Unokucinga ukuba kuya kuba yinto elula ukuyenza: yenza i-gel ye-topical okanye i-cream engayifaka isicelo ngaphambi kokuba ulale ngesondo ukubulala ngempumelelo i-HIV kumnxeba. Emva koko, ukuba into enjenge-nonoxynol-9 inganciphisa umngcipheko wokukhulelwa ngokubulala isilisa, kunzima kangakanani ukuphuhlisa into ye-HIV, akunene?
Iinyaniso kukuba ukuphuhliswa kwee- microbicidal agents kuye kwachazwa nemingeni kunye neengxaki kuba okokuqala kucetywa ngaphezu kweminyaka engama-25 edlulileyo.
Kwezinye iimeko, ukukwazi ukukhubaza i-HIV kuye kwangena ekugqibeleni ukukhohlakala kwezicubu ze-mucosal zesini okanye umxube-ukulungiselela kunokuthintela ukuhanjiswa kwe-HIV.
Kwezinye iimeko, ii-agent zangeke ziphumelele ekukhuseleni intsholongwane kaGawulayo okanye zibangele imiphumo engathintekiyo kwizonyango.
Okwangoku, akukho-HIV microbicide ekhoyo okanye iphakanyiswe ukuba isetyenziswe. Nangona kunjalo, inani elininzi labaviwa liphandwa ngokubanzi, kubandakanywa i-gel esekelwe kwi-tenofovir, iindandatho zangexesha elide, kunye nama-microbicide angama-rectal.
Kutheni i-Microbicides ithathwa njengebalulekileyo?
I-Microbicides ayibonakali ukufaka iikhondom okanye ukukhusela isondo esilondekileyo , kodwa kunokuba unikeze umqobo wokukhusela ngexesha lokulala- ikakhulukazi kwisini esilumkelekileyo okanye esithandweni sokulala kwesinye isini , apho umngcipheko wokudluliselwa komzimba uphezulu.
Nangona kunjalo, ukusuka kumfanekiso obanzi, i-microbicides ibonwa njengeendlela zokunciphisa ukusasazeka kwe-HIV phakathi kwabantu abasengozini.
Ezi ziquka abafazi abasengozini yokuxhaphazwa ngokwesondo okanye ukusetyenziswa kakubi, okanye ukuba ngubani ozaziyo ukulala ngokwesondo (kungakhathaliseki ukuba unomnqweno wokuzala abantwana, okanye imithintelo yenkcubeko enqanda ukuzimela kwabo namandla).
Kucingelwa ukuba i-microbicide ekugqibeleni iyakwazi ukubonelela ngokusemandleni abasetyhini-engozini iindlela ezisebenzayo zokuzikhusela ngenkqubela kubasebenzisi abakukhuselekileyo abongezelelweyo kufuneka ukuba ikhondom iqhume okanye ichithe ngexesha lokulala.
Ukukhutshwa kwangaphambili kwi-Microbicidal Research
Uninzi lweengcungcipheko zophando lwe-microbicidal lugxininise ekusebenziseni i-detergents okanye i-agents ezikwazi ukuguqula i- pH yangasese ukuze ibulale (okanye ingasebenzi) i-HIV.
Phakathi kwabaviwa bokuqala bekuyi-nonoxynol-9 ekhankanyiwe ngasentla, umntu osebenza ngokusetyenzwa kwezinto eziphilayo ezisetyenziselwa ubabini kunye nesigqabi somzimba. Ngokugqithisileyo, uhlalutyo lweemeta oluqhutywe ngo-2002 lwagqiba ukuba ukusetyenziswa kwe-nonoxynol-9 empeleni kwandisa umngcipheko we-HIV kwabasetyhini ngamashumi ama-50%, kunye neziganeko eziphezulu zezilonda zesisu ezenza umngcipheko.
