PRIMARY CARE NURSING AND HIV GYNECOLOGIC MANIFESTATIONS

外阴阴道念珠菌病是严重痛苦的根源， 艾滋病毒感染妇女的发病率。 预防方法 困难的问题包括积极的病人教育和阴道 卫生，通过使用外源性药物恢复正常阴道植物群 乳酸杆菌，以及局部和全身抗真菌预防。 然而，在这方面， 关于这些战略的相对有效性，我们知之甚少 for women妇女with HIV艾滋病毒. 鉴于大量的处方药 对于艾滋病毒感染者，可能发生重大药物相互作用， 关于选择抗真菌耐药微生物的问题， 有充分的理由探索局部治疗方案预防 外阴阴道念珠菌病 一种有效、无毒、患者可接受的 预防外阴阴道念珠菌病的方法将有助于 对感染艾滋病毒的妇女的门诊管理有重大意义。 我们建议进行一项随机、双盲、安慰剂对照的研究， 三种初级保健护理策略预防老年痴呆症的试验 外阴阴道念珠菌病，其中艾滋病毒感染的妇女谁不是 接受全身抗真菌治疗的患者将根据以下因素分层： 他们的基线CD 4计数（<100，100-300，300-500，>500）和随机分组 三个研究组之一接受以下治疗的概率相等：1）标准 单独的护士-助产护理（患者教育和监测），2）标准 护理加嗜酸乳杆菌明胶自我管理 胶囊阴道内每周一次，或3）标准护理加自我- 克霉唑500 mg阴道片每周一次给药。

Vulvovaginal candidiasis is the source of significant distress and morbidity among HIV infected women. Prophylactic approaches to this difficult problem include aggressive patient education and vaginal hygiene, restoration of normal vaginal flora through the use of exogenous lactobacilli, and local and systemic antifungal prophylaxis. However, little is known about the comparative effectiveness of these strategies for women with HIV. Given the large number of pharmaceuticals prescribed for people with HIV, the potential for significant drug interactions, and concern regarding selection for antifungal resistent organisms, there are good reasons to explore the efficacy of local regimens for prophylaxis of vulvovaginal candidiasis. An effective, non-toxic, and patient-acceptable approach to prophylaxis of vulvovaginal candidiasis would contribute significantly to outpatient management of women with HIV. We propose to conduct a randomized, double-blinded, placebo-controlled trial of three primary care nursing strategies for prophylaxis of vulvovaginal candidiasis, in which HIV infected women who are not receiving systemic antifungal therapy will be stratified according to their baseline CD4 count (<100, 100-300, 300-500, >500) and randomized with equal probability to one of three study arms receiving: 1) standard nurse-midwifery care alone (patient education and monitoring), 2) standard care plus self-administration of Lactobacillus acidophilus gelatin capsules intravaginally once a week, or 3) standard care plus self- administration of clotrimazole 500mg vaginal tablets once a week.