{"id":24301,"date":"2022-03-03T19:28:22","date_gmt":"2022-03-03T16:28:22","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=24301"},"modified":"2022-03-31T13:13:17","modified_gmt":"2022-03-31T10:13:17","slug":"hizli-art","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/03\/03\/hizli-art\/","title":{"rendered":"HIV \u0130nfeksiyonunda H\u0131zl\u0131 Antiretroviral Tedavi Ba\u015flanmas\u0131"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

Etkili antiretroviral tedavilerin (ART) klinik kullan\u0131mda olmalar\u0131na kar\u015f\u0131n, tedaviye ba\u015flanmas\u0131, s\u00fcrd\u00fcr\u00fclmesi ve virolojik bask\u0131laman\u0131n sa\u011flanmas\u0131 a\u015famalar\u0131nda istenen ba\u015far\u0131 elde edilememektedir (1).<\/p>\n

ABD Sa\u011fl\u0131k ve \u0130nsani Hizmetler Bakanl\u0131\u011f\u0131 (\u201cUnited States Department of Health and Human Services, DHHS\u201d) rehberi, \u201chuman immunodeficiency virus\u201d (HIV) infeksiyonu tedavisine ilk kez ba\u015flan\u0131rken, tedavi se\u00e7iminin y\u00f6nlendirebilmesi i\u00e7in baz\u0131 testlerin yap\u0131lmas\u0131n\u0131 \u00f6nermektedir. Ancak bu testlerden bir k\u0131sm\u0131n\u0131n sonu\u00e7lanmas\u0131 g\u00fcnler hatta haftalar alabilir (\u00f6rne\u011fin genotipik diren\u00e7 testleri ve HLA-B*5701 testi) (2). H\u0131zl\u0131 tedavi ba\u015flama programlar\u0131, hastada tan\u0131n\u0131n koyuldu\u011fu g\u00fcn ya da tan\u0131y\u0131 takip eden birka\u00e7 g\u00fcn i\u00e7inde, ba\u015flang\u0131\u00e7ta istenen testlerin sonu\u00e7lar\u0131n\u0131 beklemeden tedavi ba\u015flamay\u0131 \u00f6ng\u00f6r\u00fcr (3-10). Bu tedavi modellerinin amac\u0131, daha fazla say\u0131da ve oranda hastay\u0131 tedavi program\u0131n\u0131n i\u00e7inde tutmak, virolojik bask\u0131lanmay\u0131 daha h\u0131zl\u0131 bir \u015fekilde sa\u011flamak ve bu \u015fekilde HIV infeksiyonuna ba\u011fl\u0131 morbidite ve mortaliteyi azaltmakt\u0131r.<\/p>\n


\n<\/b>HIV \u0130NFEKS\u0130YONUNDA HIZLI TEDAV\u0130N\u0130N TANIMI<\/h2>\n

HIV infeksiyonu tan\u0131s\u0131ndan hemen sonra tedavi ba\u015flanmas\u0131 ile ilgili literat\u00fcrde ve rehberlerde farkl\u0131 kavramlar bulunmaktad\u0131r. Hemen (\u201cimmediate\u201d), h\u0131zl\u0131 (\u201crapid\u201d) ya da ayn\u0131 g\u00fcn (\u201csame-day\u201d) tedavi kavramlar\u0131 kullan\u0131lm\u0131\u015f; ancak h\u0131zl\u0131 tedavi kavram\u0131 \u00f6ne \u00e7\u0131km\u0131\u015ft\u0131r. Ayn\u0131 g\u00fcn tedavi kavram\u0131 kendini a\u00e7\u0131klamakla birlikte hemen tedavi ve h\u0131zl\u0131 tedavi kavramlar\u0131n\u0131n tan\u0131mlanmas\u0131 gerekmektedir.<\/p>\n