Amanye amajenti ayenzelwe ukugcina i-acidity ( vaginicel ) ye-vaginal acid (kubandakanywa nokuphandwa kwe- BufferGel ) eboniswe ukunyanzeliswa kakuhle kwabasetyhini, kodwa ekugqibeleni kukhombise ukunciphisa ukuhanjiswa kwe-HIV.
Amacandelo okuPhuhliso
Kukho iindlela ezinokwenzeka zokuphuhliswa kwe-HIV microbicide esebenzayo, enokuthi iphulwe phantsi kwiindidi ezibini eziqhelekileyo.
Iyokuqala ingabalwa njenge -antiretroviral microbicide , ii-agents ezenza njenge-receivors ye-HIV (ukukhusela ukuxhamla kwintsholongwane ekubhekiselele kwiiseli zesini) okanye ukusebenzisa i-macromolecules ebizwa ngokuthi i-dendrimers ebophezela ngokunyanisekileyo kwi-HIV ukukhusela intsholongwane.
Nangona iinjongo zangaphambili zibonakaliswe zingaphumelelanga (i- PRO 2000 , iCarraguard , i-cellulose sulphate), inani elitsha lamagosa ahlaziywa -kuquka i-dendrimer microbicide VivaGel , kunye nokusetyenziswa kwe-dendrimers kunye ne-CCR5 yokungena inhibitor uSelententry (maraviroc) esetyenziswe ngokudibanisa unyango lwe-antiretroviral (ART) .
Okwesibini, kwaye ngokugqithiseleyo, i- antiretroviral microbicides . Uphuhliso lwala ma-agent lusekelwe kuphando ekusebenziseni i- tenofovir kunye nezinye izidakamizwa ze-antiretroviral kwii-gels eziphezulu, izindandatho, ii-lubricants, kunye nezinye iinkqubo zokuhambisa.
Isifundo se-CAPRISA 004 ngo-2010 saba ngowokuqala ukubonisa ukuphumelela kwendlela, esebenzisa ukusetyenziswa kwe-1% yejelesi ye-tenofovir ngaphambi nangemva kwezesondo zobulili kwi-889.
Ngokubanzi, izinga lokusuleleka liye lancitshiswa ngama-39 ekhulwini kwiqela elingenalo indawo, ngelixa abathathi-nxaxheba abanamathelisi aphakamileyo (ngaphezu kwama-80 ekhulwini) banokunciphisa ama-54 ekhulwini.
Ngokwahlukileyo, i-VOICE Trial ibonwe njengento yokubuyisela. Ukulandela kwizithende ze-CAPRISA, i-Trial Voice yafunda ezimbini iindlela ezahlukeneyo zokukhusela i-HIV-ukusetyenziswa kwansuku zonke kwe-antiretroviral (mhlawumbi i- Viread okanye i- Truvada ) okanye ukusetyenziswa kwe-gel ye-tenofovir-kubafundi abangama-5,029. Icaleni lapheliswa xa kungekho nanye yeendlela ezafunyanwa zisebenza.
Uhlalutyo lwangemva kokuhlola lubonise ukuba ukungaphumeleli kwakungekho ngenxa yezokwelapha, kodwa kubangelwa ukungabambelelwanga kwamanyathelo kubandakanyekayo (ikakhulukazi kwabasetyhini abasetyhini). Uphando olongezelelweyo luya kunceda ekuphuculeni ngakumbi izinto zokuziphatha.
Indlela eya phambili
Ukulandela ukubuyiswa kwesilingo se-VOICE, ukunyanzeliswa kanobuqili kwenzelwa ukuhlola iindlela ezizezinye zokuphuhliswa kwee-microbicidal agents. Iziphumo zixutywe kakhulu. Phakathi kwesilingo sesigaba se-II kunye no-III esandula kugqitywa:
- I-FACT 001 Inzame, eyabamba abafazi abangama-2 900 eMzantsi Afrika, yabonelela abathathi-nxaxheba kwi-regimen efanayo njengoko basebenzisa i-CAPRISA 004 (1% i-gel ye-tenofovir ngaphambi nangemva kwesondo). Ngokweziphumo zeseva, akukho nciphiso kwinani le-HIV phakathi kwabasebenzisi.
