Zv`i eMvgx mKi gvag| 8.3.5. GKKMvgx : Mvcb mKi gvag GBWm msgY GKK ev gbvMgvm mKi welqwU AvwiK A_ GUv evSvq h GKRbi m Ab AviKRbi mviv Rxebi mK| GKRbi ci GKRb GKvwaK mx eenvi Ki GKvwaK wewQb GKK mK (Serial monogamy) mKi `vI iqQ| ZZxq wek GKi ci GK x MnY wKsev AvBbMZ mKi evBi mK vb G aibi wewQb GKK mKi D`vniY| G mKI wec`gy bq| `kZt GKwb `wZ`i ga KD Mvcb GK ev GKvwaK hb mK vcb Kij GBWm msgYi mvebv I wec` eo hvq| mx`i GBPAvBwf msv Aev AvZ _vKvi KviY GKK mKi Zzjbvq GKvwaK mK eY GBWm msgYi mvebv evovq| mgKvgx`i ga GK cwimsLvb `Lv MQ cuvPRbi AwaK ewi m mshvM GBWm msgYi mvebv 18 Y ew Ki| 8.3.6. `xNKvji GKK mxi KvQ _K Kxfve GBPAvBwf msgY nZ cvi? GBWm cwZiva hbmxK KZUzKb Rvbv cqvRb? z
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hbmxi AZxZ hZ ewk ARvbv _vKe wKsev Zvi bvbv Mvcb mK hZ AvZ _vKe ZZ ewk hbevwnZ ivM Ges GBWm msgYi mvebv evoe| Kbbv, msLvMwi eMvgx`iB GBPAvBwf wwbs Kiv nqwb| ZvQvov AbK bZzb ev cyivbv mx Zv`i ivM msgYi welqwU MvcbI KiZ cvi| G KviY hv`i hbmx GKvwaK Zv`i ga GBPAvBwf msgYi mvebv ewk| Gmei cvcU bZzb mxi mv_ mshvMi c~e KbWg eenvi

Kiv DwPZ|

8.4.1 eMvgx: eMvgx`i GBPAvBwf msgYi mvebv ewk Kb? eMvgx`i GBWmn wewfb hbivM msgYi mvebv mePq ewk| eMvgx`i hb^v iv KivI KwVb evcvi| G KviY eMvwgZvi Kz-Afvm cwiZvM Ki GKRb gv mx eQ bevi j mvgvwRK Av`vjb Mo ZzjZ ne| hviv GKvwaK evwi mv_ gjvgkv KiQb wKsev Kib Zv`i meviB GBPAvBwf wwbs Kwiq bqv cqvRb mKji wbivcvi RbB| G KviY weqi AvM cv-cvx Dfqi hbevwnZ ivMmn GBPAvBwf wwbs Kwiq wbwZ nZ ne| eMvgx`i mvaviYZ h ivMjv nq Zv nj iKviU nvicm Rvvi (Recurrent herpes zoster), cvwcjvgv, wmGgwf BbdKkb, Bwewf BbdKkb, wnDgvb wjvmvBwUK fvBivm msgY BZvw`| Gjvi ek KqKwU Avevi Kvvii KviY nZ cvi| hgb wmGgwf fvBivm Zwi Ki Kvdvwmm mviKvgv, wekl Ki mgKvgx`i mnhvMx mx`i ga| wmwdwjm, Mbvwiqv, KvgvBwWqvmn wewfb hbivM msgYi cavb KviY eMvwgZv Ges ivMvv`i mv_ wgjb| wmwdwjm GBWm msgYI mnvqK f~wgKv cvjb Ki| mvaviYfve mgKvgx, eMvgx I hbKgxiv wewfb hbivMmn Kvvi Avv nq ewk| 8.5.1 hbKgx`i Rxeb: G`i GBPAvBwf msgYi mvebv ewk Kb? evaZvg~jKfve hbKgx`i cwZgvm GBPAvBwf I Abvb hbivM msv PKAvci eev KiZ ne| Amy cwZZviv hvZ KvR bv Ki mRb Zv`iK wbivc` vb mwiq djZ ne| hbKgx`i bvbvwea wecbK gjvgkvi KviY GBPAvBwf msgYi mvebv evwoq `q| wekl wekl fMwjK Aji hbKgx`i ga DPnvi GBPAvBwfi DcwwZ Ges G`i mv_ wecbK gjvgkv AbK `kB GBPAvBwf msgYi AbZg KviY| KbWg eenvimn wbivc` wgjb
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Ges `~wlZ exh, hvwbim I ii mv_ mshvM cwinvi Gme GBPAvBwf msgYi mvebv Kwgq `q | GiciI hbKgx`i mv_ gjvgkv wecbK G`i bvbv aibi mxi wecbK AvPiYi KviY| bvbv eYi, bvbv RvZi AmsL mxi h KviI kixi _K fvBivmwU Qwoq coZ cvi G`i `n| Gici GivB fvBivm msgYi Drm wnmve KvR Ki| Gme KviY wewfb `ki ^vKgx I GbwRIiv hbKgx`i Dy KiQ hb myiv MnY Kievi Rb| G`i hb^v ivi mv_ mv_ wdgj KbWg eenvii Ici Rvi `qv nQ| mB mv_ G`i MvnK`iK KbWg eenvi Dy KiZ ejv nQ| GZ KvRI nQ| wdgj KbWgi MnYhvMZv Zgb AvkveK bv njI ZZxq weki `kjvZ Gi mdj eenvii mvebv iqQ| Ze Dchy wkvi Afve AbK hbKgx GKwU wdgj KbWg GKvwaK cyili Rb eenvi KiQ| G KviY KbWg DcwZ GKRbi exhi mv_ Abi hbvi mshvM NUQ Ges GBPAvBwf msgYi mvebv _K hvQ| wdgj KbWgi jyweKUi mv_ fvBwimvBWvj cqvMi Ki G msv wkvi cmvi G Aevi DbwZ NUvZ cvi| evsjv`ki cvcU AviKwU iZc~Y welq nj, GLvbKvi `wi` hbKgxiv mvgvwRK Aevbi KviY AbK MvnKK KbWg eenvi eva KiZ cviQ bv| G mK G eBqi ZZxq Aavq AvjvPbv Kiv nqQ| G cwqvq hviv KbWg eenvi KiQ bv, Zv`i h KD ivM Qwoq `evi mvebv ivLQ Ges wbRivI mswgZ nevi vi Dby KiQ| y Gi Ici iqQ mwVK cwZZ KbWg eenvii wkvi Afve| hbKgx`i eywSq `qv cqvRb h, MvnK`i exh Ges hbimi mv_ msk Zv`iK Gwoq PjZ ne| Zv`iK Lqvj ivLZ ne h, Gjv hb KvbfveB Zv`i hvwbc_, Zvbhy ZK ev wgDKvm AveiYi mv_ msk bv Avm| GQvov gjvgkvi ci cwiQbZvi welqwUI G iZc~Y| hbKgx`i nvZ I hvwbc_ mvevb, fvBwimvBWvj BZvw` w`q aZKiYi welqwUi Ici Rvi `qv cqvRb wbR`i cwiQbZv Ges bvbv ivM cwZivai RbB| 8.5.2 h me hvwbc_ fvBivmhy exh we`gvb _vK: hv`i GKvwaK hbmshvM NU (hgb, hbKgx`i ga) hbwqvi ci hvwbc_ fvBivmhy exh ek wKQyY we`gvb _vKZ cvi| GwU Ab bxivM ewK ivMvv Kivi gZv ivL| G KviYI hviv GKvwaK jvKi mv_ wgwjZ nQ Zv`i hvwbc_ hbwqvi ci ayq djv cqvRb|
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Gme Ici Dwj-wLZ aZKiY cwZZ hvwbc_ cwivi Kij fvBivmi msLv Kg Avme| Ze Zv KLbB MvnKi wbivcvi MvivwU bq| hbKgxi wbRi Rb Zv bqB| 8.6.1 hbmshvM: cvqyc_ wgjb cvqyc_ Kvb KvUv-Quov ev Z bv _vKjI cvqyc_ wgjb wecbK| gjvkqi big jvjP AveiY ev wgDKvmvi wbP gv Kvl (M-cell) Ges jvvinv (langerhans) Kvl bvgK `yaibi Kvl _vK| Gjv ewnivMZ c`v_i mv_ mv_ fvBivmK `Z BwgDb Kvli KvQ wbq hvq| GB `Z cwienb eevi KviY GBPAvBwf fvBivm BwgDb eevK PURjw` AvNvZ KiZ cvi| hme KviY cvqyc_ wgjb GBPAvBwf msgYi mvebv evo Zvi ga AbZg nj wgDKvmv wQuo hvIqv Ges AvNvZcv nIqv| G aibi BbdKkbi KviY GBPAvBwf msgYi nvi wY eo hvq| AviKwU iZc~Y welq nj hbmshvMi mgq ivMi i Ges i we`gvb fvBivj jvW| ay ivMi kl chvqB bq, GBPAvBwf AvwKDU BbdKkbi cv_wgK chvq fvBivj jvW ewk _vKvZ G mgq hKvb aibi wgjb AwaK nvi ivM Qovq| Avi ivMi kl chvq fvBivj jvWi welqwU Zv mnRB evaMg| GQvov myiv Qvov cvqyc_ wgjbi msLv Ges mxi msLvi mv_ mv_ ivM wevii GKwU mK iqQ| hZ ewk myiv Qvov wgjb ne ZZ ewk ivM Qove| Ze mgKvgx mx`i KDB hw` GBPAvBwf Avv bv nq Zvnj ivM msgYi mvebv _vK bv| Aek Abvb hbivM msgYi mvebv _KB hvq| GZ GBPAvBwf msgYi mnvqK cwiekI Zwi nq| mgKvgx`i ga A_vr cvqyc_ hbmshvM AskMnYKvix `yciB mvebv _vK GBPAvBwf msgYi| KbWg Qvov G aibi mshvMi cyilv GKw`K hgb gjvkqi wgDKvm AveiY I Zvi Zi gyLvgywL nq, Abw`K Zgwb cyilv we`gvb Z ev AuvPo Dy c_ Zwi Ki `q GBPAvBwf fvBivmi Rb| Avi G aibi Z Qvov fvBivm kixi cek KiZ cvie bv, GUvI wVK bq| g~bvjxi wgDKvm AveiYi wbP ivM cwZivaKvix Ggb me Kvl (gv Kvl, jvvinv Kvl BZvw`) _vK hv ewnivMZ kjvK BwgDb Kvli KvQ wbq hvq cwZiva eev Zwi Kievi RbB| G cwqvq G Kvljv NvZK GBPAvBwfKI wbq hvq BwgDb Kvli wbKU| GiciI GwU mwZ h,
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mnhvMx mx ev wimwf mx (receptive partner) Zvi AvKwUf ev mwq mxi Pq wY gvvq wec` enb Ki GBPAvBwf msgYi | Gi cavb KviY nj GBPAvBwf cwRwUf ewi exh AmsL fvBivmi DcwwZ Ges gjvkqi weZZ RvqMv Ryo wgDKvm AveiYi weZwZ| Gme KviY cvqyc_ wgjbi AekB KbWgi gZ myivi eev wbZ ne Ges cvqyc_ hb AvNvZcv bv nq mw`K Lqvj ivLZ ne| GQvov RbwUK KviY cvqyc_ wgjb ceYZv hv`i ga cfve wevi KiZ cvi bv, Zv`i Pv KiZ ne G aibi A^vKi gjvgkv cwinvi Kievi Rb| 8.6.2. cvqyc_ wgjb AvKwUf I mnhvMx (Passive) mx`i Suwy K KZUzKz ? mgKvgx`i ga mnhvMx mx`i wbKU _K GBWm msgYi welqwU LyeB iZc~Y| G wecyj msLK GBWm fvBivm Avkq bq exh| mvaviYfve gjvi Ges iKUvg Lye cvZjv wgDKvmv viv AveZ _vK| gjvi I iKUvg i mieivnKvix wkiv ewk _vKvq Ges NlYi viv Z mwi KviY GBPAvBwf fvBivmi msgY ewk nq _vK| GQvov gjviwU Zzjbvg~jKfve mi, kKvZi I msKvPbkxj nq _vK| Gme KviY cvqyc_ hbwgjb AwZmnR bvbvwea Z Zwi Ki Ges GBPAvBwf msgYi SuywK evovq| GQvov GB vb we`gvb gv Kvl (Mast cells) I jvvinv Kvl (Langerhans cells) Lye mnRB ewnivMZ ejvK BwgDb eevi wbKU nvwRi Ki| gjvii i mieivnKvix wkivjv KZ mnR ewnivMZ eK ii fZi wbq hvq Zvi GKwU D`vniY nj Ri I e_vbvkK Ilyajvi kvlY ev AveRic&kb Kvhg| e_v eva Kg hvevi KviY gjvi Z eo hvevi mvebv _vK| GBPAvBwf fvBivm GKviYI mivmwi BwgDb eevK AvNvZ KiZ cvi| 8.6.3. bvixi cvqyc_ cyili wgjb : MelYvq `Lv MQ h, 20 fvM bvix-cyil bvbv KviY G aibi hbmshvM NwUq _vK| Gi ga Dj-LhvM KviYjv nj mZxZ iv, MfaviY cwinvi Ges Kvb Kvb wbQK hbAvb` I ewPi Rb| GQvov AcwZiva nvgvmyqvj ceYZvi mv_I Gi GKwU Dj-LhvM mK iqQ ej jLK gb Kib| cyil`i gZ bvix`i mv_ cvqyc_ wgjbi wec`i mvebv GKB iKg| ay GBPAvBwf cwRwUf cyili mv_ my bvixi wgjbB wecbKfve ivM Qovq bv, GBPAvBwf cwRwUf bvixi mv_ my cyili wgjbI GKBfve ivM msgY NU _vK|
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cvqyc_ mKj aibi wgjb KbWg Zv eenvi KiZB ne, ZvQvov Rvbv GBPAvBwf cwRwUf ewi mv_ hbwgjbi cvqyc_ cwinvi Kiv wbivc`| Avi GBPAvBwf cwRwUf`i Rb mePq wbivc` nj mve mKj hbmshvM cwinvi Kiv| Aek wekl wekl Zviv wPwKrmKi civgk mKj myiv wbq vqx GKK mxi mv_ wbivc` hbwgjb NUvZ cvi| G Dfq mxKB ZZxq ci mv_ hbmshvM eRb KiZ ne Ges wbR mwZZ ^vKgx`i Zveavb _vKZ ne| G Zv`i AvcwKfve wbivc` hbmshvM mK fvj aviYv _vKZ ne| wbivc` hbmK welq GB M wevwiZ AvjvPbv nqQ| 8.6.4. cvqyc_ wgwjZ njB GKRb GBWm Avv ne wK bv : cvqy c_ wgwjZ njB h GKRb GBWm Avv ne, Ggb Kvb K_v bB| GBPAvBwf Avv cvwmf ev mnhvMx mxi mv_ wgwjZ nj ZeB GBWm fvBivm msgYi mvebv _vK| Avi mwq mnhvMx hLb GBPAvBwfZ Avv ZLb ivM msgYi mvebv GgwbZ ewk _vK| cvqyc_ wgwjZ nj GBWm msgYi mnvqK cwiek Zwi nq cvwmf I AvKwUf Dfq mxi ga| Gi KviYhbwqvi gvag cvqyc_ AvNvZ I Z mw, cvqyc_i ii wkiv Dby nIqvi mv_ mv_ AwaKZi BwgDb Kvl ev UvMU Kvl Zwi| mB mv_ cvqyc_ wbtmZ GBWm msgY mnvqK AvZ (Unknown) dvi Zv iqQB| 8.6.5. cvqyc_ ev hvwbc_ exh wbMZ bv njI GBPAvBwf msgY NUe? AbKi ga Ggb aviYv iqQ h, hbwgjbi mgq cvqyc_ ev hvwbc_ exh wbMZ bv nj GBPAvBwf msgY NUe bv| GwU mc~Y fyj aviYv| exh wbMZ nIqvi AvM hbvi kxlc_ h hbim wbMZ nq ZvZI fvBivm we`gvb _vK| Ze hZ ewk Zij c`v_ wbtmZ ne ZZ ewk fvBivmi cwigvY AvbycvwZK nvi evoe| GBPAvBwf Avv`i cyilv wbtmZ hbimi gZ GBPAvBwf Avv bvix`i hvwbc_ we`gvb im ev Zij wbtmiYi gaI cPzi cwigvY GBPAvBwf _vK| Ze Zzjbvg~jKfve hvwbimi Zzjbvq exh we`gvb fvBivmi msLv AbK ewk nq _vK| my cyili hbv we`gvb AvuPo, KvUv-Quov, Nv BZvw` GBPAvBwf msgYi Rb mnR c_ Ki `q| hbevwnZ ivMi KviY hbv Zwi dvv, c`vn Ges Avjmvijv GBPAvBwf `Z msgYi mnR eev Ki `q|
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8.7.1 BbRKkbi m~uPi gvag GBPAvBwf mswgZ nZ cvi? nuv, cvi| GBPAvBwf msgYi GUv GKUv AbZg c_| 8.7.2. bvix`i ga BbRKkbi gvag GBWm Qovevi SuywK KZUzKz? hbmshvM eZxZ h mg bvix GBPAvBwf Avv nq Zv`i ga BbRKkbi gvag bkv MnYKvixi msLv Lye Kg bq| GQvov iqQ ^vKgx`i ga `yNUbvg GBWm Qovevi NUbv| cw_exi eo eo knijvZ AviI evowZ Suwy K iqQ beRvZ wki nmwcUvj BbdKkb-Gi | hyivi GKwU MelYvq `Lv hvq, gUvcwjUb GjvKvZ GKmgq cwZ nvRvi 2.6 fvM wk GBPAvBwf fvBivm Avv nqQ| GB nvi gdt^j Aj 0.3 fvM Ges Mvg GjvKvq 1.2 fvM, cwZ nvRvi| Aek GkxqAvgwiKvb Ges mv`v Pvgovi gwnjv`i ga cwZ `k nvRvi 3 fvM Avv nqQ| jvwUb AvgwiKvZ cwZ `k nvRvi Avv nqQ 7 fvM, AvwdKvbAvgwiKvb`i ga cwZ `k nvRvi 36 fvM Avv| 8.7.3. bvixi GB Suwz Ki KviY Kx? Awbivc` I SuywKc~Y hbwgjb, BbRKkbi gvag bkv`e MnY, ckvMZ `yNUbv, A cwZvcb, Kwg Dcvq (artificial) MfaviY BZvw`|

