Impilo engcono, Umngcipheko ophantsi wokuThuthoka phakathi kweziNcedo
NgoSeptemba 30, 2015, i-World Health Organisation (i-WHO) ihlaziye izikhokelo zayo zonyango lwe-HIV ukukhuthaza ukuqaliswa kwangaphambili kweyeza-antiretroviral (ART) ngexesha lokuxilongwa.
Kuze kube kutshanje, bekukho ukuxoxwa okuqhubekayo phakathi kwabenzi bomgaqo-nkqubo kunye nabaphandi malunga nokuba i-ART ifanele iqaliswe ngokukhawuleza okanye ilibalekile kude kube lixesha lokuba isigulo somzimba sesiguli siwela ngaphantsi komyinge othile wenani (njengoko kulinganiswa nombolo ye- CD4 yomntu).
Abaxhasayo be-ART abasondeleyo babhekiselele kwiinkcukacha ezibonisa ukuba ukungenelela kwangaphambili kwanciphisa umonakalo omdala we-HIV onokuyichaphazela umzimba womntu-umonakalo onokuthi unyuse umngcipheko wokugula kwexesha elide. Abaqapheli bayalumkisa ukuba kwakungekho ubungqina bokuba ingaqala i-ART ngaphaya komngcipheko okwangoku unconywayo (ii-CD4 izibalo ngaphantsi kweelitha ezili-500 / mL) zinexabiso eliyinyani kwiimpembelelo zesifo okanye ixesha lokuphila kwesigulane.
Utshintsho kwinkqubo ye-WHO iya kuphinda iphindwe kabini inani labantu abafuna i-ART, ukususela kwezigidi ezili-15 ukuya kwi-HIV yezigidi ezingama-37.
UKUQALA UFundo Uguqula iNkqubo ye-HIV yomhlaba wonke
NgoMeyi 27, ngo-2015, izazinzulu kwiSizwe seZiko loMbane kunye neZifo ezithathelwanayo (NIAID) ekugqibeleni zibeka umxube wokuhlala ukuhlala ngokucima iSicwangciso esiCwangcisiweyo seNyango ye-Antiretroviral Treatment (START) ukufunda ngaphezu konyaka ngenxa yokucima ubungqina bokuba unyango malunga nokuxilongwa, kungakhathaliseki ukuba yi-CD4 count, luncedo kakhulu kwizigulane ezine-HIV.
Isifundo, esabhalise abantu abangama-4,685 abane-HIV kunye nabasetyhini abaneminyaka eli-18 ubudala nangaphezulu, kwakusetyenziswe ukugqiba ekupheleni konyaka we-2016 kodwa yaphela ngaphambi kokuba iziphumo zesikhashana zibonisa ukunciphisa ama-53% kunani lezigulo ezibi phakathi kwabo abaye baphathwa ngokukhawuleza kunye nalabo abanesifo se-ART esilibazisekile.
Iziphumo zazingqinelana kuzo zonke izixhobo zokufunda, nokuba ngaba izigulane zivela kumazwe aphezulu, aphantsi okanye aphakathi.
Ekuphenduleni, izazinzulu kunye nabenzi bomgaqo-nkqubo bakhupha isitatimende esisemthethweni ngoJulayi 19, 2015, babonwa njengeVancouver Consensus, efuna ukuba kuqaliswe ukuqaliswa kwe-ART kuzo zonke izigulane. Kwiingxelo zabo, iqela lichaze izizathu zokuthi i-ART ekuxilongweni inikezelwe kwiziphumo ezingcono kwizigulane ezine-HIV.
Ukwelashwa kwangaphambili kuNciphisa Impembelelo yoKhulelwa kwexesha elide
Ngaphambi kwecala le-START, abaphandi abaninzi babeqaphele ngokunyanga i-HIV xa bexilongwa njengamazinga okufa kwabagulane abaqala i-ART ngaphezu kwama-CD4 ama-350 cells / mL babenomdla ofanayo wokuphila njengabantu bonke. Kutheni, bebambene, ngaba sifanele siphephe ingxaki yokungabikho kwempilo engalindelekanga xa kuqalwa kwii-CD4 eziphezulu zokubala aziboneli nzuzo enye ngokubhekiselele kwandiso lobomi?
Ngokwe siseko sobuntu kuphela, oko kunokubonakala kungqinelana kakuhle. Ngokona kugula, nangona kunjalo, iinyani zithetha ngokungafaniyo.
