Ukuba intsholongwane kaGawulayo iye yaqinisekiswa, iimvavanyo ziqhutyelwa rhoqo ukuze zichongile isimo sesistim somzimba somntu kunye nenqanaba lomsebenzi wentsholongwane emzimbeni. Ezi zichazwe kwizinto ezibizwa ngokuba yi- CD4 count kunye nomthamo wentsholongwane .
Yintoni eyi-CD4 Count?
Uvavanyo lwe-CD4 ngenye yezilingo zokuvavanya eziqhelekileyo ezaziwa ngabantu abane-HIV. Uvavanyo lulinganisa izinga lama- T-cell ancedisayo kwii-cell-cells ezingabalulekanga kuphela kumsebenzi wokuzivikela komzimba kodwa zijoliswe ku-HIV ephambili.
Njengoko i-HIV igqithisa kancane iiseli, umzimba uyahluleka ukuzimela ngokubhekiselele kuluhlu olubanzi lwabachaphazelekayo.
Uvavanyo luqhutywa ngokuthatha isampuli yegazi, iziphumo zokulinganisa inani le-CD4 eliseli-microliter (μL) yegazi. Isibalo esisezantsi sisenza isimo se-immune system, ngelixa uvavanyo olulandelayo lukwazisa ngokubanzi
- kwisigaba sentsholongwane kunye nesantya sokukhula kwesifo
- amathuba okuba ezinye iintsholongwane ziya kukhula njengoko iiseli ze-CD4 ziphelile
- indlela ophendula ngayo kunyango ngokugcina okanye ukuvuselela umsebenzi wakho wokuzivikela
Izibalo eziqhelekileyo ze-CD4 ziphakathi naphakathi kwama-500-1,500 amaseli / μL. Ngakolunye uhlangothi, i-CD4 count of 200 cells / μL okanye ngaphantsi isetyenziswe ngokwasemthethweni njengeAIDS. Uphando lubonisile ukuba ukuqaliswa kweyeza kunyango okanye ngaphantsi kweli nqanaba kuyahambelana neziphumo zezonyango ezihluphekayo kunye nokunciphisa ixesha lokuphila iminyaka engama-15.
Izikhokelo zangaphambili zonyango zinconywe ukuba unyango lwe-antiretroviral (ART) luqaliswe kwizigulane ezine-CD4 count ngaphantsi kweeseli ezingama-500 / μL okanye phambi kwesifo esichaza i-AIDS . Ngo-2016, izikhokelo ezihlaziyiweyo zivunyelwe i-ART kuzo zonke izigulane ezinegciwane le-HIV, kungakhathaliseki ukuba yi-CD4 count, indawo, ingeniso okanye isigaba sesifo.
Namhlanje, inani le-CD4 lisetyenziselwa ukuqikelela isiphumo sesifo ngokuninzi ukulinganisa amandla omzimba omzimba. Ngokomzekelo, i- CD4 nadir (indawo ephantsi kakhulu apho inani le-CD4 liye lahla) liqikelele ukuxhatshazwa kwexesha elide, kunye namaxabiso aphantsi achaza ingozi eyongezelelekileyo yezifo ezihlobene neHIV kunye non-HIV, kunye ukuphucula omzimba.
Iyintoni Umthwalo Wentlungu?
Nangona i-CD4 count isalathisi se-immune status kunye nokuphumelela kwonyango, umthamo wentsholongwane ngokuqinisekileyo umlinganiselo obalulekileyo xa unyango lwe-antiretroviral luqala.
Umthamo wentsholongwane ulinganisa intsholongwane yegazini egazini, eyaziwa ngokuba "ngumthwalo wentsholongwane." Amabhanki aya kusebenzisa i-teknoloji yokuhlola i-genetic-ngokuqhelekileyo, ukusabela kwe-polymerase chain (PCR) okanye i-bDNA (i-DNA ehlanganisiweyo) -kulinganisa inani leentsholongwane zentsholongwane kwi-milliliter (mL) yegazi. Imithwalo ye-HIV yentsholongwane ingahlawulela ekungabonakaliyo (ngaphantsi kwamazinga okuvavanywa kwamalinge okuvavanya kwangoku) kwiimashumi eziligidi.
Isiphumo esingabonakaliyo asithethi akukho ntsholongwane egazini lakho okanye "ususiwe" usulelo. (Enyanisweni, ngaphantsi kwe-5% ye-HIV emzimbeni inokufunyanwa egazini.) Akubonakali nje kuthetha ukuba inani le-virus liye lawela ngaphantsi kwezinga lokuvavanya kwigazi kodwa lingafunyanwa kwenye indawo, njengalesi sembewu.