- I-ASPIRE (MTN-020) ihlolisise ukuphumelela kwendandatho engenanto equkethe i-dapivrine (isichengiselwano esinamandla kakhulu, i-antiretroviral test) xa isetyenziswe kwinyanga enye kuma-3,476 abafazi base-Afrika. Iziphumo ngo-2015 zibonise ukunciphisa iipesenti ezingama-27 kwiingcipheko ze-HIV phakathi kwabasetyhini besetyenziselwa isandi se-dapivirine, ikakhulukazi kwabasetyhini abangaphezu kweminyaka engama-21. Ukukhuselwa kancinane okanye akukho kubonwabhinqa abangaphantsi kweminyaka engama-21, ngokuyinhloko ngenxa yokusetyenziswa okungahambisaniyo kwesixhobo .
- Ngokufanayo, i-RING (IPM 027) Isifundo siphinde siphucule isondlo esincinci kumabhinqa angama-1,650 e-Uganda nakwi-Afrika eNzululwazi. Abathathi-nxaxheba baya kusebenzisa amasongo abo ithuba leminyaka emibini. Iziphumo zazingcono kunokuba zibonwe kwi-ASPIRE, ngokunciphisa i-37%. Kwakhona, iziphumo zingcono phakathi kwabasetyhini abaneminyaka engama-21 nangaphezulu. Akukho zibonelelo ezabonakala kubasetyhini abaneminyaka eyi-18-21.
- Okwangoku, i-MTN 017 iya kuphinda isebenzise i-gel rectal gel ngokusetyenzisweni kwansuku zonke kweTruvada kwiqela labantu abali-186 abalala ngesondo kunye nabesilisa (MSM) kunye nabasetyhini abagqwebileyo . Ucwaningo lwesiGaba II luqhutywe ngaphezu kweeveki ezisibhozo, ngamanqanaba aphezulu ukwamkelwa kunye nokunamathela kwiirimenimitha ezininzi. Izifundo ziza kuba zijolise ekusebenzeni nasekusebenziseni i-gel rectal iindlela zokukhusela ngaphambi nangemva kwesondo.
- Ekugqibeleni, ngo-Matshi 2014, isifundo sezilwanyana esiqhutywe ngamaziko okuLawula nokuVimbela (i-CDC) sibonise ukuba i-gel yenkcazo yokusebenzisa i-antiretroviral Isentress (ratelgravir) inokuthintela ngokufanelekileyo ukuthintelo lwe-HIV kwabasetyhini emva kokungcola ngokwesondo. Akukho gama nangona ingaba isifundo siya kwandiswa ngaphaya kobungqina bokuba ukhona.
Ezinye iinkalo zophando ziphanda uphuhliso lweefilimu ezincinci, ezinokuphelisa ngokukhawuleza iifilimu, kunye neendlela ezahlukeneyo ze-antiretroviral (okanye ii-formulations).
Imithombo:
Abdool Karim, Q .; Abdool Karim, S .; Frohlich, J .; okqhubekayo. "Ukuphumelela kunye noKhuselo lweGelenolivir Gel, i-Antiretroviral Microbicide, ekukhuselweni kweNtsholongwane kaGawulayo kwabesetyhini." Sayensi. NgoSeptemba 3, 2010; 329 (5996): 1168-1174.
I-Microbicide Trials Network (MTN). "Ngokumalunga ne-Microbicides Fact Sheet: I-Microbicide Trials Network." EPittsburgh, ePennsylvania. Iphepha elikhishwe ngoMatshi 25, 2014.
Dobard, C .; Sharma, S; Parikh, U .; okqhubekayo. "Ukukhuselwa kwe-postexposure of Macaques ukusuka kwiVaginal SHIV Infection yi-Topical Integrase Inhibitors." Inzululwazi yokuguqulela isayensi . Matshi 12, 2014. 6 (227): 227ra35.