alYmn wewfb iKg hbwbhvZb, Kbv wgjb (Dry Sex) hv wK bv hvwbc_ Z Zwi Ki BZvw`|
8.8.1 Kvb wekl Ilya BbRKkbi gvag bkv`e MnYKvix`i (IDUs) GBWm msgYi Szwu K evovq wK bv? GK mgq fvev nqwQj GgvjbvBUU I eyUvjbvBUU GBWmi GKwU KviY| G msv fyj aviYv Ges cKZ evLv GB eBqi Ab AvjvwPZ nqQ| BbRKkbi gvag nivBb, KvKb, GgdUvgvBbmn bvbv Ilya eenvi Ki _vK gv`Kvmiv| GB Ilyajv mivmwi GBWm msgYi mnvqK cwiek Zwi bv KijI Gme Ilyai KviY ewZ I AvPiYi cwieZb wecbK hbmshvMi mvebv Zwi Ki hv GBPAvBwf msgY iZc~Y f~wgKv ivLZ cvi| GQvov bkvMnYKvix`i ga hviv iqW bq Zv`i ga BwgDbvmvckb NUvi KviY GBWm-mn evwiqv I fvBivmRwbZ bvbv ivM msgYi mnvqK cwiek Zwi nq| Ze BbRKkbi gvag gv`Kmex`i Rb g~j welqwU nj `~wlZ wbW&j, hv GKRbi kixi _K AviKRbi ga GBWm Qwoq _vK| G Qvov bkv`e MnYKvixi m~uPi gvag ncvUvBwUm-we I wm msgY nq _vK| 8.9.1 gq`i Lvrbv GBPAvBwf msgYi c_ mnR Ki `q? gq`i Lvrbv, Z mw Ki Ggb Kbv wgjb, gvvwZwi wgjb (Frequent Sex) Ges eMvwgZvmn wewfb hb AbvPvi cwinvi KiZ ne| mvaviYZ Gmei cwicwZ h Z I cwiek Zwi nq Zv GBWm msgY mnvqK| AvwdKvmn cw_exi wewfb `k gq`i fMvzi (Clitoris) KU dj mZxZ ivi bvg hbmse`bkxjZv Kwgq `evi eei ixwZ cPwjZ AvQ| hbv Z mw Kivi GB fqi wbhvZbg~jK ixwZi wei RvwZmsN I wek^v msvmn gvbevwaKvi msMVbjv KVvi Aevb wbqQ| 8.10.1. gyLi jvjvi (mvjvBfv) gvag GBPAvBwf Qovq wK bv : gyLi jvjvq (mvjvBfv) mvaviYZ fvBivmi cwigvY _vK Lye Kg| Ze gyL ev `uvZi Mvovq icvZ nj jvjvq fvBivmi cwigvY eo hvq| GQvov Avvi `ni jvjvq fvBivm Qvov GBPAvBwf Avv BwgDb Kvl _vKZ cvi| mvaviYfve gyLi jvjvi ga fvBivm I RxevYy webvkx GKwU gZv _vK Ges GwU fvBivm weivax f~wgKv ivL| GZ AbK mgq fvBivm wbwq nq co|
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1990-Gi kli w`K _K hme bvix egywL hbwgjb Ask wbqQ Zv`i ga GBPAvBwf msgY AvcwKfve ew cvQ Ges BbRKkb I Abvb gvag GBWm msgY Kg AvmQ| hme KviY bvixiv G aibi AwaKZi Szwu KZ coQ ewgjb, wecbK hbmshvM, RbwbqYmn bvbv KviY cvqyc_ wgjb, hbivMi KviY hvwbc_ Nv ev Z nvicm, cvwcjvgv fvBivm msgY AvwdKvi Kvb Kvb Aj bvix`i Lvrbv I wgDwUwjkb (mutilation) ev hbv ZweZ KiY,
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GiciI AbK fvBivm BwgDb Kvli ga jywKq _vK| gyLi Nv, `uvZi Mvovq msgY, gvwoi Z, `uvZi Mvovmn gyLi hKvb vb _K icvZ Avvi `n fvBivm wbtmiYi cwigvY evwoq `q| GBPAvBwf Avv`i gyLi jvjvq fvBivmi cwigvY ev msLv Kg _vKvZ mvaviYZ Pyb ev Kwg Dcvq VuvU VuvU jvwMq kvm-ckvm Pvjy Kivi cwZi ^ (Cardio Pulmonary Resuscitation ev CPR) gvag GBPAvBwf msgY NU bv| Ze VuvU I gyL Z, Nv ev c`vn _vKj GBPAvBwf QovZ cvi| GBPAvBwf msgYi Rb fvBivmi msLvwU GKwU iZc~Y m~PK| Ze Kg cwigvY fvBivm _vKjB h GBPAvBwf msgY NUe bv wKsev Kx cwigvY fvBivm _vKj (wgwbgvg WvR) GBPAvBwf msgY NUe Zv mwVKfve Rvbv hvqwb| jLK gb Kib, GBPAvBwf msgYi fvBivmi msLvi mv_ mv_ fvBivj wfijiI (Virulence) GKwU iZcY f~wgKv iqQ| Kvb Kvb ~ GBPAvBwf wgDUU GZUv fqi (Virulent) nq _vK h, GUv ^vfvweKi Pq AbK `Z mgq GBWmi jY Zwi KiZ cvi Ges gZI ZvovZvwo z NUvZ cvi| fvBivmi msLv Ges wfij hgb GBPAvBwf msgYi Rb GKwU kZ wnmve KvR Ki, Zgwb kixii BwgDb Kvli wmwW-4 AveiYi mv_ fvBivmi mshvM ivM msgYi Rb GKwU AZvekK kZ| G KviY mivmwi ii gvag mePq mnR msgY NU| GBPAvBwf mswgZ i 30 fvM gvbyli `n ivMi wevi NUvZ cvi| AZ I my VuvU BwgDb Kvli msLv Kg _vKvq Gi gvag fvBivmi msgY Kg NU| Avevi hvwbc_ I cvqyc_ i mieivn ewk _vKvq Ges BwgDb Kvli msLv ewk _vKvq Ime c_ fvBivmi msgY ewk nq _K| 8.10.2. a~gcvb Ges g`cvb GBPAvBwf msgY KZUzKz f~wgKv ivL? a~gcvb Ges g`cvb GBPAvBwf wevi mnvqK fywgKv cvjb Ki Ges GBPAvBwf msgYi mvebv evwoq `q| g`cvb hb AvPiYi cwieZbi gvag AvPiYMZ mgmv Zwi Ki wecbK hbmshvMi w`K Vj Zv `qB, mB mv_ G Afvm BwgDb eevK AvNvZ Ki Ges kixii cwZiva gZv Kwgq `q| a~gcvbi KviY Kvevwg_ (meth) ngvM-vweb eo hvevi KviY wewfb wUmyZ AwRb cwimvjb ev cviwdDkb GgwbZB Kg Avm Ges ivM wbivgq I my Kvl Zwii cwqvq evav mw Ki| GQvov G Afvm dzmdzmi c`vn mw Kivi mv_ mv_ wbDgvwbqvmn bvbvwea AmyL wbivgqi c_ evav mw Ki|
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AvjKnj kixii ievnx wkivjvK dzwjq GBPAvBwf msgYi mvebv hgb evovq, Zgwb ivM wbivgq cqvMKZ Ilyai mv_ wewqv Ki Ilyai KvhKvwiZv Kgvq| 8.11.1. h me KviY g` Ges Abvb bkvRvZxq c`v_ GBPAvBwf msgYi mvebv evwoq `q : bkvM nevi ci GKRb Ggb ecvqviv hbmshvM wj nq h wbRi wbivcv weZ nq| hviv bkv Ki Zv`i Ggb PvwiwK cwieZb NU h ^vfvweK AevZI Zviv AmZK Ges ecivqv nq _vK| bkvi KviY Ggb me hbwqvi m nq hvZ mvaviYZ GKRb ^vfvweK ew m nq bv| hviv BbRKkbi gvag bkv Ki Zv`i ga GgwbZB ievwnZ GBPAvBwf msgYi mvebv ewk| GBPAvBwf Avviv hbwgjb QvovI i`vb cwqvq gvagI GBWm Qwoq _vK| ZZxq wek bkvM iv mvaviYZ i wew Ki _vK| 8.12.1. gwnjv`i gvwmKKvjxb GBPAvBwf msgYi mvebv KZUzKz? gvwmKi mgq hbmshvMi dj cyil _K bvixi `n bvbvwea RxevYy ceki mvebv iqQ| Ze G cwqvq GBWm msgYi welqwU cwivi bq| wK Gmgq wgjbi dj GBPAvBwf Avv bvix _K cyil`i `n GBPAvBwf msgYi mvebv e Ask ew cvq| gwnjv`i gvwmK msv wKQy mgmv hgb GBPAvBwf Avv`i cRbb ^v msv RwUjZv ew KiZ cvi, Zgwb GBPAvBwf msgYi KviYB cRbb nigvb P ev Gvwm wecw NU _vK GUvI mwZ| GKviY G`i ga gvwmK e nq hvIqv (Amenorrhoea), gvwmK Kg hvIqv (Oligomenorrhoea) BZvw` mgmv `Lv w`Z cvi| GZ ivMxi A^w I Amyweavi mv_ mv_ GKw`K hgb Avv`i gv nIqvi mgq wbevPb Kiv me nq bv, Zgwb Amgq i Sivi KviY hbwgjbi I GBPAvBwf msgYi mvebv AbK eo hvq| 8.13.1. GBPAvBwf cwZiva RbwbqYi Lvevi ewoi f~wgKv wKiKg? AbK bvix fyjekZt GBWm I hbivM wbqYi j RbwbqYi ewo meb Ki| GZ Kvb jvf Zv nqB bv, eis AbK mgq GwU cyil _K bvixZ GBPAvBwf msgY mnvqK f~wgKv cvjb Ki| (m~- HIV Infection
in Women; Lora A Warth)
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RbwbqY ewo cjwfK BbdvgUwi wWwRR (PID) Kwgq Ges gvwmK wbqY Ki ivM msgYi mvebv wKQyUv Kgvq, mB mv_ hvwbc_ I mviwfi wgDKvmvi NbZ evwoqI GK aibi cwZeKZv mw Ki ivMi wei| wK Abw`K mvifvBKvj GKUvwc (Ectopy) Zwi Ki Kvl cwievwnZ cwZwqv (Cell mediated response) Kwgq GBPAvBwf msgYi mvebv evovq Ges ivMi AebwZI NUvq| 8.14.1. `kgvbfve GBWmi Kvb jY bB, A_P GBPAvBwf cwRwUf Ggb ew GBWm Qovq wK? Ggb ck AbKB Ki| AwaKvsk ewi GBPAvBwf Avv nevi ci Zvi jY cKvwkZ nZ KqK eQi jM hvq| Gmgq Zviv bxie ivM Qovq, wekl Ki ivMi cv_wgK Aevq Ges ivMi kl chvq i fvBivmi cwigvY eo hvIqvq GBPAvBwf msgYi mvebv eo hvq| 8.14.2. GBWmi jYwenxb GKRb cyil Zvi mxK Avv KiZ cvi wK? cyili kixi _K bvix `n GBPAvBwf msgYi Rb Avv cyili `n GBWmi jY `Lv w`ZB ne Ggb K_v bB; eis GBWmi jY `Lv `evi c~eI GKRb cyil GBPAvBwf fvBivm enb KiZ cvi| GKRbi kixi GBPAvBwf AvQ wK bv Zv Rvbevi cKZ Dcvq nj i cixv Kiv| GwU memgq me bv nevi KviYB ARvbv-APbv mx ev bZzb mx`i m wgjbi mgq KbWg eenvi Kiv AwZ AvekK| 8.14.3. GKevi gv hbmshvM njB GBPAvBwf mswgZ ne? cvqyc_ mshvMi gvvi mv_ GBPAvBwf msgYi GKwU mK iqQ| GUv cwZwZ mZ h, AbK GBPAvBwf Avv cyil ev bvixi mv_ evi evi wgjbi ciI AbK GBPAvBwfZ Avv nq bv| Avevi GUvI wVK h, AbK Avv ewi mv_ GKevi wgjbi ciB GBPAvBwfZ Avv nqQ| 8.14.4. GBPAvBwf Avvi m wgwjZ njB wbwZfve ivM mswgZ ne? GBPAvBwf Avv mxi mv_ wgwjZ nj 100 fvM GBPAvBwf mswgZ neB- Ggb wbqZv `qv hvq bv| Gi GKwU Rj `v nj gvwRK Rbmb cwievi| Kb GKRb bvix GBPAvBwf Avvi m gjvgkvi ciI fvBivm Avv nq bv mwU AviI wek` MelYvi welq njI G evcvi AvjvKcvZ Kiv nqQ GB M|
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ewMZ cwZiva eev QvovI hbmxi `n we`gvb fvBivmi cKwZ I cwigvYwU G GKwU iZc~Y welq| GBPAvBwf msgYi cv_wgK Aev I kl Aevq Avv ew hZUv fvBivm Qovq, ivMi gaeZx Aevq ZZUv fvBivm wbtmZ nq bv| GQvov hvwbc_ KvUv-Quov, Nv, wewfb hbivMi DcwwZ Ges wgDKvm AveiYi cyiZmn Kv-dvijv GBPAvBwf msgYi wbqvgK kw wnmve KvR Ki| GiciI Ggb GKRbK wPwZ Kiv me bq, hvK kZfvM wbqZv w`q GBPAvBwf cwZiva gZvmb ejv hve| GKwU K_v gb ivLZ ne h, hbmshvMi cyili kixi _K bvix`n GBPAvBwf msgYi mvebv wY _K `kY ch nZ cvi| Gi KviY, exh we`gvb fvBivj WvR| Gi A_ GB bq h, GBPAvBwf Avv bvix _K cyili `n fvBivm msgYi welqwU Kvb MY evcvi| 8.14.5. Rxebi c_g wgjbB GKRb GBPAvBwf Avv nZ cvi wK? KbWg Qvov wecbK hbwgjbi KviY GKRb Rxebi c_g wgjbB GBPAvBwf Avv nZ cvi| GKviY eMvwgZvK GBPAvBwf msgYi AwZwi iZ w`q GBPAvBwf msgYi Abvb mvebvjvK Avovj Kiv wecbK welq ej weewPZ ne| hbv I cyilv KvUv-Quov, Z ev hbivM wenxb KviI m wgjbI GBPAvBwf msgY nq _vK| Kbbv fvBivm wgDKvm AveiY viv hvwbc_ kvwlZ nZ cvi| ZvB cwZwU wecbK hbmshvMi hb myiv Aej^b Kiv AwZ AvekK| 8.15.1. AvZ dvi (Unknown factor) : AbK MelKB A I gjvi _K wbtmZ Ggb GKwU AcwiwPZ e Ges Kvhgi K_v fveQb hv mnR BwgDb eevK wech Ki bvbvwea weN NUvq Ges mgKvgx`i mwq mxmn Zv`i x mx`i ga GBPAvBwf msgY mnvqK cwiek Zwi Ki| jLK AvgwiKvb BbwwUDU Ae AvjvwR G BbdvKkvm wWwRR BbwwUDUi GBWm wWwfkbi wiwfD KwgwUZ c` GK MelYv c `wLqQb h, Kxfve wekl aibi BKvjvB I B A Kvvi DxcK f~wgKv cvjbi mv_ mv_ GBPAvBwf msgY mnvqK cwiek Zwi Ki| wekl Ki hv`i Lvrbv Kiv nqwb Zv`i evowZ Pvgovi wbP Ges gwnjv`i AcwiQb hvwbc_ Gme gvBvei Aevb MnY GBPAvBwf msgY mnvqK cwiek Zwi Ki| B KZK m gvBv jfj BDwf (U.V) iwWqkb
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wgDUkb mnvqK I Kvvi DxcKI eU| meZ GKviYB mgKvgx`i gvag GBWm msgY AwaK nvi NU _vK| eZgvb hyiv Awfevmx cvUvb-2 `kmg~ni mBme bvMwiKi ga GBWm msgY ewk `Lv hvQ hviv wK bv mgKvgx| mvaviYfve cvUvb-2 `kmg~ni bvMwiK`i mv_ hviv gjvgkv Kie Zv`i GBPAvBwf wwbs Kiv bwZK KviYB cvq evaZvg~jK| hyivi bZzb AvBb G aibi mKj Awfevmxi Rb GBPAvBwf wwbs evaZvg~jK Kiv nqQ| gvbevwaKviKgxiv Gi weivwaZv KijI ewkK wbivcvi Rb GwU Aek KiYxq| 8.16.1. alY, cvPvi Ges bvix `vmZi m GBWmi mK AvwdKvi KqKwU `k Nb Nb RvwZMZ msNvZ I hy GBWm wevii GKwU KviY| Gme hy alYK RvwZMZ wbcxob Ges k DrLvZi GKwU cwZ wnmve eenvi Kivq GBWmi evcK wevi NUQ| MYalY cwqv Qvov mvaviY alYI GBWm msgYi GKwU eo aibi mvebv _vK| Kbbv mvaviYZ alYKvgxiv bkvMnYKvix Ges wecbK hbPwii nq _vK| G`i evcK Acivag~jK hb AwfZvI _vK| G aibi Acivaxiv RjLvbvq AixY nqI GBWm QovZ cvi| Acivax`i ga ekvjq Mgbi BwZnvm Ges bkvMnY ceYZv Lye mvaviYfve `kgvb nq| 8.17.1. Abvb Suwy K : GQvov hviv BbRKkbi gvag bkvMnY KiQ Zv`iK kbv Ki wbLiPvq GBPAvBwf wwbs KiZ Dy Kiv cqvRb| BbRKkbi gvag gv`K mex`iK mvgwqKfve Kvb AvkqK` iL bkv _K wdwiq Avbvi Pvi mv_ mv_ eeZ m~P cwiZvMi Rb Zv`iK Dy Kiv cqvRb| u mB mv_ mKj nvmcvZvj I wKwbKi eeZ wmwi I eR wbivc` cwZZ asm wbwZ Kiv cqvRb| giwdb, cw_wWbmn bvbv aibi gv`K I bkvi BbRKkb weqi Ici KVviZg wbqY cqvRb| mB mv_ mKj hbevwnZ ivMx, i`vZv, mgKvgx, we`kx kwgK I Kgx`i GBPAvBwf wwbs Kwiq bqv cqvRb|

Aavq 9
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9.1.1 ckvMZ KviY GBPAvBwf msgYi mvebv KZUzKz? GB mvebvi GKwU wP cvIqv hve wmwWwmi GK wicvU| 1998 mb cgvYmn G aibi 54wU Km cvIqv hvq, hLvb ckvMZ wecwi KviY GBPAvBwfi msgY NUQ| GQvov AviI 134 Rb mve ivMx cvIqv hvq hviv 1985 mbi ci hyiv ^vmev `qvi Kvj GBWm Avv nqQ| m~uPi dzUvZ wKsev Qywii LuvPvRwbZ AwZ QvU Z GBPAvBwf mswgZi ii msk Gj wec` nZ cvi| Ze cwimsLvb G mvebvwU 0.3 fvM A_vr cwZ GK nvRvi Rbi ga wZbRbi Gfve GBPAvBwf msgYi mvebv iqQ| GBPAvBwf mswgZ i `yNUbvg jM hZ cvi wPwKrmvKgx`i PvL, bvK A_ev gyL| G aibi `yNUbvi nvi 0.1 fvM A_vr cwZ nvRvi GKRb| jve wccwUsmn bvbv KvR, Acvikb PjvKvj, GBPAvBwf Avv gvq`i Wwjfvwimn wewfb mgq G aibi `yNUbv NU _vK| 9.2.1. mswgZ i wPwKrmvKgx`i ZKi msk Avmj Kx nZ cvi? A cwigvY i hw` AZ ZK jM hvq ZvZ ivM msgYi Kvb mvebvB _vK bv| KqK duvUv i ZK jM hvevi dj ivMi msgY nqQ Ggb cgvY Kv_vI bB| Ze ZK hw` Kvb Z _vK A_ev B`vwbsKvj NU hvIqv Kvb KuvUv Quov _vK, Zvnj GBPAvBwf msgYi GKUv mvebv _vK| GBPAvBwf Avv ivMxi ek LvwbKUv i hLb wPwKrmvKgxi ZKi GKwU eo vbK AveZ Ki A_ev KqK Nvevcx jM _vK, ZLb GBPAvBwf msgYi GKUv mvebv `Lv `q| G 0.1 fvM A_vr cwZ nvRvi GKRbi GBPAvBwf msgY NUZ cvi| 9.2.2. GBPAvBwf Avvi i ^vKgxi PvL, gyL, bvK jM Mj Kx KiZ ne? bvK, gyL, ZK c_g cvwbi SvcUv ev wcPKvix w`q ayq djZ ne|

