Ungacabanga ukuthi kungaba into elula ukuyenza: yenza ijelisi noma i-ayisikhilimu ongayisebenzisa ngaphambi kokulala ngokobulili ukuze ubulale i-HIV ngokuphumelelayo. Phela, uma into enjenge-nonoxynol-9 inganciphisa ingozi yokukhulelwa ngokubulala isidoda, kungaba nzima kangakanani ukuthuthukisa okuthile nge-HIV, akunjalo?
Iqiniso liwukuthi ukuthuthukiswa kwama- microbicidal agents kuye kwaba nezinselele nezinkinga kusukela kuqala kuhlongozwa eminyakeni engaphezu kwengu-25 eyedlule.
Kwezinye izimo, ikhono le-ejenti lokukhubaza igciwane lesandulela ngculaza liye laholela ekudakaleni kwamathisini omzimba we-vagin or rectum-facilitation kunokuvimbela ukudluliselwa kwe-HIV.
Kwamanye amacala, ama-agent ayemane engasebenzi ekuvimbeleni ukutheleleka nge-HIV noma okwenzeke emiphumeleni engasabekiyo kulabo abakwelashwa.
Kuze kube manje, ayikho i-HIV microbicide etholakalayo noma inconyelwe ukusetshenziswa. Kodwa-ke, inani elikhulu labacwaningi licwaningwa ngokucophelela, kufaka phakathi i-gel esekelwe e-tenofovir, izindandatho zesikhumba eside, kanye nama-microbicide angama-rectal.
Kungani ama-Microbicides abhekwa njengabalulekile?
Ama-Microbicide awahlosiwe ukuthi athathe amakhondomu noma athathe imikhuba evikelekile yobulili , kodwa kunokuba ahlinzekele isivinini esengeziwe sokuzivikela ngesikhathi socansi-ikakhulukazi ekulaleni okulalelayo noma kwesisu- lapho uthola khona ingozi yokudlulisela.
Noma kunjalo, kusukela esithombeni esibanzi kakhulu, ama-microbicides abonakala njengendlela yokwehlisa ukusabalala kwe-HIV kubantu abanobungozi kakhulu.
Lokhu kubandakanya abesifazane abasengozini yokuhlukunyezwa ngokocansi noma ukuhlukunyezwa, noma ukuyeka ukuzibandakanya ngokocansi akuyona into engokoqobo (mhlawumbe ngenxa yesifiso sokuzala abantwana, noma izithiyo zamasiko ezivimbela ukuzimela kwazo namandla).
Kucatshangwa ukuthi ama-microbicide angase ekugcineni akwazi ukuhlinzeka abesifazane besengozini izindlela eziphumelelayo zokuzivikela ngenkathi kubanika abasebenzisi ukuvikeleka okungeziwe kufanele ikhondomu iqhume noma iqedwe ngesikhathi sokulala.
Izithiyo Zokuqala Ekucwaningeni Kwe-Microbicidal
Ucwaningo oluningi lwe-microbicidal lokuqala lwalugxile ekusetshenzisweni kwama-detergents noma ama-agent angakwazi ukuguqula i- pH yesisu ukuze ibulale i-HIV ngempumelelo (noma ingasebenzi).
Phakathi kwabokuqala bokuqala kwaba yi-nonoxynol-9 eshiwo ngenhla, umuntu osebenza ngokuzimela osebenzayo wasebenzisa obabili njenge-spermicide kanye nama-creams ebusweni / ebusweni. Ngokuphawulekayo, ukuhlaziywa kwe-meta eyenziwa ngo-2002 kwaphetha ngokuthi ukusebenzisa i-nonoxynol-9 empeleni kwandisa ingozi ye-HIV kubantu besifazane ngamaphesenti angama-50, futhi kunezimo eziphakeme zezilonda zangasese ezenza ingozi.
Amanye ama-agent ahloselwe ukulondoloza i-acidity ephezulu yesisindo (ehlanganisa nokucwaninga okuningi kwe- BufferGel ) yaboniswa ukuthi ibekezelela kahle abesifazane, kodwa ekugcineni akubonisi ukunciphisa ukuthunyelwa kwe-HIV.
