Nangona kunjalo, iNgxaki phakathi kwabesetyhini abane-HIV ihlala ingatshintshi
Abantu abanentsholongwane kaGawulayo banomngcipheko ophakamileyo wokuphuhlisa i-cancer echaphazelekayo, inani elithile lingabalwa njengeemeko ezichazwe nguGawulayo. Phakathi kwabo umonakalo wesibeleko somlomo wesibeleko (ICC), isigaba sesifo apho umdlavuza usasazeka ngaphaya komphezulu wesibeleko ukuya kumathambo anzulu e-cervix nakwezinye iinxalenye zomzimba.
Ngelixa i-ICC ingahlakulela kwabasetyhini abane-HIV kunye nabangenayo i-HIV, iziganeko phakathi kwabasetyhini abane-HIV zingaba ziphakamileyo zihlandlo ezisixhenxe.
Kuyabasetyhini abane-HIV, ubungozi be-ICC bubonakala bunyuke ngokuncipha kwi- CD4 count , kunye nokunyuka kwamaxesha angama-6 kwabasetyhini abaneengxelo ze-CD4 ngaphantsi kweeseli ezingama-200 / mL uma kuqhathaniswa nalabo abane-CD4 zibalo ngaphezu kweeseli ze-500 / mL.
Malunga neCercer Cancer
I-papillomavirus yabantu (HPV) ithathwa njengento ebalulekileyo ekuveliseni umdlavuza womlomo wesibeleko, ubalekele phantse onke amacala acweyo. Njengawo onke ama-papillomaviruses, i-HPV imisela izifo kwiiselithile ezithile zesikhumba kunye neembrane ze-mucosal, ezininzi zazo ezingenakubungozi.
Phantse iindidi ezingama-40 ze-HPV eyaziwayo ukuba isatshatyalaliswa ngesondo kwaye ingabangela ukusuleleka kwi-anus kunye nezitho zangasese, ngezihlandlo zibonakala njengeemfazwe. Phakathi kwezi, iintlobo ezili-15 "ezinobungozi obuphezulu" zingakhokelela ekuphuhliseni izilonda ezinqabileyo. Ukuba ishiywe ingaphendulwanga, izilonda ezinqabileyo zingadla ngokuqhubekayo kumhlaza wesibeleko. Ukuqhubela phambili kwezifo kudla ngokukhawuleza, kuthatha iminyaka ngaphambi kokuba iimpawu ezibonakalayo ziphuhliswe. Nangona kunjalo, kulabo abanamasosha omzimba (ii-CD4 ngaphantsi kwama-cell cells / ml), ukuqhubela phambili kunokukhawuleza kakhulu.
Ukufunyanwa kwangaphambili ngendlela yokuhlola i-Pap smear ngokuqhelekileyo kwanciphise ngokuphawulekayo iziganeko zomhlaza wesibeleko kwiminyaka yamuva, ngoxa uphuhliso lwe-vaccine ye-HPV luye lwaholela ekunciphiseni ukunciphisa iintlobo ezinobungozi obuphezulu ezinxulumene nama-75 ekhulwini enomdlavuza wesibeletho.
Ukuqikelelwa kwe-HPV ukuxhaphaka phakathi kwabasetyhini base-US ngamaphesenti angama-26.8 ngelixa ama-3.4 ekhulwini anesifo se-HPV ezinobungozi ezili-16 kunye ne-18, eline-akhawunti engama-65% weengcingo zomhlaza wesibeleko.
Umhlaza wesibeleko kwabasetyhini abane-HIV
Nangona le ntshukumo, umhlaza wesibeleko usabonwa njengomdla wesibini oqhelekileyo phakathi kwabasetyhini emhlabeni wonke, uqikelela malunga nokufa kwama-225,000 ngonyaka. Nangona uninzi lwamatyala lubonakala kwihlabathi eliphuhlisayo (ngenxa yokungahambi kakuhle kwe-Pap ukuhlolwa kunye ne-HPV immunization), umhlaza wesibeleko usabangele ukufa kwabangama-4 000 eMelika ngamnye ngonyaka.