Ngethuba leyiphi na intsholongwane, umzimba uya kuphendulwa ngokukhawuleza phambi kwe-arhente echaphazelekayo njenge-HIV. Ukuba ukushiywa kungakhange kulandelwe, ukuqhubeka, ukuvuvukala okuqhubekayo kunokubangela ukuba umonakalo ongenakulinganiswa kwiiseli kunye nezicubu zomzimba.
Ngenxa yokuba i-HIV iyisifo esingapheliyo, nokuba ukunyuka kwezinga eliphantsi, kungabangela ukuguga kwangaphambili kweeseli ezibizwa ngokuba yi- senescence yangaphambi kwexesha okanye "ukuhlambalaza" -iingxelo zamanani aphakamileyo esifo senhliziyo kunye namanomdla kumntu abane-HIV, Iminyaka engama-15 ngaphambili ngaphambili kunabalingani abangenasifo.
Kwaba bantu abane-genetic resistant-HIV-eyaziwa ngokuthi "abalawuli abakhulu" -futhe lokuvuvukala okungapheliyo kwiziphumo ezihlwempuzekileyo kunye nezinga eliphezulu lokugula xa kuthelekiswa nabantu ngabanye kwi-ART enegciwane elikhuselekileyo ngokupheleleyo .
Ukubeka nje, ngokubeka umntu kwi-ART kwizigaba zokuqala zentsholongwane , ulondoloza loo mntu ingozi engenakuncedo yokuvuvukala ehambelana nesifo esingaphendulwanga.
Ukulahla kuvumela kuphela ukuvuvukala ukuqhubeka, ukungacatshangwanga, nokuba kuphi na phakathi kweminyaka emi-5-10.
Izidakamizwa ezitsha zinikeza ukunyaniseka okuphantsi, ukuphikiswa okuphuculwayo
Uninzi lweengxakini ezinxulumene nokutyalwa kweziyobisi zangexesha elide zisekelwe kumava abonwayo kunye nezidambisi ze- antiretrovirals zangezizukulwana , apho ukusetyenziswa ngokubanzi kubangele kukhokelela kwimpembelelo engalindelekanga kwisigulane.
Ngokomzekelo, izidakamizwa ezifana ne-stavudine, zaboniswa ukuba zenze amazinga aphezulu ezinobungozi beziyobisi kwizigulane, ezivela kwi- lipodystophy (ukulungelelaniswa okungaqhelekanga kwamanqatha omzimba) kwi- neuropathy (umonakalo obangela ubuhlungu kwiiseli zesisindo) kwi-lactic acidosis (eyingozi yokuphila ukwakha i-lactic acid).
Ngokufanayo, ezininzi iintsholongwane ze-antiretrovirals zangaphambili zineempembelelo ezichasayo zeziyobisi. Ukusetyenziswa kwe- nevirapine kwi-monotherapy, umzekelo-ukuhlala kwexesha elifutshane ngo-2002 ukukhusela ukudluliselwa komama ukuya komntwana- kuhlaselwa kwizinga eliphezulu eliphezulu lokumelana nevirapine, ngamanye amaxesha emva kwesilinganiso esisodwa.
Ezi nkxalabo ziye zanciphisa izidakamizwa ezitsha zamanzi, ezingabonakali nje ngeempembelelo zecala elingaphantsi kodwa zincinci kakhulu imithwalo yeepilisi kunye "nokuxolelwa" okukhulu (oko kukuthi ukukwazi ukugcina amanqanaba okusetyenziswa kwezidakamizwa, nangona ukuba amanani angabikho).
Ukongezelela koko, ukwesaba malunga nokuxhatshazwa kwezidakamizwa- ukunyuka komntu omnye ukuya kwesinye-kuninzi kuye kwapheliswa, idatha ekhoyo evela kwi-World Health Organisation ibonisa izinga lokuchasana ne-7% kumazwe aphantsi angenayo. malunga nesiqingatha esibonwayo e-US naseYurophu).
Kwamazwe angeniso ephezulu, ukuxhatshazwa kwezidakamizwa ezithengiswayo ngokuqhelekileyo kuxhamla kwiidakamizwa zangezizukulwana zangaphambilini ezazisetyenziswe kwala maninzi kwiminyaka eyi-10-15 ngaphambili ngaphambili kumazwe amaninzi asakhulayo.