HIV tedavisinde h\u0131zl\u0131 tedavi, hastaya tan\u0131n\u0131n koyuldu\u011fu g\u00fcn ya da tan\u0131y\u0131 takip eden birka\u00e7 g\u00fcn (yakla\u015f\u0131k 3 g\u00fcn) i\u00e7inde ART ba\u015flamay\u0131 ifade eder. Uluslararas\u0131 Antiviral Derne\u011fi ABD Paneli (\u201cInternational Antiviral Society-USA, IAS-USA\u201d), h\u0131zl\u0131 tedaviyi, HIV infeksiyonu tan\u0131s\u0131 koyulduktan sonra m\u00fcmk\u00fcn oldu\u011funca erken (ilk 7 g\u00fcn i\u00e7inde) tedavi ba\u015flanmas\u0131 olarak tan\u0131mlar (4).<\/p>\n

HIZLI TEDAV\u0130N\u0130N KAPSAMI<\/h2>\n

Mevcut literat\u00fcr bilgisi, h\u0131zl\u0131 tedavinin, HIV ile infekte t\u00fcm hastalara uygulanabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. G\u00fcncel HIV\/AIDS tan\u0131 ve tedavi rehberlerinde h\u0131zl\u0131 tedavinin kapsam\u0131 \u015fu \u015fekilde belirtilmi\u015ftir:<\/p>\n

Antiviral Derne\u011fi ABD Paneli (\u201cInternational Antiviral Society-USA, IAS-USA\u201d)<\/h3>\n

IAS-USA, h\u0131zl\u0131 tedavinin, kaynaklar\u0131 k\u0131s\u0131tl\u0131 b\u00f6lgeler ba\u015fta olmak \u00fczere, antiretroviral tedaviye eri\u015fimin \u00f6n\u00fcnde engellerin oldu\u011fu yerlerde uygulanmas\u0131n\u0131 \u00f6nermektedir (4). Rehber, ayr\u0131ca h\u0131zl\u0131 tedavi verilecek hastalarda dolutegravir\/lamivudin tedavisinin se\u00e7ilmemesi gerekti\u011fini vurgulamaktad\u0131r.<\/p>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (\u201cWorld Health Organization, WHO\u201d)<\/h3>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6)\u2019n\u00fcn h\u0131zl\u0131 ART Rehberi, HIV ile infekte t\u00fcm hastalara h\u0131zl\u0131 tedavinin (HIV infeksiyonu tan\u0131s\u0131n\u0131 takiben 7 g\u00fcn i\u00e7inde) \u00f6nerilmesi gerekti\u011fini belirtmekte ve tedaviye ba\u015flamaya haz\u0131r hastalara, ayn\u0131 g\u00fcn tedavinin ba\u015flanmas\u0131n\u0131n teklif edilmesi gerekti\u011fini vurgulamaktad\u0131r (3).<\/p>\n

ABD Sa\u011fl\u0131k ve \u0130nsani Hizmetler Bakanl\u0131\u011f\u0131 (\u201cUnited States Department of Health and Human Services, DHHS\u201d)<\/h3>\n

DHHS rehberi, mortalite ve morbiditeyi azaltmak ve bula\u015f\u0131 engellemek i\u00e7in HIV ile infekte her hastaya, h\u0131zl\u0131 ART\u2019yi \u00f6nermektedir. Hastan\u0131n tedaviyi alma ve tedavi alt\u0131nda kalma ihtimallerini art\u0131rd\u0131\u011f\u0131, viral bask\u0131lanmay\u0131 sa\u011flamak i\u00e7in gereken s\u00fcreyi azaltt\u0131\u011f\u0131 ve viral bask\u0131lanma oranlar\u0131n\u0131 art\u0131rd\u0131\u011f\u0131 i\u00e7in tedavinin m\u00fcmk\u00fcn oldu\u011fu kadar erken ba\u015flanmas\u0131 gerekti\u011fini vurgulamaktad\u0131r. Antiretroviral tedavi ba\u015flan\u0131rken, tedavinin \u00f6nemi ve tedaviye uyumun gereklili\u011fi hakk\u0131nda hastaya e\u011fitim verilmesi gerekti\u011fi bildirilmektedir<\/p>\n

Rehber, h\u0131zl\u0131 tedavi i\u00e7in integraz inhibit\u00f6r\u00fc ya da alternatif olarak da g\u00fc\u00e7lendirilmi\u015f proteaz inhibit\u00f6r\u00fc bazl\u0131 tedavileri \u00f6nermektedir (2).<\/p>\n