Okungakumbi malunga noko kunjalo ukuba iziganeko zesifo somhlaza wesibeleko phakathi kwabasetyhini abane-HIV abazange batshintshe ukususela ekuqaliseni unyango lwe-antiretroviral (ART) ngasekupheleni kweminyaka yama-1990. Oku kwahluke kakhulu kwi -sarcoma ye-Kaposi kunye ne-non-Hodgkin lymphoma, zombini izimo ezichazwe nguGawulayo eziye zawela ngaphaya kwama-50 ekhulwini ngexesha elifanayo.
Nangona izizathu zezi zinto zingacaciswanga ngokupheleleyo, isifundo esincinci kodwa esifanelekileyo kwiziko le-Fox Chase Cancer eFiladelphia libonisa ukuba abafazi abane-HIV abanakuzuza kwiigciwane ze-HPV eziqhelekileyo ezisetyenziselwa ukukhusela iintlobo ezibini zegciwane (iintsholongwane ezili-16 kunye 18). Phakathi kwabasetyhini abanentsholongwane kaGawulayo, ii-52 kunye no-58 zihlala zibonwa kakhulu, ezo zombini zibhekwa njengengozi enkulu kwaye zingabonakali kwiindlela ezikhoyo zokugonya.
Iimpawu zeCercer Cancer
Kukho impawu ezimbalwa kakhulu kwiimpawu zokuqala zomhlaza wesibeleko .
Enyanisweni, ngexesha lokuphuma kwegazi kunye / okanye ukuxhuma ukuxhamla kwenzeka-ezimbini ezibini zibonakaliswe zibonakaliso-isifo esingaba se siphulile. Ngesinye isihlandlo, kunokubakho ubunzima besisu, kunye nokukhulelwa kwesisu, ubuhlungu be-pelvic, intlungu engaphantsi kwesisu, kunye nentlungu ngexesha lokwabelana ngesondo.
Kwizigaba eziphambili zesifo, ukuphuma kwegazi elikhulu, ukulahleka kwesisindo, ubuhlungu be-pelvic, ukukhathala, ukuphelelwa kwesidlo, kunye nokuphuka kwethambo zibonakaliso eziqhelekileyo ezibonakalayo.
Ukuxilongwa kweCarcer Cancer
Nangona uvavanyo lwePap smear lunconywa ngenjongo yokucoca, iirhafu ezingalunganga zingaba ziphezulu njengama-50%. Ukuqinisekiswa komdlavuza wesibeleko okanye i- dysplasia yomlomo wesibeleko (ukuphuhliswa okungavumelekanga kweeseli kwilitha yomlomo wesibeleko) kufuna i-biopsy yoviwo ngophando lwezilwanyana.
Ukuba i-dysplasia yesibeleko iqinisekiswa, ikwahlula ngokusekelwe kwinqanaba lobunzima . Ukwahlula kwe-Pap smear kuluhlu oluvela kwi- ASCUS ( iiselpical cell cells) ezingenakuqinisekiswa ngokubaluleka) kwi- LSIL (i-lesi-lower grade grade squamous intraepithelial lesion) kwi- HSIL (i-high-grade grade squamous intraepithelial lesion). Amaseli okanye iisisi ezixubileyo zifana nezicwangciso ezincinci, ezilinganayo okanye ezinzima.
