Ingqwalaselo yeNtsholongwane kaGawulayo
Akungabazeki ukuba iziyobisi ezisetyenziselwa unyango lwe-HIV ziye zahamba ngokugqithiseleyo kwiminyaka elishumi edlulileyo. Oku kuyinyaniso xa kuthelekiswa nama-agental age generation ayenamazinga aphezulu okutyhefu kwaye ayenze ngakumbi ukuphuhliswa kokuqala kweziyobisi. Oko abanye abangaziqondiyo kukuba i-science isifikile kangakanani ukususela ngo-1996, xa unyango lokuqala lwezonyango luye lwaguqula le nkqubo yesifo.
Ngaphambi kowe-1996, ubude bomyinge wobomi obesandul 'umntwana oneminyaka engama-20 ubudala e-US beyiminyaka eyi-17 kuphela. Namhlanje, iindlela zokwelapha ezitsha ziyakwazi ukuhlawulela ubomi obulinganayo nobuninzi kubemi ngelixa ziqhayisa iziphumo ezincinci zeziyobisi kunye nokunikezela iishedyuli ze-dosage njengento elula njengepilisi enye ngosuku.
Nangona kunjalo, naphezu kwezi nkqubela, abangaphantsi kwesigamu samaMerika abafumana unyango banako ukufezekisa iinjongo zonyango, ngenxa yokubambisana ngokungahambiyo okanye ukuphazamiseka kwonyango ngokuzithandela.
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Ngaba izidakamizwa ezinokutshalwa kwezidakamizwa kwi-Frontier elandelayo kwiHIV?
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Iingcebiso ezi-4 zokwenza i-HIV yakho ibe neziyobisi ezininzi
Okungakumbi malunga noko kunjalo kukuba, kwi-1.2 yezigidi zabantu baseMerika abaphila ne-HIV namhlanje, naphi na phakathi kwama-20 ukuya kuma-25 ekhulwini akukafumaneki.
Ekugqibeleni, unyango lwe-HIV lungaphezulu kweepilisi kuphela. Ngokuphathelele ukuqonda indlela osebenza ngayo iziyobisi kunye nokuchonga oko kufuneka uyenze njengomntu ukuphumeza iziphumo ezilungileyo kakhulu, nokuba usanda ku sulelwa okanye uphinde uthatha inxaxheba.
Ziziphi ii-Antiretroviral Drugs?
Intsholongwane kaGawulayo ichazwa njenge- retrovirus , oku kuthetha ukuba iphinda ichaze indlela enye iindiza eziphendulela ngayo. Esikhundleni sokuguqula i-code ye-genetic kwi-DNA ukuya kwi-RNA njengezinto ezininzi eziphilayo, i-HIV iguqula ikhowudi yayo kwi-RNA ukuya kwi-DNA.
Ngokuchonga iindlela ezenziwa yi-HIV, izazinzulu zivelise iziyobisi ezinokukwazi ukuphazamisa izigaba ezithile kwi-virus's cycle cycle. Ezi zi yobisi, esizibhekisela kuzo njengee- antiretrovirals , zisetyenziselwa kwizixhobo zokudibanisa ukukhusela ukuphindaphinda kwentsholongwane kwinqanaba apho kuthathwa ngokungabonakali.
Ngelixa iphumelele kakhulu, izidakamizwa ze-antiretroviral aziqhelisi intsholongwane kodwa zithintela ikhono layo lokuphindaphinda. Ngokwenza njalo, i-immune system ihlala ihleli kwaye ikwazi ukulwa nezifo (ezaziwa ngokuba yizifo ezichaphazelekayo ) ezinokuthi zenzeke ukuba izikhuselo ze-immune ziyancipha.
I-Antiretrovirals isebenza njani?
