Ngexesha eliphantsi, uphando lubonisa ukuba umngcipheko awukwazi ukupheliswa ngokupheleleyo
Uphando lwezonyango luye lwabonisa ukuba unyango lwe-antiretroviral (ART) lunokunciphisa kakhulu ingozi yokusuleleka kwintsholongwane kaGawulayo ( kwi-serodiscordant) izibini-apho umlingani omnye une-HIV kwaye enye ingenayo i-HIV.
Amanqanaba afaka ukunciphisa ukunyanzeliswa komlingane osuleleke ngentsholongwane kaGawulayo ngokuqinisekisa umthwalo wentsholongwane engabonakaliyo (ngokubhekiselwe phambili njengonyango njengokuthintela, okanye i-TasP ), kunye nokusetyenziswa kwansuku zonke kwepilisi ye-antiretroviral ukwenzela ukunciphisa ukukhutshwa kwe-HIV kumlingane ongakhuselekanga (eyaziwa ngokuba yi- pre-exposure prophylaxis, okanye i-PrEP ).
Kwakhona kuqwalaselwe okubalulekileyo izixhobo zokuthintela ii-ART, ezifana neikhondom kunye nolwaluko lwendoda ngokuzikhethela (ezaziwa ngokunciphisa ingozi ye-HIV kumadoda angenayo igciwane). Nangona uphando lwangaphambili lubonise ukuba inzuzo ye-ART ingaba mkhulu kwiibini ezixutyanisiweyo-kunye ne-TasP ukunciphisa ingozi ye-HIV ngamaphesenti angama-96 kunye ne-PrEP yokunciphisa ingozi ngamaphesenti angama-75-abanye baye babuza ukuba ngaba la manani aya kubamba imeko yehlabathi yangempela.
Iingcambu zesondo kunye neHIV
KwiNgqungquthela ye-2014 kwi-Retroviruses kunye neeNtsholongwane eziKhuselekileyo (CROI) eBoston, abaphandi abanolwazi oluqhubekayo lwe-PARTNER babonisa ukuba, phakathi kweembambano ezingama-767 ezixutyanisiweyo zisebenzisa i-TasP yodwa, akukho ntshosulelo olulodwa lwenzeka nangona ngaphezulu kwe-44,000 izenzo zesondo ezingenasondo. Esi sifundo sasiquka imibini yesibini ebesinikwa ngokwesini kunye nesigxina esinobudlova esichaza umyinge wama-37 ukuya ku-43 izenzo zesondo ezingenasiphelo ngokwesondo.
Nangona kunjalo, nokuba ngabafakeli bamkelwa ngokwabo, amanani alunzima. Ngokusekelwe kwizinto ezininzi eziguqukayo-kubandakanywa iintlobo zesenzo somzimba kunye nokuba kuqhutywe i-ejaculation okanye kungekhona-ixesha lokuzithemba (elisetyenziselwa ukulinganisa ukuqinisekiswa koqikelelo) lwama-96 ekhulwini.
Oku kuguqulela kwingcipheko ye-4 engozini yokusuleleka-kwaye kungekhona iipesenti ezingama-0 abanye abangayifumana. Kulabo ababandakanyeka ngesondo esilwe, umngcipheko oqikelelweyo unyuke kwi-10 ekhulwini. Uphando olulandelayo luye lwabangela ukungathandabuzeki ngokubanzi malunga nendlela ezi zixhobo zokukhusela ezinokunciphisa umngcipheko wosulelo kwixesha elide.
Utshintsho phakathi kwengozi phakathi kwama-Heterosexual and Gay Couples
Kwisifundo esenziwa ngamaziko e- US for Control and Prevention (CDC) , i- CDC) , izazinzulu zihlalutye iinkcukacha ezikhoyo ngokusebenza kwe-TasP, PrEP, kunye neikhondom kumabhinqa angama-sex-sexual and sexuality. Injongo yocwaningo kwakungekho ukuqikelela ingozi yokudluliselwa kwenqobo kwiindawo "zehlabathi ngokwenene", kodwa ukubonisa indlela umngcipheko uqokelela ngayo ngexesha-oko kukuthi, emva kwexesha elilodwa kunye ne-10.