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 PvL we cvwb A_ev mvjvBb BwiMkb KiZ ne| ZKi hLvbUvq dzUv nq hve ev KU hve ZrYvr m vbwU mvevb cvwb w`q iMwoq ayq djZ ne| 9.2.3. GwUmcwUK w`j A_ev i Swiq djj GBPAvBwf msgY cwZiva Kiv hve wK? G cm jLK gb Kib, Zvb AvqvwWb A_ev fvBwimvBWvj cqvM Kij wbwZ jvf bv _vKjI Kvb wZ bB| cvwfWb-AvqvwWb (0.5% AvqvwWb) mvaviY BbdKkbjvK cwZiva KiZ cvi| 9.3.1. fyj ev `yNUbvg Kvb GBWm Avvi m mshvM NU Mj wKQy Kivi AvQ wK? nuv, AvQ| wmwWwm Gme wcBwc (Post exposure prophylaxis ) bvgK GKwU cwZi K_v ejQ| GZ wRWvfywWbmn Abvb GwU-GBPAvBwf WvM c`vb Kiv nq hbmshvMi 72 NUvi ga| AvgwiKvi mUvi di wWwRm KUvj G wcfbkb G cwZwU cqvM KiZ ejQ mB mg ^vKgx`i hviv `yNUbvg GBWm Avvi m~uP ev i _K Avv nq| ievwnZ GBPAvBwf msgY QvovI alYRwbZ hbmshvM ev `yNUbvRwbZ gjvgkvi myiv `evi GKwU cixvg~jK cwZ nj wcBwc| 9.3.2. G aibi `yNUbv NUj Avi Kx KiZ ne? `yNUbvi mv_ mv_ wbKUeZx ^v KgKZvK RvbvZ ne, wekl Ki GBWm wekli m hvMvhvM KiZ ne GB KviY h, Kvb Kvb cv GcvRvi wUUgU ev wcBwc `qv hZ cvi Zv ZvivB wbaviY Kie| GUv hZ ZvovZvwo `qv hvq ZZB fvj| AbK GBWm ivMx ncvUvBwUm-we I wm fvBivm Avv _K _vK| ZvB GB mg `yNUbvi cvcU ^vKgxi i ncvUvBwUm-we I wm fvBivmi msgYiI mvebv _vK| hviv we fvBivmi fvKwmb wbqQb Zv`i ga BbdKkbi Kvb mvebvB _vK bv| Avi hviv fvKwmb bbwb Zv`i ga m~uP I `yNUbvRwbZ mvwRKvj Zi gvag ncvUvBwUm-we msgYi mvebv Qq _K wk fvM| hv`i ga ncvUvBwUm-we mvidm GwURbi mv_ ncvUvBwUm-B (HBe Ag) we`gvb Zviv AwaK msLvq we fvBivm Qwoq `evi gZv ivL| 9.4.1. ncvUvBwUm-wm (HCV) msgYi mvebv KZUzK? z ncvUvBwUm-wm fvBivm (HCV) msgYi Ici evcK KvR nqwb| Ze wmwWwmi GKwU vwW _K Rvbv hvq hviv ncvUvBwUm-wm fvBivm Avv _vKe Zv`i i ^vKgxi kixi we`gvb KvUv Quovq jM Mj 1.8 fvM msgYi mvebv iqQ| GB vwWwU AKzckbvj GcvRvi-Gi B chvR|
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Dj-L Kiv cqvRb, AKzckbvj GcvRvi eve GKwU cwZwZ myivf`x `yNUbv| G aibi ii (wm fvBivm Avv) wQU duvUv wKsev SvcUvI hw` ZK jM hvq Zvnj ivMi msgYi mvebv Kg njI _K hvq| Gfve ivM msgYi ekwKQy cgvY iqQ| 9.5.1. G aibi ckvMZ `yNUbv Govevi c_ Kx? cvwb RvZxq c`v_ cwZiva KiZ cvi Ggb gv, Uzwc, MvDb eenvi Kiv DwPZ cwZwU wPwKrmvKgxK| mB mv_ M-vfm, Pkgv Ges RyZvi Kfvi eenvi Kiv DwPZ| GZ PvL, bvK, gyL I ZKK euvPvbv me| eeZ mu~PjvK wiKvwcs (recapping) bv Ki mivmwi asm Kiv Ges wbivc` asm ev wWmcvRvj cwZ Abyhvqx GKwZ Ki asm Kiv cqvRb| gwWKvj wWfvBmjv Ggbfve eenvi Kiv DwPZ hvZ wbR`i wbivcv wewNZ bv nq| 9.6.1. `yNUbv _K cwZivi Rb cv GcvRvi wUUgU ev wcBwc: `yNUbvi ci Dcivwj-wLZ cwZZ cv_wgK cwZiv wbZ ne| Gi ci ciB ivMxi i cixv Ki wewfb msgYi Aev ev vUvm Rb wbZ ne| ^vKgxi i cixv KivZ ne Ges wcBwc MnY KiZ ne| i cixv Ki ncvUvBwUm-we I wm fvBivmi BwgDwbwU msv Aev Rb wbZ ne| we fvBivmi fvKwmb bqv _vKjI fvKwmb mwKZ BwgDwbwU RvbZ ne| GgwbZI we fvBivmi fvKwmb `qvi GK _K `yB gvm ci U Ki GUv Rb bqv cqvRb fvKwmbwU we fvBivmi wei BwgDwbwU Zwi KiQ wK bv| GBPAvBwf msv wcBwc bevi AvM ^vKgx`i Ilyai cvkcwZwqv mK Rvbvbv ek cqvRb| wcBwc cqvMKvj ncvUvBwUm-we msgY cwZiva ncvUvBwUm-we BwgDbvM-vweDwjb (globulin) cqvM Kiv hZ cvi| GUv ncvUvBwUm-we msgY cwZiva KiZ cvi| Ze GUv cqvMi c~e i ncvUvBwUm-we mvidm GwURbi DcwwZ, fvKwmb msv BwgDwbwU BZvw` welqjv Rb bqv cqvRb| Ggb Kvb fvKwmb Zwi nqwb hv wK bv ncvUvBwUm-wm cwZiva KiZ cvie| Ggb Kvb wPwKrmvI bB hv GUv iva KiZ cvie| G ivM BwgDbvM-vweDwjb cqvM Ki Kvb dj nebv| AZGe `yNUbvi ci Acv Kiv Qvov Avi Kvb wKQy KiYxq bB| 9.6.2. cv GcvRvi wUUgU ev wcBwc-G Avi Kx Kiv hvq? ncvUvBwUm-we fvKwmb bv `qv _vKj hKvb `yNUbvq fvKwmb w`q bqv fvj| ncvUvBwUm-we BwgDbvM-vweDwjb I fvKwmb `qvi ivMx ev mvmi msgYi AevUv chvjvPbvq Avbv hZ cvi|
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9.6.3. hv`i ga GBPAvBwf msgYi mvebv Zwi nq Zv`i `yNUbvi ci Kx Kx Ilya w`Z ne? mvaviYZ Pvi mvni Rb wRWvfywWb I jvwgfywWb (Lamivudine) Ilya `yUv `qv nq `yNUbvi ci ciB| Ze hLvb `yNUbv evcK nq, A_vr AbK i kixi Qwoq co A_ev ivMxi i we`gvb fvBivmwU GBPAvBwf WvM iwRmv, m wRWvfywWb I jvwgfywWbi mv_ GKwU cvwUqvm BbwnweUi hvM Kiv cqvRb| cvwUqvm BbwnweUijvi ga Bwbvwfi (Indinavir) A_ev bjwdbvwfi (Nelfinavir) cqvM Kiv hZ cvi| Ze wKwbwkqvb I wekl wPwKrmKK DcwZ bvbv RwUjZv gvKvejvq wmv MnY KiZ ne Ges mB mv_ Ilyai msLv I cqvRbxq cwieZbi K_v gv_vq ivLZ ne| 9.6.4. cv GcvRvi wUUgU bevi mgqmxgv KZUzKz? GBPAvBwf msgYi `Z KqKNUvi ga Ilya cqvM Kiv DwPZ| `yNUbvi ci w`b MovZ bv `qvB fvj| RxeRi Ici cixv Ki `Lv MQ h, Pwek _K Qwk Nv AwZevwnZ nevi ci Ilya cqvM Kij msgY Avqi evBi hZ cvi| Aek gvbyli ga cwiPvwjZ Kvb cixvi djvdj Avgv`i Rvbv bB| Gme KviY gvbyli ga GK _K `yB mvni ciI G aibi wcBwc `qv nq GB KviY h, GZ GBPAvBwf msgY cwZiva bv Kiv MjI ivMi ZxeZv nvm Ki Zv wbqY ivLv hvq| GBWm msv `yNUbvq cv GcvRvi wUUgU ev wcBwc AvgwiKvi wPwKrmKiv Abygv`b KijI GdwWG GLbI GUv Abygv`b Kiwb| Ze AvBbi `wZ wPwKrmK Zvi wbR^ cv eenvi Ki Ggb Ilya eenvi KiZ cvib hv ivMxi Rxeb iv KiZ cvi| (m~: wWcvUgU Ae nj_ G wnDgvb mvwfm; wmwWwm)| 9.6.5. cv GcvRvi wUUgU eeZ Ilyajv Kx Kx cvkcwZwqv Zwi KiZ cvi? mvaviYZ wRWvfywWb ewg ewg fve, ewg, cvZjv cvqLvbv, `yejZv, gv_ve_v BZvw` cvkcwZwqv mw Ki| cv GcvRvi wUUgU ncvUvBwUm-we, ik~bZv, ii Kvl ZwiZ cwZeKZv mw Kivmn wKWwbZ cv_i Zwi KiZ cvi| cvwUqvm BbwnweUijvi ga Bwbvwfi A_ev bjwdbvwfi iZi cvkcwZwqv Zwi Ki Ges Abvb Ilyai mv_ cwZwqv Ki| ncvUvBwUm-we fvBivmi fvKwmb A_ev BwgDbvM-vweDwjb cqvMKvj hw` `Lv hvq h, Avv gwnjv gv nZ hvQb A_ev wkK eyKi `ya w`Qb mI Ilya cqvM Kvb evav bB| eis GUv ZvK Ges Zvi wkK myiv `e| GB fvKwmb Yi Kvb wZ mvab nq bv| (m~ : wWcvUgU Ae nj_ G wnDgvb mvwfm; wmwWwm)|
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Ze GBWmi mve gvq`i Ilya MnYi c~e mnmevi fveZ ne| GBPAvBwf msv `yNUbvq hviv Rwoq coe Zv`i GKwU eRjvBb cixvi gvag GBPAvBwf GwUewW wbYq QvovI Qmvni gv_vq, eviv mvni gv_vq Ges Qgvm ci cixv Ki `LZ ne Zv`i ga GBPAvBwf msgY nqQ wK bv| `yNUbvi ci nVvr Ki dzi gZ AmyL nj wekl Ki Ri, Mv e_v, Mvq jvj jvj PvKv, `yejZv, Mv gvR gvR Kiv, M-vjv dzj hvIqv BZvw` jY `Lv w`j ai wbZ ne h Ggb GKwU AmyL nqQ hvi cwZ wekl gbvhvM w`Z ne| GUv nZ cvi GBWm, WvM wiqvKkb A_ev Ab Kvb AmyL| cixv wbixvi gvag wbYq KiZ ne cKZ AmyLwU| Qq _K eviv mvn ci h gyn~Z ivMi jY `Lv `e mB gyn~Z _KB wKQy wewa wbla gvbZ ne| Gi ga c_g nj Nwb hvMvhvM I hbmshvM cwinvi Kiv| Gici nj i `vb ivwR bv nIqv| Avi kixii wUmy, AMvb, exh Gjv `vbi Zv ckB IV bv| 9.6.6. G Aevq gvqiv Kx Kie? gvqiv wk`i b`vb GKeviB e Ki `e| GwU ncvUvBwUm-we I wm fvBivm Avv gvq`i I cqvR| 9.7.1. WwU`i wbKU _K GBPAvBwf ivMi msgY nZ cvi Kx? GBPAvBwf Avv WwU`i wbKU _K ivMxiv Avv ne Ggb mvebv Lye Kg| AvgwiKvi dvwiWvZ GKevi `yRb ivMx GKRb WwU gvidZ mswgZ nqwQj ej Rvbv hvq| G cvcU dibwmK Z`i ci `Lv hvq h, WwUi eeZ hcvwZ Zvi wbRi i wm wQj| NUbvwU `yNUbvg, bvwK BQvKZfve NUwQj Zv cgvwYZ nqwb| Ze mvaviYfve h mg myiv cwZ GKRb WwUi gb Pjv DwPZ Zv AbymiY Kij WwU gvidZ GBPAvBwf msgYi mvebv _vK bv| 9.8.1. Abvb Szwu K : GBPAvBwf Avv ivMxi i viv hcvwZ `ywlZ _vKj GBWm QovZ cvi| Ze hcvwZ wWUviRU viv ayj Ges Zvc cqvM wijvBRkb Kij hcvwZi gvag GBPAvBwf msgY NUe bv| GUv mKj mvwRKvj cwqvi B chvR| avivjv h mg hcvwZZ Zvc cqvM Kiv hvqbv mjv wWUviRU viv cwivi Ki Kvwibhy cvwbi ga Wyweq ivLv cqvRb| mve mKj wWmcvRej hcvwZ eenvi Kiv cqvRb, wekl Ki mvwRKvj e-Wjv KLbB cybteenvi Kiv DwPZ bq| Avi hme wPwKrmv cwZi gvag GBPAvBwf msgY me Zvi ga AbZg nj wKWwb WvqvjvBwmm| GKviY WvqvjvBwmm hcvwZ ivMxi Rb eenvii ci cwivi Kiv cqvRb| GQvov hviv ivMxi kixivfi nvZ ev Avyj
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eenvi Kie wKsev ivMxi ii mv_ m Kvb KvR Kie Zv`i mevB jvU M-vfm eenvi Kie| h mg wPwKrmK Ges mevKgx GBWm Avv Zviv Ggb Kvb KvR nvZ `e bv hv GBWm msgYi mvebv mw KiZ cvi| 9.9. Abvb mevKgx`i Avv nevi Szwu K 9.9.1. hviv mjyb I cvjvi KvR Ki GBWm _K euvPZ Zviv Kx Kie? GBWm Avv`i KvQvKvwQ Avmevi KviY bvwcZ, nqvi Wmvi, gvwjk c`vbKvix G iKg ckv`vi`i ga GBWm msgY NUQ wKsev ckvMZ mev `vbKvj ivMi msgY NUQ Ggb Kvb evwbK cgvY bB| Avevi GBWm Avv Kgxi nvZi Quvqvq Kvb MvnK GBWm Avv nqQ GUvI `Lv hvqwb| GBPAvBwf msgYi Rb memgq KvUv Quov ZKmn wgDKvm AveiYi mv_ `ywlZ i A_ev Zij wbtmiYi (secration) mshvM cqvRb| AZ ZKi gvag GBWm msgY KLbB NU bv| Gme KviY ckv`vi`i hme mZKZv MnY Kiv cqvRb Zvi ga AbZg nj ewMZ cwiQbZv| nvZi ev ZKi Kvb vb _K hLb Kl eie A_ev kixi `M`M Nv _vKe ZLb MvnK Ges Kgxi ga hvMvhvM bv NUvB fvj| cwZwU MvnKK mev `qvi AvM Ges ci fvj Ki nvZ ayq bqv cqvRb| mjyb Pzj KvUv I mf Kivi mgq wbwZ nZ ne h e-WwU bZzb| eeZ e-W eenvi wecbK nZ cvi| wWmcvRej e-W eenvi KiZ ne| yi RvZxq wKQy eenvii AvM AvqvwWb w`q ayq wbZ ne| KuvwPmn Abvb avivjv Ajv h_vh_ wbqg RxevYygy KiZ ne| Dw `evi m~uP, Zvii evk, Kvb dzUv Kivi I AvKzcvsPvi Kivi h BZvw`I AvRv wZK vvW Abyhvqx wijvBRkb Kiv cqvRb| eenvi Kivi ci Gjv cwivi KiZ ne Ges KwgKvjm Wyweq A_ev WvB wnUi mvnvh RxevYyg KiZ ne| hjv dj `qv me, mjv dj w`Z ne y wekl Ki hjvi mv_ ii mshvM NU| KwgKvjmi ga Kvwib cvwb Ges KbmUUW AvqvwWb fvj RxevYybvkK| WvB wnU Ifb A_ev AUvKf hi mvnvh AvKzcvsPvi I Dwi m~uPjvK RxevYygy Kiv hZ cvi| dzwUq wbqI GBPAvBwf fvBivmK mnR gi djv hvq| Ze KwwWqvg-Gi gZ Kvb Kvb RxevYy DP Zvc Qvov wbw nq bv| 121 mwUMWi Dci Zvcgvvq GwU wbwq A_ev asmcv nq| eenvii ci dj `qv ne Ggb wRwbmjvK memgq wbw` wWmcvRvj evM fi wbivc` vb djv DwPZ| mjv Ggbfve asm Kiv DwPZ hb Zv KviI bvMvji ga bv Avm Ges cybteeZ bv nq|
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Aavq `k
GBWm cwZiva
10.1.1. wbivc` hbRxeb : KbWg eenvi I Abvb cwZiv Rvbv _vKv cqvRb h, wewfb hbevwnZ ivM I GBWm msgY GKB myZvq evuav| G GBWm _K cwZiv cvevi Rb ewMZ cwiQbZvi Ici Rvi w`Z ne| hb^v mK mPZbZv, my I hbRxeb hvcb nj GBWm msgY cwZivai g~jg| h Kvb aibi hbivM nj Aenjv bv Ki wPwKrmKi civgk MnY Ges mB m cqvRbxq GBPAvBwf wwbs Kwiq bqv GBWm _K euvPvi c~ekZ| GBPAvBwf cwRwUf`i Rb Avjv`v I wekl wPwKrmv cwZi eev Kiv cqvRb| hLvb jve myweav bB mLvb wKwbKvj AvmmgU ev jYDcmM wfwK g~jvqbi Ici wPwKrmv PvjvZ ne| GBPAvBwf I Abvb hbevwnZ ivM cwZivai Rb mePq ewk cqvRb Avv ewi mv_ mKj aibi hbwgjb cwinvi Ges Avv`i mx`i cixv wbixv Ki Zv`i wbivcv wbwZ Kiv| AbK GBWm ivMi mv_ Abvb hbivMi mnvevb _vK| ZvB Gme ivMi DcwwZZ GBPAvBwf wwbs Kiv GKv cqvRb| AbK GBWm ivMvviv mivmwi wPwKrmKi kiYvcb nq bv| ZvB G ivMi jYjv Ges G ivM nj mve hme msgY nq Zv Rvbv I Rvbvbv AwZ Riwi| 10.1.2. Kv`i Rb KbWg eenvi evaZvg~jK? hLbB GKRb ARvbv KviI mv_ hbwgjb wj ne wKsev Ggb KviI mv_ gjvgkv Kie hvi bxivM Aevi welqwU wbwZ bq, m AekB KbWg eenvi KiZ ne| cwZevi wgjbi c~e mZKZvi m GKwU bZzb KbWg eenvi KiZ ne| wmwWwmi GKwU Rwic `Lv MQ 31 fvM wQuo hvIqv, dU hvIqv, dyUv _vKv, wbgvbi nIqv BZvw` bvbv KviY KbWg AKvhKi nq _vK| G cm GdwWG `vex Ki h, Zv`i Abygvw`Z
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BjvwbKvwj UW KbWgjv mwVK wbqg eenvi Kij kZKiv 98 fvM cwZiv cvIqv hve| Ab GKwU MelYv _K Rvbv hvq, mvaviYfve KbWg 69 fvM GBPAvBwf BbdKkb iva KiZ cvi| h cwievii GKRb mivwWmKWU A_vr hLvb hbmx`i GKRb GBPAvBwf cwRwUf Ges AbRb bMwUf m KbWg eenvi evaZvg~jK| 10.1.3. KbWg eenvi h wbqgjv gb Pjv DwPZ : cwZevi wgjbi (Iivj, cvqyc_ wKsev hvwbc_) bZzb KbWg eenvi KiZ ne| mZKZvi mv_ KbWg eenvi KiZ ne hvZ bLi AvMv, `uvZ ev Ab Kvb avivjv wKQyi mv_ jM GUv wQuo ev dU bv hvq| GUv ciZ ne wgjbi AvM Ges KvbiKg mshvMi c~e| IqvUvi eRW jyweKU eenvi Kij mvaviYZ KbWgi Kvb wZ nq bv| Ze cUvwjqvg Rwj, ewWjvkb, Lvevi Zj BZvw` eenvi Kij KbWgi jvU wZM nq| KbWg Lyjevi mgq Mvov Pc ai m~YUv mveavb LyjZ ne hvZ GUv kixii mv_ msck bv Avm| Ze G eevi weK nj wdgj KbWg| Gi GKwU bvg iqQ wiqvwjwU (Reality)| GwU cwjBDiw_b wkU Zwi jyweKUhy myiv eev| Gi `ycvk jvMvbv _vK `ywU wis| GwU GKwU gKvwbKvj evwiqvi hv wK bv gq`iK GBPAvBwf I hbivM _K cwZiv w`Z cvi| mvwfKvj Kvc I Wvqvdvg AvswkK cwZiv `q| Avgv`i gZv `k hLvb hbKgx`i gvbevwaKvi bB, cwZivai fvlv bB, mLvb G aibi myiv eevi mv_ fvBivmbvkK Ilya Ges BwgDb imc gwWdvB KiZ cvi Ggb Ilya eenvii civgk w`Qb jLK| G hvwbc_ Nv ev c`vni wPwKrmv Kwiq wbZ ne AvM _K| mB mv_ wbqwgZ gwWKvj PKAvcI KiZ ne| Ze Gme eev KbWg eenvi Kvb weK bq| Gjv Amnvq hbKgx`i wKQy evowZ wbivcv gv| 10.1.4. KbWg eenvi msv cPvi KZUzKz mv_K nq? KbWg eenvi msv cPvi KZUzKz mv_K nq Zvi GKwU D`vniY myBRvijv iqQ, hLvb mZiv _K wk eQi eqmx`i ga GKK mKi evBi KbWg eenvi 8 _K 50 fvM DbxZ nqQ 1987 _K 1991 mbi ga| `ytLRbKfve evsjv`k hbivM cwZiva KbWg eenvi msv Z_ Ges GBWm welqK cPviYv I vb RbMYi wbKU wekl Ki bvix mc`vqi wbKU
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Lye KgB cuQQ| GgbwK bvix hbKgx`i ga Ges Zv`i MvnK`i ga AbK B cuQwb| dvwgwj nj_ BUvibvkbvj (GdGBPAvB), wWGdAvBwW Ges BDGmGBW-Gi h_ D`vM cwiPvwjZ GK MelYvq (Trends in Sexual and DrugTaking Behaviours in Bangladesh) `Lv hvq, evsjv`k ckv`vi hbKgxiv Li`i m wgjbi mgq gv 21 fvM KbWg eenvi Ki| cvi fviZi gnviv GB nvi kZKiv 77.4 fvM, Ac`k 80 fvM, RivU 93 fvM, KivjvZ 89 fvM Ges cwge 92 fvM| GKB MelYvq `Lv MQ, jvIm GB nvi 91 fvM, B`vbwkqvZ 41 fvM, bcvj 67 fvM Ges wfqZbvg 94 fvM| KbWg eenvii Dci Rvi w`q _vBjv GBWm GwcWwgK AbKUv wbqY KiZ mg nqQ| MelYvq AviI `Lvbv nqQ evsjv`ki ckv`vi hbKgxiv Zv`i mekl Lii m wgjbi mgq mivmwi KbWg eenvi KiQ kZKiv gv 0.5 fvM| cvi GB nvi gnviv 74 fvM, Ac`k 62 fvM, RivU 73 fvM, KivjvZ 52 fvM, DwolvZ 51 fvM, cwg evsjvq 76 fvM, K^vwWqvq 78 fvM, B`vbwkqvq 12 fvM, jvIm 72 fvM, bcvj 40 fvM Ges wfqZbvg 64 fvM| AviI GKwU welq nj MvnKi msLv| mvcwZK mgq GK cwimsLvb `Lv MQ h evsjv`ki cwZZviv cw_exi ga mevP msLK MvnKmev w`q _vK| weqKi njI mZ, GB msLv KLbI KLbI 24 Nvq 40 RbiI Ici nq _vK| mxgvnxb `vwi` Gi GKwU AbZg KviY| evsjv`k fvmgvb hbKgx KZK KbWg eenvii jLK Dciv MelYvi mv_ wfbgZ cvlY Kib| jLKi MelYvq `Lv MQ `ki fvmgvb hbKgx`i ga kZKiv 9.84 fvM KbWg eenvi KiQ bv| AwaKvsk hbKgxiv KbWg eenvi KiZ e_ nQ Lii Avcwi KviY| KbWg eenvi I ivM mPZbZv msv welqwU GB eBqi ZZxq Aavq AvjvPbv Kiv nqQ| KbWg eenvii mgmv mK gZvgZ : 54 fvM jvKi gZ hbmshvM KbWg AKvhKi| 41 fvM jvKi gZ GUv cwZeKZv mw Ki| 35 fvM jvKi gZ KbWg KbvKvUv I RvMvo Kiv Amyweav| 21 fvM jvKi gZ GUv GKwU evowZ Svgjv| KbWg eenvi MvnKK ivwR Kivbvi evcvi h mg cwZeKZv `Lv hvq, Zvi ga AbZg nj hbKgx`i AwaKvi eva msv mPZbZvi Afve, RvZxq chvq iZifve gvbevwaKvi jNb ceYZv, fvmgvb cwZZv`i ga cwZhvwMZv Ges wbivcvi Afve,
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hbKgx`i MvnK`i gvbwmK ceYZv, mgvR bvixi Aevb I bvixi cwZ cyili `wfw| GQvovI hbKgx`i ga hbivM Dcv Kiv ev Mvcb Kivi Rb bvbvb iKg Pvc BZvw`| Lvevi ewoi f~wgKv : Lvevi ewoZ mvwfi wgDKvmvi NbZ wKQyUv eo hvq hv fvBivm cwZiva GKwU wekl f~wgKv ivL| Avevi AbK wecwI Zix Ki| 10.2.1. GBPAvBwf msgY cwZiva fvBwimvBWvj cqvM : GBPAvBwf fvBivm hvwbc_i wgDKvmvi msk AvmjB GBWm ivMi msgY NUe wKsev KZfvM msgY NUe Ggb Kvb mywbw` cwimsLvb bB| Ze GKwU cixvq AvURbi ga PviRb bvixi GBWm ivMi msgY NUwQj GBPAvBwf mivcwRwUf Wvbvi`i exh Kwgfve hvwbc_ cek Kivevi ci| GZ h KqKwU welq cgvwYZ nq Zv nj (K) hvwbc_ fvBivmhy exh cek KijB GBPAvBwf msgY NUe GUv wVK bq, (L) hvwbc_ Nv ev AbKvb mnvqK cwiwwZi AbycwwZZI GBPAvBwf fvBivmi msgY NUZ cvi| MelYvq `Lv MQ, fvBivm mivmwi mvwfi ga w`q RivqyZ cek Kij AwaKvsk GBWmi msgY NU _vK| bxivM hvwbc_i wgDKvmvi cwZiva KZUv fvBivm msgY VKvZ cvi Zv MelYvi welq| BwgDb gwWdvBs Ilya cqvM Ges hvwbc_ fvBwimvBWvj cqvM GBPAvBwf msgY cwZiva iZc~Y f~wgKv ivLZ cvi| wi Mci AMZ bvix`i ivM msgYi wei GwU GKwU evowZ myiv w`Z cvi| `Lv MQ 0.05% nvBWvwKvivKzBb Rj wbqwgZfve cqvMi dj bvbv cwqvq BwgDb imci cwieZb NU _vK| dUvAwWkbi gvag GwU fvBivm webvk KvhKi f~wgKv ivL| jLKi MelYvq `Lv MQ Gb_vKzBbvb RvZxq Ilyajv GB cwqvq Gbfjc fvBivm webvk KvhKi f~wgKv ivL| GUv fvBivj wdDkb cwZiva Ki GBPAvBwf ew Ges cwZwjcb iva Ki| jLK AviI `wLqQb h, WUvb mvjdU Gi gZ Ilya Rj AvKvi hvwbc_ eenvi Kij KvlMv fvBivm GvWRickb iva Kiv me| GUv GBPAvBwf BbdKkb I fvBivm wmbwmwUqv digkb iva Ki| G cm jLK KbWgi e_Zv Ges GUv eenvi cyili AbvMni K_v wPv Ki hbmwq bvix`i myivi Rb mvifvBKvj Kvc I Wvqvdvgi gZ wdwRKvj ewiqvii mv_ mv_ hbwgjbi mgq G RvZxq fvBivmbvkK Ilya eenvii civgk w`qQb| Zuvi ^DvweZ GBPAvBwf fvBivmbvkK Rj-G BwgDb
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imc gwWdvqvi Gi mv_ mv_ gvBvebvkK GKwU Ilya cqvMi K_v ejQb (DQX Combi Gel)| GUv cqvM cyili exh we`gvb fvBivmjv hvwbc_ mnRB gviv hvq Ges hvwbc_i wgDKvmvi evowZ cwZivai gyLvgywL nq| G aibi Ilya hv Ki Zv nj hvwbc_ cwe fvBivmi Gbfjc cvwUb asm mvab| iZ fvBivm GvWRickb cwZiva| wRwc-120 I wmwW-4 Gi ga Avw ewqv I eb cwZiva| fvBivm wdDkb I cwZwjcb cwZiva|

fvBivmbvkK `ywU Ilyai mswgkYi dj GUv h mg KvlMv wmwW-4 Gi Aevb bB Zvi mv_ GBPAvBwfi eb I cwZiva KiZ cvi| Gme Ilya cqvMi h welqwU Lqvj KiZ nq Zv nj GUv hb mnR `eYxq nq| Ges eeZ Ai Kvli Rb wZKviK bv nq|

AvjvP WUvb mvjdU Kvl viv kvwlZ bv nIqvq GUv Kvli gUvewjK wqvZ Kvb wZKviK cfve ivL bv| Aciw`K DQX Combi Gel G Ggb GKwU fvBivm I wbivc` flR pesticide eenvi Kiv nqQ hv Kvli Kvb wZ bv KiB Kvli mv_ ebhy I ebnxb mKj GBPAvBwf fvBivmK wbab I wbwq KiZ cvi| GUv GBPAvBwf-1 I GBPAvBwf-2 RvZxq fvBivmi mKj mveUvBci (Subtype) DciI KvhKi| mywbw`fve G Ilyai j I cqvRbxZvK evaMg Kievi Rb 2002 mb cKvwkZ jLKi g~j MelYv c _K DZ Kiv hvQ
Initial Target of DQX Combi Gel was To create a hostile field for the virus for its survival. To kill the virus outright. To suppress its replication by preventing membrane fusion.

To eradicate the favorable environment and cofactor which stimulates virus transmission.
To reduce number of HIV targets. To modify host cells immunity to prevent HIV transmission.

DQX Combi Gel is a combination therapy planned in such a way that while one component destroys the viral envelop with direct contact, another prevents GP-120-CD4 interaction. They block viral fusion and prevent replication.
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Dextran sulphate used in the combination prevents adsorption of virus. As dextran sulphate is poorly absorbed by the cell, the intracellular and metabolic side effects are nill. The D component of the gel is microbiocide of plant origin commonly used as a safe pesticide. The combination can overcome fusion of virus with human cell type that lack CD4 and it is effective against almost all subtype of HIV1 and HIV2. It acts on both free virus and virus on cell surface. Site of Action & Target Env protein of virus Virus adsorption HIV CD4 binding Membrane fusion Fusion leading to reverse transcription

GBPAvBwf msgYi mvebv Kwgq Avbvi ewMZ cwiQbZv I hb ^vi Dci iZ `qv nQ| GBWm cwZivai Rb Kvwibhy cvbxq Rj cUvk cvigvvbU wgwkZ Ki hvwbc_ wbqwgZ ayZ ne| Ze wcPKvwi eenvi Ki ev DPvgvvq cvwb cqvM Ki aZKvh Kij DcKvii Pq AcKviB ewk ne| Gme KvR GBWm msgY iva Kej mnvqK cwiek Zwi Ki | Wvqvdvg Ges Kvc eenvi Kivi GKwU AcvKZ bwZevPK w`K nj gq`i mvwf Ges cyil`i wji AMfvM Z Zwi nIqv| gq`i RbwbqYi Rb AvBBDwW (IUD) eenviI GvvgwUqvj (Endometrial) c`vn Zwi Ki ivM msgY mnvqK cwiek Mo Zvj| gq`i mvwfKvj GKUwc hv Rivqyi GK aibi ivMvv Aev, cyil _K bvixZ GBWm msgYi mvebv evwoq w`Z cvi| hbKgx`i Rb KbWgi mv_ bbvwbj-9 hy dvg, Rwj, wg eenvii Rb weklfve mycvwik KiQb jLK| ^gvvq nvBWvw-KvivKzBbhy Rj I wg eenvii gvag fvBivm msgYi mvebv AbKvsk wbqwZ nq| GwU kixii ga BUviwjDwKb-6 (Interleukin-6) BbwnweUi wnmve KvR Ki| GB BUviwjDwKb-6 gbvmvBU I gvvdRi ga GBPAvBwf ewZ Mv_ dvi wnmve KvR Ki| nvBWvw-KvivKzBb GBPAvBwfi Gbfjvc cvwUb wRwc-120 ZwiZ evav Zwi Ki mvgwMKfve GKw`K G`i msLv Kwgq Avb, Abw`K GBPAvBwf UvMU Kvli msLv wbqY Ki| 10.3.1. aZKiY: GBPAvBwf Ggb GKwU fvBivm hv wK bv mnR wewfb KwgKvj I wWUviRUi msk webvkcv nq| Kvwibhy cvbxq Rj viv mvaviY cwqvq hvwbc_ aZKiYI hvwbc_ we`gvb fvBivm, evwiqv I QvKi msLv Kwgq Avb| mvaviY cUvk wgwkZ cvwb AwWvBwRs GRU wnmve GvbvivweK evwiqvmn ek wKQy QvKi Dci g`fve KvR Ki| Gi y k GBPAvBwf RvZxq fvBivmI wbg~j nq| Ze AbK MelK gb Kib, hbmshvMi ci aZKiY cwZ fvBivmK Ici Vj w`Z cvi ev Qwoq w`Z cvi| Wyk cqvM Ki hvwbc_ aZ KiZ Mj cvwbi Pvc fvBivm fZi XyK hZ cvi| jLKi gZ, e cyili msk Avmv bvix`i hvwbc_ wmgb GwUewW ^vfvweK BwgDb eevK AKvhKi Kivi GKwU KviY| ZvQvov G aibi mshvMi dj wmwdwjm, Mbvwiqv, KvgvBwWqvmn QvK msgYi h mvebv
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GB IlyawU cvwbZ `eYxq nIqvq GUv hvwbc_ GKwU cjc Zwi Ki| Ze eve G aibi Ilya eenvii evcK cixv I mgxvi cqvRb| h KbWg eenvi gv 69 fvM myiv w`q _vK, mLvb `wi` `ki hbKgx hviv MvnKK KbWg eenvi ivwR KiZ cvi bv A_ev h me MvnK KZK mwVKfve KbWg eeZ nq bv, mLvb G aibi GKwU myiv eev mevBK Avkvw^Z KiZ cvi| 10.2.2. wdgj KbWg I mswk- fvBwimvBWvj KZUzKz KvhKi? bbwbj-9 (Nonoxynol-9)-mn jvU KbWgB mePq fvj hbmyiv w`Z cvi| KbWg Zv mvaviY myiv w`qB _vK, Gi Ici bbwj-9 bvgK vYy NvZKwU GBPAvBwfK AKvhKi KiZ mg nq| Ze wPvi welq, GB bbwj-9, AbK mgq ZK Ges wgDKvmvZ PzjKvwbmn Zi mw KiZ cvi| ZvB Gi weK LuRQb wevbxiv| y Wvqvdvg I mvifvBKvj Kvci mv_ bbwbj-9 eenvi A_ev Ab Kvb fvBwimvBWvj eenvi evsjv`ki gZ `kjvZ hbKgx`i ga GBWm msgY cwZiva KiZ cvi, wekl Ki hv`i hbv Kvb Z _vK bv| mywbw` GwUevqvwUK I jvKvj GwUgvBvevqvji cqvM hvwb Afii NvjvK wbivgq Ki ^vKi cwiek Zwi Ki cwZiva kw evovZ mvnvh KiZ cvi|

