IiNtsholongwane zoLwabiwo-HIV kunye ne-HIV ezidibeneyo kwiNkcazo yokuKhutshwa koMngcipheko
Uhlobo lwe-2 lwesifo sikashukela luvame ukudibana nokusuleleka kwexesha elide le- HIV , oko kubangelwa ukuba kudlulele kwixesha elidlulileyo ukusebenzisa izidakamizwa ezithile ze- antiretroviral (ii-ARVs) -kudala "indala" ye- protease inhibitor -iyeza elinjengeCrixivan (indinavir) kunye namandla onke Norvir (ritonavir) .
Ngelixa singacaciswanga ngokupheleleyo ukuba zininzi i-ARVs, siyazi ukuba umngcipheko wesifo sikashukela ukuba umntu onentsholongwane kaGawulayo isoloko esekelwe kumanani amanqaku athile, okuquka:
- Iminyaka yobudala (ngokubanzi 40 nangaphezulu)
- Imbali yentsapho
- Ukunyanya
- I-Hepatitis B (i-HBV) kunye ne- hepatitis C (HCV)
- Igazi elonyukayo
- Cholesterol ephezulu
- Ukukhulelwa kwangoku
- Ubuhlanga (ama-Asiya, ama-Afrika-amerika, amaSpanishi)
Kwiminyaka yakutshanje, nangona kunjalo, uphando luye lwaphakamisa ukuba izibilini ezingapheliyo ezinxulumene nokusuleleka kwexesha elide kunye neengxaki ezingapheliyo ezisetyenziselwa ukujongana neemeko ezinxulumene ne-HIV zinokunyusa kakhulu ingozi yesifo sikashukela.
Isifo sikashukela ne-HIV-Associated Chronic Inflammation
Nangona xa i-HIV ilele okanye ikhutshwe ngokupheleleyo ngeyeza lokusebenzisa unyango lwe-antiretroviral (ART) , ubukho begciwane lesigxina luphumela kwimpendulo eqhubekayo yokuvuvukala njengoko isistim somzimba sogonywa ngumzimba sisalumkileyo.
Ngethuba lokuvuvukala okungapheliyo kwe-HIV, abathile bamakhwala abavuthayo-abizwa ngokuba yi- C-reactive protein (CRP) kunye ne-interleukin-6 (IL-6) -yaziwa ukwandisa. Uphando olutsha lubonisa ukuba ukunyuka kwala manqaku kukhulisa kakhulu amathuba okuba nesifo sikashukela kubantu abakwi-ART.
Inzululwazi ezineenkcukacha ze-SMART kunye ne-ESPIRIT ziphande iziganeko zesifo sikashukela phakathi kwama-3,695 izigulane ezine-HIV kwi-ART kwiminyaka engama-4.6. Umyinge we-CD4 count phakathi kwabathatha inxaxheba uthathwa njengophakamileyo kwi-523 cell / mL.
Ngokusekelwe kwidatha, izigulane ezine-CRP ephezulu kunye ne-IL-6 zazinokwenzeka ukuba zenze uhlobo lwesifo sikashukela se-type 2, ngokuphindwe kabini kwe-CRP kunye ne-IL-6 ukusuka kwisiseko esiphumelele ekubangeni i-20% ne-33% enkulu yengozi, ngokulandelanayo.
Bonke baxelelwe ukuba, abantu abangama-137 bahlakulele isifo sikashukela ngexesha leetyala ngesantya se-8.18 ngeminyaka-isigidimi.
Nangona i-co-factors zemveli yabonwa ukuba negalelo ekuphuhlisweni kwesifo sikashukela phakathi kwabathathi-nxaxheba-kubandakanywa nesicatshulwa samathambo aphezulu (BMI), ubudala, i-hepatitis coinfection kunye neziyobisi ze-statin-into yokuba ukuchithwa kwezinga eliphantsi kunokuba kuthathwa njengento ebalulekileyo , ukubonelela isikhokelo esichazela ngakumbi abantu abasengozini enkulu yesifo sikashukela se-2 kunye nokuqinisekisa ukungenelela okufanelekileyo phambi kokuqala kwe-ART.
Isifo sikashukela esixhamle kwiStatin drug Use Use?
