Ngaba izizukulwana ezitsha zinezidakamizwa zitshintshe imithetho malunga nokunyanzelwa kwe-HIV?
Ukubambelela kweziyobisi kusekho icandelo eliphambili ekuphatheni ngempumelelo nokulawula usulelo lwe-HIV. Ngokungafani nemichiza engapheliyo esetyenziswa ekuphatheni izifo ezifana nesifo senhliziyo okanye isifo sikashukela-esifuna ukunyanzeliswa kwe-70% ukufezekisa iinjongo zekliniki- unyango lwe-antiretroviral (okanye i-ART) ludinga ukulandelelana okuthe ngqo ukugcina unyango lwe - virus kunye nokukhusela ukuphuhliswa kwexesha elide ukumelana .
Kodwa kunikezelwa ukuba ngoku sinokutsha, ukuveliswa kwezidakamizwa ze- antiretroviral eziphuculweyo, ngaba imigaqo iyafana?
I-95% Yokumelana neMantra
Izikhokelo zonyango lwe-HIV zithethelela ukuba izigulane zifuna ukugcina imilinganiselo engaphezulu kwama-95% ukuqinisekisa ukunyanzeliswa kwe-virus. Kwi-regimen ye-drug-once-day, eguqulela malunga neentsuku ezili-14 zezinye izihlandlo, izilingo ezingekho phantsi kwonyaka.
Nangona kunjalo, abanye baye baqala ukuphikisa ukuba "i-mantra engu-95%" isekelwe kwidatha eqokelelwe ngasekupheleni kweminyaka yama-1990, xa izidakamizwa zeerakamiza zinzima kakhulu kwaye iziyobisi zinesigwebo esincinci. Nangona kukho abambalwa abaza kuvakalisa ngokufanelekileyo i-85% okanye i-90% njengenqanaba elitsha lokunamathela, "abaninzi bakholelwa ukuba imfuneko yokuhlambalaza okanye yokugxeka izigulane ngokungaphantsi kokugqibeleleyo ayikho ndawo enokubaluleka njengokuba bekuyiminyaka eyi-10 edlulileyo.
Sekunjalo, kukho ininzi ekholelwa ukuba ukunciphisa umgca wokubambelela (okanye ukubonisa ukuba utshintsho) yimpembelelo, ukuvumela amanqanaba okutshatyalaliswa okuya kwandisa ngaphezu kwexesha.
Kukho ubungqina bokuxhasa le ngxabano. Ngokweenkcukacha ezilungiselelwe ngamaziko e-US for Control and Prevention (CDC), ama-30% aseMerika kwi-ART akakwazi ukuphumeza ukunyuswa kwe-virus. Abaninzi bayavuma ukuba ukunamathela ngokuthe ngqo kubambe indima ebalulekileyo kule nto, ngelixa ezinye iingcaphephe zibonisa ukuba ukunyanzelana ngokuqhelekileyo kunqabile emva kokuqala kwinyanga "yokunyanga" emva kokuqaliswa kwe-ART.
Nangona kunjalo, kukho ubungqina obaneleyo bokuxhasa ukuba izidakamizwa ezitsha zintsholongwane zininzi kakhulu "ukuxolela" ngokunjalo nokuchasene nokuxhatshazwa, ngokugqithiseleyo "ukunyusa" izidakamizwa ezinokukwazi ukugcina iiplasma ezinkulu zeengxowankulu kwixesha elide.
Kodwa ngaba ubungqina baneleyo ukubiza ukuphucula ukunyanzelisa? Ngaphandle kwimiba engcono, i-antiretroviral medication, ingaba kunjalo ngokwenene kweli nqanaba?
Ukulinganisa Ubungqina
I-Protease inhibitors (i-PIs) ngumzekelo oyintloko wophuhliso kwi-ART yanamhlanje. Namhlanje, ii-PIs ziphantse "zikhulisa" -ukuthi zilawulwa ngokubambisana nesicatshulwa sesibini esakwazi ukuwandisa i-serum ye-half-life ye-PI. Uhlalutyo lwe-meta lweengcali ezi-5 eziphambili lubonisa ukuba isizukulwana esitsha sivuselela i-PIs-njenge-Prezista (darunavir) -nokuthi, eqinisweni, ifuna ukunyanzeliswa kwe-81% ukwenzela ukufezekiswa kwintsholongwane.
Ngokwahlukileyo, ii-PI ezinokukhudlwana njenge-Kaletra (lopinavir + ritonavir) ziboniswa ukuba zingasebenzi kangangoko xa ukunyanzelwa kwehla kuhla ngaphantsi kwama-95%, ngokuphononongo olunye lucacisa ukuba i-53% yezigulane ziyakwazi ukufumana imithwalo engavonakaliyo yentsholongwane phantsi kweli nqanaba lokunamathela.
Uphando alucaci ngakumbi malunga nefuthe lokunamathela kwezinye iiklasi ze-antiretrovirals. Nangona ezinye izifundo zibonisile ukuba iziyobisi ezingenayo i-nucleoside reverse transcriptase inhibitors (NNRTI) ezinjengeSusvava (efavirenz) zingadinga kuphela u-80% ukuya kwi-90% ukunamathela xa zisetyenziselwa ukuxhamla kwi-PI, abanye bathi amazinga aphezulu okunamathela ayadingeka ngenxa kwiimeko ezinokubakho ukuxhatshazwa nokunganyangeki kwamanye amayeza e-NNRTI.
Ngokufanayo, i-CPCRA YOKUQALA YOKUQALA ifunyenwe ukuba iirhafu zokuchasana phakathi kwe-nucleoside reverse transcriptase inhibitor (NRTI) izidakamizwa ezifana ne- Retrovir (AZT, zidovudine) zanda ukulungiswa ngokuthe ngqo kunye nokunciphisa ukunyanzelisa iziyobisi.