HIZLI TEDAV\u0130 PROGRAMLARININ DEZAVANTAJLARI<\/h2>\n

Hastan\u0131n ba\u015flang\u0131\u00e7 de\u011ferlendirmesi ve testlerinin tamamlanmas\u0131n\u0131 takiben tedavi ba\u015flanmas\u0131 programlar\u0131nda (standard yakla\u015f\u0131m) t\u00fcm d\u00fcnyada \u00f6nemli bir deneyim elde edilmi\u015ftir. Buna kar\u015f\u0131l\u0131k h\u0131zl\u0131 tedavi programlar\u0131 g\u00f6receli olarak yenidir ve tecr\u00fcbe daha azd\u0131r. \u00d6zellikle tedavinin emniyeti, tedavi ba\u015flang\u0131c\u0131nda hastada diren\u00e7 olup olmamas\u0131 ve g\u00fcvenlik profili a\u00e7\u0131s\u0131ndan daha fazla bilgi ve tecr\u00fcbeye ihtiya\u00e7 vard\u0131r.<\/p>\n

Tedaviye uyum, yeni tan\u0131 koyulmu\u015f baz\u0131 hastalarda zor olabilir. Yeni tan\u0131 alm\u0131\u015f ve hastal\u0131k ile ilgili yeni bilgilendirilmi\u015f hasta, i\u00e7inde bulundu\u011fu stres ve \u015fa\u015fk\u0131nl\u0131kla; tedavi ile ilgili bilgilendirmeyi, ilaca uyumun \u00f6nemini ve ila\u00e7lar\u0131n olas\u0131 yan etkilerini tam olarak anlayamayabilir. Bu bilgi eksikli\u011fi, \u00f6m\u00fcr boyu devam eden ve dolay\u0131s\u0131yla \u00e7ok uzun s\u00fcren tedavide \u00f6nemli uyum sorunlar\u0131na yol a\u00e7abilir.<\/p>\n

H\u0131zl\u0131 tedavi stratejisinin kullan\u0131labilmesi i\u00e7in sa\u011fl\u0131k kurulu\u015funun yap\u0131lanmas\u0131n\u0131n buna uygun olmas\u0131 gerekir. Hastan\u0131n ilk de\u011ferlendirmesinde; \u00f6yk\u00fcs\u00fcn\u00fcn al\u0131nmas\u0131 ve fizik muayenesinin detayl\u0131 olarak ger\u00e7ekle\u015ftirilmesi, test sonu\u00e7lar\u0131n\u0131n ayn\u0131 g\u00fcn al\u0131nmas\u0131, hastan\u0131n test sonucu ile tekrar de\u011ferlendirilmesi ve bu bilgiler \u0131\u015f\u0131\u011f\u0131nda tedavisinin d\u00fczenlenmesi gerekir. Ayr\u0131ca hastan\u0131n re\u00e7etesinin yaz\u0131larak ila\u00e7lar\u0131n kullan\u0131m\u0131, etkileri, yan etkileri ile ilgili bilgilerin verilmesi, ila\u00e7 raporunun haz\u0131rlanmas\u0131, laboratuvar ve g\u00f6r\u00fcnt\u00fcleme istemlerinin planlanmas\u0131 yap\u0131lmal\u0131d\u0131r. Hastaya bilgi vermek, soru sormas\u0131na imkan sa\u011flamak ve sorular\u0131n\u0131 cevaplamak i\u00e7in zaman ay\u0131rmak gereklidir. Hastan\u0131n standard tedavi yakla\u015f\u0131m\u0131nda 2-3 poliklinik kontrol\u00fcne yay\u0131lan bu i\u015flemlerin, tek bir g\u00f6r\u00fc\u015fmeye s\u0131\u011fd\u0131r\u0131lm\u0131\u015f olmas\u0131, bu yakla\u015f\u0131m\u0131n zorluklar\u0131ndan biridir.<\/p>\n

