Ukuba ishiywe ingalawulwa, i-HIV iya kuqhubela phambili kwi-AIDS; ngumgaqo jikelele. Nangona kunjalo, i-subset encinci yabantu abane-HIV ikholelwa ukuba bayakwazi ukulawula i-HIV ngaphandle kokuqhubela phambili kwi-AIDS-kwaye ngaphandle kokusetyenziswa kwezidakamizwa ze- antiretroviral . Aba bantu, ababizwa ngokuba yixesha elide abangengenququli phambili , namhlanje banokubizwa ngokuba ngabalawuli abaphezulu be-HIV .
Nangona iingcali zade zicinga ukuba le nqanaba liyi-mystery, ubuninzi bokuba ubungqina namhlanje bubonisa ukuba utshintsho oluthile lwezityalo luye lwaba "ulawulo" lwe-HIV. Ngaloo ndlela, kugxininiswa ngakumbi kwiinkqubo ezifanayo nakwabanye abantu, ngenjongo yokugqiba ukugonywa kwe-AIDS okanye indlela yokuzivikela nge-immunologic yokulawula i-HIV ngaphandle kokusetyenziswa kweziyobisi.
Uluphi Umlawuli Wabadala?
Abalawuli be-Elite bachazwa ngokubanzi njengabantu abanentsholongwane kaGawulayo abagcina imithwalo ye- HIV engabonakaliyo ngaphandle kokusetyenziswa kweziyobisi ze-HIV. Ukuxhaswa kwemithwalo yemisebenzi ye-viral engalawulwayo, abalawuli abakhulu basoloko banamasosha omzimba (njengokuba kulinganiswa ngama- CD4 count ), oku kuthetha ukuba umngcipheko wokusuleleka usulelo ungancitshiswa.
Kuqikelelwa ukuba abalawuli be-alite account account for about 1 in 300 people infected with HIV. Loo nani ungatshintsha, nangona kunjalo, unikwe ukuba uphando luhlala luchaza abalawuli abakhulu ngokuhlukileyo.
Kwezinye iimeko, abalawuli abaphakamileyo bachazwa njengokuba banako ukugcina intsholongwane engabonakaliyo kunyaka; abanye baqukwa emva kokuphela kwimizuzu engama-3-15.
Oku kubaluleka kubalulekile ngenxa yokuba asinakuthetha ngokuzithemba ukuba abalawuli be-elite abanakuze baqhubele phambili kwisifo sabo okanye bafumane ukusebenza ngokukhawuleza kwemisebenzi yentsholongwane.
Kufuneka sicinge ukuba abanye balaba bantu baya kuba.
Yintoni Eyenza Umlawuli Wabazali?
Izifundo zakuqala aziphumelelanga ekufumaneni iimpawu eziqhelekileyo kunye neempawu phakathi kwabalawuli abakhulu. Kwakungekho ukufika kophando lwezofuzo kunye nobuchwephesha esasikwazi ukuyijonga ngokufanayo phakathi kwalabo babecala ukuba balawulwe.
Phakathi kwabaphandi abaziintloko, i-Harvard Medical School isazi senzululwazi uBruce Walker, MD wayephakathi kweyokuqala ukuhlukanisa ukungalingani kofuzo ekwenzeni aba bantu, kubonisa ubungqina obuvela kwiqela elingu-1,100 labalawuli abakhulu kunye nabantu abangama-800 abane-AIDS.
Kwiimeko eziqhelekileyo zokuzivikela, iistim ze-immune ezikhethekileyo, ezibizwa ngokuba "ngumncedisi" weeseli ze-T , zibona iintsholongwane ezibangelwa zizifo kwaye "zithengise" ukuba zingabonakali. "Umbulali" I-T-seli ivale intsholongwane kwiindawo ezithile zokunamathisela kwaye ibulale intsholongwane ngokufanelekileyo.
Nangona kunjalo, i-HIV iyakwazi ukuzivumelanisa nokuhlaselwa komzimba, ukuguqula ukukhusela isalathisi se "celler", ngelixa utshabalalisa iiseli "zoncedo" ezifunekayo ukubonisa ukuhlaselwa kokuqala.
Ngophando lwalo qela, u-Walker wakwazi ukucacisa ukuba "umbulali" iiseli ze-T kwiqela elilawulayo elikhulu lakwazi ukusebenza ngokuzimela "kwi-T-cell".