Kukho okwangoku zifundo ezimbalwa ezikhoyo ukuvavanya ubudlelwane phakathi kokunyanzelisa nokuvelisa izidakamizwa ezintsha njenge-Intelence (etravirine) okanye kwane-analogue ethandwa kakhulu, i-Viread (i-tenofovir). Ngokufanayo, i-integrase inhibitors evunyelwe ukusetyenziswa, isifundo esisodwa kuphela se- Isentress (raltegravir) sibonisa ukuba amazinga okunamathela kuma-90% angamkeleka.
Ngaba Kufuneka Ulahlekelwe Ngamanye (okanye Amaninzi) Amanani Ndikhathalele?
Ukungaphumeleli kwimizuzu ethile okanye ukuhluleka ukuthatha umthamo ngexesha yinto eyenzeka kuwo wonke umntu onamayeza angapheliyo.
Ngokona nxalenye, oku akufanele kubangele ukukhathazeka ngokungathandekiyo. Nangona kunjalo, ixesha elide okanye ngokuphindaphindiweyo oku kuphelelwa lixesha, kuncinci ukuba izidakamizwa zigcina ukunyanzeliswa kwentsholongwane engabonakaliyo.
Olunye uphando oluqhutywe yiZiko leSizwe leZifo ezithathelwanayo eRoma lubonise ukuba izikhelo zonyango lweentsuku ezimbini ebudeni benyanga ziye zanda ukunyuka kwintlanu kwintsebenzo yentsholongwane ebonakalayo. Ukuxhasa uphando ngo-2013 uye wabonisa ukuba nokunyamekela, "ukuthatha i-viral-load" (phakathi kwama-50 no-199 ikopi / mL) kungabangela umngcipheko omkhulu we-400% we-virologic failure.
Ngokufanayo, uphando olusuka kwisibhedlele saseYunivesithi yaseCôte de Nacre lubonise ukuba izikhalazo ezide kwi-ART zandisa amathuba okuphulwa kwonyango , kunye nokuphazamiseka kweentsuku ezili-15 ezifaka ithuba elingama-50% lokungeniswa kwintsholongwane.
Ngokufanayo, ukuxhaswa kunye nokusebenza kovavanyo lwe-Protease Inhibitor Therapy (AEPIT) zilingo zafunda impembelelo yeempembelelo zexesha le-dose kwi-viral activity. Ngokutsho kophando, izigulane eziye zavumela ukufikelela kwiiyure ezintathu kwixesha eliqhelekileyo lexesha eliqhelekileyo lokuthatha i-dosing zine-300% enkulu yentsholongwane yentsholongwane kunokuba abo bathathe amachiza abo ngexesha.
Ngoko Kuthetha ntoni Oku?
Akungabazeki ukuba izidakamizwa ezitsha zintsholongwane zilula ukuyisebenzisa nokunyamezela, ukunikela "ukuxolelwa" okukhulu kufuneka isiguli singaphutheli idilesi engavumelekanga. Kwaye ngelixa sisuka ngokucacileyo ukuya kumayeza athatha ixesha elide edinga ukuba i-dosing engaphantsi, i-jury isaphambili ukuba ingaba oku kubonakalisa utshintsho olwenziwe kwiziphakamiso zokubambelela.
Ekugqibeleni, i-ART isekelwe kwintsebenziswano ye-antiretroviral agents, ngasinye sinemizuzu eyahlukileyo yokuphila kunye ne-pharmacokinetics. Ezinye zeerimim zineemida ezincinci zeephene; abanye abaninzi. Ukususela kumbono ongokoqobo, bekuya kuba nzima ukutshintsha iinjongo zokumamela kunye nayo yonke imirhumo yonyango.
Kunoko, imiba yokuthobela imele ifumaneke ngokunyamezela okukhulu kubaphathi kunye nokuxhalabatha okungaphantsi kwezigulane ezivayo ukuvuma iimpazamo zabo. Ukuba kukho nantoni na, ifuna ukusebenzisana okukhulu nomguli, kunye neenjongo ezithile kunye nokungenelela ukuqinisekisa ukunyaniseka kokuphila kwangempela. Ezi zibandakanya:
- Ukuhlolwa okusebenzayo kwemithintelo yokuthobela phambi kokuqaliswa kwe-ART (umzekelo, ishedyuli yomsebenzi, abantwana, ukudalulwa, ukwahlukana, njl.
- Uvavanyo lokuqhubeka kunye nentsebenziswano ukujongana naziphi na iingxaki ezintsha okanye ezikhoyo (kubandakanywa nemiphumo emibi yonyango, iingxaki zentsapho, imiba yeemeko, njl.
- Ukuncincika kwimiqathango yonyango, apho kuboniswe khona
- Ukujongana nezinto eziguqulwayo ezinxulumene nokunyanzeliswa kakubi (umzekelo, ukusetyenziswa kakubi kweziyobisi, ukudandatheka, ukungabi nakhaya, njl.
- Ukusetyenziswa kwezixhobo zokunamathela (umzekelo, abaququzeleli bamachiza, izixhobo zokukhumbuza) okanye iinkqubo zokuncedisa ukunamathela.
Ngamafutshane, kuvelisa ngakumbi ukujongana nokunamathela ngokungagqibekanga ngokwemiqathango ethi " Kwanele kangakanani ?," kodwa kunendlela yokuchonga izixhobo zokuqinisekisa ukuba i-ART isebenzayo, inxalenye yongcinezelo yenkqubo yomntu yansuku zonke .
Ukuba le nto ingafezwa, ngoko umbuzo othi "ubuninzi" bunokusiwa ngokupheleleyo.
Imithombo:
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