Izifundo e-Afrika naseYurophu zenza izigqibo ezahlukeneyo
NgoDisemba 2014, izifundo ezimbini zokuphanda ukuxhatshazwa kwe- HIV kumzantsi we-Afrika kunye ne-Yurophu, ngokulandelana, zenze izigqibo ezihlukileyo ezimbini.
Eyokuqala, eqhutyelwa eBotswana kunye naseMzantsi Afrika, icebisa ukuba intsholongwane 'ilungelelaniswe kwiintlobo ezithile zeengqungquthela ezingamelana ne-HIV ezibizwa ngokuba yi- leukocyte antigen B (i-HLA-B) -nokuthi iyanciphisa intsholongwane yeli gciwane ", ngoko ke ukunyuka kwesifo.
Owesibini, owalandela isigidimi sezilwanyana zaseYurophu kwiminyaka emininzi, wayejonge ngokuthe ngqo umyinge we- viral load kunye ne- CD4 count emva nje kwesigaba esichukumisayo sokusuleleka kwaye saphetha ukuba, ngokubhekiselele kwintlupheko yesifo kuphela, i-HIV iye yagqithisa kakhulu ngokukhawuleza. ukuqhubeka kwesifo.
Kungenzeka njani ukuba ezi zifundo ziphelile ngeenguqulelo ezahlukeneyo kangaka? Ingaba yimeko nje yoyilo olucatshulwayo, okanye ngaba kunokwenzeka ukuba ukuhlukahluka kwegciwane ukusuka kwilizwekazi ukuya kwilizwekazi- okanye kwimihlaba ukuya kwilizwe-kuye kwabangela ukuba iinqununu zenzululwazi zichazwe ngokupheleleyo?
Ukulinganisa ukunyuka kwe-HIV eBotswana naseMzantsi Afrika
Kwisifundo sokuqala, izazinzulu kwiYunivesithi yaseOxford, ekhokelwa ngumphandi okhokelayo uRebecca Payne, yabuza ukuba ubukho bezakhi ezithile ze-HLA-B-ezinxulumene kakhulu nokukhula kwesifo esicothayo kunye nokulawula okungcono kwintsholongwane-kunokubangela ukuba utshintsho lwe-HIV lunokuthi lube buthathaka "ugulo lwentsholongwane."
Uphando lwangaphambili lwabonisa ukuba abantu abathile babe nepesenteji ephezulu yabantu abanalo ukuguqulwa kwe-HIV, abangama-75% eJapan ukuya kuma-20% eMzantsi Afrika. Xa bejonge ukungafani, abaphandi baqala ukubuza ukuba ngaba oku kunokuba negalelo, kwinqanaba elithile, kumbambano omkhulu phakathi kwamazwe aphantsi kohlobo olufana neJapan kunye nemimandla echaphazelekayo efana ne-Afrika engezantsi kwe-Sahara.
Ukusukela ekubeni ama-HIV amanqanaba asezantsi aseJapan, abaphandi bajolise uphando lwabo kwiqela lezigulane eBotswana, ilizwe apho isifo sengculaza sifinyelele kwinani lalo ngo-2000, kwaye lilifanisa neqela elifanayo eMzantsi Afrika, elifikelela kuphela ukuphakama kwayo ngo-2010.
Uphando lokuqala luye lwabonisa ukuba umthamo we-viral load phakathi kwezigulane ezingaphenduliyo eBotswana, apho isifo "siphelile," sasingaphantsi kweloMzantsi Afrika, apho eso sifo sishumi "esincinane" (iikopi ezingama-15,350 / mL ngokumalunga neikopi ezingama-29,350 / mL, ngokulandelanayo). Ngaphezu koko, nangona kukho i-CD4 count 50 cells / mL ngaphantsi kwelaseMzantsi Afrika, amaBotswanans abane-HIV bahlala ixesha elide, bacebisa nge-subtype encinci.