Uphando olufanayo lubonise ukuba ukunyaniseka kwe-HIV kumazwe aphantsi-mali angaphantsi , apho i-infringed of infections yaziwa khona, yinto ephantsi kakhulu, ngenxa enkulu, ukuba abantu abancinci bebekwe unyango xa kuthelekiswa ne-US neYurophu.
Unyango kwi-Diagnosis inokunciphisa ukusasazeka kwe-HIV
Unyango njengoThintelo (i-TasP) luyiqhinga lokukhusela elijolise ekunciphiseni oko kuthiwa "umthamo wentsholongwane yoluntu" ngokubeka iqela labantu kwi-ART. Ngokwenza njalo, amathuba okutshintshwa kwe-HIV ancitshiswa kakhulu njengoko abantu abaninzi banako ukugcina uxinzelelo olupheleleyo lwe-viral activity .
Esi sicwangciso sisekelwe ngokubanzi ngubungqina obuvela eSan Francisco, isixeko esibonile ukuhla kwe-30-33% kwiintsholongwane kaGawulayo ukususela ngo-2006-2008 ngenxa yokuhanjiswa kwe-antiretrovirals. Ngokusekelwe kwezi ziphumo, izikhulu zedolophu zazisa umgaqo-nkqubo we-ART ekuxilongweni ekuqaleni kuka-2010.
Ngokufanayo, uphando luka-2015 oluvela kwiphondo laseHenan laseChina lubonisa ukuba umngcipheko wokudluliselwa kumabini e-serodiscordant (okt, omnye umlingani we-HIV kunye nomntu ongekho-HIV) wasancitshiswa ngama-67% ukususela ngo-2006-2009 malunga nama-80% Abalingane abane-HIV bahlaselwe kwi-ART.
Ekuphunyezweni komgaqo-nkqubo we-ART ekuxilongweni, amaninzi amagosa ezempilo akholelwa ukuba inzuzo efana nayo ingenziwa nakwiindawo eziphakamileyo ezibonakalayo ezifana neMzantsi Afrika, apho iirhafu ezintsha zonyango ziqhubeka zikhula nangona kubhaliswa kwe-ART.
Ingaba iziphathamandla zomhlaba ziyakwazi ukufezekisa ezi njongo zinikezelwa ngemali yemali evela kwiintlanga ze-G8 ezona ziyimpumelelo. Ngabantu abangaphezu kwezigidi ezingama-35 abanentsholongwane kaGawulayo namhlanje-kunye nezigidi ezi-13 kwi-ART-umngeni omkhulu kunokuba ukwandisa unyango kumazwe apho izibonelelo zonyango zihlala ziqiniseke, ngokufanelekileyo.
Imithombo:
Iziko zeSizwe zezeMpilo (NIH). "Ukuqalisa unyango lwe-Antiretroviral Early Uphucula iziphumo zabaNtsholongwane kaGawulayo." EBethesda, eMaryn; kukhutshwa ngoMeyi 27, 2015.
Hasse, B; Ledergerber, B; Egger, M., et al. "Ukuguga kunye no-Non-HIV-nxu lumene ne-HIV-Abantu abane-HIV: I-Swiss Cohort Study (SHCS)." INgqungquthela ye-18 kwi-Retroviruses kunye neZifo eziHlangayo (CROI). EBoston, eMassachusetts; NgoFebruwari 27-Matshi 2, 2011; 792.
Pantazis, N .; Porter, K .; Costagliola, D .; okqhubekayo. "Iikhompyutri zeNkcazo kwiMpawu zeNgcaciso ze-HIV-1 Ukunyanzela nokuThatshulwa: IsiFundo seKomiti yokuHlola." I-Lancet HIV. Disemba 2015; 1 (3): e119-126.
Smith, K .; Westreich, D .; Liu, H .; okqhubekayo. "Unyango lokuthintela ukuhanjiswa kwe-HIV kuma-Serodiscordant Couples eHenan, eChina, ngo-2006 ukuya ku-2012." Izifo ezithathelwanayo zonyango. Matshi 13, 2015; pii: i-civ200. [Epub ngaphambi kokuprinta].
IBhunga leZakhono zoLuntu (HSRC). "Uvavanyo lweNtsholongwane kaGawulayo , iNkcazo kunye noPhulo lwaBantu baseMzantsi Afrika , ngo-2012." EPitoli, eMzantsi Afrika; kukhutshwa ngoDisemba 1, 2012.