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mw nq Zv wKQyUv cwZiva Kiv me aZKiY cwZZ| G mgmv mgvavb bv njI GZ we`gvb RxevYy I ciRxexi msLv Kg Avme| ^vfvweK hbgjvgkvi ci hbv ayq djj mvgwMK cwieki DbwZ NU Ges GBWm msgY mnvqK ekwKQy Kv-dvii bwZevPK cfve Kg Avm| ivM msgYi Rb fvBivj WvR I evwiqvj WvR GKwU iZcY dvi| ~ GQvov cvqyc_ _K mswgZ AvZ dvi (Unknown factor) Ges Lvrbv Kiv nqwb Ggb ew`i hbvi Pvgovi wbP we`gvb wi dvi Kwgq Avbevi Rb aZKiY cwZwU KvhKi nZ cvi| G aibi cwZ wmwWwm ev wek^v msv KZK cPvwiZ cwZi AMZ bv njI `wi` `k Gi cqvM Rb^v_B Riwi| Ze e-vB cwZZ Gmei cqvM hbivMi mywbw` wPwKrmvi Kvb weK bq| Ze hbvK bxivM iL BwgDb cwiwwZi DbwZ NUvZ cvij GBPAvBwf msgYi mvebv Kg Avme| G cwfWb AvqvwWb (Povidone-Iodine) RvZxq wg hvwbc_ eenvi Kij bvbv aibi RxevYymn fvBivm I QvKi msgY wbqwZ nZ cvi| GUv Mvg cRwUf I Mvg bMwUf `yaibi evKUwiqvmn QvKi vijvK asm Ki| Ze GwU GK bvMvi `ymvni ewk eenvi Kij AwZwi AvqvwWb GfRickbi Rb wZ mvab nZ cvi| GZ _vBiqW M-vi mgmv nZ cvi| hviv gv neb Zv`i Rb GUv eenvi GKeviB wbla| Kbbv Mf wki _vBiqW MwZ mgmv nevi mvebv _vK| 10.4.1. Qj`i Lvrbv GBPAvBwf msgYi SzuwK Kgvq? Qj`i Lvrbv bv Kivi KviY hbvi evowZ Pvgovi wbP wMgv (Smigma) bvgK h gqjv Rg Zv GBWm msgYi mnvqK cwiek Zwi Ki| GZ mvaviY msgYi KviYI Pvgovi wbP GBPAvBwf UvMU Kvli msLv eo hvq Ges mjv Pvgovi wbPB Avkq bq| GZ gq`i _K cyil`i ga GBWm msgYi mvebv AbK Y eo hvq| GB A^vKi cwiek GBWm fvBivm wUK _vKviI mvebv iqQ| GKviY cyil`i Lvrbv Kivevi evcvi DrmvwnZ KiZ ne| hviv Lvrbv Kiwb Zv`i evowZ Pvgovi wbP Rg _vKv gqjv w`b `yevi cwivi KiZ ne| GUv KiZ PvgovUv fZi Ub nvjKv mvevb cvwb w`q ayZ ne| Ze G cwqvq cyil _K bvixZ GBWm msgY cwZivai welqwU GLbI cwivi bq| cyil ev bvixi hbv Nv, Z ev Kvb ivM _vKj GBWm msgYi mvebv ew cvq| G cyil _K bvix ev bvix _K cyil Dfq c_B GBPAvBwf msgYi nvi ew cvq| 10.5.1. BbRKkbi gvag WvM MnY ceYZv cwZiva Kiv hve Kxfve? BbRKkbi gvag bkv`e MnYKvix`iK (IDUs) weklfve cwZiva KiZ ne| GB msgY _K euvPvi Rb BbRKkbi m~uP GKevi eenvii
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ci dj w`Z ne Ges Abi eeZ m~uP KLbB eenvi Kiv hve bv| GUv wbwZ Kivi Rb evcK RbmPZbZv mw KiZ ne| KD wbR wbR BbRKkb bevi Pv Kie bv| Wvvii civgk wPwKrmvKgxi mnvqZvq wWmcvRej wmwii viv BbRKkb wbZ ne| wekl Ki Bbmywjb eenviKvixiv ev Ab hviv Nb Nb m~uP eenvi Kib Zv`iK wWmcvRej wmwi I m~uP eenvi KiZ ne| 10.5.2. wbW&j GP cvMvg KZUzKz KvhKi nZ cvi? BbRKkbi mu~Pi gvag GBPAvBwf msgY wbqYi Rb Kvb Kvb `k wbWj GP bvgK GKwU cwZi cPjb Kiv nqQ| GB cwZZ hviv BbRKkbi gvag bkv Ki Zv`iK mnRfve RxevYygy wWmcvRej wmwi I m~uP mieivn Kiv nq| 80-i `kK GUv c_g BDivc Pvjy Kiv nq| cieZxZ GUv AvgwiKvZI cPwjZ nq| G cwZi bwZevPK w`K nj, wmwi I wbW&j mnRjf nIqvq GZ WvM meK`i msLv ew cZ cvi| Gi GKwU weK cwZ iqQwmwi I wbW&j cwivi Kivi Rb we-P RvZxq mvgMxi eenvi| G cm gb ivLv cqvRb, AvjKnj cqvMi gvag GBPAvBwfK gi djv me bvI nZ cvi| Ze dzUvbvmn Abvb Dcvq Zvc cqvM cwZ fvBivm webvk KvhKi| 10.6.1. GBWm msgY _K euvPvi Rb Kx aibi Kgm~wP MnY KiZ ne? bvix wbqwZ hbivM I GBWm ivM cwZivai welqwU cPvi cZ ne| bvixi ^vK cvwievwiK, mvgvwRK I RvZxq KjvYi mv_ mswk- KiZ ne| mgvRi wewfb ii bvix`i KvQ cuQvevi Rb nj_ wfwRUi I dvwgwj c-vwbs IqvKvi`i gZ bvix`i wbevwPZ KiZ ne| eZgvb evsjv`k hviv Gaibi KgKv mswk- AvQ Zv`iK GBWm msgY I cwZiva msv wkv `vb Ki gvwUfkb cvMvg Dy KiZ ne| mswgZ nQ ev nZ cvi Ggb wi McK Ges cvwK mxgvi `wi` bvix, fvmgvb bvix, hbKgxmn bkvq Af bvix`iK wPwZ Kie GB ^vKgxiv| Zviv bvix`i wewfb mgmv Ges cqvRbjv wjwce Kie| fvmgvb bvix I hbKgxmn `y`kvM Amy cm~wZ`i cybevmb mnvqZv `e|
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GBPAvBwf mK hviv wkv `e Zv`i KZKjv welq weePbvq ivLv DwPZ; hgb mvaviYi hb AveM, ceYZv, cg fvjevmv, Ai mK, gvbwmK ^v, bkv`ei cwZ Avmw BZvw`| GQvov fqfxwZ, bvbv weKwZmn NYv wel I Anvii welqjvI Kgx`i gv_vq _vKv cqvRb| cwievii KvQ wkv `vb chvq `ki mvgvwRK Aev Abyhvqx wewfb cwiKbv MnY KiZ ne Ges cwievii ^vgx xK h_fve wkv `vbi eev KiZ ne| bvix I cyilK GBWm QvovI Abvb hbivMi wPwKrmv MnY Dy KiZ cvij Ges mdj wPwKrmvi gvag Zv`i hbivM cwZiva KiZ cvij AwaKvsk GBWm cwZiva cwiKbv evcK A_ mdj ne| ejvi Acv ivL bv h, hbmshvM cwinvi A_ev cviwiK wekvm I Avvi Ici vwcZ GKK mK GBPAvBwf msgY cwZivai mePq eo myiv| wK cKZ Aevq `Lv hvQ GKvwaK mK, weevn ewnfZ ~ mK, weevnc~e mK, fvmgvb cwZZvmn hbKgx`i m msmM mgvR evcK| 10.6.2. mvgvwRK Av`vjb Mo Zvjv : GBWm cwZiva cwiKwZ Ges mwwjZ Kgv`vM cqvRb| G Rb egyywL KgcwiKbv MnY KiZ ne| h_v hviv GBWm Avv Ges hv`i Avv nevi mg~n mvebv iqQ Zv`iK wPwZKiY Z_v wi Mc wbaviY| evcK RbmPZbZv mw, wkv I Z_i mieivn| ivMi wevi, cwZiva, wec` BZvw` msv wkv Ges ivMi jY msv Z_ cwiekb| Z_ I ivM cwZivai DcKiY mieivn wbwZKiY (iZ Abyhvqx) Ges ivMi jY Abyhvqx mve wPwKrmv mev c`vbi myeev| GBPAvBwf cwRwUf`i cwievi, mx I AvZxq^Rb`i cixv wbixv, mZKxKiY Ges wbewKiY GKwU Riwi evcvi| wbLiPvq mKj hbivMi wwbs I eevc `vbi cwZ cPjb| GBWm cwZiva c_g h welqwU ejv cqvRb Zv nj ewMZ hb AvPiYi mskvab I AvPiYMZ cwieZb AvbZ ne| ivM cwZivai Rb mePq ewk cqvRb wbivc` gjvgkv Ges hb AvPiY Zv Avbv|
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Kvb Kvb hb AvPiY wec` AvQ Zvi evLv Ki GKK mx ev gbvMgvm mKi Ici Rvi w`Z ne| Ze GB Dc`k `evi mgq gvbeghv`vi cwZ kv I fvjevmv c`kb KiZ ne Ges wePviKi gZ AvPiY cwinvi KiZ ne| GBWm cwZiva KiZ hq ivMxK GBPAvBwfmn mKj hbevwnZ ivMi wec` mK RvbvZ ne| 10.6.3. kbvKiY Kgm~wP : c_gB kbv KiZ ne hv`i ivMi jY `Lv `qwb A_P Avv nqQ, wekl Ki hviv ivM kbvKiYi Rb wPwKrmKi kiYvcb nQ bv Ges wPwKrmv wbQ bv| UvK PvjK, wiv PvjKmn wewfb aibi gRyi, e`ii wbKUeZx GjvKvq wewfb Kg I eemv evwYR wj jvKRb, AvBb cqvMKvix msvq KgiZ m`m I eemvqx eweM hviv GB mg hbKgx`i m gjvgkv Ki wKsev hviv ninvgkv we`k hvQ, we`k wMq KvR KiQ, mLvb hbKgxmn wewfb SuywKc~Y bvix-cyili (Potentially infected persons) mv_ gjvgkv KiQ Ges `k wdi GK ev GKvwaK mxi m _vKQ| Zviv mevB GBWm cwZiva Kvhg UvMU Mci Af~| mKj UvMwU Mci KvQ hbevwnZ ivM I GBPAvBwf msgY msv Z_jv cuQ w`Z ne| MvgUm Kgx, evm I UvKi WvBfvimn wewfb kwgK, fvjbviej Mc, wi Mc, nvmcvZvji Kgx, cv_jwR wefvMi Kgx, imvjb wefvMi Kgxmn mswk- mKji wbqwgZ GBPAvBwf cixv evaZvg~jK KiZ ne| we`k cZvMZ wekl Ki AvwdKvi `kjv, BDivc I AvgwiKv _K cZvMZ mKj kwgK, KgPvix, MnfZmn mKjK evaZvg~jKfve GBPAvBwf wwbs KivZ ne A_ev Zviv GBWm, ncvUvBwUm, gwbbRvBwUm BZvw` ivMgy msv nj_& mvwUwdKUmn `k AvMgb I wbMgb Kie| GUv we`k hvevi mgq Ges divi mgq `yeviB Kiv hZ cvi| gYKvix wbRB cixvi LiP enb K ie| GBPAvBwf cwRwUf nj ZvK wPwZ KiZ ne Ges we`k hvevi evcvi Zvi Ici wblavv Avivc KiZ ne| GBWmK bvwUdvBqej wWwRR wnmve MY KiZ ne| cwZwU we`kMvgxi wbKU GBWm ivM msv KvMRc I Z_vw` cuQ w`Z ne|
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 we`kx RvnvR e`i wfoj Zvi bvweK ev ziv hw` `k XyKZ Pvq Zvnj e`iB Zv`i GBPAvBwf cixv KiZ ne A_ev Zv`iK GKB cwZZ nj_& mvwUwdKU `vwLj KiZ ne| Avgv`i `k h mg we`kx KvR KiQ ev KvR KiZ BQyK Zv`i Rb Zv GUv evaZvg~jK nIqv cqvRb wekl Ki AvwdKv Ges `wY I `wY-c~e Gwkqvi wKQy `ki Rb| bvix cvPvi e KiZ ne| cvPviKZ`iK we`k _K diZ Gb AekB GBPAvBwf wwbs KivZ ne| evaZvg~jKfve mKj hbKgx`i iwRkb Ges Zv`i wePiY wbqY KiZ ne| GBWm ivMi mv_ AvjKnj Ges ZvgvK MnYi mK iqQ| dj Gmei cwZ hv`i Avmw iqQ Zv`iK Gjv cwinvi KiZ ne| Lvjvgjvfve hbivM I Ilya msv evcvi AvjvPbvq AskMnYi eev KiZ ne| me K_vi kl K_v GBWm msv Riwi Z_jv zj-KjRi cvVm~wPZ Afy KiZ ne|

Aavq GMviv
GBWm ivM wk I MfeZx gv
11.1.1. GBPAvBwf Avv`i MfaviY Kx aibi RwUjZv `Lv `q? ivMx Gmgq gv nj kvixwiK RwUjZvi K_vwU fveZ ne| GQvov hviv Ilya MnY Kie bv Zv`i gv _K wkZ GBPAvBwf msgYi nvi AbK ewk GUvI gb ivLZ ne| fviwUKvj Uvwgkb Ae GBPAvBwf welq bvbv MelYvq `Lv hvq h mewb 35 fvM _K mevP 66 fvM gv _K wkZ GBPAvBwf msgYi mvebv iqQ| AvgwiKvb I BDivcxq`i ga GB nvi Kg njI AvwdKvb`i ga GUv ewk| 11.2.1. gv _K wki ga Kxfve AvBPAvBwf msgY NU? nUivmyqvj mKi gvag hZ `Z MwZZ GBPAvBwf msgY NU, ZviPq AwaK `ZZvq gv _K Mf mvbi ga GBPAvBwf fvBivm Qwoq co| GBPAvBwf AvgYi iZ I kl chvq hLb fvBivj jvW ewk _vK ZLbB gv _K wki ga mePq ewk GBPAvBwf msgY NU _vK| mivmwi gv _K wki ga GBPAvBwf msgY ev fviwUKvj Uvwgkbi h welqjv cfve wevi Ki Zv nj Avvi c_g ev c~eeZx wki GBPAvBwf msgY msv Aevb| c_g wkwU GBPAvBwf Avv nj cieZx`i gaI GBPAvBwf msgYi mvebv eo hvq| hv`i wmwW-4 Kvli msLv Pviki wbP Zv`i wk`i ga GBPAvBwf msgY ewk nq _vK| GQvov iZi chvqi GBPAvBwf Avv h mg ivMxi (Advanced class-4 HIV) ga wc-24 GwURwbwgqv iqQ A_vr DP chvq fvBiwgqv ev fvBivj jvW iqQ Zv`i ga AwaK nvi fvBivj Uvwgkb NU _vK| GQvov wcgvwPDiW& mvb A_vr hviv 38 mvni AvM RbMnY Ki, Zv`i gaI GBPAvBwf msgY ewk nq _vK| Aek GgbI nZ cvi h, GBPAvBwf msgYi gvv ewk nIqvZ wcgvwPDiW& wki msLv ewk nQ|

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11.3.1. GBPAvBwf cwRwUf wk`i RbMZ Amyweavjv Kx Kx? Rbi ciciB Avv wk I Abvv wki cv_K Kiv KwVb nq co| Ze GK eQii ga ivMi bvbv DcmM `Lv `q| Gi ga Dj-LhvM nj wcwmwc RvZxq wbDgvwbqvi msgY Ges vqyZi wewfb ivM| G ivMjv ZiY I cveq`i Zzjbvq wk`iK `Z AvgY Ki| GQvov BwgDb eevi wechqi KviY cv eq`i ga h mg ivM I RwUjZvi mw nq, Zv wk`i ga NU _vK AwZ `Z| GBPAvBwf msgYi KviY wk`i `ivM I nvU dBji NUvi welqwU GKwU wekl wechqKi w`K| GZ wkiv Zzjbvg~jKfve `Z gZzgyL cwZZ nq Ges Giv Lye Kg euvP| GBPAvBwf cwRwUf wk`i mgmv Abvb GBPAvBwf Avv`i gZB| G`i ga ay msgYi nviB ewk nq _vK bv, mB mv_ cvq mevi `wc my wki Zzjbvq eo nq _vK| Zv`i `wci msKvPb ev cv Kivi gZvI Kg nq _vK| `wci GB eKj ev cv_jwR hviv GBPAvBwfZ Avv nQ Ges hviv nQ bv Dfq aibi wk`i gaB mgvb| `wci GB cwieZbi mv_ Avv gvq`i Rb wRWvfywWb ev Ab Kvb Ilya cqvMi mK Avwevi bv nIqvq MelK wjcmyR (Lipshultz) aviYv Kib h, gvqi kixi we`gvb ivM, ivMi KviY c`vn Ges gvqi Acywi KviYB wki GB Amyweav NUQ| Ze jLKi aviYv GB h, Gi KvhKviYwU A I AbvweKZ iq MQ| `wc Amyweav wbq RbMnY Kiv `yaibi wk`i (GBPAvBwf cwRwUf I bMwUf) `wci IRb ew Ges msKvPb gZv nvm c_g mgvb _vKjI 4 _K 30 gvmi ga GBPAvBwf Avv wk`i evg fbwUKvji KvhgZv nvm cvq Ges c_g KeQii gaB nvU dBjii w`K GwMq hvq; wekl Ki hv`i ga dzmdzmi wewea msgY nq, Zv`i gaB `wci GB RwUjZv `Z weKvk jvf Ki| AvgwiKvi bvkbvj nvU jvs e-vW BwbwwUDUi (NHLBI) MelK W. RR mcKv G cm Dj-L Kib h, GBPAvBwf gy wk`i `wci Amyweavjv Zzjbvg~jKfve Kg _vK Ges eqm ewi mv_ mv_ g AcvKZ fvj nq IV| A_vr hmKj wk GBWm Avv bq, Zv`i ga GUv cieZxZ ^vfvweK nq Avm| GbGBPGjweAvB-Gi cwiPvjK W. KW (Dr. Claude Lenfant) ejb,
These results reinforce the importance of careful follow-up and the
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need to be alert to the possibility of cardiac complications when caring for children born to HIV infected mothers.

G cvcU GBPAvBwf Avv gvq`i wk`i cwZcvjbi RwUjZv Ges KvwWqvK gwbUwis-Gi cqvRbxqZvi Ici Rvi `qv nQ Ges Avv MfeZx gvK A.Z.T ev wRWvfywWb cqvMi K_v ejv nQ| GZ kZKiv 66 fvM gv _K wki `n GBPAvBwf msgY cwZiva Kiv hvq| AvgwiKv hyiv wRWvfywWb-Gi mv_ Abvb iUvfvBivj WvMi Kw^bkbI `qv nq _vK| 11.4.1. beRvZK I wk`i GBPAvBwf msgY : eo`i gZ GKB cwqvq GBPAvBwf fvBivm beRvZK`i wU-njcvi wjvmvBU KvlK AvgY Ki BwgDb eevK wech Ki| cwic~Y cwZiva eev Mo bv IVvq Avv beRvZK`i ga wekl aibi mgmvi mw nq| mvaviYZ GBPAvBwf Avv gv`i wbKU _KB beRvZKiv fvBivm Avv nq| GBPAvBwf Avv gv`i wkiv mewb 35 fvM _K mevP 66 fvM GBPAvBwf cwRwUf nq| gv _K wki ga fvBivm msgY ev fvwUKvj Uvwgkb ZLbB ewk NU hLb gvqi i fvBivj jvW mePq ewk _vK| ivMi c_g chvq Ges kl chvqB fvBivj jvW mePq ewk nq| Ze ivM msgYi AeewnZ ci AvwKDU (acute) BbdKkbi mgq i h fvBivmi msLv eo hvq Zv Avevi KgI hvq| GBPAvBwf Avv wkiv eo`i Pq AbK Kg evuP| mvaviYZ Rbi ci ciB GBPAvBwf Avv wkK `L ivM kbv Kiv KwVb nq| Rbi ci GBPAvBwf Avv gv`i h mg wk fvBivm Avv nq Ges hviv fvBivm Avv nq bv Dfqi iB mivcwRwUf nq _vK| Qgvmi ga wki BwgDb cwZiva eev Mo IVvi mv_ mv_ kixi hLb h_ cwigvY GwUewW Zwi nq, ZLb my wki i mivbMwUf nq Avm| Gi AvM ch wki i we`gvb GwUewW cixvZ fyj msKZ `q| gvqi ii GwUewWjv Rivqyi dzj w`q wki icevn cuQ hvq| GB GwUewW Rbi wZb _K Qq gvm ci kixi _K `~i nq hvq| Gici hviv mwZ mwZB Avv Zviv bZzb Ki GwUewW Zwi Ki| ZvB Qgvmi ga cixv msv RwUjZv `~i Ki GBPAvBwf kbv Kivi Rb h cwZ MnY Kiv nq ZvK ejv nq cwjgvim PBb wiqvKkb (Polymerase chain reaction ev PCR) cwZ|
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wcwmAvi cwZ ay Rbi ci ciB eenvi Kiv nq bv, GUv ivMi kl chvqI eenvi Kiv hvq Ges eenvi Kiv nq| GQvov GBPAvBwf cvwUb wc24 kbv KiI wbaviY Kiv hvq beRvZKwU GBPAvBwf Avv wK bv| GBPAvBwf Avv gvqi wk hw` AvVviv gvm eqm ch U bMwUf nq Zvnj wbwZ ai wbZ ne h wkwU GBPAvBwf bMwUf| GBPAvBwf Avv gvqi Mf Rb bevi KviY h mg wk mwZKvi A_ GBPAvBwf viv mswgZ nq, Zviv GBPAvBwf msv bvbv AmyL Avv nq GKeQi eqm mxgvi gaB| G mgq Zviv wcwmwcmn bvbv aibi wbDgvwbqvZ Avv nq| wkiv GBPAvBwfZ Avv nj wbDgvwbqv QvovI Nb Nb bvbv aibi ivM Avv nq| GZ Giv c_g _KB Rxeb msKU ev failure to thrive-G fvM| BwgDb cwZiva eevwU AKvhKi _vKvi KviY eo`i Zzjbvq wkiv AwZ`Z gZzgyL cwZZ nq| GBPAvBwf msgYi KviY beRvZK I wk`i gw I vqyZ ivM msgY nq| GBPAvBwf Avv wk`i BwgDbvBRkb welqwU wbq gv I wPwKrmK `v`yjgvbZvq fvMb| G gb ivLv cqvRb h, GBPAvBwf Avv wk`i BwgDbvBRkb KiZ ne Abvb mvaviY wk`i gZbB| GZ Zviv AbK ivM _K euP hZ cvi| Ze wekl aibi fvKwmbjv wbevPbi evcvi wk wekl`i IciB wbfi KiZ ne| 11.4.2. wbivc` wki Rb`vb wK me? `Lv hvQ, GBWm Avv gvqi wkiv GBPAvBwf cwRwUf nZI cvi, Avevi bvI nZ cvi| Ze Mfvevq gv wPwKrmv MnY Kij GBPAvBwf bMwUf wk Rb`vbi welqwU wbwZ Kiv hZ cvi| fvwUKvwj UvwgUW GBPAvBwf msgY cwZivai Rb h mg Ilya cqvM Kiv nq Zvi ga Dj-LhvM nj wRWvfywWb (GRWwU)| Aek Kw^bkb _ivwc gbv_ivwci Pq AwaK KvhKi| AvgwiKvi bvkbvj BwbwwUDU Ae PvB nj_ G wnDgvb WfjcgU (NICHD)-Gi cavb Wb Avjvvi gv _K wki ga GBPAvBwf msgY cwZiva Kw^bkb _ivwci f~wgKvwUK AZ g~jevb ej Dj-L Kib 2002 mb cKvwkZ Zvi GK MelYvc| c~e myBRvijvi GKwU MelYvq `Lv wMqwQj h, Kw^bkb _ivwci ga hviv cvwUqvm BbwnweUi MnY KiQ Zv`i wc-gvwPDiW& MfcvZ NUQ ewk| G cvcU 1990 _K 1998 mb ch AvgwiKvi 1590 Rb GBPAvBwf cwRwUf gvqi Ici mvZwU MelYv Pvjvbv nq| G`i ga 396 RbK `qv
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nq Kw^bkb WvM, hv`i ga cvwUqvm BbwnweUi wQj bv| 137 Rbi ga cvwUqvm BbwnweUi Afy Kiv nj| Aewk 1143 RbK Kvb IlyaB `qv nj bv| MelYv djvdj `Lv Mj, hviv Ilya MnY KiQ Zv`i wc-gvwPDiW& wk (Prematured birth), A IRb, wj ev_, wbPz AveMvi vii nvi (hv wK bv GKwU wki RbKvjxb myZvi m~PK) hviv Ilya MnY Kiwb Zv`i _K Kg bq| Ze hviv Ilya cj Zv`i ewkifvM wkB GBPAvBwf bMwUf Aevq Rb wbj| `y`ji gaB wcgvwPDiW& Wwjfvwi cvq mgvb mgvb; hviv Ilya MnY KiQ Zv`i ga 16 fvM Ges hviv Kiwb Zv`i ga 17 fvM| Ze hviv cvwUqvm BbwnweUi MnY KiQ Zv`i ga 5 fvM Lye Kg IRb wbq RbMnY KiQ| GB MelYvq cgvwYZ nq, GBWm Avv gvq`i GwU iUvfvBivj _ivwc w`j h DcKvi nq Zv Ilyai cvkcwZwqvi Pq AbK g~jevb| G evcvi jLKi ewMZ AwfgZ nj, GBPAvBwf cwRwUf gvq`i wPwKrmvq cvwUqvm BbwnweUi cqvM eRb KivB Dg| GBPAvBwf Avv gvq`iK _ivwc `qvi AvM Ilyai fvjg` w`Kjv ej `qv cqvRb| GRWwU _ivwc `qvi ci hgb BwgDbvjwRK gwbUwis Kiv cqvRb, Zgwb wbDgvwbqv (wcwmwc) cwZiva I wewea Ilya cqvMi cvkcwZwqvwUI weePbvq Avbv DwPZ| GBPAvBwf Avv bvix`iK gv nevi c~eB Rvwbq `qv cqvRb h Avv 100 Rb gvqi ga 33Rb GBPAvBwf Avv wk Rb w`Z cvi| Gici iqQ Avv gvqi cmevi DP ^vmev I gvbwmK mvcvUi cqvRbxqZv| Atmv Aevq KVvifve Zv`i BwgDbvjwRK gwbUwis Kiv cqvRb| wbqwgZ cixv Kiv cqvRb wmwW-4 I wmwW-8 Kvli msLv| wcwmwc cwZiva `qvi AvM Rb bqv cqvRb h, wmwW-4 msLv `yki wbP iqQ wK bv| wcwmwc Avv`i wmwW-4 Kvl `yki wbP nj wcwmwc cvdvBjwm wnmve UvBg_vwcg mvjdvg_vRj `qv cqvRb| 11.4.3. gv _K wki ga GBPAvBwf msgY Kxfve cwZiva Kiv hve? mve GBPAvBwf Avv`i gv bv nIqvUvB fvj| Ze bvbv eve KviY welqwU gb wbZ nq wPwKrmK`iK| GKviY hviv GBPAvBwf msgYi iZi chvq _vKe Ges hv`i c~eeZx mvb GBPAvBwf Avv, Zv`iK msgY msv RwUjZvi K_v evSvbv cqvRb| Zey Giv gv nq Mj AbvMZ wki wbivcvi Rb Ggb me eev wbZ ne hvZ wk Kvb
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Z bv wbq Rbvq| wcwf ev hvwbc_ Rivqyi cmeKvjxb AMMwZ g~jvqbi Rb wPwKrmK hLb evievi Avyj w`q wki gv_vi bg AvmvUv Abyfe Kivi Pv Kib, m mgq AmZKZvi KviY wki gv_vi Pvgov AvNvZcv nZ cvi, hv wK bv GBPAvBwf msgY mnvqK nZ cvi| Gici iqQ wki msgY iva GwU-iUvfvBivj Ilya I BwgDbvM-vweDwjb cqvM| GZ 66 fvM GBPAvBwf msgY cwZiva Kiv hZ cvi| AvKwUf BwgDbvBRkb AviKwU mvebvi w`K DbvPb KiZ cvi| GBPAvBwf Avv gvq`i fvBivj jvW hLb wb chvq _vK ZLb Zv`i `n GBPAvBwf GwUewW hy wdviW& mivg chvqg AwZ wbg gvv _K AwaK gvvq eenvi Kij kixii ga DP chvq GwUewW Zwii GKwU mvebv mw nZ cvi| GwU Avv gvq`i kixi GwU iUvfvBivj cqvMi weK bq| G MelYvi mve mKj w`K evcK chvjvPbv Kiv cqvRb| 11.5.1. eyKi `ya GBPAvBwf wbtmZ nq wK bv : AbK ck Kib eyKi `ya GBPAvBwf wbtmZ nq wK bv| Gi Reve njnuv, GBPAvBwf Avv gvq`i b wbtmZ im Ges eyKi `ya GBPAvBwf wbtmZ nq| wU-njcvi gbvmvBU Ges gvvdRGjv eyKi `ya h_ cwigvY we`gvb _vKvq fvBivm msgY nq _vK| h mg wk GBPAvBwf Avv nqwb ZvivI G aibi `~wlZ b Pzl ev `ya cvb Ki GBPAvBwf Avv nZ cvi| GBPAvBwf Avv gvqi `ya GZUv cwigvY fvBivm _vK h mnRB Zv wkK ivMvv KiZ cvi| 11.5.2. GBPAvBwf Avv gvqi `ya wK wki Rb wbivc`? Avv gv wk`i eyKi `ya w`Z cvie bv| Ze wki m gjvgkv KiZ cvie| G Zv`iK AekB GBWm ivMi wPwKrmv wbZ ne| `Lv MQ GBPAvBwf Avv gv I wk hviv wRWvfywWb cqQ Zv`i 66 fvMi ga GBWm msgY ceYZv Kg GmQ| 11.6.1. bi euvUv _K GBPAvBwf msgY nZ cvi? GBPAvBwf Avv bvixi bi euvUvq Kvb Nv ev KvUv bv _vKj Ges b _K `ya ev G RvZxq Kvb Zij c`v_ wbtmZ bv nj G c_ fvBivm msgYi mvebv _vK bv| 11.7.1. MfeZx gv wK GBPAvBwf Avv nZ cvi? ay GBPAvBwf Avv MfeZx gvqivB AbvMZ wki `n fvBivm Qwoq `q bv, AbK MfaviYi ci hbmshvMi gvag ZvivI fvBivmcv nq Ges Zv Zv`i Mf wki ga Qwoq `q|
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Aavq eviv
ewZi mv_ GBPAvBwf msgYi mvebv Ges Avvi gbvivM I weKvi
12.1. ewZi mv_ GBPAvBwfi mK : 12.1.1. GBPAvBwf Avvi gvbwmK ceYZv Kgb? mvaviYfve hviv GBWm ivM Avv nQ, wPwKrmv wbQ Ges kbv nevi ci wbR`iK Avovj ivLevi Pv KiQ A_ev Avv nqQ Rb wPwKrmKK Gwoq PjQ Zv`i gbi Aev, AveM, DrKv I fqK Abyfe Kiv Ges ewZK wek-lY Kiv wPwKrmKi wbKU GKwU AwZ cqvRbxq evcvi| ecvivqv ewnmex Rxeb hvcbi Rb hviv wewfb hbivM Avv nQ Zv`i gbvwek-lYI AwZ cqvRbxq| gvbyli h bwZevPK ^fve Aea, bxwZewnf~Z, AcwiQb, AmvgvwRK KvhKjvc I wecbK hb AvPiY Dy Ki ZvK GKwU DP SuywKc~Y AvPiY (high risk behavior) ej AwfwnZ Kiv hvq| GUvK Zv`i e_Zv bv ej ceYZv ejvUvB AwaKZi mZ ne| GB ceYZv Zv`i Pwi Ggbfve we`gvb _vK h, AbK mgq hbivM msgY msv wkv w`q Ges Gi fqven cwiYvg mK AewnZ KiI Zv`iK wecbK hbmshvM _K wbeZ Kiv hvq bv| ew I mgvRK wec` _K euvPvevi Rb G`iK KbWg eenvimn hmg myiv I ivM cwZivai civgk `qv nq Zv AbK mgq e_Zvq chewmZ nq| `k I RvwZK asmi nvZ _K evuPvevi RbB G`i ewZ wek-lY Ki ivxq Z_v mvgvwRK KZZ I wbqY vcb Kiv cqvRb| DP SuywKc~Y AvPiYi bvbvwea cKvk NU Aea ecvivqv hbRxeb hvcbKvix Ges gv`Kmex`i ga| G`i AbK mgKvgx nevi KviY GBWmmn Abvb hbivM Avv nevi mvebv ewk _vK|
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mgKvwgZv GKwU ceYZv, GUv gvbyli ewZ I Anvi weKvki mv_ mwKZ GKwU wePzwZ| AbK GUvK GKwU RbwUK UBU ej ^xKvi KiQ wevbxiv| 12.2.1. GBPAvBwf msgY ewZ Kx aibi cfve ivL? Rb ncwK wekwe`vjqi GBWm mvwfmi GKwU MelYvq (Understanding the Role of Personality in HIV Risk Behavior) GBPAvBwf msgYi mv_ ewZK Mfxifve m Kiv nqQ| GB MelYvq Personality characteristic & personality disorder in HIV risk behavior evLv KiZ wMq ew Pwii extroversion/ introversion Ges stability/ instability K ewZi WvBwfs dvm wnmve wPwZ Kiv nq| GB MelYvq ewZi msv Gfve cKvk Kiv nqPersonality is defined
by emotional and behavioral characteristics or traits that constitute stable and predictable ways that an individual relates to, perceives and thinks about the environment & the self.