Ngokusekelwe kwinani lezinto eziphazamisayo, amathuba okusuleleka phakathi kwezibini ezixubileyo usebenzisa i-ART kuphela ziqikelelwe ukuba zibini iipesenti zezillo zesini kunye neepesenti ezingama-25 kwizibini zesini. Ezi ziphumo zisekelwe kwinani leencamango zokuvavanya, kuquka:
- Ukunciphisa ama-80 ekhulwini kwengozi ekusebenziseni ikhondom
- Ukunciphisa ama-96 ekhulwini kwengozi xa amaqabane aphethwe yi-HIV e-ART / TasP
- Ukunciphisa ama-73 ekhulwini kwengozi yokusebenzisana nabalingani abangabandakanyekanga kwi-PrEP
- Ukunciphisa ama-44 ekhulwini kwengozi yabalingani abangatshatanga nabangama-gay kwi-PrEP
- Ukunciphisa ama-54 ekhulwini kumngcipheko womlingani wesilisa ongasakhuselekanga olwaso
- Ukunciphisa ama-73 ekhulwini lomngcipheko wesigxina somntu osalulwanga, ongasalathanga (ophezulu ") ngexesha lokulala ngesondo
- Umyinge weesithandathu zokuziphatha ngesondo ngenyanga
Kubalulekile ukuba uqaphele ukuba ukuhluka kweentlawulo phakathi kwezilwanyana zesini kunye neengqungquthela zengqingili kungabandakanywa kuphela kwimeko engakumbi yokusuleleka kwisondo sangasese , kodwa kuphando lwangoku olubonisa amaxabiso aphantsi kwe-PrEP phakathi kwamaqabane angama-gay. Abaphandi bavuma ukuba uphuculo oluphezulu lwe-PrEP kunye / okanye ukuphucula ukulandelelana kwedatha kunokwenza ngcono oku kuqikelelwa.
Ukongezelela, eziliqela zophando zakutshanje zicebise ukuba ukusetyenziswa kwe-PrEP yesikhashana kwi-MSM kunokuba luncedo olufanayo lokukhusela njengendlela yokusetyenziswa kwe-PrEP nsuku zonke. Ukuba iziphumo ezinjalo zingaqinisekiswa, baninzi balindele, impembelelo ye-PrEP ngempumelelo kwimibhangqwana ye-MSM iya kuphuculiswa kakhulu.
Izinto ezinobungozi bemizuzu emfutshane
Abaphenye baqhubeka babonisa ukuba izibini ezisebenzisa kuphela indlela yokuthintela inomngcipheko omkhulu kakhulu wokusuleleka, kokubili kwithuba elifutshane nelide. Phakathi kweziphumo zabo:
- Imibhangqwana yamaGay eyayithembele kuphela kwiikhondom ine-13 engozini yentsholongwane ye-HIV kunyaka omnye kunye ne-76 engama-engama-engama-76 engozi engaphezu kweminyaka eyi-10, ngokusekelwe kwidatha yokusetyenziswa ngokufanelekileyo. Ngokwahlukileyo, abesilisa abathandanayo nabo baboniswa ukuba babe neepesenti ezi-1 kunye ne-11 engozini, ngokulandelana.
- Izibini ezitshatileyo zakwa-Gay ezazithembela kuphela kwi-TasP zazinomngcipheko we-3% kunyaka omnye kwaye ingama-25 engama-25 engama-10 engozini. Ngokuthelekiswa, izibini ezitshatileyo zineengxaki ze-0,2 neepesenti ezi-2, ngokulandelanayo.
