Ukuchonga izizathu kunye nokukhetha iRejim entsha yeDrug
Ukungaphumeleli kwonyango lwe-HIV kwenzeka xa kuqinisekiswe ukuba izidakamizwa zakho zokulwa ne-antiretroviral azikwazi ukufezekisa iinjongo zonyango-oko kukunciphisa intsholongwane ye-HIV okanye ukubuyiswa kwemisebenzi yokuzivikela ekukhuseleni izifo . Ukungaphumeleli kwonyango kunokuhlelwa njenge- virologic (ngokubhekiselele kwintsholongwane), i-immunologic (ngokumalunga ne-immune system), okanye zombini.
Xa ukungaphumeleli kwonyango kubakho, inyathelo lokuqala kukuchonga into okanye izinto ezinokubangela ukungaphumeleli, ezinokubandakanya:
- Ukunamathela kwezidakamizwa
- Ukuchaswa kweziyobisi
- Ukungaphumeleli kokonyango kwangaphambili (s)
- Ukunganyanzelwanga kwemithintelo yokutya
- Isibalo se- CD4 esandulela unyango
- Izifo-nentsholongwane (njenge- hepatitis C okanye isifo sofuba)
- Ukusebenzisana kweziyobisi
- Iingxaki zokuxhatshazwa kweziyobisi okanye imetabolism
- Imiphumo emibi yeziyobisi, ezinokuchaphazela ukuthobela
- Ukudakumba okungekho nto okanye ukusetyenziswa kweziyobisi, ezinokuchaphazela ukuthobela
Ukuhluleka kweVrologic
Ukungaphumeleli kwe-Virologic kuchazwa njengokungakwazi ukufezekisa okanye ukugcina umthamo wegciwane lesandulela ngculaza elingaphantsi kwama-200 ikopi / mL. Oku akuthethi ukuba umntu kufuneka atshintshe unyango ngokukhawuleza ukuba umthamo we-viral wehlise ngaphantsi kwe-200. Usebenza nje ngomlinganiselo apho ugqirha angenza isigwebo esineenkcukacha ngekliniki emva kokunyamezela ngesigulane kunye neendlela zokuguqula.
Ngokufanayo, inkcazo ayifanele icacise ukuba iyamkeleka ukugcina ngaphantsi kokunciphisa i-virus. Nokuba "iindawo ezinokungabonakali" kwintlobo yesifo se-viral (ie, iikopi ezingama-50 -99 / i-mL) kufuneka zixhalabele, ngezifundo zakutshanje zibonisa ukuba umsebenzi oqhubekayo we-viral level kwisithuba seenyanga ezintandathu unokunyusa umngcipheko wokungaphumeleli kwe-virologic kunyaka 400%.
(Ngokwahlukileyo, i-virus "ye-blips" ngokuqhelekileyo ayinakucingela ukuhluleka kwe-virological.)
Ukunyanzeliswa kweziyobisi ezingafanelekanga kunye nokufumana ukungqinisiswa kwamachiza namhlanje kubonwa njengezimbini ezibalulekileyo zokungaphumeleli kwe-virologic, ngokukodwa kwiyeza lokuqala. Ngokomphando, umyinge wesinye sezigulane ezine uya kuba nokungaphumeleli ngenxa yokunyanzeliswa kakubi, ngoxa i-4% kunye ne-6% yezigulane ziza kuphumelela ngenxa yokuchasene neziyobisi.
Ukuba ukunyanzeliswa kakubi kwintliziyo yokungaphumeleli, kubalulekile ukuba ugqirha kunye nesigulane ukufumanisa nayiphi na isizathu esenzayo. Kwiimeko ezininzi, ukululaza unyango (umzekelo, ukunciphisa umthwalo weepilisi, ukulandelana kwexesha) kunokuncedisa ukunciphisa izithintelo zokusebenza zokunamathela. Imiba yoxhatshazo lwezobuhlungu okanye ukusetyenziswa kweziyobisi kufuneka iqwalaselwe, kunye nokuhanjiswa kwenzelwe amaziko enyango okanye abacebisi abancedisayo, ukuba kuyimfuneko.