eZgvb wfwK wPvfvebv, mivmwi Abyfe wfwK cKvk I KvR, PURjw` cwZ`vb I cyivi cZvkv BZvw`| G`i wPv PZbv _vK ZvrwYK AveM I Abyfei evevqb| G`i Pc emv wPv Ges AbZg clYv _vK ZvrwYK BQvi evevqb Ges kixi I gbi bvbvwea Pvc _K `Z cwivY jvf| Giv mvgvwRK nq, DRbv fvjevm| ZvrwYK I nVKvix AveM wbfi KvR KiZ Ges SuywK wbZ cQ` Ki| AbK Giv ecvivqv, Avkvev`x I Awi nq _vK| 12.2.3. AgyLx`i PvwiwK ewk Kgb nq _vK? Abc AgyLx`i (introvert) ga hmg PvwiwK ewk j Kiv hvq Zv nj Giv nq AZxZ I eZgvbgyLx| PZbv wbfi I cwiYvg`kx| KvR I hyw G`i ZvrwYK AbyfeK Ae`wgZ Ki| AgyLx Pwii ewiv AZxZ AwfZvi wePvi Ki fwelZ Amyweavjv cwinvi Kivi Pv Ki| Giv mZK| hme KvR fwelZ Rxeb Amyweav NUvZ cvi Zv Giv Gwoq hvq| G kYxi ewiv DRbv wegyL I kv nq _vK| ZvrwYK AveMK Giv wbqY KiZ cvi| Giv MvQvbv I wek njI bwZevPK welv`M wPvq AvQb _vK| 12.3.1. wigwZ I AwigwZ ew`i ewk Kgb nq _vK? ewZi AviKwU eo gvv nj wiZv I AwiZv hv wK bv PvwiwK wewfb gvvq AveMceYZv I wbwqZvi mv_ mivmwi mwKZ| gvbwmKfve hviv wi Zv`i AveMi Dvb nq axi I gvvi ga Ges Zviv `Z wdi Avm wbR`i Aevb| Aciw`K, AwigwZ ew`i AveM Ggb Zxe I `Z cwieZbkxj nq hv wK bv Zv`iK ZvrwYK AveM I BQvi Ici wbfi Ki AhwK KvR Dy Ki| G`i gRvR AbKUv cvi`i gZ IVvbvgv Ki| ewngyLx (Extroversion) I AgyLx (Introversion) Ges mywigwZ (Stability) I AwigwZ (Instability) Pvi aibi Pwi Zwi nq wewfb gvvi ewk wbq|
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ewi GK GK aibi ceYZv GK GK gvvq _vK Ges Gi cfveI _vK GK GK iKg| Kvb ceYZvKB AvwiK A_ BwZevPK ev bwZKevPK bv ej cwiek I mgvRi AvKvvi mv_ Zv KZUzKz mvgmc~Y mUv ejvB fvj| hLb KviI ceYZv mgvRi evcK Aski mv_ Amvgmc~Y nq Ges AvPiYMZ AbgbxqZvi KviY gvbwmK AwiZv mw Ki ewi KvR I cKvki ga eKj NUvq ZLb ZvK cvimvbvwjwU wWRAWvi ej AwfwnZ Kiv nq| ewZ msv wewfb Zjvi Ici wfw Ki ew PwiK ewngywL I AgywL Ges mywigwZ I AwigwZGB Pvi KvUvMwiZ wef Ki evLv Kiv hZ cvi| [m~: Costa PT & Windiger TA (EDs). Personality Disorders &
the Five-factor Model of Personality, Washington, APA, 1994, Eysenck HJ. J Pers 1990. 50 : 245; Lucas RE, et al. J Pers & Soc Psych 2000; 79 : 452]

ew Pwi we`gvb ewngywLZv I AgywLZvi gvvB ewi DRbv I Bbwnwekb-RwbZ msKZ I AvPiYMZ cKvkwU wbqY Ki| 12.2.2. ewngyLx`i PvwiwK ewk Kgb nq _vK? ewngyLx`i ga hmg PvwiwK ewk j Kiv hvq Zvi ga Dj-LhvM nj
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hviv GBPAvBwf Avv nqQ ev nZ cvi Zv`i wecbK PvwiwK ceYZvi mv_ ewZi mK wek-lY Ki `Lv hvq, hviv Awi Ges ewngyLx Zv`i gaB mevP gvvq GBPAvBwf wi wenvwfqi-Gi cKvk NU| 12.3.2. AwigwZ ewngyLx (Instable Extrovert) Mc: Rb ncwK wekwe`vjqi mvBwqvwUK mvwfmi MelYv I wek-lY `Lv hvq, GBPAvBwf Avv ivMx`i ga 60 fvMB ewngyLx I Awi AveMmb| G aibi ewiv ZvrwYK BQv I AveM Abyfei Ici KvR Ki| Giv `Z cwieZbkxj| Giv GZUv cwieZbkxj h G`i KvR I wPvK Abygvb Kiv me nq bv| bvbv MelYvq cgvwYZ nqQ, G`i wPvfvebv I KvRi ga Mfxi AmwZ| DP eywi Ges GBWm mwKZ vb G`iK wecbK mshvM GovZ Zgb Kvb mvnvh Ki bv| gyn~Zi AveM hv`i KvQ gyL Zv`i KvQ AZxZ AwfZv I fwelr wPv MY ejB weewPZ nq| eveZvK fyj Giv ZvrwYK Avb` DcfvM I mvgwqKfve e_v e`bv fyj hvIqvUvKB ewk iZ w`q _vK| gvbwmK AwiZv I fvimvgnxbZvi KviY G`i dvKPzqwUs gyW (Fluctuating mood)-G cwieZb Ggbfve NU h, G`i Avb` I e`bvi Abyf~wZI `Z cwieZbkxj nq _vK| G aibi ewZmcbiv cwiKbv Ki wKQy KiZ bvivR _vK Ges KbWg eenvi AgbvhvMx nq _vK| Giv myiv Qvov ecivqvfve cvqyc_ I hvwbc_ hbmshvM Ki _vK| Giv hb Avb`i Ici GZUv ewk iZ `q h, hbevwnZ ivMi fxwZwU G`i KvQ MY nq IV| Giv KbWgi bvbvwea myweavjv gvbZ bvivR _vK Ges DRbvi gynZ ~ Kvb wKQyi w`KB wdi ZvKvq bv| GKB mv_ G aibi Awi ewngyLxiv gv`K `ei cwZ SuyK co| gv`Ki ZvrwYK Avb` G`iK fywjq `q Gmei wecbK cwiYvg| Giv bvbvaibi bkv`e PL `LZ Pvq Ges AbK mgq AwaK cwigvY bkv`e MnY Ki|
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BbRKkbi gvag MnY Kiv gv`Kjvi Zxe Dbv`bv _vKvq Giv Gjvi w`K SuyK co| kvixwiK wbivcvi welqwU G`i AveMi wbKU MY nq IV| 12.3.3. mywigwZ ewngyLx (Stable extrovert) Mc: Rb ncwK wekwe`vjqi mvBwqvwUK mvwfm `jwU GBWm ivMx`i Ici MelYv Ki wZxq h McwUK wecbK ej wPwZ KiQ Zviv nj mywigwZ ewngyLx (Stable extrovert) Mc| Giv GBWm Avv`i ga 25 fvM| wigwZ ewngyLxiv eZgvbwfwK Avb`-wPvq AvQb _vK| G`i AveM Zgb myZxe I mnR DxcK bv njI Giv wec` co wfb KviY| gvS gvS Giv Ggb wbweKvi nq IV h, GBWm msgYi wec` G`i KvQ gvivZK wKQy ej Mvn nq bv| Giv AwZwi Avkvev`x, wbR`i cwZ Avvevb Ges wbR`i aviYvq wbwZ nevi KviYB wecbK Avb` wbcwZZ nq| 12.3.4. AwigwZ AgyLx (Instable Introvert) Mc: ncwK wekwe`vjqi MelYv gZ GBPAvBwf Avv`i ga AgyLxiv mePq Kg| Kbbv, Giv fwelZi K_v wPv Ki| bwZevPK cwiYwZi K_v wPv Ki Giv ^vfvweK eva I weePbvi Ici Rvi w`q _vK| Giv wbR`i Rb bvbvwea myiv wbq _vK| G`i ga BbvwewjwU Ges vwewjwU-B wecbK mK Rwoq covi welqwU wbaviY Ki| Rb ncwK wekwe`vjq MelYvaxb ivMx`i 14 fvM Avv`i Pwii ga BUvfvikb I BbvwewjwU-Gi mswgkY LyuR cqQ| AwigwZ AgyLxiv `ytwvceY, gywW Ges cwmwgmwUK| Giv Ilya I hb msmM LuvR Avb`i Rb bq, gbve`bv _K AevnwZ cvevi Rb| Giv fwelZi K_v fve Ges wecbK cwiYwZi K_vI wPv Ki| Ze GUvI gb Ki h, fvMi Ici G`i wbqY bB| 12.3.5. mywigwZ AgyLx (Stable Introvert) Mc: mywigwZ AgyLx ivMxi msLv gv 1 fvM| G`i wbR`i Ici wbqY AvQ| Giv mykxj| Giv wecbK I gv_v Mig KvR cwinvi Ki Pj| G`i AwaKvsk i mvjb I ckvMZ `yNUbvi KviY GBWm Avv nqQ|
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Rb ncwK wekwe`vjqi GB wek-lYwU Zv`i `ki bvMwiK wfwK nIqvq Gi ewkK MnYhvMZv cki gyLvgywL nZ cvi| cvvZi GBPAvBwf Avv`i ga GKwU evcK msLK AvwdKvb eskvyZ Kvjviv Ges `wi` kYxi wnvwbiv| ^vfvweKfveB G`i evcK Ask ewngyLx (Extrovert) Ges AwigwZ (Instable) Pwii nq _vK| ZvB ewZi mv_ GBPAvBwf wi ceYZvi wek-lY RvwZMZ ewk I RbwUK UBUi mK weePbvq Avbv cqvRb| evsjv`ki hbivMx`i ga GKwU eo Ask AwigwZ I AgyLx PvwiwK ewki| AvcvZ`wZ kv, myweePK, eywgvb, hywev`x I wevb`i ga hbivMi wevii welqwUK gvbe Pwii Unpredictable Ask ev MelK`i wPvi AZxZ ej gb Kiv nQ| Ze GB kYxi ga Rb b hbivMvv`i mv_ gjvgkvi mvebv Kg| 12.4. GBWm ivMvv`i gvbwmK ^v, gbvivM I weKvi: GBPAvBwf Avviv h mg gvbwmK RwUjZv I ivM Avv nq, Zvi ga cavb nj gyW I DMRwbZ mgmv| GQvov Zviv Avv nq AMvwbK gUvj wWRAWvi| AMvwbK gyW wWRAWvii ga Wwjwiqvg I wWgbwkqv AbZg mgmv| GQvov iqQ AMvwbK mvBKvwmm| GBPAvBwf ivMi KviY eva (Cognity) Ges gUi (Motor) dvskb DP chvq enZ nIqvq wWgbwkqvi Drcw nq _vK| ivM kbv Kivi ci ivMxi wbKUZg ewB ivMxi ga gvbwmK cwieZbjv mec_g j KiZ cvi| G`i mnvqZv Qvov cv_wgK Aevq ivM wbYq Kiv wKQyUv KwVb eU| AbK mgq AMvwbK gyW wWRAWvi I AMvwbK mvBKvwmm Avv`i gaB AwaK nvi GBPAvBwf msgY NU _vK| G mg AMvwbK gvbwmK evwajv nZ cvi ivMxi Ilya, gUvewjK mgmv, gw ivMi msgY, myweavev`x bvbv RwUj ivMi msgY Ges bZzbfve `Lv `qv Kvvii Rb| GQvov bkv`e eenvii KviYI Wwjwiqvg, AMvwbK gyW wWRAWvi, mvBKvwmm, wWgbwkqvi i nZ cvi| ivMi myz wPwKrmvi Rb wPwKrmKK ivMxi ewZ, gyW, eva, aviYv, PZbv BZvw`i cwieZbjv Mfxifve chvjvPbv KiZ ne| ivMi KviY wbYqi c~e Ilya cqvM ivMxi gvbwmK ^vi DbwZ NUjI g~j mgmvwU AvZB _K hve| Ze mvweKfve GBPAvBwf Avvi gvbwmK wPwKrmv Kiv KwVb evcvi| Kbbv AbK mgq AMvwbK I dvskbvj
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mgmvjvi jY GKBiKg nq _vK| hgb, GBPAvBwf GbKdvjvcvw_ (gwKi GBPAvBwf msgY) Ges DP gvbwmK Pvc DfqB Mfxi welv`M Zv ev wWcwmf wmbWg wbq cKvk nZ cvi| AvjKnj I KvKbi gZ bkv`e MnYi ciI welv`M Zv GKwU ^vfvweK cwiYwZ| Ze hv`i wmwW-4 Kvli msLv wZbki Ici Zviv mvaviYZ dvskbvj gvbwmK ivM ev bkv `ei KviY Amy nq _vK| hv`i wmwW-4 Kvli msLv cwZ Nb wgwjwgUvi `yki wbP, A_ev hv`i ga myweavev`x ivMi msgY cKU nq _vK ZvivB AwaK nvi AMvwbK gbvewaZ Avv nq| 12.4.1. Wwjwiqvg Kx? gw I vqyi gUvevwjK AmyZvi bvgB Wwjwiqvg Ges Gi c_g cKvk NU wLUwLU gRvRmn wb`v I RvMiY fvimvgnxbZvi gvag| Gi mv_ h jYjv eZgvb _vK Zv nj PZbvi ii `Z cwieZb, cvZwnK Rxeb gbvhvMi Afve, AmsjM K_v evZv I wPv BZvw`| GZ vb, Kvj I cwiek msv eva Ges wZi ga eNvZ NU _vK| mB mv_ we`gvb _vK BwjDkb ev vwgjK bvbvwea Abyfe hgb A`k ~ wKQy `Lv wKsev keYhvM bq Ggb wKQy kvbv BZvw`| 12.4.2. wWgbwkqv Kx? evai wecw I wWgbwkqv mvaviYZ jYwenxb GBPAvBwf cwRwUf ivMx`i ga `Lv hvq bv| Zv`i ga hv `Lv hvq Zv nj DrKv I bwZevPK gvbwmK Aemv`| mwZKvi A_ vqy ivMi KviY Abyfe I evai eKj `Lv `q gvivZK chvqi GBWm ivMx`i | ivMi jYjv i nq gbvhvMi Afve, wZkw nvm, A cZi axi MwZ, wewfb Bw`qRvZ KgKvi ga mwZi Afve (Complex sequential motor activity) -Gi gvag| AvcvZ`wZ G aibi ivMx`iK gb nq wbRxe, evanxb Ges cvwicvwkK cw_ex _K wewQb| mvaviY cixv wbixvi gvag G`iK kbv Kiv KwVb| ivMvv`i cwiYwZ bvbviKg| DP chvqi wWgbwkqvq cvw_e eva jy nq, wnZvwnZ vb jvc cvq| ivMxi nvZ cv k nq Avm, cmv e-cvqLvbvi wbqYI jvc cvq| 12.4.3. gvwbqvK wmbWg Kx? AMvwbK gvwbqvK wmbWgi cKvk iZi GBWm Avv`i ga NU _vK| GBWm Avv`i AvPiY I ivMi Aev eySevi Rb Ges Zv`iK wbqY
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Kivi Rb Aevf` ivMxi gvbwmK ewai cKvkjv evSv AZ Riwi| ivMi MfxiZv hLb DP chvq cuQvq ZLb gvwbqvK wmbWgi cKvk NU wLUwLU gRvR, wb`vnxbZv, `ZK_b ev DPviY Amyweav, A^vfvweK weivUZeva (megalomania), jvMvgnxb wPv, fqi AwiZv, wbqYnxb AmshZ eenvi Ges Ae`gbnxb bvbv eenvii bM cKvki ga w`q| G GgAviAvB RvZxq cixv wbixvi gvag Abvb mve ivMi KviY wbYq Kiv cqvRb| GQvov hv`i c~e _K evBcvjvi wWRAWvi iqQ Zv kbv Kiv Mj ivMi cKZ Aev wbaviY Kiv hvq| AbK wcwmwc RvZxq wbDgvwbqvZ DP gvvq iqWI iZi gvwbqv Zwi Ki _vK| GvgdUvgvBb, KvKb I GwU-wWcmvU _ivwc, GgbwK GBWmi Ilya wRWvfywWb cqvMI gvwbqvi cKvk NUZ cvi| gRvR I DrKvRwbZ wWRAWvijvi ga hv mePq ewk NU _vK Zv nj welYZv ev wWckb| wWckbi jYjv hfve GBPAvBwf Avv`i ga cKvk nq Zvi ga Dj-LhvM nj Nyg I zavi `kgvb cwieZb| GQvov `bw`b KvR I Rxebi Avb` _K mi hvIqv, Aemv`M nq cov, A cZi ZrciZv wbRxe nq Avmv, AKviY w nq IVv, KLbI Acivaeva I g~jnxbZv eva Wye hvIqv, bZzb Ki wmvnxbZvq AvQb nIqv, gbvhvMi Afve Abyfe Kiv, AvZnZvi ceYZv, gZzwPv BZvw` wWckbi AbZg jY| G chvq G`i IRb nvm nZ cvi, Avevi IRb ewI nZ cvi| gvbwmK ivMi mv_ GBWm ivMi kvixwiK jYjvi mvRyh wPwKrmK I ivMxi wbKURbi wbKU `yin mgmv Zwi Ki| bkv`e MnYKvix`i ga cKvwkZ AMvwbK gyW wmbWgi mv_ GBPAvBwf GbKdvjvcvw_ I Abvb vqyivM Avv`i jY cv_K Kiv AbK mgq KwVb nq co Ges wPwKrmvq evNvZ NUvq| hv`i ga KvKb, AvjKnj, GvgdUvgvBb BZvw` eenvii KviY gyW wWRAWvi NUQ, wPwKrmv ii c~e mjv e Kiv cqvRb| hv`i ivM msgYi AvM _KB gyW wWRAWvi we`gvb wQj Ges hviv bkvM bq, A_ev hv`i cwievii ga wWckb ceYZv bB Zv`iK GwU-wWcmvU _ivwc cqvM Ki `Z mywPwKrmv `qv me|
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12.4.4. weqvM e_v : GBPAvBwf Avviv GKw`K wbKURb`i nvwiq e_vKvZi _vK, Abw`K PvKwi-evKwi, evmvb, mvb me nvwiq Mfxi e`bvi ga Wye hvq| bZzb Ki h AvNvZ Avm Zv KLbI Zv`iK wbeva I Ro Ki Zvj A_ev DM I Mfxi e_vi XDq bZzb Ki wbgwZ Ki| GZ Zviv nvwiq dj e_v gyQ djvi kw| Ze KqK mvni gaB Zviv e_vi mv_ emevmi Afvm i Ki bq| hv`i ga c~e _K gvwbq bevi gZv Kg _vK Ges mvgvwRK mg_b AcZj _vK Zv`i Rb Rxeb KwVb nq co| z gvbwmK Amyweav cKU nj mvBKv_ivwci m Ilya cqvM Kiv `iKvi| cwiwwZ cheYi gvag ^ mgqi Rb ebRvWvqvRwcb w`q GvsRvBwU, wb`vnxbZv Ges `ytLevai wPwKrmv i Kiv hZ cvi| Avi hLvb Acivaeva Ges g~jnxbZv eva fvix nq `bw`b KvR evNvZ NUvq m GwU-wWcmvU _ivwc `qv hZ cvi| 12.4.5. AvZnZvi ceYZv : AvZnZvi ceYZvi mv_ ivMi MfxiZvi Zgb mK bv _vKjI mK iqQ ivMi K I ZRwbZ KviY nZvkvi mv_| mB mv_ bvbvwea e_veva, Mfxi nZvkv ivMxK AvZnbb Dy Ki| ivMx gb Ki Gi ga w`qB m wbqY KiZ cvie ivMRwbZ bvbv RwUjZvK| 12.4.6. GvsRvBwU Bbmvgwbqv : AvZnbb ceYZv ivamn ivMxi RxebK mnR I ^vfvweK Kievi Rb Ges ZvK wbqY Kievi Rb GBPAvBwf Avv`i DrKv I wb`vnxbZvi mywPwKrmv cqvRb| G KviY Amyweav hLb Ggb chvq cuQ h, ivMxi ^vfvweK Rxeb I mvgvwRK mK wecb nq Ges mB mv_ ckvMZ KvR APj nq co, ZLb Ilya cqvM Kiv AZvekK nq IV| AbK GvsRvBwU wWRAWvi ev DrKvRwbZ ivMi KviYjv AvjKnj, wbKvwUb, KvKb, GvgdUvgvBb eenvimn ebRvWvqvRwcb RvZxq Nygi Ilya nVvr Ki Qo `evi KviY ev AwZwi Kvwdb (Pv, Kwd, KvKv BZvw`) MnYi KviY nq _vK| wbDgvwbqv ev Ab Kvb ivM gv_vq i mieivn Kg AvmjI G aibi Aev mw nZ cvi| GQvovI `Lv MQ, GBPAvBwf wPwKrmvq eeZ GwUiUvfvBivj (nvU _ivwc) Ilyajvi mv_ iqW Ges bvK Lvjvi Rb eeZ wW-KbRmUU wecbK DrKvi KviY NUvq|
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12.4.7. wb`vnxbZv : DrKvRwbZ AveM ev GvsRvBwU wWRAWvi A_ev wWcwmf wmbWg ev gvbwmK Aemv`M Zvi KviY wb`vnxbZv NUv AwZ ^vfvweK| GBWmi Ilya cqvMI wb`vnxbZv NU| Kvwdb Ges DRK Ilya cqvMI wb`vnxbZv NU _vK| GQvov ivM Avv nevi ci KvRKg Qo `qvq `yejZvi KviY Ges w`evwb`vq Af nq covq Nygi Q` b nq hvq| AbKi nvmcvZvj Nygi mgmv nq| Gme KviY ivMx`i Awb`v wPwKrmvq w`evwb`v cwinvi Ki Nygi mgq wbaviY Kiv cqvRb, mB mv_ cqvRb ^vKi wb`vi cwiek Zwi Kiv| GQvov wb`vnxbZvi wewfb DxcKjv wbqY Kiv cqvRb| welv`M Zv I Aemv` hLb wb`vnxbZv NUvq ZLb biwUcUvwbj-Gi gZ mWwUs GwUwWcmvU cqvM Kiv cqvRb|