Ulwaphulo lwe-antiretroviral lusebenza ngokuthintela i-HIV ekuphenduleni kwizigaba eziphambili kumjikelezo wobomi , ichazwa ngokubanzi ngokuthi:
- Isinamathiselo-isigaba apho i-HIV idibanisa kwisitokethi esiphezulu
- I-Fusion-isigaba apho i-HIV ifaka kwi-membrane yeselula kwaye ifake izinto zayo zofuzo kwisitokethi esiphezulu
- Phinda uphendule umbhalo-kwinqanaba apho i-RNA yintsholongwane ibhalwa kwi-DNA
- Ukudibanisa-isigaba apho i-DNA ye-HIV idibaniswa kwi-cell cell (usetyenziso lwe-enzyme ye-integrase), ngokugqithisa ngokufanelekileyo ukusetyenziswa koomatshini
- Ugqithiselo-isigaba xa i-HIV isebenzisa loo mishini ukuba idale izakhiwo zeebhanki ezintsha
- INdibano-isigaba apho intsholongwane yesifo esasifumene ihlangene kwaye ishukunyiselwa kummandla weseli yamkeli
- Uhlahlo lwabiwo kunye nokuvuthwa-isigaba apho intsholongwane ihluma ngokoqobo kwiseli yesistim esebenzisa i-protease enzyme ukudala intsholongwane epheleleyo
Ngokusebenzisa ukudibanisa iziyobisi (ezivimbela amabini amabini okanye amaninzi emjikelezweni wobomi), ukukwazi ukuphendulela i-HIV kugqityiwe ngokuphela, kunye neentsholongwane ezimbalwa eziguquguqukayo ezikwazi ukuphepha kwaye zijikeleze ngokukhululekile kumlambo wegazi.
Iiklasi ze-Antiretroviral Drugs
Kukho iiklasi ezintlanu zezidakamizwa ze-antiretroviral, ngasinye sichazwe yinqanaba lomjikelezo wobomi zivimbela:
- Fusion inhibitors
- Nucleoside reverse transcriptase inhibitors
- I-non-nucleoside reverse transcriptase inhibitors
- Integrase inhibitors
- Protease inhibitors
Kulezi zifundo zintlanu, kukho izidakamizwa ezi- 39 ezichasene ne-antiretroviral ezivunyiweyo yi-US Food and Drug Administration, ezibandakanya ukudibanisa i-dose eyi-12 elinezidakamizwa ezimbini okanye ngaphezulu.
Kutheni iCandelo loPhando lweNyango liSebenza
Intsholongwane kaGawulayo iqulethwe yintsholongwane ye-viral (ebizwa ngokuba yi-"kind type") kunye ne-plethora yeentsholongwane zentsholongwane . Ulwaphulo lokuxuba lusetshenziselwa ukunqanda amaninzi kula mahluko njengoko kunokwenzeka ukuya kwindawo apho umthamo wentsholongwane yomntu uthathwa ngokungabonakali .
Xa zisetyenziselwa ukudibanisa, izidakamizwa ze-antiretroviral zisebenza njengento ethile yeqela elithi "tag tag". Ukuba isicatshulwa A, umzekelo, asikwazi ukunqanda ukuhluka ngokugqitywa kwesigaba kumjikelezo wobomi, ngoko umhlaza B kunye no-C banokugqiba umsebenzi ngokuhlasela isigaba esahlukileyo.
Ukuhlolwa koxinzelelo lwe-Genetic kusetyenziswa oogqirha ukuba bancede bachonge iindidi kunye namazinga okuguquka okukhoyo kwi-viral population. Ngokusekelwe kwiziphumo zokuvavanya, unyango lunokulungiswa ukwenzela ukuba izidakamizwa ezimiselweyo azikwazi ukuchaphazela kuphela ukulawulwa kwintsholongwane epheleleyo kodwa kwanokutshatyalaliswa nayiphi na inguqu enokungatshintshi kwezidakamizwa ezinokuthi zikho ngaphakathi kwintsholongwane yabantu.
Ukuqalisa nini unyango lwe-Antiretroviral
NgoMeyi 2014, iSebe lezeMpilo neSebe lezeMpilo lase-United States lihlaziye izikhokelo zalo zonyango lwe-HIV, likhuthaza ukuphunyezwa kwonyango kubo bonke abantu abadala abaxilongwa abane-HIV, kungakhathaliseki ukuba yi- CD4 count or stage of disease .