Ngaphezu koko, iqela lakhe lafumanisa ukuba iiseli "zokubulala" zakwazi ukunqanda ulwahlulo olubanzi lwe-HIV, kungekhona nje i-subset efana neyona nto ihlala yimeko.
Ukususela ngophando lwe-Walker lushicilelwe, izazinzulu ziye zakwazi ukuhlukanisa ubuninzi beenguqu zofuzo ezifumaneka kwi-genome yolawulo lwabantu abakhulu. Phakathi kwabo:
- Ukuguqulwa kofuzo lwe- FUT2 , efumaneka kwi-20% yabemi baseYurophu kwaye uyaziwa ngokunyamezela kwezinye iintlobo zegciwane.
- Ubukho bezinto eziphilayo ezibizwa ngokuba yi- leukocyte antigen B (HLA-B) , ezitholakala kwinxalenye enkulu yabalawuli abakhulu.
- Indlela yofuzo evumela abalawuli be-elite ukuvelisa okubizwa ngokuba yi- antibodies (ne-BNAbs) ngokubanzi ngokukhawuleza kunokuba abalawuli abangabalingani. i-BNAbs, ngencazelo, iyakwazi ukubulala iindidi ezahlukeneyo ze-HIV. Ngokuqhelekileyo, umlawuli ongeyena onobomi angathatha iminyaka ukuvelisa la maseli, ngelo xesha i-HIV sele iqalile ukugcina izixhobo ezifihlakeleyo ezifihliweyo ezingenakunceda ukuhlaselwa. Abalawuli be-Elite, ngokuphambene, babonakala bekwazi ukuvuselela i-BNAbs ngokukhawuleza, ukuthintela (okanye ubuncinci ukunciphisa) ukusekwa kwamagumbi okugcina.
Ngokuchonga ezi ndlela zendalo, izazinzulu zithemba ukuphinda ziphendule iinkqubo ngokusebenzisa i-gene gym, i-immunologic vaccine, okanye idibaniso yeendlela eziphilayo.
Ngaphantsi kolawulo lwe-Elite
Ngaphandle kokulindela ulawulo oluphezulu kunye nophando lokugonya oluchaphazelekayo, ubungqina obandayo bubonise ukuba ulawulo oluphezulu luza ngexabiso. Xa kuthelekiswa nabangewona abaphakamileyo abalawuli be- antiretroviral therapy (i-ART) , abalawuli be-elite banamathuba angaphezu kwephindwe kabini kwinani lezibhedlele, ngokukodwa kwizifo ezingahambelana ne-HIV eziyaziwayo ukuba zingabandakanyekanga nakubantu bonke abane-HIV.
Xa kuthelekiswa nabangewona abaphezulu-abalawuli kwi-ART abanemithwalo engabonakaliyo yentsholongwane, abalawuli abakhulu babenee-77% ezininzi zokubhedlele. Nangona abalawuli abangaqhelekanga abanegciwane elibonakalayo belungcono, bacebisa ukuba i-ART ilawula ukunciphisa ezinye izibilini ezihlala zihlala ixesha elide esaziyo zinokunyusa umngcipheko kunye nophuhliso olukhawulezileyo lweentsholongwane ezingenayo i-HIV , izifo ze-cardiovascular, kunye neengxaki ze-neurological .
Imithombo:
Markowitz, M .; Uvavanyo lwe-HIV Elite Controller (MMA-0951). " IYunivesithi yaseRockefeller; ENew York, NY; NgoFebruwari 9, 2011.
Olson. A; Meyer, L .; Prins, M .; okqhubekayo. "Ukuvavanywa kwe-HIV Elite Controller Iinkcazo ngaphakathi kwe-Seroconverter Cohort Cooperative." PLoS | Eyodwa. NgoJanuwari 28, 2014; INGXELO: 10.1371 / iphephandaba.pone.0086719
Crowell, T; Gebo, K .; Blankson, J; okqhubekayo. "Izibhedlele zeeNdwendwe kunye nezizathu phakathi kwabalawuli be-HIV labantwana kunye nabantu abane-HIV elawulwa ngamayeza." Izifo ezithathelwanayo zonyango. Disemba 15, 2014; i-doi: 10.1093 / infdis / jiu809.