Aavq Ziv
cvwievwiK I mvgvwRK Rxebi mv_ GBWmi bvbv mK
13.1.1. GBPAvBwf Avv`i cvwievwiK Rxeb Kgb ne? GBPAvBwf Avv`i wbR`i Rxeb Zv eUB, Zv`i Avkcvk hviv _vK Zv`i RxebI GKUv msKUi ga w`q AwZevwnZ nq bvbv KviY| msKUi KviY ivMxi kvixwiK Aev, bvbv RwUjZv Ges fqfxwZ| fqfxwZ Govevi Rb GBPAvBwf msgY msv wKQy vbi cqvRb Ges mB mv_ cqvRb mvaviY vb ev Kgbm wbtmZ GKaibi wePvieva I ^v mPZbZv| Gme h ckjv D`q nq Zv nj GBPAvBwf Avv`i k, Quvqvq ivM Qovq wK bv wKsev Zviv Mnvjx wRwbmjv GK fvM KiZ cvie wK bv| Avv ew mevi mv_ weQvbv, Pqvi, mvdv, Kzkb BZvw`mn webv`bi vbjv eenvi KiZ cvie wK bv| Gme cki Di njZvqvj I igvji gZ ejv kqvi bv KivB DwPZ| UqjU ccviwU Avjv`v nIqvB fvj| Zvqvj, weQvbvi Pv`i I cwiaq Kvco cwZevi eenvii ci D mvevbcvwb w`q ayq djv DwPZ A_ev Zv jwZ aZ nIqv DwPZ| 13.2.1. Avv`i msk Avmj GBPAvBwf QovZ cvi? hbivM Avv`i Quj, Rwoq aij wKsev gvwjk Kij GBPAvBwf y msgYi mvebv bB| Ze kixi gvivZK Kvb Z ev PgivM _vKj GBPAvBwf msgYi mvebv _vKZ cvi| G gb ivLv cqvRb, GBWm Avvi `n wbtmZ wewfb im, eR I i vivB GBWm mswgZ nq _vK| KvQvKvwQ emj, Rwoq aij, nvjKv Pzgy w`j GBWm nZ cvi GUv wVK bq| 13.2.2. GKB Kvc, M-vm kqvi Kij GBPAvBwf msgYi mvebv KZUzKz? cwievi cZKi M-vm-c-U mvaviYZ Avjv`vB _vK| Ze mywbw` Ki GBWmi KviY Lvevi c-U Avjv`v Kivi cqvRb bB| eeZ c-UwU cwZevi Mvgjvjv KvbfveB kqvi Kiv DwPZ bq| Avi cwievii h KviI gyL, VuvU, `uvZi Mvovq, wRnvq _vKZ cvi hKvb Z| mvaviYZ VuvU I

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gyLi jvjvq we`gvb GBPAvBwfi cwigvY Kg _vK| ZvB G cwqvq GBPAvBwf msgY GKwU ZvwK mvebv gv| ZeyI Gi _K mvgvb gvvq njI fvBivm wbtmiY nZ cvi| hnZz G aibi kqvwis bvbv aibi ivM QovZ cvi ZvB GUv GKeviB eRbxq nIqv DwPZ| 13.2.3. fyjg Avvi Uz_evk eenvi Kij Kx nZ cvi? Avvi Uz_evk eenvi Kiv gvUB myiwPi cwiPvqK bq Ges KvbfveB KvwZ bq| Kbbv, GUv wewfb aibi ivM QovZ cvi| Ze GBWmi fvBivm hnZz jvjvq Lye Kg _vK, G KviY wKq Mj mnRB fvBivm gviv hvq| Avevi Uz_ci KwgKvjI fvBivmjv gviv hZ cvi| ZvB G cwqvq GBPAvBwf msgYi mvebv Kg| U_evk I iRvi, gjvi I hvwbc_ eeZ wcPKvix, Gbgv (enema) Kvb Ges Abvb hv wKQy ivMxi k-v, i ev AbKvb Zij wbtmiY viv wm nZ cvi Zv GKKfve Kej ivMxB eenvi Kie, Ab mevi Rb Zv eRbxq| 13.3.1. GBPAvBwf Avvi eeZ UqjU _K ivM QovZ cvi? GUv mwZ h, GBPAvBwf Avv `i gjg~ I e wKQy gvvq fvBivm R we`gvb _vK| Ze Zv Avvi i, exh I hvwbimi Zzjbvq AbK Kg| ZvB UqjU eenvii c~e ^vfvweKfve cwivi Ki Zv cybteenvi Kij GBWm msgYi mvebv _vK bv| KgvWi DcwifvM ev emvi vb (wmUKfvi) ev Ab h mvgvb cwigvY fvBivm _vKZ cvi Zv GKRb my ewK Avv Kivi Rb h_ bq| Avi `yNUbvg hw` UqjUwUi wmU ev emvi vb Avvi i wmI _vK ev eR Ggbfve b _vK h GKRb my ewi kixi Zv jM hvq, mI kixii Kvb KvUv Quov, Nv, Z BZvw`i DcwwZ Qvov msgYi mvebv _vK bv| mivmwi i ev eR kixii weZZ RvqMvq jM Mj GBPAvBwf msgYi xY mvebv (kZKiv 0.1 fvM) _vK| gjg~ ZvMi ci UqjU ccvi eenvi Kij Zv wekl evM ivLZ ne hvZ Zv Ab KviI msk bv Avm| GQvov aZKvhi ci GKw`K hgb wbRi nvZ ayZ ne, Zgwb mvwWqvg nvBcvKvivBU A_ev Kvwibi mvnvh nvZi msk Avmv UvcwU ayq djZ ne| we`k bvbv aibi mi hy bb-UvP Uvc iqQ| KbyB cqvM Ki Lvjv ev e Kiv hvq Ggb UvcI iqQ| ev_igi hmg vb ivMxi eRi Quvqv AvmZ cvi Zvi mewKQyB ZvrwYKfve ayq djZ ne| kvIqvi, wm, cvwbi wUDe, Uvc, mewKQy 5.25 fvM mvwWqvg nvBcvKvivBU w`q ayq djZ ne| GKfvM nvBcvKvivBU GKkfvM cvwbZ wgwkq (A_vr 25 wjUvi cvwbZ 250
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wgwjwjUvi nvBcvKvivBU wgwkq) me wKQy ayZ ne| ivMxi Wwms, Wvqvcvi, cvW, wUmy BZvw` eRjv ivM QovZ cvi feB mfve wekl aibi evM iL asm Kiv DwPZ| `iRvi nvZj, Kj, dvimn k Avm Ggb wRwbmjv Lye mvgvb cwigvY fvBivm `~wlZ njI nZ cvi, Ze Kbv Aevq fvBivmjv gi hvq| Uvci Mig cvwb wKsev Kvwibhy cvwb fvBivmK gi djZ mg| we-wPs cvDWvi A_ev nvBcvKvivBU w`q dvi, `iRvi be, Kj BZvw` gyQ djj m~Y wbivcv weavb Ki| 13.4.1. GBPAvBwf Avvi Nievwo cwivi KiZ Mj Avv nevi mvebv KZUzK? z GBPAvBwf Avvi Zij wbtmiY my ewi kixii i cek KijB GBWm ivM Avv nevi mvebv _vK| ZvB cwivi cwiQbZvi mgq mvaviY mveavbZvB ivM cwZiva KiZ cvi| Aek i I eR cwivii mgq jvU ev ivevi nvM-vfm cwiavbmn wWmcvRvj msv wewfb mZKZv Aej^b KiZ ne| 13.5.1. GBPAvBwf Avvi nuvwP-Kvwk wK msvgK? nuvwP-Kvwki mgq wUmy A_ev Kvco w`q gyL XvKZ ne| eeZ nvZ ayq djv Dg| eR eevcbv gvbZ ne| hgb wUmywU GKwU evM djZ ne, eeZ igvjwU Kvwib cvwbZ ayZ ne A_ev wm KiZ ne| mveavb mvevb cvwb w`q ayq wKq djjI Zv fvBivmgy nq| 13.5.2. Avvi g~ Mvq jvMj wK GBPAvBwf mswgZ nZ cvi? AZ ZK jvMj wKQyB nq bv| Ze VuvU ev gyLMni hvZ bv hvq, Zv Lqvj ivLZ ne| 13.5.3. gjg~ fvBivm KZUv _vK? gvbyli gjg~ h cwigvY GBPAvBwf _vK Zv Zzjbvg~jKfve i, exh I hvwbimi Pq AbK Kg| G KviY mvaviYZ GBWm Avv`i jvjv, cmve I cvqLvbvi gvag GBPAvBwf Qovq bv| 13.5.4. GBPAvBwf Avvi `n we`gvb Nv ev Z Quyj GBPAvBwf ne wK? AZ ZKi gvag GBPAvBwf msgY ZvwKfve Ame| Ze Kvb AevZB jvU M-vfm Qvov Avvi Z k Kiv DwPZ bq ivMxi klvKvixmn ^vKgxi wbivcvi ^v_| mvaviYfve GBWm Avvi im
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wbtmZ nq Ggb vb k Kiv ev wbKU hvMvhvM vcb Kiv GKeviB DwPZ bq| 13.6.1. GBWm Avv ew wK ivbvNi hZ cvie? nuv, Kvhg I my nj hZ cvie| wbR`i cwievii ga G aibi ew mvevb w`q nvZ ayq mZKZvi mv_ Lvevi Zwi KiZ cvie| Ze eeZ nuvwocvwZj, PvgP, cvb BZvw` cybteenvii c~e ayq djZ ne| ivbvNijv cwZevi eenvii ci wWUviRU w`q ayq djZ ne| j ivLZ ne Aafy Lvevi, Lvevii KYv Gjv hb Kv_vI co bv _vK| Abvb Ni Ges ev_ig gc (gvQvi Rb eeZ Kvco ev dvBevi) ev viv cwivi KiZ ne| Gjv KLbB wKPb Avbv hve bv Ges Kvb AevZB Gjv wKPb ewmb ev wm avqv hve bv| 13.7.1. Avv ivMx`i Rb Lvevi `vevi msv Kx aibi mZKZv cqvRb? Lvevi AvM I ci nvZ gyL ayZ ne, eeZ wRwbmjvKI ayq djZ ne| wbRi Avjv`v Zvqvj, weQvbvi Pv`i eenvi KiZ ne| Gjv eenvii ci wWUviRU w`q avqvi AvM Ab KviI eenvi Kiv DwPZ bq| m~Y bv dzwUq, wm bv Ki, KuvPv wRwbmi Qvj bv wQj Ges fvj Ki bv ayq LvIqv DwPZ bq| AMvwbK Lvevijv hv wK bv c Ges gvbe gji Zwi mvi cqvM Drcvw`Z nq Zv cwinvi Kiv DwPZ| AMvwbK jUzm GKeviB LvIqv DwPZ bq| AMvwbK Lvevijvi ga hme RxevYy _vKZ cvi Zvi ga AbZg nj mvjgvbjv Ges ncvUvBwUm-G| G `yUv UvBdqW I Rwm ivM Qwoq _vK| AbK KuvPv wSbyK Lq _vK| wSbyKmn RjR AbK Lvevi Kjiv RxevYy _vK| GBPAvBwf Avv`i ga BwgDb cwZiva Kg _vKvq KjivRwbZ gZi nvi weivU nq _vK| GQvov GwU mcwmm (Sepsis) wmbWgI NwUq z _vK| `ya, `B, cwbi BZvw` `yRvZ Lvevi cvwiZ bv nj Gjv mvjgvbjv, emjv ivM QovZ cvi| mvjgvbjvi KviY UvBdqW, emjvi KviY emjvwmm ivM nq| 13.8.1. GBWm ivMvv`i Lv`, cvbxq-Gi cyw I ^vgvb: GBWm ivMvv`i Lv`, cvbxq-Gi cyw I ^vgvbi w`K j ivLZ ne| cvwb I Lvevi we`gvb h me ciRxex GKRb my jvKK ivMvv
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KiZ cvi bv, Zv GBPAvBwf Avv`i `n gvivZK ivM NUvZ cvi| GKviY GBPAvBwf Avv`iK Uvc IqvUvi ev mvaviY cvwb eenvi wbla Kiv nq| Zv`iK dzUvbv cvwb wdvi Ki eenvi KiZ ne memgq| 13.9.1. Lvevi nvUj I iziU _K GBPAvBwf Qovevi mvebv KZUzKz? Lv` I cvbxqi gvag GBWm Qovq Ggb Kvb cgvY AvRI cvIqv hvqwb| ZeyI msgY cwZivaK eveywP, IqUvi Ges KvUvivi`i Rb wKQy wewawbla iqQ| Giga AbZg wblajv nj cwiQbZv msv| hviv c-U I Lvevi `vevi bvovPvov Kie, Zv`i mevBK Lvevi Quvqvi c~e mvevb cvwb w`q nvZ ayZ ne| Kvb Kgx cUi cxov I eyKi mgmvq Avv nj KvR e ivLZ ne| Lvevi Zwi Ges cwiekb KiZ ne ^vwewa Abyhvqx| hv`i nvZ Nv _vKe A_ev Kl wbtmZ nq Ggb ZKivM _vKe Zviv KvR wbeZ _vKe hZY bv Zviv fvj nq DVQ| `yNUbvg hviv AvNvZcv ne Ges hv`i KvUv-Quov _K i I Kl Sie ZvivI KvR weiZ _vKe, fvj bv nIqv ch| Kvb Lvevi kixii im, Kl ev i jM Mj Zv dj w`Z ne| 13.9.2. nvUj eeZ weQvbvi Pv`i, Zvqvj BZvw` wK GBPAvBwf QovZ cvi? wekevcx cvbWwgK AvKvi GBPAvBwf msgYi mv_ mv_ nvUj weQvbvi Pv`i, evwjki Kfvi, Zvqvjjv eenvii c~e Zv jw aZ wK bv Rb bqv cqvRb| ev_ig eenvii ci Zv mvaviY wWUviRU, we-wPs cvDWvi, Kvwib BZvw`i gvag aZ nqQ wK bv Zv Rb bqv cqvRb| G RvZxq wRwbmjv hw` fvjfve avqv _vK Ze Zv GBPAvBwf fvBivm enb KiZ cvi bv| G KviY nvUji weQvbv I Abvb myweavw` GBWm Avv KD eenvi KijI cieZxZ Kvb MvnKi Rb Zv GBWm msgYi mvebv RvMvq bv| Iqvwks gwkb, Wvqvimn jw cwqvq GBPAvBwf fvBivm euvPZ cvi bv| evsjv`kmn ZZxq weki AbK `k avcviv we-wPs cvDWvi cqvM wKsev wm Ki hfve Kvco avq, ZvZI fvBivm KvbfveB euvPe bv| Ze GBPAvBwf Avv`i iwm I eR wgwkZ Kvco Pvco msMn Ges RxevYygKiY cwqvwU memgq mZKZvi mv_ cvjb KiZ ne| y 13.10.1. iwdRviUi wK ivM QovZ cvi? nuv cvi| wVKgZ cwivi bv Kij GZ bvbv aibi RxevYy I fvBivmmn QvK evmv euva| wdRi fZiUv wbqwgZ mvevb-cvwb ev evBKvevvbU w`q avqv DwPZ| 13.11.1. GBPAvBwf msgY evmvb Kvb cfve wevi Ki?
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muvZmuZ RvqMvjv wekl Ki cyivbv ev_ig, vi BZvw` vb wewfb aibi gv ev QvK Rbvq| Gjv `yej ewi `n KwVb wKQy ivM Zwi Ki| G aibi GKwU ivM AvmcviwRjvwmm| Gme vbjv mvwWqvg nvBcvKvivBU w`q ayq djv DwPZ| 13.12.1. gkv viv GBPAvBwf msgY nZ cvi? AbKjv NvZK ewa gkv viv evwnZ nq| Gi ga Dj-LhvM nj gvjwiqv, gwbbRvBwUm, GbKdvjvBwUm, Wy BZvw`| Ze Gme gkv ivMi g~j KviY fvBivm ev cvivmvBUi RxebPi Askwekl wnmve KvR Ki| Gme gkv Qvov ivM weviwU me ne bv| GK mgq aviYv Kiv nZ, GBWm ivMvvK gkv Kvgovj mB gkvi gvag my jvK ivMvv nZ cvi| cieZxZ MelYvq `Lv MQ, gkvi kixi fvBivm eo DVZ cvi bv| ZvQvov ii h mvgvb Ask gkvi j jM _vK Zv h_ fvBivmI enb KiZ cvi bv| gkv KLbB l bqv i Abi `n XywKq `q bv| Gme KviY gkv viv GBPAvBwf msgYi welqwU GKwU Aeve Kbv wnmve cgvwYZ nqQ| gkvi gZ Abvb KxUcZI GBPAvBwf fvBivm QovZ Ag ej gb Kiv nQ| Gi ga KviY Fleas-I AMZ| 13.12.2. cvlv cvYx I Abvb RxeR KZK GBWm msgYi mvebv KZUzK? z GBPAvBwf Avviv bvbv iKgi RxeR cyl _vKb| nVvr Ki Gme RxeR cwiZvM Kiv me bv njI GUv RvbZ ne h, RxeR I ccvwLiv Ggb me ciRxex I fvBivm enb Ki hv my jvKi RbB SzuwK Zwi KiZ cvi| Avi hLb BwgDwbwU wb chvq _vK ZLb Zv G wec`i mxgv cvq Amxg nq IV| AbKB weovj cyl _vKb| Uvc-vRgvwmm bvgK GK cKvi ivM weovj evwnZ nq _vK| G ivMi cvivmvBU Uvc-vRgv MvbvwW weovji gj _vK| weovj hLvb gjg~ ZvM Ki mLvb GB Uvc-vRgvi wmjv (cyst) _vK| Ze weovji kixi _K eievi ci BbdKkvm R cuQvZ ek Kw`b mgq jvM| Uvc-vRgvwmm Kej mvaviY AmyLB Zwi Ki bv, GUv gvbyli PvL I gw KI Avv Ki| wPwKrmvi gvag ivM wbivgq njI gw I PvL GUv AcwieZbxq Amyweav Zwi KiZ cvi| GQvov weovji jvjvhy jvg AbKi
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Rb gvivZK AvjvwR Zwi Ki _vK| GBPAvBwf Avv`i ga hviv AvjvwRZ fvMb Zv`i Rb GBme evowZ Dc`e kvmK Zwi KiZ cvi Ges eyK myweavfvMx msgY Zwii myhvM Ki w`Z cvi| weovji msk Avmvi dj evwmjvwi GvbwRqvgvUvwmmI nZ cvi| ZvB weovji Avvbv I eeZ wRwbmjv cwZw`b ayq djv DwPZ| Ze jLK gb Kib, h ivMxK weovjK msk bv AvbvB Dg| nuvm, gyiMx, cvwL bvbvwea fvBivm enb Ki| G aibi fvBivm k~Ki, evbi, ewR BZvw`ZI _vK| GB mg cvwL I RxeR KqK aibi bb-wnDgvb Kivbv fvBivm enb Ki hv gvbyli ga gvivZK mw`, Kvwk, wbDgvwbqv Ges Wvqwiqv NUvZ cvi| Kvb Kvb cvwL wvKvm wbIdigv I wnvc-vRgv KvcmyjUvg Qwoq _vK| wvKvm gvivZK aibi wbDgvwbqv Zwi Ki| wnmUvc-vRgv hv m`k NvZK ivM Zwi Ki| GQvov KvgvBwWqv wmUmB (Psittaci) Qovq Kvb Kvb cvwL| GKviY cvwLi LuvPv, gj mewKQy ivMxi _K AbK `~i ivLv DwPZ| Mi Qvov GK aibi gvQI hvi RxevYy Qwoq _vK| Gme _K mveavbZv cqvRb| kqvj, KzKzi, weovj, ev`yi BZvw` R GBPAvBwf Avv ewK Kvgo`evi ci mB i gyL wbq my jvKi kixi XywKq `e GwU GKwU KKwZ wP gv| eve G aibi msgYi Kvb cgvY cvIqv hvqwb| 13.13.1. GBPAvBwf AvvK Pzgy Lj ivM mswgZ nZ cvi? mvaviYZ ZK Kbvfve Pzgy Lj GBPAvBwf msgY NU bv| GgbwK gyLi jvjvi mv_ mshvM NU Ggbfve Pzgy LjI GBPAvBwf msgYi h mvebv _vK ZvK ZvwK chvqiB ejv hZ cvi| Ze gyLi Afi, wRnvq wKsev `uvZi Mvovq Nv ev Z _vKj GBPAvBwf mswgZ nZ cvi| wewfb iKgi hbivM gyL I VuvU G aibi Nv nZ cvi| 13.13.2. GBWm Avv bZKxi mvwba Gj A_ev bZmx GBWm Avv nj ivMvv nevi mvebv KZUzK? z AvMB ejv nqQ h, Nwb mshvM Qvov GBPAvBwf Qovq bv| mZzivs nvUj I Kvemn wewfb Drme Abyvb ARvbv KviI m bZ ev cvidiwgs AvU- G AskMnY Kij GBPAvBwf msgYi mvebv bB| Ze kixi Kvb Z _vKj Ges Z w`q Kl ei nj GBPAvBwf msgYi mvebv _vK|