- Iibini zengqingili ezazibandakanya i-TasP, i-PrEP, nolwaluko, zisetyenziselwa iikhondom ngokuqhubekayo, kwaye azibandakanyi ngesondo esilumkeleyo kumlingane ongathandanga, ingozi ye-HIV iye yafika kwi-0.1 yeepesenti ngaphezu komnyaka omnye kunye ne-1 yeepesenti ngaphezu kweminyaka eyi-10.
- Ngokufanayo, amaconsi abonwayo kwiibini ezitshatileyo ezidibanisa i-TasP, i-PrEP, ukusoka, kunye nokusetyenziswa kwekhondomu eqhubekayo . Kubantu, umngcipheko kunyaka owodwa bekuyi-0.1 yepesenti kunye neepesenti ezili-10 ngaphezu kweminyaka eyi-10. Umngcipheko phakathi kwabasetyhini kwaze kwaba ngaphantsi kwi-0.05 yeepesenti kunye ne-0.5 ekhulwini, ngokulandelanayo.
Ezi ziphumo zaxhaswa, ngokuyinxalenye, ngohlalutyo luka-2014 yi-Sorbonne Université eParis, ehlalutye idatha ukusuka kwizifundo ezi-6 ezahlukileyo ekusebenziseni i-TasP phakathi kweendawo ezixubileyo zesini esithandanayo. Izibini ezibandakanyiweyo kwisifundo zalala ngesondo phakathi kwamaxesha amathathu kunye nama-12 ngenyanga, kunye ne-80 ekhulwini yokusebenzisa ikhondom.
Abaphandi baphetha ngelithi idatha ekhoyo ayixhasayo isiphakamiso sokuba i-ART inokunciphisa umngcipheko we-HIV. Kunoko, uhlalutyo lwabo lubonisa ukuba, nangona umngcipheko wokusuleleka usuphantsi kakhulu kwiminyaka emibili yokuqala, loo mngcipheko unokwanda ukuya kuma-1 ekhulwini emva kweenyanga ezili-18. Uphononongo aluzange luhlolisise ukusebenza kwexesha elide le-ART kumabhangqwana angama-gay.
> Imithombo:
> Baeten, J .; Donnell, D .; Ndase, P .; okqhubekayo. "I-Antiretroviral Prophylaxis yokukhusela i-HIV kuMadoda kunye nabasetyhini." I-New England Journal of Medicine. Agasti 2, 2012; 367 (5): 399-410.
> Rodger, A: Bruun, T; Cambiano, V. okqhubekayo. "Ingozi yokudlulisela i-HIV ngentsholongwane engenayo ikhondom ukuba i-HIV + iqabane kwi-ART ecinezelayo: UKUFUNDWA KWENKQUBO." INgqungquthela ye-21 kwi-Retroviruses kunye neZifo eziHlangayo (CROI); EBoston, eMassachusetts; Matshi 3-6, 2014; 153LB.
> Lasry, A; Isihlengo, iS .; Wolitski, R .; okqhubekayo. "Intsholongwane kaGawulayo yengozi phakathi kwezibini ezisebenzayo: ukuvavanya iziphumo zokudibanisa amaqhinga okuthintela." AIDS . NgoJuni 14, 2014; 28 (10): 1521-1529.
> Supervie, V .; Viard, J; Costagliola, D .; okqhubekayo. "Umngcipheko wokuxhatshazwa kwe-HIV ngokwesenzo ngasinye sezesondo phantsi kwonyango edibeneyo ye-antiretroviral: uhlolo oluhlelekile kunye ne-Bayesian modeling". Izifo ezithathelwanayo zonyango. Epreli 19, 2014; 223 [uEpub ngaphambi kokuprinta].
> Molina, J; Fonsart, C; Ngendawo, B; okqhubekayo. "Kwi-Dementi ye-PrEP ene-oral TDF-FTC kwi-MSM: Iziphumo ze-ANRS Triperay Trial." Ingqungquthela ye-2015 kwi-Retroviruses kunye neeNtsholongwane eziKhuselekileyo (CROI); Julayi 24, 2015; Seattle, Washington; 23LB