Amasu okuthuthukiswa
Kunezinhlobo eziningi zezindlela ezenzekayo ekuthuthukiseni i-HIV microbicide ephumelelayo, engahlehliswa ibe yizigaba ezimbili ezijwayelekile.
Iyokuqala ingahlukaniswa njengama -microbicides angewona ama-antiretroviral , ama-agent angasebenza njenge-receyors ye-decoy e-HIV (ukuvimbela ukunamathela kwegciwane ukuthi libheke amaseli wesifazane) noma ukusebenzisa ama-macromolecules abizwa ngokuthi ama-dendrimers asebenza ngokuqinile kwi-HIV ukuvimbela ukutheleleka.
Ngesikhathi imizamo yokuqala ibonakala ingaphumeleli (i- PRO 2000 , i- Carraguard , i-cellulose sulphate), kuhlolwe izinombolo eziningi ze-agent-kuhlanganise ne- vivaGel ye- dendrimer microbicide, nokusetshenziswa kwe-dendrimers kanye ne-CCR5 yokungena inhibitor uSelententry (maraviroc) esetshenziselwa inhlanganisela ukwelashwa kwama-antiretroviral (ART) .
Okwesibili, futhi ngokuphawulekayo okuvelele kakhulu, isigaba kukhona ama- microbicides e-antiretroviral . Ukuthuthukiswa kwala ma-agent kuncike ocwaningweni ekusetshenzisweni kwe- tenofovir nezinye izidakamizwa ze-antiretroviral kuma-gels, ama-ring, amafutha, kanye nezinye izinhlelo zokulethwa kwezidingo.
Isifundo se-CAPRISA 004 ngo-2010 kwaba ngowokuqala ukubonisa ukuphumelela kwalendlela, besebenzisa ukusetshenziswa kwegelisi le-tenofovir elingu-1 ngaphambi nangemva kobulili besifazane ngo-889 abesifazane abangenayo i-HIV.
Ngokuvamile, izinga lokutheleleka lancishiswe ngamaphesenti angu-39 eqenjini elingewona indawo, kanti abahlanganyeli abanezinga eliphezulu lokunamathela (ngaphezulu kwamaphesenti angu-80) banciphise amaphesenti angu-54.
Ngokuphambene, i-VOICE Trial ibonwe njengento yokubuyisela emuva. Ukulandela izithende ze-CAPRISA, i-Voice Trial yafunda izindlela ezihlukene zokuvimbela i-HIV-ukusetshenziswa kwansuku zonke kwesidakamizwa se-antiretroviral (noma i- Viread noma i- Truvada ) noma ukusetshenziswa kwansuku zonke kwejelisi le-tenofovir-kubesifazane abangu-5,029. Icala laqedwa uma kungekho zindlela ezitholakalayo eziphumelelayo.
Ukuhlaziywa kokulandela kokutadisha kwenze ukuthi ukuhluleka kwakungabikho emithonjeni yokwelapha, kepha ukungabi nokunamathela okubanzi phakathi kwabahlanganyeli (ikakhulukazi phakathi kwabesifazane abasebasha, abangashadile). Ucwaningo oluqhubekayo luzosiza kangcono ukususa izimbangela zokuziphatha.
Indlela eya phambili
Ngemuva kokunciphisa kwecala le-VOICE, kusetshenziselwa ukuhlaselwa okweqile ukuhlola izindlela ezihlukile ekuthuthukiseni ama-microbicidal agents. Imiphumela yenziwe ngokuyinhloko. Phakathi kwesilingo sesiGaba II no-III esanda kuqedwa:
- I-FACT 001 Isivivinyo, esiqashe abesifazane abangu-2 900 eNingizimu Afrika, sinikeze abahlanganyeli umgomo ofana nalowo owasebenzisa i-CAPRISA 004 (1% ijelisi le-tenofovir ngaphambi nangemva kocansi). Ngokusho kwemiphumela yesikhashana, akukho ukunciphisa inani lokutheleleka nge-HIV phakathi kwabasebenzisi.
