I-Hepatitis C (HCV) yokwelashwa iphumelela kakhulu ekuphulukeleni ukutheleleka, kanti izidakamizwa ezintsha zesizukulwane zingathuthukisa isimo sabantu abane-cirrhosis esibangelwa yi-HCV, noma ngabe izindlela zokwelashwa zangaphambilini ziye zahluleka.
Ngokuvamile, phakathi kuka-20% no-30% we-HCV ukutheleleka kuvele ngaphandle kokungenelela kwezokwelapha. Kusukela kuma-70% ukuya ku-80%, ukutheleleka kungathuthuka phakathi neminyaka eminyaka bese kudala ukulimaza isibindi.
Abantu abangaba ngu-30% abanesandulela nge-HCV bathuthukisa imiphumela embi njengokwama- cirrhosis , umdlavuza wesibindi , noma ukuhluleka kwesibindi sesiphetho, futhi ekugcineni bangadinga ukufakelwa kwesibindi.
Imigomo
Umgomo we-hepatitis C ukwelashwa ukuwuvimbela igciwane kuze kube lapho kungabonakali khona egazini. Uma igciwane lihlala lingabonakali ngokuhlolwa kwegazi isikhathi eside, lokhu kuchazwa ngokuthi impendulo ye-virologic eqhubekayo (i-SVR) .
Ucwaningo luye lwabonisa ukuthi abantu abanesandulela ngculaza abane-HVV abaneSVR yamaviki angama-24 elandela ukwelashwa kwe-HCV bane-1% kuya ku-2% amathuba okuthola ukubuya kwegciwane. I-SVR-24 ihlukaniswa njengendlela yokwelapha. Ngisho nabantu abanama-HCV abangenayo isipiliyoni se-SVR-24 okuqhubekayo kwesifo se-slower nokuguqulwa kwesinye isikhathi sokuqedwa kwesibindi esihlotshaniswa nokutheleleka.
Ukubhekana Nokuvimbela Ukuvimbela Ngokuqondile (DAAs)
Ama-antiviral asebenzayo ngokuqondile (ama-DAAs), isigaba esisha semithi efinyelela emaphesenti angama-99%, enesikhathi sokwelashwa kwamasonto angaba ngu-12, nangemiphumela emibi kakhulu yesikhashana.
Le mithi ingasetshenziselwa ukutheleleka okukhulu kwe-HCV okungapheliyo, kanye nesifo esiphezulu sesibindi.
Ama-DAA angaphatha inani elikhulayo lezinkinga ze-HCV zofuzo , futhi i-DAA ngayinye inconywa kuphela ngezinkinga ezithile.
Ama-DAA alandelayo avunywe yi-FDA ekwelapheni kwesifo sofuba esingapheli C:
- I-Daklinza (daclatasvir) : ivunyelwe i-HCV i-genotype 3. Yithathwa njengethebhulethi yansuku zonke futhi ayikhuthazwa uma unesifo senhliziyo.
- I-Harvoni, i-Epclusa (i-sofusbuvir + ledipasvir ) : ivunyelwe i-HCV i-genotype 1. Ithathwa njengethebhulethi yansuku zonke, evame ukuhambisana ne-ribavirin.
- I-Sovaldi (sofusbuvir ) : ivunyelwe ama-genotype ama-HCV 1, 2, 3 no-4. Thatha njengethebhulethi nsuku zonke nge-rbavirin noma ne-ribavirin ne-peginterferon.
- I-Technivie (i-ombitasvir + paritaprevir + ritonavir) : ivunyelwe i-HCV genotype 4. Amaphilisi amabili athathwa nsuku zonke, futhi aphazamise imishanguzo eminingi kadokotela.
- I-Viekira Pak (i-ombitasvir + paritaprevir + ritonavir ehlanganiswe ne-dasabuvir) : ivunyelwe i-HCV genotype 1. Iphathwe njengethebhulethi kabili ngosuku futhi ingathathwa ne-ribavirin.
- I-Olysio (simeprevir) : ivunyelwe i-HCV genotype 1. Thatha njengethebhulethi kanye ngosuku futhi ingahlanganiswa nemithi yokutheleleka nge-HIV.
- I-Zepatier (i-grazoprevir + elbasvir) : ivunyelwe ama-genotype ama-HCV 1, 4 no-6, athathwa njengethebhulethi nsuku zonke noma ngaphandle kwe-ribavirin.
Imithi eminingi emdala, njenge-Incivek ne-Victrelis, yazinikela ngokuzithandela ngabakhiqizi, ngoba ayengasadingeki uma ama-DAA amasha avunyelwe.