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ay bvPj bq, GBWm Avv`i Mv Nulj, Mfxifve Rwoq aij, wPgwU KvUj wKsev nvjKv Ki ZK, Kvb BZvw` Kvgo w`j GBWm msgYi mebv _vKe bv, hZY bv Avvi i Zvi mxi wgDKvm AveiYK wm Kie| hbwqv QvovI hvwbim I exh kixii wgDKvm AveiY A_ev kixii Kvb Zvbi msk Gj ivM msgYi mvebv Zwi Kie| 13.13.3. myBwgs cyj muvZvi KvUj GBPAvBwf QovZ cvi? myBwgs cyj Kvwibhy cvwb Ges D cvwbi cevn mnRB GBPAvBwfK gi dj| G RvZxq cvwbZ Avv ew Ab`i mv_ h_fve vb KijI Zvi hbv we`gvb fvBivm ev Ab Dcvq kixi _K wbtmZ fvBivm viv Aci ewi Avv Kivi mvebv cvq k~bi KvQ| 13.13.4. wRgbwkqvg evqvg KiZ wMq GBWm msgY nZ cvi? GBPAvBwf Avvi eeZ hcvwZZ fvBivm _vKevi mvebv Kg njI GKevi Ame bq| Ze hcvwZ _K GBPAvBwf msgYi welqwU Kej ZvwKfveB me| KvUv Quov hy nvZ w`q mvaviYfve Avvi Quvqv `e ev hcvwZ eenvi GBPAvBwf msgYi mvebv bB ejjB Pj| 13.13.5. wmbgv, wUwf I AvWdvgi wewfb nvDmi gKvc igjvZ A_ev ckv`vi gKvcgvb`i eeZ KxU gvidZ GBWm Qovevi mvebv KZUzK? y GKB evk, wPiwb BZvw` eRb eenvii gvag wewfb QuvqvP ivM QovZ cvi| NUZ cvi ZK I PvL wewfb fvBivm I evwiqvi msgY| Ze G cwqvq GBPAvBwf msgYi mvebv cvq k~b-Gi KvQ| G cm gb ivLv cqvRb, PvLi cvwbZ mvgvb cwigvY GBPAvBwf _K _vK| G KviY Avvi PvLi Rj KviI nvZ jM ivMi msgY bv NUjI Amy ewi PvL _K my ewi PvL fvBivm msgYi GKwU ZvwK mvebv _KB hvq| 13.14.1. wmMviU kqvwis-Gi gvag GBPAvBwf mswgZ nZ cvi? wmMviU kqvi Kivi gvag mvaviYZ GBPAvBwf msgY bv njI Abvb ivM mswgZ nZ cvi| mePq eo K_v nj a~gcvb GBPAvBwf msgYi GKwU Kv-dvi| GQvov a~gcvb Kvvi DxcKI eU| kqvwis-Gi KviY BwgDb KcvgvBRW& GBPAvBwf Avv ivMx bZzb ivM Avv nZ cvi Ges Avvi gyL I Mjvq Avkq bqv wKQy wKQy myweavfvMx msgY Abi ga Qwoq coZ cvi| dU hvIqv VuvUi mshvM Gm jvjvwm wmMviU h Agvvi fvBivm Qwoq w`Z cvi, m mvebvwUI GKevi Aeve bq| 13.15.1. ng_yb wK GBWm Qovq? nvZ Kvb KuvUv-Quov Ges hbv Kvb Nv ev Z bv _vKj ng_ybi viv GBPAvBwf msgYi Kvb mvebv bB|
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13.15.2. GBPAvBwf Avv`i exh mivmwi Mvq jvMj Kx nZ cvi? exhi ga AmsL fvBivm _vKvq Zv wecbK| AZ ZK f` Ki GBPAvBwf msgY ne bv GUv mZ RbI j Kiv hvq bv Ggb Zi gvag GBPAvBwf msgYi SzuwK bqv GKeviB DwPZ bq| 13.16. GBPAvBwf Avv wk`i wkv Rxeb : 13.16.1. GBPAvBwf Avviv zj-KjR Mj Kvb mgmv ne wK? GBPAvBwf Avv wk, wKkvi I ZiYiv Kxfve covbv Pvjve Ges Zviv wbqwgZ zj-KjR hve wK bv GUv mevi RbB GKwU ck| covbvq wcwQq _vKv ev wkvMnY evnZ nIqv KvbfveB KvwZ bq| Ze bvbv wbqg kLjv I evaevaKZvi ga covbvi KvR PvjvZ Zv`i kvixwiK Aev I mvg_ weN NUve wK bv mUv AwffveK, wkK Ges wPwKrmK mevBK fveZ ne| wPwKrmKK `LZ ne h, ivMx Zvi BwgDbvjwRK Aevi KviY bvbvwea ivM Avv ne wK bv| 13.16.2. GBPAvBwf Avv wkv_xiv Zv`i mncvVx`i Rb KZUv Suwy K Zwi Kie? mvaviY gjvgkvq Ges zj KjRi cvZwnK KvRi gvag GBWm QwoqQ Ggb Kvb cgvY Kv_vI bB| Ze ivM msgYi SuywKUv weePbvq AvbZ ne bvbv wKQy wePvi Ki| wkv_xi eqm, hb AvPiY, mncvVx`i AvPiY, ivMi Aev, wkv_x`i ga hbmshvMi mvebv BZvw` welq fveZ ne| GKevi QvU wk hviv bvmvwi I wKviMvUb hve Zv`i UqjU Uwbs Ges eqmvbycvwZK eywweKvki welqwU fveZ ne| mvweKfve fveZ ne G aibi wkv_x`i wkvb cvVvevi SuywK I jvfi welqwU| mB mv_ wPv KiZ ne AvBbMZ I bwZK `vq-`vwqZi K_v| zj-KjR Ggb Kvb Kvhg bB hvZ mvaviYfve GKRbi _K AviKRbi GBPAvBwf msgY NUZ cvi| kYxK, wRgbwkqvg ev Ljvi gvV ^vfvweK gjvgkvi gvag GBWm QwoqQ, Ggb Kvb cgvY bB| Avi hnZz Avv Qv Abi Rb SuywK Zwi Ki bv, ZvB zj-KjR KZcK Zvi GBPAvBwf vUvm msv Z_ `qvUv evaZvg~jK wKQy bq| Ze Zvi kvixwiK Aev g~jvqbi Rb Ges wewawbla Rb bevi Rb ZvK AekB K_v ejZ ne wbR^ wPwKrmKi mv_| Kvb KviY zj KjRi Zid _K gwWKvj Kqvi wbZ Mj ZvK AekB mvcb Zvi Aevi K_v RvbvZ ne KZcK| Avi KZc Zvi ^v msv Z_i MvcbxqZv iv Kieb| wkv_x wb kYx ev DP kYx hLvbB Aaqb KiK bv Kb mevi wbivcvi Rb zj-KjRi wkK, KgPvwi Ges AwffveK mKjKB GBWm msgY msv cv_wgK vb `vb KiZ ne|
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Gme KviYB zj KjRi cvVm~wPZ GBWmmn wewfb ivM msv cvV A fy _vKv DwPZ| AcvKZ DP Kvmi QvQvx`i Rb hbivM cwZivai wewfb eev msv vb `qv cqvRb| KjR Ges wekwe`vjq chvq wbivc` hbRxeb m^ wevwiZ vb`vb Kiv cqvRb| GBPAvBwf Avviv mnRB wewfb QuvqvP ivM Avv nZ cvi, G mPZbZvI cqvRb mevi ga| 13.16.3. Avvi ivMi welqwU Mvcb Kivi cqvRb AvQ wK? wkv_xi GBPAvBwf vUvm Ges Zvi cvwievwiK cwiwwZi MvcbxqZv iv Kiv DwPZ| Kbbv GB MvcbxqZv f nj mZx_iv ZvK Gwoq Pje; fq cve, GgbwK NYvI KiZ cvi| GZ Avv wkv_x wbRK wewQb I evwZj gb Ki Mfxi gvbwmK RwUjZvq Avv ne| wkv_xi wbivcvi Rb, wekl Ki wewfb msvgK ivM _K ZuvK euvPvevi Rb zj KjR KZci `yGKRbK Zvi Aevi K_v RvbvZ ne| Ze GB RvbvRvwbi welqwU hb wKQyZB Abvb QvQvx I Zv`i AwffveK`i KvQ bv cuQ| 13.16.4. wKkvi Aciva mskvabx K`jvZ Kx aibi mgmv nZ cvi? Gme K` KD hw` GBPAvBwf Avv nq Zvnj wekl mPZbZv I myivi eev MnY LyeB cqvRb| Kbbv G`i ga bvbv wecbK AvPvi AvPiY j Kiv hZ cvi ^vfvweKfveB| G`i AbKB AKvjcK Ges mgqi AvM hb AwfZv mb nq| BbRKkbi gvag bkvMnY, kixi Dw AuvKvmn Ggb me KvR Zviv evcZ nZ cvi hv GBPAvBwf msgYK mnR Ki `q| Gme KviY Avv I Abvvi ga GBPAvBwf msv vb`vb Ges wecbK ceYZv mb`i GBPAvBwf wwbs Kiv cqvRb| G`i ga hviv ^Qvq cixv KivZ mZ ne Zv`iI wwbs Kwiq bqv cqvRb| GBPAvBwf'Z Avv nqQ A_P jY `Lv `qwb Ggb AbKi wPwKrmv i Ki `qvI cqvRb| Gme K` hvZ hbmshvM bv NU m aibi eev MnY hgb cqvRb, Zgwb ^vfvweK hbeva, hbPwi Ges hbivM msv vb `vb KivI cqvRb| GB wkv`vb Kgm~wP K`i Kgx Ges Avkq MnYKvix wKkvi wKkvixmn mevi RbB cqvRb| Gme K`I Avvi ivMi Aev msv MvcbxqZv eRvq ivLv cqvRb| mB mv_ `yGKRb ^vKgxi Mvcbfve Rvbv _vKv cqvRb AvvK Kx aibi myiv w`Z ne| hgb wPKbc I nvicmi gZ mvaviY ivMjvi msgY NUj GBPAvBwf cwRwUfK wekl cwZivg~jK wPwKrmv w`Z ne| cqvRb Zv`iK ivM _K euvPvevi Rb Avjv`v Ki ivLZ ne| Ze mewKQyB KiZ ne Ggb Kkj hvZ Avvi GBPAvBwf vUvm Abiv RvbZ bv cvi|
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Aavq P
GBWmi wPwKrmv
14.1.1. GBPAvBwf fvBivm webvkx GwU-fvBivj _ivwc Zwii Kkj : GBPAvBwf fvBivmi AvKwZMZ KvVvgv Abyaveb Ki, fvBivm KZK wRb I cwZQwe fvBivm Zwii cwqvwU eyS A_vr fvBivmi MVb I mvweK RxebPi cwZwU chvq cheY Ki GBWm cwZiva KiZ cvi Ggb Ilya Zwi me| Gi Rb hgb fvBivj Kgc-i cvwUbjv m^ aviYv _vKv cqvRb, Zgwb fvBivm UvMUi MVb I wqvwUI Rvbv cqvRb| GBWmi Ilya Zwii Rb G KviYB MelK`iK gbhvM w`Z nqQ Kvli ga fvBivmi ceki welqwUi Ici| fvBivm kixi cek Ki wbR^ Gbfjvc M-vBKvcvwUb wRwc-120-Gi mv_ Avvi `ni Kvl wmwW-4 wiwmii RwUj mshvMi gvag| ZvB wRwc120- I wmwW-4 eb cwqvwU enZ Kiv MelK`i cv_wgK j nq `uvovq| c_g ZvB Zwi Kiv nq wbMZ GKaibi Zij wmwW-4 AvBwR gwjKzj hv wK bv fvBivmi eb Ges eab `yB -B iva KiZ cvi| jve Zwi GB IlyawU KuvPi ga my`i KvR KijI fvBivm weKvk cwZiva Zgb Kvb f~wgKv ivLZ cviwb| Gi KviY jve KbmbUkb _K KqKk Y (`yk _K mvZvk k) ewk Ilya cqvRb nq gvbe kixii Rb| ZeyI GB `wfx wbq KvR PjQ Ges wRwc-120 I wmwW-4-Gi RwUj ebwU AviI eySevi Pv Kiv nQ| mB mv_ Pv Kiv nQ GB eb fvOevi gZ z` I KvhKi gwjKzj Zwi Kievi evcvi| Gicii KkjwU weePbv Kiv nq wmwW-4 wiwmi wenxb Kvli mv_ wRwc120 -Gi eb Zwii Pv Ki| GUvI mv_K bv nj Kvl AveiY ev mj ggebi mv_ fvBivmi wdDkb cwZivai eev bqv nq| ggeb wdDkb cwZivai Rb c_g h cwjGvbAvqvwbK (polyanionic) KvDwUK wPwZ Kiv nq Zvi GKwU nj WUvbmvjdU| GwU jve fvBivm I Kvli eb ev syncytia ZwiZ evav mw KijI gvbe`n AvcwKfve AKvhKi nq co Lv`_wj _K bMYgvvq kvwlZ nevi KviY|
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AviKwU Ilya fvBivm ew cwZiva weePbvq Avbv nq| Gi bvg Gb_vKzBbb (Anthraquinones)| GB Mvfy nvBcwiwmb (Hypericin) GKwU AvjvK mse`bkxj hM (dUvAvKwUf KvD) hv dUvAwWkbi gvag BGgwf fvBivmjvK gi djZ cvi| GwU wbq GLb ch cixv wbixv PjQ| 14.2.1. wifvm Uvwckb-Gi cwZeKZv : wifvm Uvwckb bvgK h cwqvq wbDwKqvcvwUb Kgc-i AviGbG _K fvBivj wWGbG Zwi nq m vb mdj AvNvZ GBPAvBwf cwZiva Kvhgi GKwU j| wifvm Uvwckb mdj bv nIqvi KviY fvBivmi weKvk Ggb gaeZx Aevq _vK hv wK bv gvbe`ni Kvl ^vfvweK cwqvq wbqY KiZ cvi| GB wifvm Uvmwckb cwqvq mdj AvNvZ KiB AbKjv wPwKrmv cwZ eZgvb cqvM Kiv nQ| Gi ga Dj-LhvM KqKwU cwZ nj wbDwKqvmvBW mgZzj, bb-wbDwKqvmvBW AviwUAvB, Abvb 14.2.2. wbDwKqvmvBW GbvjM : wRWvfywWb ev GRWwU nj wbDwKqvmvBW GbvjMjvi ga AbZg| GwU GBPAvBwf BbdKkb wPwKrmvq evcKfve eeZ nq AvmQ| Gi KvhKvwiZv `yfve mb nq| GKwU nj Kvl GbRvBgi mvnvh 2, 3 WvBwWqvwwbDwKqvmvBW (2, 3-Dideoxynucleoside) RvZxq GbvjMjvi dmdivBRkb| GZ Zwi nq UvB-dmdU| GwU fvBivj wWGbGi mv_ mshy nq fvBivj PBbwUK fO `q| KviY, GwU dmdvWvBvi (Phosphodiester) eb ZwiZ weN NUvq| GQvov wbDwKqvmvBW GbvjM Kvl Afi 2, 3WvBwWqvwwbDwKqvmvBWi mv_ cwZhvwMZv Ki wifvm UvwcUmi mv_ eb Zwi Ki| wRWvfywWb cqvMi wKQyw`b ci GUv cwZiva mg fvBivm Zwi nZ cvi| G KviY AviI KvhKi I wbivc` wbDwKqvmvBW GbvjM Zwii cqvRbxqZv `Lv `q| G cvcU wWwWwU ev 2, 3WvBwWqvwwbDwKqvmvBW _vBwgwWb (Thymidine) Ges wW-4-wU (2-Dideoxydro-3-Deoxythymidine) Ilyajv Zwi Kiv nq| GRWwU Gi PvBZ wW-4-wU AwaKZi wbivc` Ges nvoi gvi Ici Gi wZKi cfveI AbK Kg|
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GRWwU cqvMi ci GBPAvBwf fvBivm wifvm UvwcUm wRb wgDUkb NwUq cwZiva Zwi Ki| Ze GwU ivMi wecbK Aevq Qgvm _K GK eQi wPwKrmvi ciB NU _vK| Ilya cwZiva gZv ivL Ggb fvBivm GgwbZI `Lv hZ cvi| A.Z.T-Gi e_Zv cwZiva A_ev m iwRmUv RwbZ (Cross resistance) cwZiva wWwWAvB (ddi) I wWwWwm (ddC) bvgK AviwUAvB Dveb Kiv nqQ| A.Z.T KvhKi bv nj GwU cqvM Kiv nq _vK| GZ ivMi gvebwZ wejw^Z nq| 14.2.3. GbGbAviwUAvB (NNRTI) : G RvZxq Ilyajv wifvm UvwcUm KvUvjvBwUK (catalytic) Aevb eb Zwi Ki Gi KvhKvwiZv b Ki| G aibi Ilyajv wWGbG cwjgvimK AvgY bv Ki mywbw`fve GBPAvBwf-1 Gi wifvm UvwcUmi mv_ eb Zwi Ki| G RvZxq Ilyajvi ga wUev (tibo), bwfivwcb (nevirapine), cvBwiWvbm (pyridones) Ges GwUfviwWb (atevirdine) Dj-LhvM| GbGbAviwUAvB-Gi cavb `yejZv nj `Z fvBivmi cwZiva mw| G cvcU `yUv GbGbAviwUAvB GK m cqvM KiI Zgb fvj dj cvIqv hvq bv| G KviY fvBivmi wgDUkb cwZiva Ges Gi cwZiva gZv Kwgq AvbZ GRWwU Ges wWwWAvB-Gi mv_ cvBwiWvb eenvi Kiv nq| GRWwU Ges wWwWAvB-Gi mv_ GKwU GbGbAviwUAvB cqvMK KbfviRb _ivwc ejv nq Ges GwU GKwU Av`k wPwKrmv cwZi AMZ| Kbbv GZ fvBivj iwmmU Zwi nIqvi mvebv Kg _vK| 14.3.1. Abvb : wifvm Uvwckb BbwnweUim : GKmgq cvBivdmdU (pyrophosphate) RvZxq Ilyajv eenvi Kiv nZ nvicm wmgc- fvBivm msgY `gbi Rb| jve `Lv hvQ GwU GBPAvBwf fvBivmi weiI KvhKi| GwU AviGbG Ges wWGbG cwjgvimK Ae`gb KiZ cvi| GBPAvBwf Avvi v wmGgwf fvBivm (iwUbvBwUm) Avv nj GwU Ab GwU iUvfvBivj _ivwci mv_ cqvM Kiv nq| Ze G e msv UwwmwUi K_v gb ivLv cqvRb| 14.3.2. RNASE H Inhibitor :
RNASE H Inhibitor wbq KvR PjQ GBPAvBwf wbqY|

14.3.3. fvBivj wWGbGi BwUMkb cwZeK :

159

GBPAvBwf BwUMm cvwUbi mnvqZv wbq fvBivj wWGbG-Gi Kvli m mshy nevi ciB fvBivmi msLv ew cvq| fvBivmi RxebPi GwU GKwU iZc~Y Aevb| ZvB BwUMm cvwUbK wZM Ki fvBwiqbi ew iva Kiv me| BwUMm cvwUb AKvhKi Kivi cwZ wbq wewfb jveiUwiZ KvR nQ| 14.3.4. fvBivj wRb Gckb cwZeKZv : fvBivj wRb Gckb cwZeKZv mw Kiv hZ cvi Kvccv weUv (NF-KB) BbwnweUi cqvMi gvag A_ev wUDgvi bvwmm dvimn wewea mvBUvKvBbm Ae`gbi gvag| G cwqvq ivM cwZiva eevi Ici cfve mw Ki A_ev wKQy GwU-AwWvU cqvMi gvagI mxwgZ GBPAvBwf wbqY me| mwjwbqvg GKwU ej AvjvwPZ Kvccv weUv BbwnweUi| fvBivj wRbi mv_ m UvU (tat) bvgK cvwUb GBPAvBwf-1-Gi AMZ AviGbG Uvwm-Gi KvhKvwiZv m~PbvKvix e Uvi (tar ev transactivation responsive element)-Gi mv_ hy nevi ciB my`xN fvBivj UvwckbwU eve ic cvq| GUv Aej^b KiB cvfvBivm _K geagvb nvi fvBivm Zwi nq| GB Uvi-Gi KvhKvwiZv ii Rb UvU Qvov cqvRb nq Avv Kvli wekl aibi cvwUbi| Avi GBme wgwjq AbyK~j cwiek UvU cwiPvwjZ UvAvwwfkb (transactivation) KgwU wecbK nvi fvBivm ew NwUq _vK| Gme K_v weePbv Ki UvU cwiPvwjZ GB UvAvwwfkb KvRwU i Kievi Rb UvU-Uvi eb iva bvbv Kkj Aej^b Kiv nqQ| G Ro5-3335 Ges Ro24-7429 RvZxq evWvqvRwcb KvD UvU-Gi KvhKvwiZv e Ki GBPAvBwf ew iva KiZ cvi| gvbe`n GUv ek UwK nIqvZ KUv/Gbvj Gcvw (Keto/Enol Epoxy) iqWK eenvi Kiv nqQ UvU Ae`gbi Rb| AviwRbvBb (Arginine)-Gi z` gwjKzj mb cvwUb hv wK bv Uvi AviGbG-Gi mv_ eb Zwi KiZ cvi, mjv cqvM Kivi wPv Kiv nQ UvU-Uvi wewqvq cwZeKZv mwi Rb| z` gwjKzj cvwUbjv eenvi Ki UvU-Uvi-Gi KvhgZv Ae`gb A_ev G`i eb mv_K cwZeKZv mw GBPAvBwf wbqYK Pjgvb MelYviB Ask| fvBivm wbDwKwqK AvwmWi GjwUAvi mMgU (LTR segment)-Gi mv_ nv mj dvi-Gi mnvqZvq fvBivj AviGbG UvwcUm Zwi nq _vK| GB nv mj UvwcUm dvii ga wbDwKqvi dvi Kvccv weUv
160

(GbGd-Kwe), wUDgvi bvwmm dvi Avjdv (TNF-) -Gi gZ wKQy mvBUvKvBbm fvBivmi AviGbG Uvwckb NwUq _vK| GB mvBUvKvBbmjv DrcwZ Ges KvhKvwiZvq cwZKZv mw Ki fvBivj wRb Zwi e Kiv hZ cvi| Gfve wbqwZ nZ cvi GBPAvBwf fvBivm ew| 14.3.5. wUDgvi bvwmm dvi Ae`gb : `yaibi AYy kbv Kiv MQ hjv GKvR KiZ cvi| _vwjWvgvBW (Thalidomide) Ges cbUvwdvBwjb wUGbGd-Avjdv (Pentoxifylline TNF- ) wmb_wmm iva KiZ cvi| cbUvwdvBwjb GbGd-Kwe Dxeb evav Zwi Ki| GwU eenvi wbivc`I| GUv cqvM cvwK ivfi gbvwbDwKqvi Kvljvi ga TNF- AviGbG Dj-LhvM cwigvY Kwgq Avb| 14.3.6. BwgDbv mvcwmf GRU : hmg mvBUvKvBb Ges Kvli UvwKcUm dvi GBPAvBwf wRb ZwiZ mnvqZv Ki mjv ^vfvweKfve gvbe`n BwgDwbwUI Zwi Ki| GKviY AbK MelK gb Kib ivMi iZ _ivwc w`j fvBivm ew Kg Avme Ges Zv cieZxZ BwgDb eevq Kg wZmvab KiZ cvie| 14.3.7. GwU-AwWvU (Anti-oxidants) : GwU AwWvU gwjKzjjv GBPAvBwf Uvwckb mxwgZ KiZ cvi bvbvfve| GwU GmUvBjBb (acetylcysteine) RvZxq GbGd-Kwe-Gi KvhKvwiZv Kwgq Avb Ges fvBivj wRb GckbI wbqY Ki| GwU Kvli AvcvcUvwmm (apoptosis) wbqY KiZ cvi|
The expression of viral gene during the process of replication require collaborative activities of RNA polymerase, transcription f ctor SPI and NFKB and viral a regulatory protein (Tat and rev). Selenium inhibits NFKB and prevents HIV expression

14.3.8. AviBwf (REV) : AviKwU fvBivm ijUwi cvwUb hv wK bv GwU iUfvBivj _ivwc Kvhgi j nZ cvi Zv nj GBPAvBwf AviBwf wRb| fvBivm cvwUKj Zwi Rb AviBwf wRbi cqvRbxqZv iqQ|
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14.3.9.

fvBivj

ivBevmvgvj

dgwkdwUs

(Viral

Ribosomal

Frameshifting) :

fvBivmi MvM Ges cvj wRbi mv_ ivBevmvgvj dgwkdwUs GwU iUvfvBivj Ilyajvi j nZ cvi| 14.3.10. GBPAvBwf fvBwiqbjvi mgeZ nIqv I cwiYZ nIqvi c_ evav mw : MvM cwjcvwUbB bZzb fvBivm Zwii cv_wgK A I Lqvjv Zwi Ki| fvBivj KvcwmW Ges fvBwiqb KvcwmW Zwi nq GiB mnvqZvq| Azii gZ fvBwiqb DMgbi mgq Ges c~Y fvBivm cKvki mgq MvM cvwUbjv fvBivm cvwUqvmi mnvqZvq fvBivmi Rb AZvekK gvwU KvcwmW, wc-24, wc-9, wc-6 bvgK KvVvgvMZ cvwUb e I cvwUqvm wifvm Uvwckb Ges BwUMm RvZxq GbRvBgjv Zwi Ki| G KviY GBPAvBwf bvkK Ilya Zwii Kvhg MvM cwjcvwUbi mPj Kvhg Ges Kvli mv_ Gi mshyw cwZivaK wekl j Avbv nqQ| Kvli AveiYwU jf` Kievi Rb MvM cvwUbjv gvBwivqjkb (myristoylation) bvgK GgvBbv AvwmWi GK RwUj wewqvi gvag AMmi nq| GwU NU ivBevmvgvj Kgc--Gi ga| G cwZwU AbKUv wg_vBjkb wewqvi gZ| gvBwimwUK AvwmW Mvxq `e wg_vBj Mci vb mvjdvi A_ev AwRb AYy cwZvcb Ki cwiewZZ gvBwimUvqj Mcjv MvM cwjcvwUbi mv_ mshy nq| GZ fvBivmi wmMbvjwU AKvhKi nq IV| gvBwivqjkb wmMbvjK AZvekK bvi M-vBwmbi weKwZ NwUq A_ev MvM cwjcvwUbi Gb-Uvwgbvj cv Dcivj-wLZ cwZi cwieZb NwUq fvBivj gvwU vKPvi AvNvZ Ki GBPAvBwf fvBivm weKvk i Kiv hvq| KvlMv hmg cvwUb GB cwiewZZ gvBwimUvqj-Mcjvi m hy nq mjv my KvljvK wbivc` iL mi hvq| gvBwivqjkb e-KU (blocket) cwZ fvBivm AMZ AviKwU gvBwivqjUW cvwUb bU (myristoylated Protein Net)-GiI KvhKvwiZv Kwgq dj| fvBivj cvwUbi weKvk iva me cvwUqm bvgK GbRvBg vivI| GBPAvBwf fvBivmi weKvk Gbfjvc cvwUbi f~wgKv AZ iZcY| GB ~ Gbfjvc cvwUb eve cqvRb wbRi KvRjv avivjv Kievi Rb Ges Kvli fZi PjvPji c_ myMg Kievi Rb bvbvwea AwjMvmvKvivBW (oligosaccharide)-Gi mv_ eb Zwi Ki| wPwb RvZxq AYyi mv_ Gbfjvc cvwUbi ebK M-yKvmvBWm KvhKvwiZv ej|
162