Hastan\u0131n tedavisi, ba\u015flang\u0131\u00e7ta istenen tetkikler sonu\u00e7lanmadan planland\u0131\u011f\u0131ndan, abakavir i\u00e7eren rejimler verilemeyecektir. \u0130yi tolere edilen ve genetik bariyeri y\u00fcksek bu rejimin kullan\u0131lamamas\u0131, hastada tedavi se\u00e7eneklerinin k\u0131s\u0131tlanmas\u0131 anlam\u0131na gelir. Ayr\u0131ca tedavi \u00f6ncesi testlerde saptanabilecek akut hepatit, tedavi hemen ba\u015fland\u0131\u011f\u0131ndan saptanamam\u0131\u015f olacakt\u0131r. <\/span><\/p>\n

H\u0131zl\u0131 tedavi verilecek hastalarda, dolutegravir\/lamivudin tedavisi se\u00e7ilmemeli; hastan\u0131n ba\u015flang\u0131\u00e7 laboratuvar sonu\u00e7lar\u0131 de\u011ferlendirilmelidir. Bu tedavi y\u00f6ntemi; kronik hepatit B hastalar\u0131nda, HIV-RNA d\u00fczeyi >500 000 kp\/ml ve CD4 d\u00fczeyi <200\/mm3<\/sup> olanlarda tercih edilmemelidir (4).<\/p>\n

H\u0131zl\u0131 tedavi ba\u015flanan hastalarda tedavi ba\u015flama zaman\u0131n\u0131 etkileyebilecek hastal\u0131klar (kriptokok menenjiti, t\u00fcberk\u00fcloz gibi) ve ba\u015flanacak ilac\u0131 etkileyebilecek hastal\u0131klar\/durumlar (akut hepatit, b\u00f6brek yetmezli\u011fi, gebelik gibi) s\u00f6z konusu olabilir. \u00d6zellikle dikkatli al\u0131nacak hasta \u00f6yk\u00fcs\u00fc ve detayl\u0131 fizik muayene ile bu hastal\u0131klar\/durumlar de\u011ferlendirilmelidir.<\/p>\n

D\u0130REN\u00c7 SORUNU<\/h2>\n

H\u0131zl\u0131 tedavi programlar\u0131nda, diren\u00e7 ile ilgili bilgi mevcut olmadan hastalara ART ba\u015flanacakt\u0131r. Aktar\u0131lan bir diren\u00e7, HIV ile infekte hastalarda dikkate al\u0131nmas\u0131 gereken \u00f6nemli bir sorundur.\u00a0 <\/span>Huhn ve arkada\u015flar\u0131n\u0131n (11) \u00e7al\u0131\u015fmas\u0131nda (DIAMOND \u00e7al\u0131\u015fmas\u0131), 5 hastada proteaz inhibit\u00f6rlerine kar\u015f\u0131 birden fazla diren\u00e7le ili\u015fkili mutasyon (D\u0130M) saptanm\u0131\u015f; ancak bu hastalarda darunavire kar\u015f\u0131 D\u0130M saptanmam\u0131\u015ft\u0131r. Ayr\u0131ca iki hastadaemtrisitabin direnci anlam\u0131na gelen M184I\/V mutasyonu saptanm\u0131\u015f olup h\u0131zl\u0131 ba\u015flanan darunavir\/kobisistat\/emtrisitabin\/tenofovir alafenamide tedavisi ile viral bask\u0131lanma sa\u011flanm\u0131\u015ft\u0131r.<\/p>\n

Halperin ve arkada\u015flar\u0131n\u0131n (9) \u00e7al\u0131\u015fmas\u0131nda, h\u0131zl\u0131 tedavi ba\u015flanan 61 hastan\u0131n 14 (%23)\u2019\u00fcnde diren\u00e7 saptanm\u0131\u015ft\u0131r. \u0130ki hastada n\u00fckleozid revers transkriptaz inhibit\u00f6r\u00fc (NRTI) direnci (M184I\/V mutasyonu) ve 12 hastada non n\u00fckleozid revers transkriptaz inhibit\u00f6r\u00fc (NNRTI) direnci saptanm\u0131\u015ft\u0131r. Ancak diren\u00e7 saptanan bu hastalar\u0131n t\u00fcm\u00fcnde viral bask\u0131lanma sa\u011flanm\u0131\u015ft\u0131r.<\/span><\/p>\n