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Ukusetyenziswa kweMigqaliselo engaphantsi kwayo ingaba njani uMda weNgqungquthela kwiNtsholongwane kaGawulayo
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I-Daklinza (daclatasvir) I-Hepatitis C Iinkcukacha zeMachiza
Kwixesha elidlulileyo, unyango lwacetyiswa kuphela xa inani le-CD4 lomntu lahla ngaphantsi komda wee-cell cell / 500.
Isigqibo se-DHHS sasixhaswa bubungqina bokuba unyango lokuqala ludibene nenani leziphumo ezilungileyo, oku:
- Ukunciphisa ingozi yezifo ezinxulumene nosuleleko lwe-HIV
- Ukunciphisa umngcipheko wokusasazeka kumama ukuya kumntwana
- Ukunciphisa umngcipheko wokudluliselwa kwe-HIV
Iziphakamiso zokugqibela zixhaswa ngobungqina bokuba unyango lwe-antiretroviral lunganciphisa kakhulu ukunyanzeliswa komntu ophila ne-HIV, icebo elibizwa ngokuba nguTyango njengeCoption (okanye iTPP) . Kuye kwaboniswa ukuba abantu abanikezelwa unyango lokuqala lwe-HIV bangama- 53 ekhulwini amathuba okuba bahlakulele isifo esibi , kokubili i-HIV kunye ne-HIV.
Ngokwahlukileyo, ukunyanzelisa unyango kuze kube ngumlinganiselo we-CD4 womntu wehla ngaphantsi kwe-200 (isigaba sesifo esibizwa ngokuba yi- AIDS ) sinokunciphisa ixesha lomntu lokuphila ngokulinganiselwa kwiminyaka eyi-15.
Ziziphi Izidakamizwa Ndifanele Ndiqale Ngazo?
Nangona iikhokelo zonyango ziza kutshintshwa rhoqo kwaye ziguqule ngokukhutshwa kwamachiza amatsha okanye ulwazi lwesayensi, i-body of science yamanje ikhuthaza ukusetyenziswa kwezizukulwana ezintsha ze- integrase inhibitors kunye ne-nucleoside analogues kwindlela yokuqala yokwelapha.
Injongo yonyango lokuqala lugqirha iziyobisi eziza kunika i-schedule ye-dosing elula, imiphumo embalwa kakhulu, kunye nomngcipheko ophantsi kakhulu wokuphuhliswa kweziyobisi. Namhlanje, amaninzi edibanisa iziyobisi atholakala kwipilisi enye, kunye nokuqulunqwa kwemihla ngemihla, enokwandisa kakhulu amandla omntu wokugcina amanqanaba okunamathela okubalulekileyo kwimpumelelo yonyango.
Oku kubaluleke ngokugqithisileyo njengoko umzimba wangoku uphando uphakamisa ukuba abantu abanonyango kufuneka bahlale banamathele ngaphezu kwe-90 ekhulwini ukwenzela ukufezekisa iinjongo eziphambili zonyango.
Funda kabanzi malunga neengcebiso zonyango ezikhoyo ezikhutshwa yiSebe lezeMpilo neSebe lezeMpilo yase-United States kubantu abadala abaphila ne-HIV.
Yintoni eyenzekayo Ukuba unyango luhluleka?
Ukuba kuthathwe njengoko kuchaziwe, izidakamizwa zakho zokulwa ne-antiretroviral kufuneka zihlale zisebenza ngokugqibeleleyo ezintlanu, ezili-10, okanye iminyaka eyi-15. Oku kuyahluka kumntu kumntu, okwenene, kuxhomekeke kwiintlobo zesifo sengculaza esisifo esithelelekileyo. Kodwa ngokuqhelekileyo uthetha, ubude bokuba unyango lusebenza ngokukhawuleza nomlinganiselo wokumamela umntu uyakwazi ukufezekisa.
Ukungaphumeleli ukugcina i-virus controls kuvumela ukuba intsholongwane iphendule ngokukhululekile, ukunikezela ngokutshintshwa kwezidakamizwa ukukwazi ukukhula kwaye ibe yinto ekhethekileyo . Xa oko kwenzeka, unyango luya kuba luncedo ngaphantsi kwaye luyeke ukuyeka ukusebenza ngokupheleleyo. Oku kwaziwa njengokuhluleka kwonyango .