G M-yKvmvBWm BbwnweUi cqvM Ki Gbfjvc cvwUbi cwieZbkxjZv Ges KvhKvwiZv Ggbfve e Kiv me hvZ fvBivm GB cvwUbi mnvqZvq bZzb KvlK Avv KiZ e_ nq| My-KvmvBWm BbwnweUijv ek welv| Ze Gi ga Zzjbvg~jKfve wbivc` ev Kg welv M-KvmvBWm BbwnweUi nj Gb-weDUvBj wWAwbvRvBwigvBwmb y
(N-Butyl deoxynojirimycin ev N-BuDNJ)|

14.3.11. mvBKvmcvwib (cyclosporin) Ae`gb Ges mvBKvdvBwjb (Cyclophilin) Avtwewqvq cwZeKZv mw mvBKvdvBwjb bvgK Kvli fZii GK aibi cvwUb GBPAvBwf MvM cvwUbi mv_ eb Zwi Ki Ges GUvi cwqvKiY (Processing) mvnvh Ki| GKB mv_ GUv BwgDbvmvcwmf GRU mvBKvmcvwibi wimi wnmveI KvR Ki| GUv mvBKvmcvwib MvM I mvBKvdvBwjb Avtwewqvi ga evav mw Ki fvBivmwebvkx f~wgKv MnY Ki| 14.4.1. UwK c`v_ cqvM Ki Amy Kvljv gi djvi Kkj : AvcwKfve wbivc` wKQy UwK c`v_ eenvi Ki hmg Kvl fvBivj cvwUb Zwi Kie Zv webvk Kivi Pv Pvjvbv nq bvbv MelYvq| GmwmwW-4 (sCD4 ) gwjKzjjvK eenvi Kiv nqQ kixivfii wKQy UwbK kbv Kievi Rb hv wK bv mB mg KvlK Avv Kie hv geagvb nvi fvBivj Gbfjvc cvwUb Zwi KiQ| G cwZZ `Lv MQ wmDWvgvbvm AviwRbvmv GvUwb-G (pseudomonas aeruginosa exotoxin-A) A_ev ivBwmb-G (ricin-A) kLjjv mywbw`fve mB mg KvlK gi dj hv wRwc-120 Zwi KiQ| GUv GBPAvBwf Avv KvljvKI jve KvjPvi gvagi fZi gi djZ mg| GmwmwW-4 I wcG GvUwb RvZxq nvBweW KvDjv mB mg KvlKB gi dj hv fvBivj Gbfjvc cvwUbjv ei Ki w`Q| wK Avv Aevq hmg Kvl fvBivj cvwUb Qwoq w`Q bv mjvi Ici GUv AvNvZ KiZ cvi bv| G RvZxq Ilyajv WvR wfwK UwK ej cgvwYZ nqQ| 14.4.2. KvcwmW cvwUbi mv_ fvBwiqb AviGbG-Gi cwZeKZv : GBPAvBwf AviGbG Ges GBPAvBwf wbDwKqvKvcwmW cvwUbi ebi vbwU fwelZ Ilyai jji GKwU| wbDwKqvKvcwmW cvwUbjv fvBivm cvwUKji AviGbG-Gi mv_ Ggbfve eb Zwi Ki hv mywbw` AviGbG Wvgb-G wR wdsMvim (zinc fingers) bvgK wbDwKwqK AvwmW evBws cvwUbi AuvPov m`k GKwU wRwbm Zwi Ki| wR wdvii wgDUkb NwUq A_ev G vbwUK AvivgwUK wm-bvBUvmv (aromatic C-nitroso) hM viv AwwZkxj Kievi gvag fvBivm ew iva Kiv hve|
163

14.4.3. cvwUqvm BbwnweUi: GBPAvBwf cvwUqvm bvgK GbRvBgB MvM I MvM cwjcvwUbK GBPAvBwfi KvVvgvMZ cvwUbi AMZ Ki Ges GjvK wifvm UvwcUm I BwUMmi mv_ mshy Ki| GB GBPAvBwf cvwUqvm-Gi KvVvgvMZ w`KwU Abvb AvmcviUvBj cvwUqvm (aspartyl protease)-Gi gZB Ges GbRvBg cwievii AbKjv viv Gi webvk ev Ae`gb me| GBPAvBwf cvwUqvm-Gi Ae`gbi gvag fvBivm ew Ges bZzb Ki Kvli Avv nIqv iva Kiv me| cvwUqvm BbwnweUijv ay GBPAvBwf Pi cviwK AevZB KvhKi bq, GwU `xN mgq Amy Kvl jywKq _vKv GBPAvBwfi IciI PovI nZ cvi| GQvov hnZz cvwUqvm my Kvli m mshy nq Ges wbDwKqvi Kvccv-weUv BbwnweUiK DxweZ Ki Kvl NvZK wnmve KvR Ki, ZvB GBPAvBwf msgYi KviY kixii wechq iva GUv iZc~Y f~wgKv ivLZ cvi| ccwUWvgvBgwUK BbwnweUi (peptidomimetic inhibitor) bvgK GKaibi cvwUqvm BbwnweUi eenvi Kiv nQ hv GBPAvBwf fvBivmi AMZ cvwUqvm Lv`K cwZ viv webvk ne bv| cvwUqvm BbwnweUijv hLb Abvb Ilyai mv_ cqvM Kiv nq ZLb Zv ivM wbqY AviI ewk KvhKi nq| cvwUqvm BbwnweUi cqvMi gyL euP _vKZ cvi GiKg wKQy fvBivm `Lv `qvq AwaKZi wwZkxj wZxq cRbi BbwnweUi (second generation inhibitor)-Gi Abymvb KiQb MelKiv| GBme MelYvi cvcU eZgvb kZK Ges fwelZi wPwKrmv cwZ Mo DVQ wbDwKwqK AvwmW wfwK wRb _ivwc weKvki gvag| hmg wbDwKwqK AvwmW GBPAvBwfi wei MelYvMvi eenvi nQ Zv nj GwUm AwjMvwbDwKwUWm (antisense oligonucleotids), wievRvBgm (ribozymes) Ges AviGbG wWKqm (RNA decoys )| wievRvBgjv KvUvjvBwUK AviGbG gwjKzj| 14.4.4. wRb _ivwci mgmv : fwelZ wRb _ivwci cqvM h mgmvjv nZ cvi Zv nj, GwU my KvlK AvgY KiZ cvi Ges GBPAvBwfi KviY BwgDwbwU RwbZ mgmv Avv`i ga wZKi cvkcwZwqv mw KiZ cvi| AviKwU mgmv nZ cvi Wwjfvwi wmg ev cqvM eev wbevPb| GUvK mywbw`fve cuQvZ ne Avv Kvl Ges h_vvb fvBivm webvkx f~wgKv ivLevi myeev _vKZ ne|
164

AvcwKfve wKQyUv AKvhKvi GBPAvBwf-1 cvfvBivmK wRb Uvdvi fi wnmve wbevPb Ki cixv wbixv PjQ| 14.5.1. GwU iUvfvBivj Ilyajvi cvkcwZwqv : GwU iUvfvBivj Ilyajvi bvbvwea cvkcw Zwqv iqQ| Gi ga cavb h gUvewjK Amyweavjv GBPAvBwf Avv`i wPwKrmvKg cwZeKZv mw Ki Zv nj kixi nRvZxq c`v_i wecvKxq wechq, wewfb vb Pwe Rg hvIqv, M-yKvR wecvK wechq, jvKwUK AvwmWwgqv Ges nvoi q| Gme KviY, wekl Ki iwkivq Pwe Rg hvIqvq `wci wkiv e nq hvIqv Ges Bbmywjb viv wbqwZ nqbv Ggb aibi M-KvR ew `wci y Amyweavi GKwU eo KviY nq `vuovq| Gi ga wbDwKqvmvBW Mvxq wifvm UvwcUm BbwnweUi, bbwbDwKqvmvBW wifvm UvwcUm BbwnweUi Ges cvwUqvm BbwnweUii cvkcw Zwqvjv Avjv`v Avjv`v Ki evLv Kiv cqvRb| 14.5.2. wbDwKqvmvBW wifvm UvwcUm BbwnweUii cvkcwZwqv : wbDwKqvmvBW wifvm UvwcUm BbwnweUii KviY jvKwUK GvwmWvwmm NUvi mv_ mv_ hKZi ew NU Ges ncvwUK vUvwmm (statosis) bvgK wecw NU| wbDwKqvmvBW GbvjMi KviY cvq 5 _K 10 fvM jvKwUK GvwmWvwmm NU _vK| mivg jvKUU jfj `L GUv wbYq Kiv me| GKviY ivMx cP `yejZv, ewg ewg fve, ewg, cU e_v, IRb nvm Ges kvmK fvM| GB RvZxq Ilyai KviY mivg evBKvebUI Kg hvq| jve cixvq CPK, LDH- Gjv ew cvq| GKviY Rxebi Suwy KI mw nq| Ilya e Ki w`j wZKi cfvejv Kg Avm| me aibi wbDwKqvmvBW GbvjMB G aibi wecw NUjI wW-4-wU, wWWwU I wWwWAvBZ G RvZxq wecw ewk NU| Gme Qvov wbDwKqvmvBW Mvxq AviwUAvB-Gi KviY hmg gvBUvKwqvj UwwmwU NU Zv nj gvqvcvw_, KvwWqvgvqvcvw_, wbDivcvw_, cvbwqvUvBwUm I Gm_wbqv jvBcvGUwc BZvw`| GQvov GRvZxq Ilyai KviY ik~bZv ev Gwbwgqv, wbUvcvwbqv NU _vK| G RvZxq Kvb Kvb Ilya cU e_v, nvZ-cvqi Icii w`KUv wKq hvIqv, cwidivj wbDivcvw_i KviY myZxe e_v, ZK Aek nq hvIqv, mvqy
165

mse`bkxjZv mswk- RvK Kg hvIqv BZvw` NU| Kvb Kvb Ilya gyL, cvq, cQbi Pwe gvivZKfve mi hvq| 14.5.3. bb-wbDwKqvmvBW wifvm Uvwckb BbwnweUii cvkcwZwqv : bb-wbDwKqvmvBW wifvm Uvwckb BbwnweUijvZ Abvb Amyweavi mv_ Mvq jvj jvj gvivZK PvKv, Kvb Kvb Pvgov DV wfb Rbmb wmbWgi De NUvq| 14.5.4. cvwUqvm BbwnweUii cvkcwZwqv : cvwUqvm BbwnweUijv i wPwb ew Ki WvqvewUm gjvBUvm (mellitus) Zwi Ki| G aibi Ilya ngvdvBjwiqv Avv`i ga icvZ NUvq Ges kixii Pwejv Avb mwiq wecw Zwi Ki| GZ iI Pwei cwigvY wecbKfve eo hvq| cvwUqvm BbwnweUii KviY h nvBcviM-vBmwgqv (hyperglycemia) nq Zv Bbmywjb hviv wbqwZ nq bv| GQvov Gi KviY M-KvR mnbkxjZv Kg hvq| y Gme KviY bZzb Ki WvqvewUK gjvBUvm ivMi Drcwi mv_ mv_ G ivMi wechKi w`K WvqvewUK KUvGvwmWvwmmI (ketoacidosis) `Lv `q| 14.6.1. GBPAvBwf Avviv Kx cwqvq my _vKe Ges Kx Kij ivMwU Lvivc chvq hve bv? `Lv MQ GBPAvBwf Avv nevi ci my mgqwU AbKi B `xN nq| Gi cQb fvBivmi `yejZv Ges kixii BwgDwbwU `yUviB f~wgKv iqQ| GBPAvBwf cwRwUf nevi ci Nveo bv hq cvZwnK Rxebi iwUbK mvwRq wbZ ne| mgqi menvi, wbqgvbyeZxZv, cwiwgZ Avb``vqK KvR Ges cwic~Y wekvgK eQ wbZ ne| BwZevPK wPv KiZ ne| BwZevPK wPv I AUv-mvRkb kixii ga ivM cwZiva gZv ewZ f~wgKv ivL| Gme wbq MelYvMvi bvbv DP chvqi KvR nQ| Avb``vqK Rxebi mv_ mv_ cwiwgZ Avnvi Ges h_vh_ cywi cwZ gbvhvM `vb, mB mv_ nvjKv evqvg kixii ga ivM cwZiva gZvi DbwZ NUvZ cvi| PovI nIqv GBPAvBwfi asmvZK KvRjv G aibi Rxebhvv MnYi gvag GKevi VwKq `evi cgvY bv _vKjI G cwqvq ivMi AvMvmbK gi Ki `qv me ej gb Kib AbK MelKB| jLK ivM cwZiva Avv ivMxi gbvfvei cwieZb, BwZevPK fvebv Ges gb I kixii Ici wbqY MnYi Ici wekl Rvi `b| GKviY ivMx`iK gwWUkbi Afvm Ki cKwZi mv_ wmbvbvBRW Rxeb hvcbi Ici iZ `qv nqQ|
166

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14.7.2. Bgvkbvj mvcvU :

14.7.3. wjwfs mvcvU :

167

Avv`iK nvmcvZvj bqv, Wvvii m hvMvhvM Kwiq `qv, cqvRbxq cixvq mnvqZv, GbwRI`i m hvMvhvM Kwiq `qv, Lv` Ges cyw msv civgk `vb I mieivn wbwZ Kiv, cqvRbxq wRwbmc mieivn BZvw`|

Gme Qvov h mg cwiwwZZ ivMxK AvBwmBD-Z ivLZ nq Zv nj wcwmwc, hv Ges Abvb gvivZK evwai KviY RwUjZv, iPvc bg hvIqv I kK cwiwwZZ, wLuPzwb I euk nq hvIqvi KviY, rwci MwZi Q`cZb ev Avwi`wgqvi KviY, Ilyai UwwmwU, gvbwmK KviY AvZnbbi cPv I Abvb RwUjZv Gmei ga iqQ cixv wbixv I _ivwc msv mgmv mgvavb msv RwUj BwgDbvWwdwmqw msv mgmv gvPb|

14.8.1. GBWm Avv ivMxi wPwKrmvi cwiek Kgb nIqv DwPZ? evsjv`k hviv GBWm I hbivM Avv nQ Zv`i AwaKvskB cwievi _K wewQb, wbgwe I `wi` kYxi Af| `vwi`, wewQbZv, nZvkv, my y Avb`i Afve G`iK hb wbfi Avb`i w`K Vj w`Q| PvwiwK MVb I ewZi ewk Giv AwaKvskB AwigwZ`i (unstable personality) A MZ| G`i AbKB eZgvbgyLx Ges fwelZ mK wbweKvi| ewngyLx ewZi msLv Rb ncwK Mci Zzjbvq G`k AbK Kg| G`i AwaKvskB PvwiwKfve Lvjvgjv bq Ges AMZfve bvfvm cKw Zi| GQvov G`i Ici mgvR I agi Pvc _vKvq AwaKvsk mgq Giv wPwKrmKi wbKU ivMi K_vjv jywKq ivL Ges Kvb Kvb wg_v ej wPwKrmKK wev Ki| ivM kbvi ci GB me ivMxiv wPwKrmKi mv_ mK Q` Ki, ivMi djvAvc KvR weN NUvq Ges AbK cv_wgK DbwZi ci nvmcvZvj I ivM wbYq K` _K cvwjq hvq| AbK mgq A_bwZK KviYI m~Y wPwKrmv MnY Kibv| Gmei cvcU GBPAvBwf Avv`i wbR`i Aevb Mvcb Kiv, cKZ wPwKrmv MnY bv Kiv Ges wewa wbla gb bv Pjv GKUv eve wP wnmve ai wbZ ne| ivMx`i MvcbxqZvwcq ^fve Ges G RvZxq wecbK ceYZv evsjv`k GBWm cwiwwZi gvivZK AebwZ NUvZ cvi| Gmei AvjvKB `k GBWm cwZiva Kgm~wP MnY KiZ ne Ges ivM wbqY KVvi c`c wbZ ne| GBWm Avv ivMx`i wPwKrmv nq Zv`i kvixwiK Aev weePbv Ki| KviI wPwKrmv nZ cvi evmvq iL AvDUWvi, KviI KviI wPwKrmv evaZvg~jKfve nvmcvZvj nIqv DwPZ| GBPAvBwf Avv`i ga hviv iZi Amy Ges RwUjZvq Avv nq Zv`i wPwKrmv nvmcvZvji BbUbwmf wKwbKvj Kqvi BDwbU nIqv cqvRb| h mg KviY ivMxK AvBwmBD-Z fwZ KiZ nq Zvi ga AbZg nj wcwmwc| GQvov Abvb myweavfvMx msgYi KviY imwciUwi dBji nZ cvi| GB mg msgY GvwUwcKvj wbDgvwbqv nq _vK| mvweKfve imwciUwi dBjii KviY `yB -ZZxqvsk ivMxK AvBwmBD Kqvi fwZ ivLZ nq|
168

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169

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170

w`q Ggbfve wbqY Kiv cqvRb hvZ Zviv fxZ nq Rbmgi Avovj cvwjq bv eovq| 14.9 GBPAvBwf ivM cwZla: 14.9.1. fvBivm cek cwZeK cqvM I cwZivag~jK wPwKrmv (preventive
therapy)

hv`i GBPAvBwf-Z Avv nevi mvebv AvQ, Zv`i Rb cqvRb mycwiKwZ cwZiv eev MnY| GB KvUvMwii ew`i Rb cwZivg~jK hme eev MnY KiZ ne, Zv nj evwiqvi cvdvBjvwm Gi mv_ cqvRbxq fvBwimvBWvj cqvM, hbivM I Abvb Kv-dvi wbqY, BwgDb imc gwWdvqvi cqvM| mwjwbqvgi gZ GwU-AwWvU I wfUvwgb cqvM (Kvccv-weUv BbwnweUi cqvM)| 14.9.2 cPwjZ AvaywbK wPwKrmv (Conventional Treatment) nvU (HAART) _ivwc cqvM| (Highly active anti-retroviral treatment) 14.9.3 weK wPwKrmv (Non-conventional treatment) GBWm Avv`i ga hviv Kvb fve _ivwc wbZ mg nQ bv, Zv`i GB wPwKrmv eev `qv hvq| GwU-AwWvU Z_v Kvccv-weUv BbBweUi cqvM gyL ^gvvq nvBWwKvivKzBb cqvM GBWmi mnhvMx AmyLjvi h_vh_ wPwKrmv| AwaKvsk wekli gZ, hmg ivMxi `n GBWmi jY `Lv w`qQ Zv`iK GwU-iUvfvBivj _ivwc w`Z ne| Ze G welq h ckjvi Di `qv cqvRb Zv nj G aibi _ivwc KLb i KiZ ne ev Kv`i Rb i KiZ ne, iZ Kx aibi Ilya cqvM KiZ ne, Kx cvcU wPwKrmvi cwieZb cqvRb Ges wPwKrmv msv RwUjZvq Kx KiZ ne|
171

AbKB gb Kib h, ivM msgYi ZxeZv `kgvb nIqvi mv_ mv_ wPwKrmv `qv cqvRb| KD KD Avevi GUvI gb Kib h, GBPAvBwf msgYi GKevi iZB wPwKrmv `qv fvj| iZB wPwKrmv (early therapy) cqvMi evcvi bvbv weZK iqQ| Kbbv, ivMi iZ GwU-iUvfvBivj _ivwc `qvi cvcU ivMxi `n ^vfvweK BwgDb imc Zwi evavM nq Ges kixi `Z iwmU fvBivm ev Ilya cqvM wbqY nq bv Ggb fvBivm Zwi nq| AbK G aibi cwiwwZZ wPwKrmv i Kivi wec| Ze fwelZ hw` KLbI AwaKZi KvhKi Kvb Ilya Zwi nq, hv wK bv m~Yfve fvBivm wbqY mg ne, m GUv cqvM Kiv hve| jYwenxb GBWm ivMx`i Kxfve Ilya cqvM KiZ ne Zv wbqI weZK iqQ| G CD4 Kvli msLv cwigvci gvag ivMi Aev hvPvB Kivi ciB wPwKrmv `qv hZ cvi| Kx cwigvY CD4 Kvl _vKj wPwKrmv `qv cqvRbG cki Reve nj, CD4 Kvli msLv `yki KvQvKvwQ GjB wPwKrmv `qv cqvRb| G welq Av RvwZKfve ^xKZ ek KwU MvBWjvBb iqQ| Gi GKwU nj DHHS MvBWjvBb| AciwU IAS-USA MvBWjvBb| GB MvBWjvBbi mycvwikjv wbP e Dj-L Kiv nj:
Indications to Initiate Anti-retroviral Therapy - DHHS Guidelines (July 1, 2001) Clinical Category Symptomatic (AIDS or severe symptoms) Asymptomatic AIDS Asymptomatic CD4 Cell Count Any value Plasma IV RNA Any value Any value Any value Recommendation Treat

Indications for the Initiation of Anti-retroviral Therapy-IAS-USA Recommendations (JAMA 2000; 283:381)
CD4 Count (Cells/mm3 <350 350 to 500 >500 Viral Loda (c/mL) 5,000 to 30,000 Treat Treat Consider

<5,000 Treat Consider Defer

>30,000 Treat Treat Treat

wPwKrmv ii AvM hgb CD4 msLvwU `L bqv cqvRb, Zgwb mve fvBivj jvWwUI `L bqv `iKvi| AbKi wPwKrmvi fvBivj jvWwUi DciB ewk Rvi `qv cqvRb| fvBivj jvW cwZ Nb wgwjwjUvi 30 nvRvii Dci nj AekB wPwKrmv i KiZ ne| G CD4 msLvwU iZcY bq| ~ nvU (HAART) _ivwc `qvi ci ivMi DbwZ eySevi Rb CD4 Kvli msLv cwigvci mv_ mv_ fvBivj jvWwUI `Lv cqvRb| AbK CD4 msLvwU wPwKrmvi c_g mvn eo MjI cieZxZ Kg Avm| hv w`q wPwKrmv i KiZ ne Zv nj `yUv wbDwKqvmvBW I GKwU cvwUqm BbwnweUi (PI), `yUv wbDwKqvmvBW Ges `ywU cvwUqm BbwnweUi, `yUv wbDKvqvmvBW Ges GKwU bb-wbDwKqvmvBW UvwcUm BbwnweUi (NNRTI)|

wifvm

bZzb aibi h wPwKrmv eev weePbv Kiv nQ Zv nj K) GK mv_ wZbwU wbDwKqvmvBW, L) `yUv wifvm UvwcUm BbwnweUi (NRTIs), GKwU cvwUqm BbwnweUi Ges GKwU bb-wifvm UvwcUm BbwnweUi (NNRTI)| wPwKrmvi ci CD4 msLv `yki Dci DVj ivMxi Aev fvj gb njI me mgq GwU mwZ bvI nZ cvi| Ze GB msLvwU cvki wbP bg Avmj Ilyai KvhKvwiZv Lye fvj nQ ej gb Kiv hve bv|
14.10.1 hme wPwKrmv cwieZb KiZ ne:
Recommendations for Changing Therapeutic Regimen (Modified from IAS-USA Recommendations. JAMA 2000; 283:381, JAMA 2000; 283:2417)
Clinical Presentation Toxicity Virologic success Recommendations

Any value CD4 200 to 350 cells/mm3

Treat Treatment should usually be offered; controversy exists for patients with viral load 20,000 c/mL due to low probability of AIDS-defining diagnosis within 3 years. Some experts would treat, since viral load at this threshold predicts a 3-year risk of AIDS of 30% despite high baseline CD4 cell count. Some would defer therapy and monitor CD4 cell count.

Asymptomatic

CD4.350/m m3

>30,000 (bDNA) or >55,000) Rt-PCR

172

173

Viral load above target before 8 to 16 weeks Viral load above target after 8 to 16 weeks Virologic failure Viral load above target at 8 to 16 weeks Viral load above target after 24 to 36 weeks Viral escape after good suppression

Change offending drug Change entire regimen or use resistance testing to guide drug selection Continue regimen, check adherence and consider intensification Change entire regimen, use resistance testing, or intensify Change entire regimen, use resistance testing, or intensify

Dj-Lcw

A
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Suggested Empiric Regimens for Patients who Failed Antiretroviral Therapy: Prior Regimen 2 NRTIs + PI New Regimen 2 new NRTLs plus NNRTI or Dual PLs (RTV+SQV, RTV+NFV+SQV, RTV+APV, LPV/RTV) or Triple-class regimen with 1 or 2 NRTLs plus NVP or EFV plus 1 or 2 Pls 2 new NRTIs+ 1 or 2 PLs 2 new NRTIs (ddi+d4T)+either PL or NNRTI 2 new NRTLs+PL or NNRTI

1 NRTLs+NNRTI ABC + AZT + 3 TC 2 NRTLs

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NIAID keeps an open mind with respect to all the suggestions received regarding potential treatments and cures for AIDS. We are dedicated to advancing biomedical research and welcome the opportunity to learn more about your work. Please send any literature relevant to your work in the HIV/AIDS and we will circulate this information to our scientific staff for review. Because of the massive volume of information and inquiries received daily, you will be contacted only if there is interest or if additional information is required........ .... Again thank you for sharing this information with us. HIV disease is of the highest concern to the Public Health Service. With the dedication of researchers around the world such as yourse lf, we hope to find ways to prevent, treat, and cure this devastating disease. Sincerely, Jonathan Kagan, Ph.D. Deputy Director Division of AIDS 6700 B Rockledge Drive, Room 4 140 MSC 7620 Bethesda, MD 20892

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Date: 24 July 2002 Dear Dr. M.A. Hasan: Thank you for your recent e-mail to Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases (NIAID) regarding your low cost AIDS preventive drug. Because the Division of AIDS, within the National Institute of Allergy and Infectious Diseases, has the primary responsibility for basic and clinical research on HIV/AIDS at the National Institute of Health, your letter was forwarded to my office for reply.