Ngalobu bungqina besandla, abaphandi bajonge i-genetic yesigulane se-HIV kwaye bafumanisa ukuba inani eliphakamileyo lamaBotswanans lalingu-HLA-B "ukuphunyuka" ukutshintshwa (oku kuthetha ukuba intsholongwane yayifakwe kwi-molecule ye-HLA ukubaleka ukufumanisa). Ngokwenza njalo, izazinzulu zikholelwa ukuba "ukuqina" kwintsholongwane kunokuthi buthathaka, kuphungula amandla ayo okuphindaphinda kunye nokonakalisa kwayo amandla okulwa nomzimba wesigulane.
Konke okuxelelwe, i-46% yeqela laseBotswanan lalinentsingiselo ebalulekileyo ye-HLA-B efaniswa nama-38% kuphela aseMzantsi Afrika.
Iingxowa zokuhlola ityhubhu zazibonakala zixhasa inkxaso, i-HIV isuka kwisampula yaseBotswanan icacisa i-11% ephantsi kuneyoMzantsi Afrika.
Ngokusekelwe kwiinkcukacha zeenkcukacha ezivela kwiikliniki zangaphambi kokubeletha, i-Payne kunye neqela lakhe liye laphakamisa ukuba ukunyanzeliswa kwe-HIV kungase kuqalile ukuxhamla eMzantsi Afrika, ngokunjalo, nomthwalo we-viral load phakathi kwabasetyhini abangaphathiswayo behla ukusuka kwi-13,550 ngo-2002 ukuya ku-5 750 ngo-2012- 2013.
Ukulinganisa ukunyuka kwe-HIV kwi-CASCADE yeqela laseYurophu
Uphando lwaseYurophu lwaluthatha indlela elula kakhulu, ehlabathini, apho idatha yesigulane kwixesha elide, i-pan-European CASCADE iqela lahlaziywa ukususela ngo-1979 ukuya ku-2002.
Kuphando lwabo, abaphandi beCASCADE bajolise kwizinto ezimbini ezibalulekileyo:
- i-CD4 count count emva kokuba i- seroconversion (leyo ichaza indlela ukusuleleka ngayo intsholongwane kaGawulayo kuye kwancipha amandla omzimba omzimba), kwaye;
- umgangatho wentsholongwane "isethi yokumisela" (apho umthamo wentsholongwane uhlala emva kwesigaba esichukumisayo sesifo, kunye nemithwalo ephezulu yentsholongwane ehambelana nokukhula ngokukhawuleza kwezifo).
Kuhlalutyo lwabo lokubuyela emuva, abaphandi bafumanisa ukuba inani le-CD4 eliqhelekileyo lawa ukusuka kuma-770 cells / mL ngo-1979 ukuya ku-570 iiseli / mL ngo-2002, ngelixa i-virtual set set point ephindwe kathathu ukusuka ku-11 200 ngo-1979 ukuya kwi-31,000 ngo-2002.
Emininzi ngokuphathelele isantya esibonakalayo isifo eso, unyaka ngonyaka, kubantu abane-HIV. Ngokutsho kophando, ixesha eliqhelekileyo lithatha isiguli se-CD4 isiguli ukuhla ngaphantsi kwe-350-isigaba apho unyango lwe-antiretroviral lucetyiswa-ludlulileyo ukususela kwiminyaka esixhenxe ngo-1979 ukuya kwiminyaka engama-3.4 ngo-2002.
Ulwahlulo olubalulekileyo kuPhando
Zombili izicatshulwa zophando ekugqibeleni zinemiqathango yazo, kunye nokucwangciswa koyilo oluya kubangela ukuba kubekho ingxoxo phakathi koososayensi kunye nabaqulunqi ngokufanayo. Phakathi kwezinto eziphambili:
- Nangona uphando lweAfrika luqwalasela ulwazi lweenkcukacha ezivela kwizigulane ezingaphezulu kwe-2,000 eBotswana naseMzantsi Afrika, inani langempela lezigulane ezibandakanyiweyo kwisampula yesakhono esicacisiwe asiyinto encinci (16 ukusuka eMzantsi Afrika kunye no-63 ukusuka eBotswana) kodwa ithathwa kwinqanaba elinye ngexesha . Ngokwahlukileyo, izigulane ezingaba ngu-16,000 zafakwa kwiqela leCASCADE, bonke abo baphenywe ngamaxesha amaninzi.