Enye ye-conundrums yokukhusela isifo sikashukela kubantu abaneNTSHOLONGWANE KAGAWULAYO yimpembelelo yeziyobisi ze-statin ekuphuhliseni izifo. Iziyobisi, ezisetyenziselwa ukuphatha i-lipids ephezulu (ngokukodwa i-LDL ephezulu ye-cholesterol), zibhekwa njengento ebalulekileyo ekukhuseleni izifo zengqondo kwi-popula apho kubakho ukuhlaselwa kweentliziyo eziphantse ziphinda ziphindwe kabini zabantu bonke.
Nangona kunjalo, uphando olutsha ukusuka kwi-HIV Outpatient Study (HOPS) lubonise ukuba ukusetyenziswa kwezidakamizwa ze-statin kubantu abanentsholongwane kaGawulayo kunokunyusa ingozi yesifo sikashukela ngama-10% ngonyaka ngamnye wokusetyenziswa.
Uhlalutyo lweminyaka eyi-10, olulandela izigulane ezine-HIV ezingama-4,962 ukususela ngo-2002 ukuya ku-2011, zijonge kwiziganeko zoluhlobo lwesifo sikashukela phakathi kwabantu abanikezelwa ngamachiza e-statin (590) ngokumalunga nalabo ababengekho (4,372).
Ukulungisa imodeli yobudala, isondo, ubuhlanga, ukusebenzisa i-ARV kunye ne-BMI, abaphandi banako ukugqiba ukuba umngcipheko wesifo sikashukela wanda ngokukhawuleza ixesha elide.
Nangona kunjalo, basenokukhawuleza ukuphawula ukuba ukwanda kwaye kwaxhamla ngqo kunye nobudala kunye ne-BMI ephezulu, kunye nobuhlanga / ubuzwe (kunye namazinga aphezulu angama-50% phakathi kwamnyama kunye nokuphindwe kabini phakathi kwe-Hispanics). Akumangalisi ukuba, iimeko ezimbalwa zichazwe phakathi kwezigulane ezincinci, ngelixa iimpembelelo ze-protease inhibitors zabonakala zingabalulekanga.
Kusuka kwinqanaba leengcebiso, abaphandi be-HOPS bacebise ngokucacileyo ukuba i-statin "ayigwenywanga ukuba ikholini iboniswe" ngenxa yabo "ibonakalise inzuzo yokukhusela isifo senhliziyo."
Ngoko, xa izidakamizwa ze-statin zihlala zibalulekile njengendlela yokunciphisa i-lipids kubantu abane-HIV, akufanele isetyenziswe ngokwahlukileyo. Ukunciphisa ngokwenene umngcipheko kudinga indlela epheleleyo, kuquka ukunciphisa ukutya okunamafutha , ukuzivocavoca rhoqo , ukuyeka ukutshaya , kunye nokuqaliswa kwe-ART ngokukhawuleza ukunyanzelisa ukuqinisekisa ukunyanzelwa kwe-HIV (ukunciphisa kangcono ukuphendula okuvuthayo kwesifo se-HIV esingaphendulwanga).
Imithombo:
Béténé A Dooko, C .; De Wit, S .; Neuhaus, J .; okqhubekayo. "I-Interleukin-6, iProteinin High-sensibility C-Reactive Protein, kunye noPhuhliso lwe-Type 2 yesifo sikashukela phakathi kwezigulane ezineNtsholongwane kaGawulayo ezithatha unyango lwe-Antiretroviral." I-Journal ye-Immune Deficiency Syndromes. Disemba 15, 2014; 67 (5): 538-546.
Lichtenstein K .; IDesbes, R .; Wood, K. et al. Ukusetyenziswa kwe-statin kudibaniswa nesiganeko sesifo sikashukela esifundiswayo kwizigulane kwi-Study Outpatient Study. INgqungquthela ye-20 kwiiRevroviruses kunye neZifo eziKhuselekileyo (CROI). Matshi 3-6, 2013; Atlanta, Georgia; 767.
Freiberg, M .; Tshintsha, C. Kuller, L .; okqhubekayo. "Usulelo lwe-HIV kunye nomngcipheko we-myocardial infarction." Umbhalo we-American Medical Association (JAMA). Aprili 22, 2013; 173 (8): 614-622.