Ulungiso olungcono lokucwangcisa ulwaphulo lwe-HIV luyicutha
Ngokutsho kweNkqubo yeZizwe eziManyeneyo kwiHIV / AIDS, phantse isiqingatha sazo zonke izibini ezichaphazelekayo kwi-HIV ziyi-serodiscordant, oku kuthetha ukuba iqabane elinye linentsholongwane kaGawulayo ngelixa elinye lingenayo i-HIV. Namhlanje, e-US kuphela, kuqikelelwa ukuba kukho abangaphezu kwama-140,000 ama-serodiscordant couples of sexually-sexual couples, abaninzi babo abaneminyaka yobudala obubele abantwana.
Ngeentuthuko ezinkulu kwi- antiretroviral therapy (i-ART) , kunye namanye amanyathelo okuthintela, izibini ezinamagama angama-serodiscordant zibini zinamathuba amakhulu kakhulu okukhulelwa kunanini ngaphambili-ukuvumela ukukhulelwa ngexesha lokunciphisa umngcipheko wokudlulisela umntwana kunye nomlingane ongakhange ahlolwe.
Ukuqwalasela kwangaphambili
Namhlanje, iyakwamukelwa ngokubanzi ukuba ukusebenzisa kakuhle izidakamizwa zokulwa ne-antiretroviral kunokunciphisa kakhulu umngcipheko wokusuleleka phakathi kwamaqabane angama-HIV angama-serodiscordant:
- Ukuqinisekisa ukuba iqabane elijongene negciwane lesandulela ngculaza linciphise ukungakhuseli ngokugcina umthamo wentsholongwane kumanqanaba angabonakaliyo (isicwangciso esaziwa njengonyango njengokuthintela, okanye i-TasP)
- ukubonelela ngeqabane elingenayo igciwane lesandulela ngculazi kunye nenketho yokukhuselwa okongezelelweyo kunye nokusetyenziswa kweprophylaxis yangaphambili (PrEP)
Kwizibini ezibini zisebenzisa i-TasP ne-PrEP, umngcipheko wokusasazwa kubonakala uhla kakhulu. Uphando oluvela kwi-PARTNERS study ebonisa ukuba kwezibini ezi-1,166 ezibhaliswe kwilingo ukususela ngoSeptemba 2010 ukuya kuMeyi 2014, abalingani abane-11 kuphela abangenayo i-HIV basulelekile.
Nangona kunjalo, ukuhlolwa kofuzo kubonakalisa ukuba bonke abayishumi elinanye baphathwe ngumntu ongaphandle kobudlelwane, oko kuthetha ukuba akukho mntu ulwalamano olusenyongweni.
Nangona kunjalo, kubalulekile ukuba uqaphele ukuba ngeli thuba ukungenelela okunoku kunciphisa kakhulu umngcipheko-ngokufikelela kuma-96 ekhulwini kunye nama-74 ekhulwini, ngokulandelana-awanakususa ngokupheleleyo.
Ezinye iinkalo, kubandakanywa ukunyanzeliswa kwezilwanyana zeHIV kunye nezifo zentsholongwane, kunokubuyisela amaninzi amanqaku afumaneka kwi-TasP okanye i-PrEP ukuba ayilungiswanga kakuhle kwaye iphathwe kakuhle.
Uphando olutshanje luye lwabonisa ukuba umntu onomthamo wentsholongwane ka- plasma engabonakaliyo akanakho ukuba nomthwalo wentsholongwane engabonakaliyo. Ngoko ke, ngelixa uvavanyo lwegazi lunokubonisa ubungcipheko obuncinane bokungakhuseli, kunokubekho umngcipheko oqhubekayo kumgangatho ngamnye. Kubalulekile ke ngoko ukuba ufune ukululekwa kwangaphambili ngumphathi oqeqeshiwe ngaphambi kokuba uqalise nayiphi na inkqubo yesenzo. Iipilisi kuphela azikho isisombululo.