I-Peginterferon ne-Ribavirin
I-Peginterferon , ne- ribavirin , sekuyisikhathi eside ibhekwa njengokwelashwa okujwayelekile kwe-HCV yokutheleleka okungapheli ngaphambi kokuvela kwama-DAA.
Akuwona ukwelashwa okujwayelekile, kusaba kubalulekile kubantu abanezifo eziphambili, kubandakanya i-cirrhosis, noma njengezinye izindlela uma ama-DAA engasebenzi. Ngokuvamile, ukuphumelela kwe-peginterferon, ne-ribavirin cishe engama-90%, engekho ephezulu njengeyama-DAA amasha, amanye ama-DAA anconywa ukuba athathwe ne-ribavirin noma i-peginterferon.
Phakathi kokungalungi kwe-peginterferon ne-ribavirin yimiphumela emibi yemithi. Imiphumela emibi ihlanganisa:
- I-anemia
- Izinwele
- Ukuthukuthela, ukukhathazeka, ukucindezeleka nokuzibulala
- Ukulahlekelwa izinwele
- Ukushisa nokukhwabanisa isikhumba
- Ukuqwashisa nokukhathala
- Ubuhlungu obuhlangene nobunzima
- I-nausea nokuhlanza
- Umkhuhlane, amahlumela
Impendulo ku-DAA noma enye yokwelashwa kwe-antiviral ichazwa ngale ndlela elandelayo:
- Impendulo yegciwane lesandulela ngculazi (RVR) - Umthamo wegciwane elingenakulinganiswa ngemuva kwamasonto amane okwelashwa
- Ukusabela okusheshayo kwegciwane lesandulela ngculaza (i-eRVR) - Umthamo wegciwane elingenakulinganiswa emavikini angu-12. kulandela i-RVR yokuqala
- Impendulo yegciwane lesandulela ngculaza (EVR) - Umthamo wegciwane elingenakulinganiswa noma ukunciphisa amaphesenti angu-99 ekutheni umthamo wegciwane ngamasonto angu-12
- Ukuphela kwempendulo yokwelashwa (ETR) - Umthamo wegciwane elingenakutholakali otholakala emavikini angu-12
- Umphenduli ohlangene- Uthola i-EVR, kodwa akakwazi ukugcina umthamo wegciwane elingenakutholakali ngemva kwamasonto angu-24 ngemuva kokuphelelwa ukwelashwa
- Umphenduli we-Null- Ayikwazi ukufeza i-EVR ngamasonto angu-12
- Impendulo yegciwane lesondlo (SVR) - Ikwazi ukusekela umthamo wegciwane elingenakulinganiswa amasonto angu-12 (i-SVR-12) namaviki angu-24 (i-SVR-24) ngemva kokuphela kwelashwa
Ukuhlinzwa
I-HCV ingabangela izifo ezinzima zesibindi, futhi zingase zithuthukise ekugcineni kwesifo sesibindi. Lesi isimo esongela impilo esibangela lapho isibindi sonakalisiwe kangangokuthi asikwazi ukusebenza ngendlela efanele. Ukwelapha okuhlinzekwa ukuphela kwesifo sesibindi sesibindi kuhlanganisa ukuphathwa okuphawulekayo futhi mhlawumbe ukufakelwa kwesibindi.
- Ukufakelwa kwesibindi: Ukufakelwa kwesibindi kubhekwa ukwelashwa okuphefumulayo kwesifo sesibindi sokugcina. Kodwa-ke, i-HCV ingahle ibuyele ngisho nangemva kokufakelwa ngoba igciwane lingasaphila egazini. Ngokuvamile, ukufakelwa kwesibindi kwenziwa ngesibindi kumuntu oshonile. Ukufakelwa kwesibindi kungenziwa ngokusetshenziswa kwesibindi esiyingxenye esivela kumnikeli ophilayo. Uma uthola isibindi kumuntu ophilayo, isibindi sakho esisha esinqunyiwe kulindeleke ukuba sivuselele ngokushesha. Isibindi esinqunyiwe esihlala emzimbeni womhlinzeki ophilayo siphinde silindele ukuvuselela ngokushesha. Nakuba ukuhlinzeka kuyinkambiso enkulu yomnikeli nomamukeli, umuntu ngamunye kulindeleke ukuba asinde futhi abe nesibindi sokusebenza ngokugcwele.