Kule nqanaba, oogqirha baya kufuneka benze ukuhlolwa okungaxhatshazwanga kwemfuza ukufumanisa ukuba zininzi kangakanani ukunganyangeki kweziyobisi. Kwezinye iimeko, ukuchasana kunokuchaphazela omnye okanye ezimbini iziyobisi; kwabanye, iiklasi ezipheleleyo zingahlawulwa. Unyango luya kufuneka kwakhona luhlaziywe ukuze lunqobe ngakumbi le micimbi ngelixa ukujongana nemithintelo yokubambelela okungenzeka yabangela ukungaphumeleli kwonyango kwindawo yokuqala.
Funda kabanzi ngeengcebiso kunye neendlela zokugcina ukunyanzeliswa ngokuthe ngqo kwi-HIV.
Kutheni i-Antitretrovirals ingakwazi ukuphilisa i-HIV?
Nangona ii-antiretrovirals ziyakwazi ukunqanda ukuphindaphinda kwentsholongwane, ngokukodwa ziyenjenjalo ngentsholongwane ngokujikeleza ngokukhawuleza kumanzi omzimba.
Kwi-viral population, i-subset ye-virus, ebizwa ngokuba yi- provirus , iyakwazi ukungena ngaphakathi kwiiseli kunye nezicubu zomzimba ezibizwa ngokuba ziindawo zokugcina . Esikhundleni sokuphinda sichaze kwaye siphumelele kwiiseli ezinegciwane, i-proral HIV iyahlula ize iphinde iphinde ilandele kunye nesistim somninimzi, engayifumananga nesistim somzimba. Iyakwazi ukuhlala kweli lizwe iminyaka kunye namashumi eminyaka, kuphela ukuvela kwakhona xa unyango lugqitywa okanye lubonakalisa lungasebenzi.
Ngaphambi kokuba izazinzulu zikwazi "ukukhaba" intsholongwane kulezi zixhobo ezifihlakeleyo, ukukwazi kwanoma iyiphi i-agent ukuphelisa ngokupheleleyo i-HIV akunakwenzeka, ukuba akunakwenzeka.
Imithombo:
ISebe lezeMpilo kunye neNkonzo zoLuntu (DHHS). " Izikhokelo zokusetyenziswa kwee-Antiretroviral Agents kwi-HIV-1-abadala abadala nabachaphazelekayo." I-Rockville, Maryland; hlaziywa ngoJulayi 14, 2016.
Hogg, R .; Althoff, K .; Samji, H .; okqhubekayo. "Ukuvala i-Gap: Ukwanda kwexesha lokuphila phakathi kwabantu abano-HIV eMelika naseCanada, 2000-2007." I-7 ye-International AIDS Society (IAS) Inkomfa kwiPathogenesis, Treatment and Prevention. Kuala Lumpur, eMalaysia. NgoJuni 30-Julayi 3, 2013; Abstract TUPE260.
Skarbinski, J .; I-Furlow-Parmley, iC .; kunye ne-Frazie, E. "Iimpawu zokuBaluleka koLuntu lweNtsholongwane kaGawulayo + Abadala abakufumene unyango lwezoNyango, abaye babhalwa nge-ART, kunye noPhulo lweNtsholongwane kaGawulayo, kwi-2009 ukuya ku-2010-US." INgqungquthela ye-19 kwi-Retroviruses kunye neeNtsholongwane eziKhuselekileyo (CROI); Seattle, Washington; Matshi 8, 2013; engumlomo # 138.
Kitahata, M .; Gange, S .; Abraham, A., et al. "Impembelelo yonyango lokuqala lwe-antiretroviral ye-HIV kwindlela yokuphila." I-New England Journal of Medicine. Aprili 30, 2009; 360 (18): 1815-1826.
Sax, P .; Meyers, J .; Mugavero, M., et al. "Ukuxhomekeka kwi-Antiretroviral Treatment and Correlation kunye neNngcipheko yeZibhedlele phakathi kwabasebenzi be-HIV abasemagunyeni ase-United States." I-10 ye-International Congress kwi-Treatment of drugs kuGawulayo. Novemba 8, 2010; Glasgow; Inkcazo yomlomo # 0113.