Ukuba kukho ukuhlaselwa okuqinisekisiweyo, ikwahlula kwisigaba sesifo esekelwe kuviwo lweklinikhi yesigulane, ukusuka kwiSigaba 0 ukuya kwiSigaba IV njengale ndlela:
- Isigaba se-0: I- carcinoma in situ (i-malignancy ekhoyo engafakwanga)
- Isigaba I: Umhlaza wesibeleko okhulile kwisibeleko, kodwa awusasazeka ngaphaya kwayo
- Isigaba II: Umhlaza wesibeleko oye wasasazeka, kodwa kungekho ngaphaya kweendonga zeeplavis okanye kwisithathu esezantsi kwesini
- Isigaba III: Umhlaza wesibeleko usasazeke ngaphaya kweendonga zeeplanga okanye i-lower inferior ye-vagina, okanye udale i-hydronephrosis (ukuqokelela umchamo ezintsheni ngenxa yokuphazamiseka kwe-ureter) okanye ukungasebenzi kweentliziyo
- Isigaba IV: Umhlaza wesibeleko usasaze ngaphaya kweeplavis ukuya kwiindawo ezikude okanye ezikude, okanye ubandakanye izicubu ze-mucosal zesibindi okanye i-rectum
Unyango lweCarcer Cancer
Unyango lwe-pre-cancer okanye umhlaza wesibeleko unqunywe kwinxalenye enkulu ngokucwangcisa okanye kwisigxina sesifo. Uninzi lwabasetyhini abane-mildy (low-grade-grade) dysplasia baya kuhlaziywa ngokuzenzekelayo kwimeko ngaphandle kwonyango, efuna ukubeka esweni rhoqo.
Kwalabo i-dysplasia iyaqhubeka, unyango luyafuneka. Oku kungathabatha ifom ye- ablation (intshabalalo) yamaseli nge-electrocautery, laser, okanye cryotherapy (ipholiyo yeeseli); okanye ngokutyunjwa (ukususwa) kweeseli ngokusebenzisa ukuchithwa kwe-electrosurgical (eyaziwa ngokuba yinkqubo yokugungqa umbane, okanye i-LEEP ) okanye i- conization (i-conical biopsy of tiscu).
Unyango lomhlaza wesibeleko unokwahluka nangona ugxininiso olukhulu lubekwe kwi-fertility-therapy treatra. Utyando lunokuthatha ifom enye okanye emininzi yezi zinto zilandelayo, ngokusekelwe kwisibandezelo sesi sifo:
- chemotherapy
- unyango lwamayeza
- iinkqubo zokugada, kuquka i-LEEP, i-conization, hysterectomy (ukususwa kwesibeletho), okanye i-trachelectomy (ukususwa komlomo wesibeleko ngexesha lokulondoloza i-uterus kunye nama-ovari).
Ngokuqhelekileyo, i-35% yabasetyhini abanomdlavuza wesibeleko baya kuba nokuphindaphinda emva kokonyango.
Ngokuphathelele ukufa, amazinga okusinda asekelwe kwisigaba sesifo ngexesha lokuxilongwa. Ngokuqhelekileyo, abafazi abaxilongwa kwi-Stage 0 abanama-93 ekhulwini amathuba okuphila, ngoxa abafazi kwiSigaba IV banamazinga angama-16 okusinda.
Ukuthintela umdlavuza wesibeleko
Izenzo zesondo ezikhuselekileyo zendabuko, ukuhlolwa kwe-Pap smear kunye ne-HPV yokugonywa zibhekwa njengeendlela ezintathu eziphambili zokukhusela umdlavuza wesibeleko. Ukongezelela, ukuqaliswa kokuqala kwe-ART kuthathwa njengento ebalulekileyo ekunciphiseni ingozi ye-ICC kubasetyhini abane-HIV.
Ama-US Forces Preventive Services (USPSTF) ngoku ancomelela ukuhlolwa kwePap nganye iminyaka emithathu kubasetyhini abaphakathi kweminyaka engama-21 no-65, okanye enye iminyaka emihlanu kubafazi abaseneminyaka engama-30 ukuya kuma-65 ngokubambisana novavanyo lwe-HPV .
Okwangoku, ukugonywa kwe-HPV okwangoku kunconywa kuyo nayiphi na intombazana okanye intombazana eselula. Ikomidi elicebisa ngeendlela zokugonywa (ACIP) libonisa ukugonywa rhoqo kwintombazana eneminyaka eli-11 ukuya kwe-12 ubudala, kunye nabasetyhini ukuya kuma-26 abangenayo okanye abagqibileyo.