HIZLI TEDAV\u0130 PROGRAMI \u0130\u00c7EREN KL\u0130N\u0130K \u00c7ALI\u015eMALARIN ANAL\u0130Z\u0130<\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> H\u0131zl\u0131 Antiretroviral Tedavilerin (ART) De\u011ferlendirildi\u011fi \u00c7al\u0131\u015fmalar<\/p><\/div>\n

H\u0131zl\u0131 tedavi programlar\u0131, \u00e7e\u015fitli \u00fclkelerde kullan\u0131lm\u0131\u015ft\u0131r. Bu \u00e7al\u0131\u015fmalar\u0131n bir k\u0131sm\u0131nda sadece h\u0131zl\u0131 tedavi program\u0131 uygulanm\u0131\u015f; baz\u0131lar\u0131nda ise ilk de\u011ferlendirmede istenen tetkiklerinin sonu\u00e7lar\u0131n\u0131n beklendi\u011fi ve tedavinin sonraki poliklinik vizitlerinde ba\u015fland\u0131\u011f\u0131 uygulamalar (standard tedavi) kontrol grubu olarak kullan\u0131lm\u0131\u015ft\u0131r (5-14) (Tablo 1).<\/p>\n

S\u00f6z konusu \u00e7al\u0131\u015fmalar d\u0131\u015f\u0131nda literat\u00fcrde iki \u00f6nemli derleme ve meta-analiz yer almaktad\u0131r. Ford ve arkada\u015flar\u0131n\u0131n (15) A\u011fustos 2017 tarihine kadar olan \u00e7al\u0131\u015fmalarla yapt\u0131klar\u0131 meta-analizde; 4 randomize kontroll\u00fc \u00e7al\u0131\u015fma, 11 g\u00f6zlem \u00e7al\u0131\u015fmas\u0131, 5 kalitatif \u00e7al\u0131\u015fma ve 2 maliyet \u00e7al\u0131\u015fmas\u0131 yer alm\u0131\u015ft\u0131r. Meta-analiz sonu\u00e7lar\u0131na g\u00f6re; tan\u0131 ile ayn\u0131 g\u00fcn ART ba\u015flanmas\u0131, 12. ayda viral bask\u0131lanma ve takip-tedaviye devam etme oranlar\u0131n\u0131 art\u0131rm\u0131\u015ft\u0131r. Hastaya tan\u0131 sonras\u0131 90 g\u00fcn i\u00e7inde tedavi ba\u015flanm\u0131\u015f olma ihtimali, h\u0131zl\u0131 tedavi programlar\u0131nda daha y\u00fcksek bulunmu\u015ftur. G\u00f6zlem \u00e7al\u0131\u015fmalar\u0131n\u0131n de\u011ferlendirilmesine g\u00f6re, hastalara h\u0131zl\u0131 antiviral tedavi teklif edilmesi, takip eden 90 g\u00fcn i\u00e7inde bu hastalar\u0131n daha y\u00fcksek oranda tedavi almalar\u0131n\u0131 sa\u011flam\u0131\u015ft\u0131r.<\/p>\n

Mateo-Urdiales ve arkada\u015flar\u0131 (16), Cochrane veritaban\u0131nda yer alan derlemelerinde A\u011fustos 2018 tarihine kadar olan randomize kontroll\u00fc \u00e7al\u0131\u015fmalar\u0131 analiz etmi\u015ftir. Analizde bir hafta i\u00e7inde ART ba\u015flanan 18 011 hastay\u0131 i\u00e7eren 7 \u00e7al\u0131\u015fma yer alm\u0131\u015ft\u0131r. Analiz sonu\u00e7lar\u0131na g\u00f6re; standard tedavi ba\u015flama programlar\u0131na k\u0131yasla h\u0131zl\u0131 tedavi programlar\u0131, 12. ayda daha y\u00fcksek oranda bir viral bask\u0131lanma ve takip-tedaviye devam etme sa\u011flam\u0131\u015ft\u0131r. H\u0131zl\u0131 tedavi daha d\u00fc\u015f\u00fck bir mortaliteye e\u015flik ediyor gibi g\u00f6r\u00fcnmekle birlikte, s\u00f6z konusun verinin g\u00fcven aral\u0131\u011f\u0131 dikkate al\u0131nd\u0131\u011f\u0131nda anlaml\u0131 olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Yan etkilerle ilgili bir sonuca varmak i\u00e7in yeterli veri bulunamam\u0131\u015ft\u0131r.<\/p>\n

