Inzululwazi kunye nabenzi bomgaqo-nkqubo baxhasa ukuqala kweNtsholongwane kaGawulayo
Kudala kube neengxoxo phakathi kwabenzi bomgaqo-nkqubo, abaphandi kunye neekliniki ngokuthe ngqo ukuba ukuqala unyango lwe-HIV ngexesha lokuxilongwa kunokuncedisa isigulane, kokubili ngokubhekiselele kwimpilo engaphezulu kwexesha elide kunye nokuphepha kwe-HIV kunye kunye Izifo ezinxulumene ne-HIV.
Ucwaningo oluphawulekayo olukhutshwe yiNew England Journal of Medicine ngoJulayi 20, 2015 lugxininisa impikiswano ngokugqiba ukuba unyango olukhawulezileyo aluyi kunciphisa kuphela amathuba okugula nokufa ngama-57% kodwa okwenza oko kungakhathaliseki ukuba ngumntu, ubuhlanga, ubulili, umthamo wentsholongwane , indawo yehlabathi, isimo sezoqoqosho okanye isimo somzimba (njengokuba kulinganiswa ngumoya obizwa ngokuba yi-CD4 count).
Ngaphambili kweso sifundo, unyango lwe-antiretroviral (ART) lucetyiswa xa inani le-CD4 lomntu lihla ngaphantsi komda othile (ngokubanzi ngaphantsi kweeseli ezili-500 / mL okanye, kwamanye amazwe, ngaphantsi kwama-cell cells / mL).
Uphando olutsha-olubizwa ngokuba yiCandelo loCwangciso loPhilo lwe-Antiretroviral (START) lwe-trial-lusetyenziswe ukuba ngaba unyango oluphezulu kumaxabiso angama-CD4 lungabangela iziphumo ezingcono zempilo ngaphandle kokwandisa ingozi yesigulane senhliziyo, isifo okanye ezinye izifo ezinxulumene ne-HIV.
QALISA Uyilo lokuFunda kunye neziphumo
Iziphumo zokugqibela ezipheleleyo zetyala le-START, ezinikezelwe kwiNgqungquthela ye-AIDS ye-AIDS e-Vancouver ka-2015 nguDkt. Jens Lundgren weNkqubo ye-HIV yaseCopenhagen, yayilindeleke kakhulu emva kokuba ivakaliswe ngoMeyi ukuba isifundo siya kugqitywa ngaphambi kokubakho ubungqina obunzima ezintle iingenelo.
Uphononongo olwenziwe ngo-2009, lwafumana amadoda angama-4,685 abesetyholongwane abane-HIV kumaziko angama-215 kumazwe angama-35, abo bonke babenamaxabiso e-CD4 angama-cell angaphezulu kwama-500 / mL. Iminyaka yobudala yayineminyaka engama-36, ngelixa i-27% yabathathi-nxaxheba bebhinqa.
Izigulane zaza zahlula ngamaqela amabini: enye apho i-ART yaqaliswa ngokukhawuleza enye enye apho i-ART yachithwa kwaze kwaba yilapho inani le-CD4 lomntu lahla ngaphantsi kweelitha ezingama-350 / mL okanye kwakukho ukuphuhliswa kokugula okunxulumene noGawulayo okanye ukufa.
Ngethuba lokupheliswa kokufunda, iziganeko ezingama-50 ezinxulumene noGawulayo ziye zaphawulwa phakathi kwengalo echaseneyo yolu cwaningo, phantse amaxesha amane kunezi zi gulane zanikwa ii-ART zangaphambili (14). Ngokufanayo, kwakukho iziganeko ezinxulumene neengxaki ezingekho phantsi kweGawulayo (29) ezinokuthi zibonwe kwangoko (ARM).
Isifo sesifo sofuba, i- lymphoma kunye ne- Kaposi sarcoma (KS) ziziganeko ezintathu ezinxulumene ne-AIDS eziboniswe kumathathi-nxaxheba afundayo, kunye nama-62% alezi zibandakanyeka kwiintlanganiso zaseAfrika. Iziganeko ezinzulu ezingahlobene ne-AIDS zibangelwa ngumdlavuza , isifo se-cardiovascular (CVD) kunye nokufa.
Ngeqela, uninzi lweziganeko ezimbi zibonwa kwizigulane ezithe zadala, ezinokubonakala zinengqiqo zinikezelwe ngamazinga aphezulu omhlaza kunye ne-CVD phakathi kwabantu abadala ngokubanzi. Okumangalisa kukuba, ukutshaya akuzange kubonakale ukutshintsha iziphumo, kubonisa ukuba i-ART esheshayo yayingenzuzo eninzi kwabangabhemi kunokuba bangabhemi.
Nangona kunjalo, ukufumana okungaqhelekanga, kwakungenxa yokuba iziganeko ezimbi zazingekho kwizigulane ezinomlinganiselo ophantsi we-CD4, njengoko kulindeleke, kodwa phakathi kwala manani angaphezulu kwama-CD4. Nangona abaphandi bengenakukwazi ukuchaza ngokucacileyo iziphumo, iziphumo zifunyenwe kwizifundo zangaphambilini ezazicebise ukuba i-CD4 zibalo zodwa azikwazi ukubonelela ngokugcwele umfanekiso wesifo somntu.
Kwintetho yakhe, uDkt. Lundgren wabiza uphando kwiindlela ezinje zokuqapha ukukhusela i-immune ukuze kuqondwe kakuhle iindlela zezinye iziganeko ezinxulumene ne-AIDS ezinxulumene ne-AIDS kunye neziganeko ezingekho phantsi kwe-AIDS.
UKUQALA Ucatshangelwa ixesha elichazayo kwi-AIDS Research
ICANDELO le-START laqala ukubaluleka ngo-2011 xa esinye isifundo, i-HPTN 052, sibonisa ukuba ukuthatha i-ART kunciphisa umngcipheko wokudlulisa intsholongwane kumntu osulelwe ngu-HIV kumlingane ongathintekiyo ngesondo-isicwangciso esaziwa ngokuba yiNyango njengoThintelo okanye TASP .
Ngenxa yezi ziphumo zibini, iinkokheli kwiNgqungquthela ye-IAS ye-2015 zanikezela oko kuthiwa yi-Vancouver Consensus statement, ivakalisa ukuba "(bonke) abantu abaphila ne-HIV kufuneka banokufumana unyango lwe-antiretroviral xa bexilongwa."
Ngelixa iinkokeli zavuma imithintelo emininzi ekuphunyezweni-kungekhona ubuncinci kubandakanya ukunyuka kwe-$ 8-10 yezigidigidi zonyaka, ukuxhaswa kweengxowa-mali kumazwe ngamazwe kunye nabaxhasi-baqinisekisa ukuba isicwangciso sinokugqiba "ukuphelisa" ubhubhane njengoko siyazi ngaphambili ngowe-2030.
Ukubeka izimvo malunga neziphumo ze-START, uKate Thomson we- Global Fund wamemezela ukuba ityala libhekiselele "umzuzu ochazwe" kwihlabathi jikelele lokulwa ne-HIV, enye esabona ngaphezu kwezigidi ezi-2 ezitsha kunye nokufa kwabantu abayizigidi ezi-1.2 ngonyaka.
Imithombo:
ICANDELO LOKUQALA IQela lokuFunda. "Ukuqaliswa kweNtsholongwane kaGawulayo kwi-Antiretroviral Infection." I-New England Journal of Medicine. Julayi 20, 2015; INGXELO: 10.1056 / NEJMoa1506816.