Nangona ukungaphumeleli kwe-virologic kuqinisekiswa ngendlela yokuhlolwa kokuveliswa kwemfuyo , kubalulekile ukulungisa nayiphi na imicimbi yokumanyanisa phambi kokuqhubela phambili ngeyeza elitsha. Ngaphandle kokuba ulandelelwano lubhekiswe njengento eqhubekayo yokulawulwa kwe-HIV, amathuba okuphinda aphinde aphinda aphezulu.
Ukutshintsha unyango emva kokusilela kweVrologic
Ukungaphumeleli kwe-virologic kuthetha ukuba i-sub-population of virus kwisigulane "sepilati ye-viral" ayixhatshali kumntu omnye okanye kwiinkampani zonyango.
Ukuba kuvumelekile ukuba sikhule, inqindi enganyangekiyo iya kwakha ukuxhatshazwa kokuxhatshazelwa kude kubekho ukuhluleka kwamachiza amaninzi.
Ukuba ukuxhatshazwa kweziyobisi kukhankanywa kwaye umthamo wegciwane lesigulane ungaphezu kwama-500 ikopi / mL, ukuhlolwa kokunyamekelwa kofuzo kunconywa . Ukuvavanywa kwenziwa ngelixa isigulane sisathatha i-regimen engaphumelekanga okanye kwiiveki ezine zokuyeka unyango. Oku, kunye nokuhlaziywa kwimbali yesigulane yonyango, kuya kunceda ukukhokela ukhetho lwonyango oluqhubela phambili.
Xa ukuchaswa kwezidakamizwa kuqinisekiswa, kubalulekile ukutshintsha unyango ngokukhawuleza ukwenzela ukunqanda ukuguqulwa okongezelelekileyo kwezidakamizwa ekuphuhliseni.
Ngokufanelekileyo, i-regimen entsha iya kuba neebini ubuncinane, kodwa ngokukhethekileyo ezintathu, ezitsha iziyobisi. Ukongeza isicatshulwa esisodwa esisetyenziswayo asikhuthazwa njengoko kunokunyusa kuphela ukuphuhliswa koxinzelelo lweziyobisi.
Ukukhethwa kweziyobisi kufuneka kusekelwe ekuhlaziyweni kweengcali ukwenzela ukuvavanya ukuxhatshazwa kwezidakamizwa eziphambili, okanye ukuchonga ukuba ngaba ezinye iziyobisi ziye zaqhubeka zisebenza ngaphandle kokuchasene nokukhetha .
Uphando lubonise ukuba izigulane zivame ukuphendula ngokubhetele kwiindlela zokwelapha ezilandelayo. Oku kungenxa yokuba izigulane ziba ne-CD4 count / umthamo ophantsi we-viral load xa uqala unyango olutsha, okanye ukuba izidakamizwa ezitsha zitsha zilungele ukunyanga izigulane ezinzulu. ukumelana. Uphando luye lwabonisa ukuba izigulane ezingaphumeleli unyango ngenxa yokunyamezela okunyanzelekileyo zivame ukuphucula izinga lokunamathela kwipilisi yesibini.
Nangona kunjalo, kubalulekile ukuba uqaphele ukuba ukunyanzeliswa kwegciwane elingapheliyo akunakwenzeka kuzo zonke izigulane, ingakumbi abo baye bahlala kwiindlela ezininzi zokwelapha ngaphezu kwexesha leminyaka. Kwiimeko ezinjalo, unyango kufuneka luhlale luqhutyelwa ngenjongo yokuqinisekisa ukungcoliswa kweziyobisi ezincinci kunye nokulondolozwa kwe-CD4 count.
Kwizigulane ezinamava ezine-CD4 zibalwa ngaphantsi kwama-cell cell / mL kunye neendlela zokwelapha ezimbalwa, ukongezwa kwelinye i-arhente kunokuncedisa ukunciphisa umngcipheko wokukhula kwesifo esheshayo.
Ukusilela kwe-Immunologic
Inkcazo yokungaphumeleli kwe-immunologic iyancipha ngakumbi, kunye nabanye bachaza oko
- ukungakwazi ukunyusa isibalo se-CD4 yesigulane ngaphezu komda othile (umzekelo, ngaphezu kwama-350 okanye 500 cells / mL) naphezu kokunciphisa i-viral, okanye;
- ukungakwazi ukunyusa i-CD4 yesigulane ngesilinganiso esithile ngaphantsi kwamazinga angaphambi kokunyanga naphezu kokunciphisa i-virus.
