I-Hepatitis C isifo esithathelwanayo esichaphazela isibindi, esisasazwa yi-virus ye-hepatitis C (i-HCV) kwaye yenye yezona zinto ezibangela ukulaliswa esibhedlele nokufa phakathi kwabantu abane-HIV.
I-American Association for Study of the Liver Illness (AASLD) ithi iingxaki ze-viral hepatitis-ezibandakanya i-hepatitis A, B , kunye ne-C namhlanje zibangelwa yimbangela yokufa emhlabeni wonke, ngokulahlekelwa ubomi obugqithiseleyo kwi- AIDS , isifo sofuba kunye ne-malaria .
Okwangoku akukho sitofu sokukhusela i-hepatitis C.
I-HIV / HCV Coinfection
Ubuninzi obubiweyo be -HIV / HCV coinfection luyahlukahluka ngokufunda, kodwa uphando lubonisa ukuba izinga lokutheleleka kwe-HCV kubantu abane-HIV liphezulu kangama-30 ekhulwini eMelika naseYurophu. Ehlabathini lonke, umthwalo jikelele weHIV / HCV ujikeleze abantu abayi-4-5, okanye phakathi kwe-10-15 ekhulwini labantu abane-HIV.
Abasebenzisi beziyobisi ze-injection (IDUs) banomngcipheko ophezulu kakhulu we-HIV / HCV coinfection, ngokuxhaphaka ukususela kuma-82 ukuya kuma-93 ekhulwini. Ngokwahlukileyo, ukuhlawuliswa kwemali ngeendlela zokusasaza ngesondo kufikelela kuma-9 ekhulwini.
Nangona abantu abalala ngesini kunye nabesilisa (MSM) bengenayo ingozi yokunyangwa kwe-HCV, umngcipheko unokwanda ukuya kuma-23% kwi-MSM enokuziphatha okubi kakhulu-njengamaqabane amaninzi ezesondo, isini lesini okanye kwabelwana ngezidakamizwa ezithathwe ngokusemthethweni okanye ngokwasemthethweni.
Abantu abaxhamliweyo bafumana i-HCV ephezulu yeentlobo zengcinezelo kunabo bafana nabo, okubangelwa ukuqhubela phambili ngokukhawuleza kwi- fibrosis , i- cirrhosis , kunye ne- hepatocellular carcinoma (uhlobo oluqhelekileyo lwesifo somhlaza).
Ukongeza koko, abantu abaxhamliweyo banomngcipheko ophindwe kabini we-antiretroviral-ehlobene ne-hepatotoxicity (isifo sobungozi) kunabo abane-HIV kuphela.
La manani abonisa isidingo sokwazisa ngokubanzi i-HCV phakathi kwabantu abane-HIV, kunye nokunyanga okunyanga ngakumbi ukucima ukukhulelwa kwe-HCV okanye, ubuncinci, ukunyuka kwesifo.
Ukuqala nini Ukwelashwa
Xa ukuqala i-HCV ingaba ngumcimbi onzima. Ngokuqhelekileyo, unyango lwe-HCV luboniswa kubantu abane-HCV-ehambelanayo nesibindi esingabonakaliyo. ISebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu (i-DHHS) ngoku ikhuthaza ukuba unyango lweHCV luqaliswe kubantu abathintekayo abane-fibrosis ebalulekileyo kwaye basengozini ephezulu yokuphuhliswa kwe-cirrhosis.
Ngenxa yobungakanani obubalulekileyo bemiphumo emibi yeziyobisi-kunye nelokuba unyango aluqinisekisi ngokupheleleyo i-HCV-isigqibo sokunyanga sisekelwe ngokusisigxina ekukulungiseni isigulane, kwakunye nokuhlola izibonakaliso zokuxela impumelelo (umzekelo, i- HCV genotype , i- HCV umthamo wentsholongwane ).
Nangona kunjalo, kubalulekile ukuqaphela ukuba izidakamizwa ze-HCV zisoloko ziphucula ngokukhawuleza ekunciphiseni izithintelo zonyango, kunye neenzuzo zonyango olugqithiseleyo kwimiphumo emihle.
I-DHHS ikhuthaza kwakhona ukusebenzisa i- antiretroviral therapy (ART) kubo bonke abantu abaxhamliweyo kungakhathaliseki ukuba yi- CD4 count , eye yaboniswa ukuba iphucule ukuqhubela phambili kwezifo ezinxulumene ne-HCV. Ngaphezu koko:
- Kubantu abanamaxabiso aphantsi kwe-CD4 (ngaphantsi kweeseli ezingama-200 / mL), unyango lwe-HCV kufuneka lulibazisekile kude kube nexesha eliya kuqhubeka ne-CD4. Ukukhethwa kwamachiza okulwa ne-antiretroviral kuphephe ngokupheleleyo ekusebenzisaneni kweziyobisi, kunye nokutywala kweziyobisi. (Inkxalabo ebalulekileyo kukuba ezinye iziyobisi ezisetyenziswa kwi-HCV unyango zixhaswa ngendlela efana neminye imishanguzo ye-antiretrovirals, ukunciphisa ukuphumelela kwezidakamizwa zombini ngelixa ukwandisa ingozi yecala.)