Iinjongo zeNtsholongwane
Injongo yonyango lwe-antiretroviral kukukhusela ngokupheleleyo umsebenzi wentsholongwane kumanqanaba angabonakaliyo, edibanisa nayo
- unyango olungakumbi
- umngcipheko omncinci wokuphuhliswa kwintsholongwane engagwenyanga
- iziphumo ezingcono zeeklinikhi ezihambelana nokunyuka kwexesha lokuphila,
- ukunciphisa umngcipheko we-HIV kumngane ongasakhuselekanga (isicwangciso esibizwa ngokubhekiselele njengonyango njengolukhuseleko (iTraP) .
Ngakolunye uhlangothi, ukwanda kwimizi yesifo somthamo kunokuba yinto yokubonisa ukungaphumeleli kokonyango , ukunyanzelwa kweziyobisi, okanye zombini.
Kubalulekile ukuba uqaphele ukuba ukunyanzelwa kweziyobisi okungenani kuma-95% kuyadingeka ukuqinisekisa ukunyanzeliswa kwegciwane kumanqanaba angabonakaliyo.
Ukuthobela okungafaniyo kunciphisa kuphela amandla omntu okufezekisa oku, kukhulisa amathuba okuphulwa kweyeza ngokuvumela igciwane lesigqirha esinganyangekiyo. Ubu budlelwane obunobangela bangela isizathu sokubambelela kufuneka kuhlolwe rhoqo phambi kokuba unyango luguqulwe.
Oko kwathiwa, uguquko oluthile kumthwalo wentsholongwane (okanye "i-blips") lwenzeka nokuba phakathi kwabo banamathela kwi-100%. Ezi zinto zihlala ziphantsi kwaye akufanele zibe yimbangela ye-alamu.
Ukubekwa kweliso rhoqo kwe-CD4 count kunye nomthamo wentsholongwane kunconywa, ngokuqhelekileyo emva kweenyanga ezintathu ukuya ezintandathu emva koko i-CD4 ingahlolwa rhoqo kwiinyanga ezi-6 okanye ezili-12 ukuba phakathi kwama-350 ne-500 amaseli / μL. Izigulane ezikwazi ukugcina ama-CD4 amanani ngaphezu kweeseli ezingama-500 / μL zingahlolwa rhoqo ngexesha njengoko zilawulwa ngonyango.
Iinzuzo zolawulo lweNtsholongwane
Ngokomphando ovela kwi-United Collaborative Cohort Study (UK CHIC), abantu abanemithwalo engabonakaliyo yintsholongwane abaphumelele i-CD4 count ye-350 cells / μL okanye ngaphezulu komnyaka wokuqala unyango kungenzeka ukuba babe nexesha eliqhelekileyo lokuphila.
Kwiphepha le-flip, ukungaphumeleli ukufezekiswa kwintsholongwane kwanciphisa ixesha lokuphila iminyaka engama-11-kufana nokutshaya ugwayi 40 ngosuku.
Uhlalutyo olulindelekileyo olwenziwe ngo-2013 yiYunivesithi yaseMontreal luye lwagqiba ukuba abantu "abanokungabonakali" kwimiqathango yeentsholongwane zentsholongwane kwiinyanga ezintandathu (okt, phakathi kweengu-50 no-199 iikopi / mL) bekuphantse ku-400% umngcipheko omkhulu wokuhluleka kwe-virologic kungakapheli unyaka kunezo ezikwazi ukufezekisa ukunyanzeliswa kwe-viral.
Uphononongo olwalubonayo amadoda angama-1,357 abane-HIV ukususela ngo-1999 ukuya ku-2011, aphinde abonisa izinga lokungaphumeleli kwe-virologic malunga nama-60% abantu abaneempawu zentsholongwane eziqhubekayo phakathi kwama-500 ne-999 ikopi / mL.
Imithombo:
ISebe lezeMpilo leSebe lezeMpilo (DHHS). "Izikhokelo zokusetyenziswa kwee-Antiretroviral Agents kwi-HIV-Infected Adultscents." Uhlaziyo lwe-AIDSinfo. Rockland, MD; NgoFebruwari 12, 2013: C9-C21.
NgoMeyi, iM .; Gompels, M .; noSabin. C. "Ukulindela ubomi be-HIV-1-positive individuals approach eziqhelekileyo kwimpendulo yonyango lokulwa ne-antiretroviral: I-United Collaborative HIV Cohort Study." Umbhalo we-International AIDS Society. Novemba 11, 2012; 15 (4): 18078.
Baligh, Y; Fleishman, J .; Metlay, J; okqhubekayo. "Ukuxhaswa kweNtsholongwane ye-Viral kwi-HIV-Infected Patients Receiving Antiretroviral Therapy." Umbhalo we-American Medical Association. Julayi 25, 2012; 308 (4): 339-342.
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.
ICANDELO LOKUQALA IQela lokuFunda. "Ukuqaliswa kweNtsholongwane kaGawulayo kwi-Antiretroviral Infection." I-New England Journal of Medicine. Julayi 20, 2015; INGXELO: 10.1056 / NEJMoa1506816.