- I-ASPIRE (MTN-020) ihlolisise ukuphumelela kwendandatho yangaphakathi equkethe i-dapivrine (umuthi omkhulu we-antiretroviral wokuhlola) uma isetshenziselwa isikhathi senyanga eyodwa kuma-3,476 abesifazane ase-Afrika. Imiphumela ngo-2015 iboniswe ukunciphisa amaphesenti angu-27 kwengozi ye-HIV phakathi kwabesifazane abasebenzisa indandatho ye-dapivirine, ngokuyinhloko kwabesifazane abangaphezu kweminyaka engu-21. Ukuvikeleka okuncane noma akukho kubonakala kwabesifazane abaneminyaka engaphansi kwengu-21, ngokuyinhloko ngenxa yokusetshenziswa okungahambisani kwedivayisi .
- Ngokufanayo, isifundo se-RING (IPM 027) sifunda nophawu lwe-dapivirine kwabesifazane abangu-1 650 e-Uganda naseNingizimu Afrika ngokuhlolwa okungahleliwe, kwesigaba sesi-III. Ababambiqhaza bazosebenzisa amasongo abo isikhathi seminyaka emibili. Imiphumela yayihle kangcono kunaleyo ebonwayo esifundweni se-ASPIRE, ngokunciphisa jikelele kwama-37%. Futhi, imiphumela yaba ngcono phakathi kwabesifazane abaneminyaka engama-21 nangaphezulu. Azikho izinzuzo ezabonakala kubesifazane abaneminyaka engu-18-21.
- Phakathi naleso sikhathi, i-MTN 017 izohlola ukusetshenziswa kwegelisi elilodwa elisetshenziselwa i-tenofovir esekelwe eceleni kokusetshenziswa kwansuku zonke kweTruvada eqenjini lamadoda angu-186 alala nobulili namadoda (MSM) nabesifazane abaphambukile . Ucwaningo lwesiGaba II lwaqhutshwa ngaphezu kwamasonto ayisishiyagalombili, kanti amazinga aphakeme ukwamukeleka nokunamathela emgomeni owenziwe ngezikhathi eziningi.Ukuhlola okuyiqiniso kuzogxila ekusebenzeni kanye nokusetshenziswa kwegelisi elingama-rectal izindlela zokuzivikela ngaphambi nangemva kocansi.
- Ekugcineni, ngo-Mashi 2014, isifundo sezilwane esenziwa yi-Centers for Disease Control and Prevention (CDC) sabonisa ukuthi i-gel ephezulu esebenzisa i-Isretress Isentress (ratelgravir) ingaphumelela ekuvimbeleni ukutheleleka ngegciwane lesandulela ngculazi kubantu besifazane ngemuva kokuvezwa ngokocansi. Alikho igama okwamanje ukuthi ngabe lolu cwaningo luzokhuliswa ngaphesheya kobufakazi bomqondo obukhona.
Ezinye izingcwaningo zocwaningo ziphenya ukuthuthukiswa kwamafilimu omzimba omncane, okusheshayo okuqothula ama-vaginal, kanye namafomu ahlukahlukene we-antiretroviral (noma ama-co-formulations) ama-gels angama-topical noma amasongo.
Imithombo:
Abdool Karim, Q .; Abdool Karim, S .; Frohlich, J .; et al. "I-Genoli ye-Tenofovir esebenzayo neyokuphepha, i-Antibicroviral Microbicide, yokuvimbela ukutheleleka nge-HIV kwabesifazane." Isayensi. Ngo-September 3, 2010; 329 (5996): 1168-1174.
Microbicide Trials Network (MTN). "Mayelana ne-Microbicides Fact Sheet: Microbicide Trials Network." Pittsburgh, ePennsylvania. Ishidi langempela elikhishwe ngo-Mashi 25, 2014.
I-Dobard, i-C.; I-Sharma, i-S.; I-Parikh, U .; et al. "Ukuvikelwa kwe-postexposure Macaques kusuka ku-Vaginal SHIV Infection yi-Topical Integrase Inhibitors." I-Science Translational Medicine . Mashi 12, 2014. 6 (227): 227ra35.