T\u00dcRK\u0130YE\u2019DE HIV \u0130NFEKS\u0130YONUNDA HIZLI TEDAV\u0130<\/h2>\n

COVID-19 pandemisi s\u00fcrecinde sa\u011fl\u0131k hizmetlerinin \u00f6nemli bir b\u00f6l\u00fcm\u00fc zorunlu olarak bu hastal\u0131\u011fa ayr\u0131lm\u0131\u015f ve infeksiyon hastal\u0131klar\u0131 uzmanlar\u0131 b\u00fcy\u00fck \u00f6l\u00e7\u00fcde pandemi ile m\u00fccadele kapsam\u0131nda g\u00f6rev yapmak zorunda kalm\u0131\u015ft\u0131r. Di\u011fer hastal\u0131klara ayr\u0131lan imkan ve zaman do\u011fal olarak azalm\u0131\u015ft\u0131r. Ayr\u0131ca hastalar, hasta olma korkusu ile hastanelere daha az ba\u015fvurmaktad\u0131r. Bu nedenlerle, h\u0131zl\u0131 tedavi programlar\u0131, HIV\/AIDS\u2019le m\u00fccadelede aksamalar\u0131 \u00f6nleyebilmek i\u00e7in \u00f6nemli bir strateji olarak ele al\u0131nmal\u0131d\u0131r.<\/p>\n

\u00dclkemizde HIV infeksiyonu prevalans\u0131 d\u00fc\u015f\u00fck olmakla birlikte giderek artmaktad\u0131r. Di\u011fer yanda, Birle\u015fmi\u015f Milletler HIV\/AIDS Program\u0131 (\u201cThe Joint United Nations Programme on HIV\/AIDS, UNAIDS\u201d)\u2019n\u0131n belirledi\u011fi, olgular\u0131n en az %90\u2019\u0131na tan\u0131 konulmas\u0131, %90\u2019\u0131na ART ba\u015flanmas\u0131 ve %90\u2019\u0131nda viral bask\u0131lanma sa\u011flanmas\u0131 (90-90-90) hedeflerine ula\u015f\u0131lm\u0131\u015f de\u011fildir (17). Sonu\u00e7 olarak h\u0131zl\u0131 tedavinin; tedaviye ba\u015flama, hastay\u0131 tan\u0131-tedavi program\u0131 i\u00e7inde tutma ve viral bask\u0131lanma sa\u011flama oranlar\u0131n\u0131 art\u0131rma a\u00e7\u0131s\u0131ndan sa\u011flayaca\u011f\u0131 katk\u0131lar d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde, \u00fclkemiz i\u00e7in de uygulanmas\u0131 gereken bir tedavi program\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclebilir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Etkili antiretroviral tedavilerin (ART) klinik kullan\u0131mda olmalar\u0131na kar\u015f\u0131n, tedaviye ba\u015flanmas\u0131, s\u00fcrd\u00fcr\u00fclmesi ve virolojik bask\u0131laman\u0131n sa\u011flanmas\u0131 a\u015famalar\u0131nda istenen ba\u015far\u0131 elde edilememektedir (1). ABD Sa\u011fl\u0131k ve \u0130nsani Hizmetler Bakanl\u0131\u011f\u0131 (\u201cUnited States Department of Health and Human Services, DHHS\u201d) rehberi, \u201chuman immunodeficiency virus\u201d (HIV) infeksiyonu tedavisine ilk kez ba\u015flan\u0131rken, tedavi se\u00e7iminin y\u00f6nlendirebilmesi i\u00e7in baz\u0131 testlerin yap\u0131lmas\u0131n\u0131 \u00f6nermektedir. […]<\/p>\n","protected":false},"author":2,"featured_media":24701,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5127],"tags":[5390,5109,5163],"class_list":["post-24301","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-derleme","tag-aids-2","tag-antiretroviral-tedavi","tag-hiv-2"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=24301"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24301\/revisions"}],"predecessor-version":[{"id":24738,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24301\/revisions\/24738"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/24701"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=24301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=24301"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=24301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}