Iigonti ezimbini zivunyiwe ngoku ukusetyenziswa: isitofu sokugonya esinokuthi sinqande iintlobo ze-6, 11, 16 kunye ne-18 (i-Gardasil) kunye neentsholongwane ezikhuselekileyo ezinokukhusela kwiintlobo ze-16 kunye ne-18 (iCervarix). Ngayinye idinga uluhlu lwezihlunu ezintathu ezinikezelwa malunga neenyanga ezintandathu.
Nangona izitofu zingenakukhusela kuzo zonke iindidi ze-HPV, abaphandi kwiziko leCcercer Chase leCcercer baqinisekisa ukuba abafazi abane-HIV kwi-ART abanako ukufumana ingozi ephezulu ye-HPV ye-52 kunye no-58 kuneendlela ezingahambisani nazo. Oku kugcizelela ingxabano yokuba i-ART yokuqala yinto ephambili yokukhusela ii -cancer ezinxulumene ne -HIV kunye non-HIV ezinxulumene ne-HIV kubantu abane-HIV.
Iingcebiso kunye neCandelo lezoPhuhliso
Ngokuphathelele ekuphuhliseni izicwangciso, uphando olutshanje luye lwaphakamisa ukuba izidakamizwa eziqhelekileyo ezichazwe ngama-antiretroviral, i-lopinavir (efunyenwe kwi-dose edibeneyo yezilwanyana zeCalatra), inokukwazi ukukhusela okanye ibuye ishintshe i-dysplasia yesibeletho ephezulu. Iziphumo zakuqala zabonisa izinga eliphezulu lokuphumelela xa zithunyelwa nge-intravaginally ngokuphindwe kabini-iintsuku zemihla kwisithuba seenyanga ezintathu.
Ukuba iziphumo zinokuqinisekiswa, abafazi banokwenza olunye usuku banokunyanga i-cervical pre-cancer ekhaya, ngelixa abo abane-HIV banakho ukukhusela i-HPV njengenxalenye ye-ART yabo eqhelekileyo.
Imithombo:
Abraham, A .; D'Souza, G .; Jing, Y; okqhubekayo. "Umngcipheko womhlaza wesibeleko ochaphazelekayo phakathi kwabasetyhini abane-HIV: intsebenziswano yaseNorth American multicohort." I-Journal ye-Immune Deficiency Syndromes. Epreli 1, 2013; 62 (4): 405-413.
Adler, D. "Impembelelo yeHART kwi-HPV ehlobene nesifo somlomo wesibeleko." Uphando lweHIV lwangoku. Oktobha 8, 2010; 8 (7): 493-7.
AmaDames, iD .; Blackman, E .; Butler, R .; okqhubekayo. "Izifo eziPhakamileyo zengozi zePillomavirus zoLuntu phakathi koLuntu lwe-Immunodeficiency Virus-Positive Women in the Bahamas." PLoS | Nye. NgoJanuwari 23, 2014; 9 (1): e85429. i-doi: 10.1371.
I-US Preventive Services Task Force (USPSTF). "I-US I-Preventive Services Task Force Issues Iintsholongwane zokuHlola iCerical Cancer Inkcazo: Ubungqina bubonisa ukuba ukuhlolwa komhlaza kuyasebenza." Rockville, Maryland; kukhutshwa ngoMatshi 15, 2013.
Amaziko okuLawula nokuKhuselwa kwezifo (CDC). "I-Quadrivalent Human Papillomavirus Vaccine: Iziphakamiso zeBhunga elicebisi malunga neMigudu yokuNgcwaba (ACIP)." Ukuxhatshazwa kunye nokufa kweveki ngeveki (MMWR). Matshi 23, 2007; 56 (RR02) .1-24.