Ukuba umlingani wesifazana unesifo se-HIV
Kubudlelwane apho umfazi ekhuselekileyo kwaye indoda yinto engafanelekanga, inketho ekhuselekileyo iyisistim e-intestinal (eyaziwa ngokuba yi-insemination, okanye i-IUI). Iyakususa isidingo sokulala ngesondo kwaye ivumela ukuzincama ngokusebenzisa isisu somlingani.
Nangona kunjalo, oku kungabi yinto enokusetyenziswa kwabanye, nokuba ngenxa yeendleko okanye ezinye izinto. Ngoko ke, akunangqiqo ukuphonononga umtshato ngesondo esingakhuselekanga esinikezelweyo ukuba amanyathelo akhona ukuze kuncitshiswe umngcipheko wokuhambisa.
Kwiimeko ezinjalo, loo mfazi uza kufakwa kwi-ART efanelekileyo ukuba awunakunyulwa, ngenjongo yokufezekisa umthamo wentsholongwane engapheliyo.
Oku kungenzi nje ukunciphisa amandla okudluliselwa kwabesilisa nabesifazana, kunciphisa umngcipheko wokutheleleka komama kwanomntwana ngokunjalo.
Xa ukukhutshwa kwe-viral suppression efikelekile, ukuxilwa kwexesha lokungaxhatshazwayo olukhuselekileyo usebenzisa iindlela zokufumanisa i-ovulation kunokunciphisa umngcipheko. Iikondom kufuneka zisetyenziswe kuzo zonke izihlandlo. Ukusetyenziswa kwe-PrEP kumlingani wesilisa kunokubonelela ngokukhusela okongezelelweyo, nangona iziphumo zisalinde kwiziphumo zophando lwe-PrEP ekukhulelweni.
Ngaphambi kokuqalisa i-PrEP, iqabane lamadoda kufuneka lihlolwe i-HIV, i-hepatitis B, nezinye izifo ezithathelwana ngesondo, kunye nokuhlaziywa kwe-enzyme zeentso .
Ukubekwa iliso rhoqo kufuneka kwenziwe ukwenzela ukuphepha ukuthintela unyango, kubandakanywa ukungasebenzi komzimba kunye nezinye izinto ezinobungozi. Ukongezelela, zombini iqabane lamadoda kunye neyendoda kufuneka ihlolwe izifo zentsholongwane. Ukuba isifo sifumaneka, kufuneka siphathwe kwaye sisombulule ngaphambi kokuba kwenziwe nantoni na.
Emva kokukhulelwa kuye kwaqinisekiswa, i-ART iya kugcinwa kumlingani wesetyhini, kunye nezikhokelo zangoku zikhuthaza ukunyanga okusisigxina, ixesha elide kungakhathaliseki ukuba yi- CD4 count . Zonke ezinye izibonelelo zokuthintela ukuthunyelwa komama ukuya komntwana ziya kuphunyezwa, kubandakanywa nokukhethwa kwinqanaba elicwangcisiweyo kunye nokulawulwa kweyeza zonyango eziza kuzalwa.
Ukuba uMlingani wesilisa unesifo sengculaza
Kwimeko enobudlelwane apho indoda ikhangelekile kwaye loo nto ibhinqa, ukuhlanjwa kwesidoda kunye kunye ne-IUI okanye i-vitro fertilization (IVF) inokubonelela ngendlela ekhuselekileyo yokukhulelwa. Ukuhlanjululwa kwesidoda kufezwa ngokuhlula umdombo kwisifo somzimba esasifikelwe ngumhlaza, okwangaphambili oko kufakwa kwi-uterus emva kokugqiba ixesha lokuvuthwa.
Ukuba akukho i-IUI okanye i-IVF ayikhethayo-nge-IUI ibiza i-$ 895 eyi-dollar kwaye i-IVF ibiza i-$ 12,000, ngokwemyinge-ke kufuneka kuqwalaselwe ukuba kuhlolwe iindlela ezikhuselekileyo, "zokuzalwa".
Kunconywa kakhulu ukuba uhlalutyo lwembewu lwenziwe ekuqaleni. Izifundo ezininzi zicebise ukuba i-HIV (kwaye mhlawumbi unyango lwe-antiretroviral) linokuthi lidibaniswe nokuxhaphaka kwe-sperm okungabonakaliyo, kubandakanywa isibalo esiphantsi se-sperm kunye ne-motility ephantsi. Ukuba ukungaqhelekanga okunjalo kungashiywanga, unobhinqa unokubekwa engozini engadingekile okanye kungekho nhlobo ithuba lokukhulelwa.