- Ngoxa i-Payne kunye neqela lakhe lijolise kwiimpembelelo zokuguquka kwe-HLA kwisigulane segciwane lesigulane, abazange bakhombise ukuba ukuguquka kwezi zinguqu kukho konke ukuchaphazeleka kwe-CD4. Ngokwahlukileyo, abaphandi beCASCADE babecinga ukuba i-CD4 / umthamo wentsholongwane eguqukayo phakathi kokuseka i-HIV. Baye banciphisa ukufakwa kuphela kwezi gulane ezithe zafunyaniswa kwisithuba seenyanga ezintathu zentsholongwane, zibonelela ngokucacileyo ukuqala kwendlela yokujonga ukunyuswa kwesifo / ukukhutshwa kwe-CD4.
- Kubalulekile ukuba uqaphele, nangona kunjalo, ukuba iqela leCASCADE liqhuba kuphela uhlalutyo lomntu ongcono, omama-gay (ukuqinisekisa ngokucacileyo ukuqhelekileyo kwimbali yonyango kunye ne-subset virus). Nangona uhlalutyo lucetyiswa ukuba ukunyuka kwezilwanyana kunganqandeka eYurophu ngokupheleleyo-kunye nomthamo wentsholongwane yomphakathi wehla ukusuka kwi-31,000 ngo-2002 ukuya kuma-25 500 ngo-2008-okufanayo akunakuthiwa ngamadoda angama-gay. Ekubeni kuyaziwa ukuba ukusasazeka ngokukhawuleza kwe-HIV kumntu wesilisa ongama-gay (kunye namanqanaba aphakamileyo okwenyuka kwonyango) kuye kwabangela ukuhlukahluka kofuzo kunye nokuxhatshazwa kwegazi , kunokwenzeka ukuba i-subset ye-virtual echaphazela eli qela ingaba ngaphezulu ezintle.
- Ngokwahlukileyo, isifundo se-Afrika sasiqhutyelwa kumazwe apho ukulala ngesondo ngokobulili kwakungeyona kuphela indlela yokudluliselwa kwezinto eziphambili kodwa apho, kude kube kutshanje, abantu abancinci bafumaneke kwi- anti-HIV . Ngenxa yoko, ukuhlukahluka kofuzo lwe-HIV ngaphakathi kwe-Afrika yaseMzantsi Afrika kuthathwa njengento encinci, kunye nophando oluthetha ukuba ukuhlukahluka kwendawo yesifo kwintsholongwane kunokuvumela ukungafani kancinci kwi-HIV.
Ngamafutshane, nangona iingaphumeleli kwizifundo zaseAfrika kunye nokunciphisa uphando lweCASCADE, zombini izigqibo zichanekile kakuhle. Uphando olongezelelweyo kulindeleke kuzo zombini amaqela.
Imithombo:
Payne, R .; Muenchhoff, M .; Mann, J .; okqhubekayo. "Impembelelo ye-HIV eqhutyelwa yi-HLA eqhutyelwa yi-HIV kwi-virulence kubantu abanentsholongwane ephezulu ye-HIV." PNAS. Disemba 16, 2014; 111 (50): E5393-5400.
Pantazis, N .; Porter, K .; Costagliola, D .; okqhubekayo. "Iimpawu zengqesho kwiimpawu zokuxhaswa kwe-HIV-1 kunye nokudluliswa komzimba: isifundo seqela lokuqwalasela." I-L anety HIV. Disemba 2014; 1 (3): e119-126.