Nangona i-data ihlala iguquke kakhulu, ezinye iingcaphephe zicebise ukuba inani lezigulane ezine-CD4 ezingabonakaliyo ngaphandle kokunciphisa i-viral zingaphezulu kwama-30%.
Ubunzima bokujongana nokuhluleka kwe-immunologic yiloo nto idla ngokuqhagamshelana ne-CD4 count yangaphantsi okanye inani le-CD "nedir" elincinane (oko kukuthi, i-CD4 ephezulu, i-CD4 count). Ukubeka nje, ngakumbi isistim somzimba sesigulane sigxiliswe ngaphambi kokuba unyango, kunzima kakhulu ukubuyisela loo mzimba.
Yingakho izikhokelo ze-HIV zangoku ziphakamisa ukuqaliswa kokunyanga kwangoko xa unyango lwe-immune luqhubeka.
Ngakolunye uhlangothi, ukungaphumeleli kwe-immunologic kuyenzeka nangaphandle kwamaxabiso angama-CD4 angaphambili. Oku kungaba ngumphumo weziganeko ezidlulileyo okanye ezisebenzayo, ubudala, nokuba nempembelelo yokuvuvukala okuqhubekayo okubangelwa yi-HIV ngokwayo. Ngamanye amaxesha, akukho sizathu esicacileyo sokuba kutheni le nto.
Ingxaki eyona nto kukuba akukho nziswano ngokwenene malunga nokunyanga kwe-immunologic failure. Abanye baphathi bacetyisa ukutshintsha unyango okanye ukongeza i-antiretroviral engummmeli, nangona kungekho ubungqina bokuba oku kunayo impembelelo yangempela.
Nangona kunjalo, ukuba ukuhluleka kwe-immunologic kubonakala, izigulane kufuneka zihlolwe ngokupheleleyo malunga nokuba zikhona
- nayiphina imishanguzo enokuthi inganciphisa imveliso yamhlophe yegazi (ingakumbi i- CD4 + T cells ), ukufaka endaweni okanye ukuyeka iziyobisi xa kunokwenzeka, okanye;
- naluphi na ulwaphulo-mthetho olungaxelwanga okanye izifo zonyango ezinzulu ezingabangela ukuba kubekho ukuphendula kwisifo esiphantsi kwe-immunologic response.
Kuphandwa uphando oluninzi lwe-immune-based, nangona akukho namnye okwangoku kunconywa ngaphandle kwimeko yesilingo seklinikhi.
> Imithombo:
> Isebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu (DHHS). "Ulawulo lweNyango-Umonde owaziyo: I-Virologic ne-Immunologic Failure." I-Rockville, eMaldin; fi kelele ngoFebruwari 21, 2014.
> Paredes, R .; Lalama, C .; Ribaudo, J .; okqhubekayo. "Iintsholongwane zengcinezelo ze-HIV-1 ezincinci ezikhoyo, ezinamathele, kunye nomngcipheko we-antiretroviral." I- Journal of Infectious Diseases . Matshi 2010; 201 (5): 662-671.
> I-Laprise, iC .; de Pokomandy, A .; Baril, J; okqhubekayo. "Ukungaphumeleli kwe-Virologic emva kwe-viremia ephantsi eqhubekayo kwiqela lezigulane ezine-HIV: iziphumo ezivela kwiminyaka eyi-12 yokujonga." Izifo ezithathelwanayo zonyango. Novemba 2013; 57 (10): 1489-96.
> I-Hammer, S .; Vaida, F .; Bennett, K .; okqhubekayo. "I-anti-single protease inhibitor yonyango emva kokuhluleka kwonyango lwe-antiretroviral: ityala elingahleliyo." Umbhalo we-American Medical Association (JAMA) . Julayi 10, 2002; 288 (2): 169-180.
> Gazzola, L .; Tincati, C; Bellistri, G; okqhubekayo. "Ukungabikho kwe-CD4 + T ye-cell recovery recovery" nangona kufumene unyango olusisigxina kakhulu lwe-antiretroviral therapy: ingozi yekliniki, izikhelo ze-immunological, kunye neendlela zokwelapha. " Izifo ezithathelwanayo zonyango . Fe bruwari 2009; 48 (3): 328-337.