Izikhokelo Zilungiselele uhlolo lwe-CD4 Unokuzikhethela
Ngempumelelo yokwandisa unyango lwe-antiretroviral (i-ART) yanamhlanje, ugxininiso akufanele kubekwe ekusebenziseni izibalo ze-CD4 njengomlinganiselo wempumelelo ye-ART. Ngokwezikhokelo ezikhutshwe yiSebe lezeMpilo neSebe lezeMpilo (DHHS) eMelika ngomhla we-Meyi 1, 2014, imithwalo ye-viral kufuneka yodwa isetyenziswe ukucacisa oku.
Nangona oku kungathi kubonakale kukuguqulwa kwamanye amazwe, kuyavuma iimbakala ezimbini ezibalulekileyo:
- Ukuba isifo sengqondo somntu ogulayo kwisifo se-ART (njengoko sisilinganiswa yi-CD4 count) sinokutshintsha kakhulu nakubhekene noxinzelelo lwe-viral.
- Ukujonga iliso lwe-CD4 akufakanga negalelo ngokubanzi malunga nendlela i-ART iphethwe ngayo kwizigulane zonyango.
Ngaphambi kwexesha elitsha le-antiretrovirals , kwakungavamile ukuba oogqirha abathile batshintshe i-ART esekelwe kuphela ukuba isiguli singakwazi ukufezekisa ukubuyiswa komzimba. Oku kudla ngokubangela ukuyeka ukuyeka ukunyanga kwexesha, kaninzi naphezu kokulawulwa kwe-virologic (njengoko kulinganiswa ngumthamo wentsholongwane) kwaye kaninzi iminyaka ngaphambi kokuba kwenziwe utshintsho olunjalo.
Ekukhutsheni izikhokelo ezihlaziyiweyo, i-DHHS iphetha ngokuthi "impendulo engafanelekanga ye-CD4 kwisigulane esinokunyanzelwa kwe-viral ishicilelo sokuguqula umbuso (antiretroviral)." Kuye kwavuma kwakhona ukuba amandla okubuyisela iimpendulo zomzimba wegulane zihlala ziphazamiseka ngenxa yezinto eziza ngaphaya kokufikeleleka kweziyobisi-kubandakanywa nokubalwa kwe-CD4 ekuqaleni kwonyango, ubudala okanye imbali yezifo ezihambisana ne-HIV.
Kwizigulane ezinolu hlobo lwemiba, ukutshintsha ii-ART ezisekelwe kwi-CD4 count kungenokuba yingozi ngaphezu kokulungileyo, ukwandisa umngcipheko wokuchasana nezidakamizwa ngokutshintsha ii-regimen ngokukhawuleza okanye ngokukhawuleza.
Ukuphindaphinda kwe-CD4 Count Monitoring
Ngokutsho kwe-DHHS, inani le-CD4 yesigulane kufuneka lisetyenziswe enye yeenjongo ezintathu eziphambili:
- Ukukunceda ukufumana ixesha lokuqalisa i-ART kumntu osuleleke ngu-HIV
- Ukuqondisa xa uqala okanye unqanda unyango lweprophylactic ukukhusela kangcono ukuphuhliswa kosulelo oluchaphazelekayo (OIs)
- Ukuvavanya ukuba isifo sengqondo somzimba we-ART sisanele (kuchazwe njengenyuka kwi-CD4 count ngama-50-150 amaseli kunyaka wokuqala wonyango, kunye nokunyuka okufanayo kunyaka de kubekho isimo esifanelekileyo)
Izigulane ezisandul 'ukufumana i-ART, kufuneka uvavanyo lwe-CD4 ngexesha lokungena kwiinkathalo kwaye emva kweenyanga ezi-3-6.
Kwiigulane apho i-ART ibonisiwe, ukuhlolwa kwe-CD4 kufuneka kuphindiwe emva kweenyanga ezintathu emva kokuqaliswa kweyeza kwaye emva kweenyanga ezintathu ukuya kwezi-6-6.
Ekugqibeleni, kwizigulane eziye zahlala kwi-ART ubuncinane ubuncinane iminyaka emibili kwaye zinezinto ezingapheliyo zentsholongwane, kuyacetyiswa ukuba
- Uhlolo lwe-CD4 lwenziwa rhoqo kwiinyanga ezili-12 kubafundi abaneengxelo ze-CD4 phakathi kwama-300 ne-500 cells / mL, kwaye;
- Ukujonga iliso lwe-CD4 kuthatyathwa njengenqununu kulabo abanama-CD4 amanqaku angaphezulu kwama-500 / mL.
Ngapha koko, ukubeka iliso lwe-CD4 kufuneka kuqhutyelwe kwizigulane kunye nesaphulelo se-virologic; isifo esihambisana neHIV; okanye nayiphina imimiselo okanye unyango olunokuthi lunciphise inani le-CD4 yomntu.
Ukubekwa kwelinye i-subsets (i-CD8, i-CD19) ayisaphakanyiswa ukususela ekubeni iimvavanyo zibini zindleko kwaye aziboneli ngexabiso leklinikhi yangempela.
Ukuphindaphinda kweNtsholongwane yokuLawula iVilva
Kwizigulane ezisandul 'ukufumana i-HIV, ukuhlolwa komthamo wentsholongwane kufuneka kuqhutywe ngexesha lokungena kwiinkathalo. Ukuba kuthathwa njengokuba i-ART inokuchazwa, ukuphinda ukuvavanywa kungathatyathwa njengokhetho kwezinye iimeko.
Kwizigulane apho i-ART ibonisiwe, ukuhlolwa komthamo wentsholongwane kufuneka kwenziwe phambi kokuba kuqaliswe unyango (ukubonelela isiseko esiliphi na ukulinganisa impendulo yonyango). Kufuneka kwakhona iphinde iphindwe kabili kwiiveki ezi-4 emva kokuqaliswa kwe-ART kunye neveki ezi-4 ukuya kwezi-8 emva koko umda we-viral ukhutshwe ngokupheleleyo.
Kwizigulane ezithe zafunyanwa ngumthwalo ongenakulinganiswa wentsholongwane, ukuhlolwa kufuneka kuphindwe rhoqo emva kweenyanga ezintathu ukuya kwezi-4. Ukuba ukunyanzelwa kwegciwane kuyagcinwa ubuncinane ubuncinane iminyaka emibili, ukuvavanywa kungadluliselwa kwiinyanga ezintandathu.
Imithombo:
ISebe lezeMpilo leSebe lezeMpilo (DHHS). " Izikhokelo zokusetyenziswa kwee-Antiretroviral Agents kwi-HIV-1-abadala nabachaphazelekayo." EBethesda, eMaryland.