- Kuye umntu osele ku-ART, kuqwalaselwe ukuba kuhlaziywe unyango ukuze kuncitshiswe imiphumo emihle, kunye neenzuzo zokutshintsha kwakhona ukuxhalabisa ngokubanzi malunga nokuphuhliswa kwe- HIV .
- Kubantu abangaphenduliweyo abane-CD4 zibalo ngaphezu kweeseli ezili-500 / mL, oogqirha banokukhetha ukulibazisa i-ART ade kugqitywe unyango lwe-HCV.
Uqwalaselo lwee-HCV zeMidiya
Umqolo we-HCV unyango sele udibaniswe ne- alpha-phosphate alpha (okanye i-PEG-IFN) kunye ne- ribavirin . I-PEG-IFN inxulumene ne-antitivirals emithathu eyenza iiseli zivelise inani elikhulu leemzyme ezinokukwazi ukubulala intsholongwane kunye neeseli ezithintelayo.
I-Ribavirin, enye i-agent agent, iphazamisa i-RNA metabolism eyimfuneko yokuphindaphinda.
Abantu abatsha abasebenzisa i-anti-virus (DAAs) ngokukodwa bayakwazi ukuphatha iintlobo ezahlukeneyo ze-hepatitis C ngaphandle kokusetyenziswa kwe-PEG-INF kwaye, kwiimeko ezininzi, i-ribavirin. Ngokwenjenjalo, iziphumo ezichaphazelekayo kunye ne-HCV unyango luyancitshiswa kakhulu, njengokuba ubude be-treament.
Phakathi kwezi-DAA ezivunyiweyo ezikhoyo ezisetyenziselwa ukunyanga ukusuleleka kwe-hepatitis C engapheliyo (ngolawulo lwe-FDA imvume):
| Iziyobisi | Kuvunyelwe | I bhaliswe | Ukukhetha | Ubude |
| I-Epclusa (sofosbuvir + velpatasvir) | i-genotypes 1, 2, 3, 4, 5, no-6 kunye nathi ngaphandle kwe-cirrhosis | i-ribavirin kwiimeko ze-cirrhosis ezingenayo kwaye ngaphandle kwe ribavirin kuzo zonke iimeko | iipilisi enye imihla ngemihla okanye ngaphandle kokutya | 12-16 iiveki |
| I-Zepatier (elbasvir + grazoprevir) | i-genotypes 1 ne-4 kunye okanye ngaphandle kwe-cirrhosis | ribavirin okanye ngaphandle kwe ribavirin, kuxhomekeke kwi-genotype kunye nembali yonyango | iipilisi enye imihla ngemihla okanye ngaphandle kokutya | 12-16 iiveki |
| Daklinza (daclatasvir) | i-genotype 3 ngaphandle kwe-cirrhosis | Sovaldi (sofosbuvir) | Iipilisi enye imihla ngemihla ngokutya | Iiveki ezili-12 |
| I-Technivie (ombitasvir + paritaprevir + ritonavir) | i-genotypes 4 ngaphandle kwe-cirrhosis | ribavirin | ezimbini iipilisi imihla ngemihla ngokutya | Iiveki ezili-12 |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, ehlanganiswe ne-dasabuvir) | i-genotype 1 kunye okanye ngaphandle kwe-cirrhosis | ribavirin okanye ithathwe ngokwawo, apho kuboniswe khona | Amacwecwe amabini e-ombitasvir + paritaprevir + ritonavir athathwe kanye ngosuku ngokutya, kunye neepilisi enye yedasabuvir ithathwa kabini imihla ngemihla ngokutya | 12-24 iiveki |
| Harvoni (sofosbuvir + ledipasvir) | i-genotype 1 kunye okanye ngaphandle kwe-cirrhosis | kuthathwa ngokwabo | iipilisi enye imihla ngemihla okanye ngaphandle kokutya | 12-24 iiveki |
| Sovaldi (sofosbuvir) | i-genotypes 1, 2, 3 ne-4 kunye ne-cirrhosis, kuquka abo abane-cirrhosis okanye i- hepatocellular carcinoma (i-HCC) | i-peginterferon + ribavirin, i-ribavirin yodwa, okanye ii-Olysio (simeprevir) kunye okanye ngaphandle kwe ribavirin, apho kuboniswe khona | iipilisi enye imihla ngemihla okanye ngaphandle kokutya | 12-24 iiveki |
| Olysio (simeprevir) | i-genotype 1 kunye okanye ngaphandle kwe-cirrhosis | i-peginterferon + ribavirin, okanye iSovaldi (sofosbuvir), apho kuboniswe khona | i-capsule enye imihla ngemihla ngokutya | 24-48 iiveki |
Iziphumo eziPhakathi
Enye yeengxaki ezibalulekileyo malunga nokunyanga i-HIV / HCV coinfection yimiba echaphazelekayo engasenokwenzeka ngenxa yonyango. Nangona ukuqaliswa kwezidakamizwa ezitsha kwintsholongwane kuye kwaguqula unyango lwe-HCV, ayikho into ejongene nemingeni eyenziwa ngabanye izigulane.