Xa ukuqinisekiswa kokusebenza komzimba kuqinisekiswa, okokuqala kunye nenkxalabo eyokuqala kukubeka iqabane lamadoda kwi-ART ngenjongo yokufezekisa umthamo wentsholongwane engapheliyo. Umlingani wesetyhini unokuphanda ukusetyenziswa kwe-PrEP ukunciphisa umngcipheko, kunye neengcomo ezifanayo zokuhlolwa kwangaphambili kwonyango kunye nokulandelelana.
Ubundlobongela obukhuselekanga kufuneka buchaneke ngokuchanekileyo kwi-ovulation, usebenzisa iindlela eziqhelekileyo zokufumanisa kunye / okanye i-ovulation kick predictor njenge- Clearblue Easy okanye i- First Response test urine. Iikondom kufuneka zisetyenziswe kuzo zonke izihlandlo.
Emva kokukhulelwa kuye kwaqinisekiswa, iqabane lomfazi kufuneka lihlolwe i-HIV njengenxalenye yepaneli yexesha eliqhelekileyo leemvavanyo zangasese. Kwakhona kufuneka acebise malunga nokusetyenziswa kwekhondom kunye neempawu zesifo se -retrovirus syndrome (ARS) ukukunceda ngakumbi ukuchonga intsholongwane kaGawulayo.
Kuphinda kunconywe ukuba uvavanyo lwesibini lwe-HIV luqhutywe ngekota yesithathu yokukhulelwa, mhlawumbi phambi kweveki ezingama-36, okanye ukuvavanywa kwe-HIV ngokukhawuleza kunikwe ngexesha lokunikezelwa kwabo bangakhange bavavanywe ngexesha lesithathu. Kwimeko apho ukutheleleka kwe-HIV kuye kwenzeka, kufuneka kwenziwe amanyathelo afanelekileyo okunciphisa umngcipheko wokudluliselwa komzimba kwangaphambili, kuquka ukuqaliswa kwe-antiretroviral prophylaxis eyiyo kunye nokuqwalaselwa kwecandelo elikhethiweyo le-carean.
> Imithombo:
> Uhlelo lweZizwe eziManyeneyo kwi-HIV / AIDS (UNAIDS). "I-UNAIDS yoNyaka kaGawulayo weNgxelo ka-2011." Geneva, eSwitzerland; I-ISBN: 978-92-9173-904-2.
> Ilampe, M .; Smith, D .; Anderson, G; okqhubekayo. "Ukufumana ukukhulelwa okukhuselekileyo kwizibini ezithintekayo nge-HIV: inxaxheba engumlomo wepreexposure prophylaxis (PrEP) eUnited States." I-American Journal ye-Obstetrics ne-Gynecology . 2011; 204 (6); 488.e1-488.e8.
> Baeten, J .; Donnell, D .; Ndase, P .; okqhubekayo. "I-Antiretroviral Prophylaxis yokuLungisa i-HIV kuMadoda kunye nabasetyhini," i- New England Journal of Medicine. Agasti 2, 2012; 367 (5): 399-410.
> Isebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu (DHHS). "Iziphakamiso zokusetyenziswa kwezidakamizwa ze-Antiretroviral Izidakamizwa kwi-HIV-1-abafazi abachaphazelekayo kwiMpilo kaMama kunye neNguqulelo ekunciphiseni ukuhanjiswa kwe-HIV kwi-United States." NgoJanuwari 16, 2014.
> Rodger, A .; Cambiano, V. Bruun, T .; okqhubekayo. "Ukusebenza ngokwesondo ngaphandle kweeNkcaso kunye nobungozi bokudluliselwa kwe-HIV kwizitshatsheli ezinobomi xa umlingani onentsholongwane kaGawulayo usebenzisa i-Antiretroviral Treatment. Umbhalo we-American Medical Association. NgoJulayi 12, 2016; 31 (2): 171-181.