Kubantu abaqala unyango okokuqala, iziphumo eziqhelekileyo zonyango lweHCV (okwenzeka okungenani ama-5% amatyala):
- I-Epclusa: ukukhathala, intloko
- I-Zepatier : ukukhathala, intloko, isinambuzane
- I-Daklinza : ukukhathala, intloko, isicathulo, isifo sohudo
- I-Technivie : Ubuthakathaka obuthathaka, ukukhathala, isisongela, ukulala
- Viekira Pak : ukukhathala, isisonguluko, isikhumba esiqhenqileyo, ukusabela kwesikhumba, ukulala, ukusilela, ubuthathaka, ukukhathala
- IHarvoni : ukukhathala, intloko
- I-Sovaldi + PEG / INF + ribavirin: ukukhathala, ukulala, ukunyamezela, isisu, i-anemia
- I-Sovaldi + ribavirin: ukukhathala, intloko
- I-Olysio + PEG / INF + ribavirin: ukugqithisa, isikhumba esilumkileyo, isisongela, intlungu yesisu, ukuphefumula okufutshane
Nangona ezininzi iziphumo zecala zihamba ngokukhawuleza, zixazulula ngaphakathi kweveki okanye ezimbini zokuqala, ezinye iimpawu zingaphala kwaye zivakaliswe (ngokukodwa kwiipilisi ezisekelwe kwi-PEG / INF). Thetha nodokotela wakho ngokukhawuleza ukuba iimpawu ziphathelele kunye / okanye ziqhubeka.
Ngaphambi kokuqala i-HCV iTradio
Ukuqonda nokukulindela iziphumo eziphambili eziyimpembelelo kubaluleke kakhulu ekuthatheni unyango lwabantu kunye nokufikelela kwiinjongo zonyango ezifanelekileyo. Iipilisi zomthwalo, ishedyuli yokulandelela, kunye neenguqu zokutya (oko kukuthi, ukunyuka kwamafutha okudliwayo kulabo abasondeza i-fat fat) yimiba ethile yimiba efuna ukujongiswa ukuze kuqinisekiswe ukulungelelaniswa kwezigulane.
Nangona ukukhethwa kwezidakamizwa kunokuba kuthathelwe ingqalelo ebalulekileyo kwimpumelelo yonyango, ngokunjalo, nokunamathela kwezidakamizwa . Akunxulumani kuphela kwiziphumo ezingcono kodwa kwiimeko ezininzi kunciphisa iziganeko kunye nobuqhamo bemiphumo emibi. Ukunyanzelisa ngokufanelekileyo, ngokwenene, kubaluleke kakhulu ukuba kunokwenzeka ukungaphumeleli kwonyango njengemicimbi yonyango.
Ukuguquka kwesibindi
I-cirrhosis ngenxa yokusuleleka kwintsholongwane ye-HCV yinkcazo ekhokelayo yokudluliselwa kwesibindi e-US, eYurophu naseJapan, nangona intsholongwane iyaziwa ngokuphindaphinda malunga ne-70 ekhulwini yabamkeli be-transplant kwiminyaka emithathu. Ukongezwa koko, ukusuleleka kwireferensi ngokwayo kungabangela ukuba phakathi kweepesenti ezingama-10 ukuya kwezi-30 zezigulane ezisakhulayo kwi-cirrhosis kwisithuba seminyaka emihlanu.
Kubantu abafuna ukufakelwa kwesibindi, ukuqaliswa kwe-HCV yonyango kathathu kunokunciphisa kakhulu umngcipheko wokulahlekelwa ngamaxabiso ngama-30%.
Nangona kukho ingozi ebambisene nayo, kubalulekile ukuqaphela ukuba izinga lokusinda isigulane lifaniswa nazo zonke ezinye izibonakaliso zokufakelwa kwesibindi-kunye namazinga okusinda emva kokusebenza phakathi kwama-68% kunye no-84% kwiminyaka emihlanu yokuqala.
Iimveliso zintsholongwane zeHCV ezitsha ziyakwazi ukuqhubela phambili ezi ziphumo, ngelixa lijonganisa izinga eliphezulu lezonyango ezichaphazelekayo kunyango.
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