- Ukuxoshwa kwe-Esophageal: Ukuthuthukiswa kwamagciwane okuqeda amandla, ukuxilonga kwesifo sesibindi sokuphela kwesifo sesibindi, ukuvuvukala kwemithambo yegazi yesifo esivela izinkinga zokugeleza kwegazi esibindi sesifo. I-varices ingase igcine iphelile. Inqubo ebizwa ngokuthi i-banding ingamisa ukuphuma kwamagciwane okuqeda amandla ngokubeka ama-rubber bands emithini.
Ukunakekela komuntu siqu / Indlela yokuphila
Uma une-HCV, kunezinto ezibalulekile ezibalulekile okufanele uzikhumbule njengoba uthola. Ukuqinisekisa ukuthi ugwema noma yini engalimaza isibindi sakho kuqala.
- Gwema Utshwala: Ukusetshenziswa kabi kotshwala kungabangela ukwehluleka kwesibindi. Ngokulinganisela, utshwala akufanele kubangele ukuhluleka kwesibindi kumuntu onesibindi esinempilo. Kodwa, uma usuvele unesimo esithinta ukusebenza kwesibindi sakho, awukwazi ukugcoba utshwala ngokujwayelekile, ngakho-ke ngisho nenani elincane lingaba yingozi.
- Ungasebenzisi i-Acetaminophen: Imithi eminingi isetshenziselwa isibindi , futhi awukwazi ukuthatha uma unobungozi besibindi kusuka ku-HCV. Iningi lala mithi idinga imithi, ngakho-ke akunakwenzeka ukuthi udokotela wakho noma ummithi uzokuvumela ukuba uthathe uma uwazi i-HCV. Kodwa-ke, i-acetaminophen (iTylenol) ingaphezu kwe-counter, imithi esetshenziswa ngokuvamile ongase uyenayo kakade ekhaya. Awukwazi ukuthatha uma unesifo sesibindi nganoma yisiphi isizathu, kuhlanganise ne-HCV. Uma unezimpawu zobuhlungu noma umkhuhlane, cela udokotela wakho ukuthi akhombise enye imithi yakho engaphazamisi eminye imithi oyithathayo noma idinga ukusebenza kwesibindi esihle.
- Ukulawula Ukucindezeleka Kwegazi: Ukuhluleka kwesibindi kungabangela isimo esibizwa ngokuthi i-portal hypertension, okuyinto ukwanda kwengcindezi emithanjeni yegazi yesibindi. Nakuba lokhu kungahlobene ngqo nomfutho wegazi lakho jikelele, ukugcina ingcindezi yegazi evamile kuyindlela ebalulekile yokugwema ukungeza ezinkingeni ze-hypertension ye-portal.
Imithi ehambisanayo neyodwa
Amanye amaphutha amavithamini avezwe phakathi kwabantu abane-HCV. Ukuntuleka kwe-Vitamin akukwazi ukubangela i-HCV, ngoba kubangelwa ukutheleleka. Ukuhluleka kwesibindi ngokwayo kubangela ukungabi khona kwamavithamini athile.
- I-Vitamin D: I-Vitamin D, ikakhulukazi, ibhekwa njengengozi ye-HCV, futhi imbangela yale nhlangano ayicacile. I-Vitamin D iyinvithamini enamafutha angenashukela, okusho ukuthi kudinga ukuthi amafutha afakwe kahle. Uma unesibindi sokuhluleka ngenxa ye-HCV, lokhu kungenza kube nzima kuwe ukuthi uthathe i-vithamini D. Kunconywa kuphela ukuthatha izithako uma izinga lakho le-vitamin D liphansi.
- I-Vitamin A, i-Vitamin E: Zombili zi-vithamini ezinamafutha angenakunyakaziswa kahle uma unesifo sebindi. Ukwengezwa kungadingeka, kodwa kuphela uma amazinga akho ephansi.
Kunezinhlobo eziningi zokwelapha okunye okuye kwaphakanyiswa emiphakathini ehlukahlukene yokwelashwa nokuphathwa kwe-HCV, kodwa azikho izifundo ezibonisa ukuphepha kwempumelelo. Ngenxa yokuthi amakhambi amaningi namavithamini asetshenziselwa isibindi, ezinye izindlela zokwelapha ezingasiza uma unesibindi esinempilo zingabangela ukulimala uma isibindi sakho singekho emzimbeni. Kubalulekile ukuba uqaphele uma usuvele usebenzisa ama-vitamin noma ama-herb supplements, njengoba ungase ungakwazi ukuwacubungula uma une-HCV.
Ezinye izithako ezivamile eziyingozi uma unesibindi sokuhluleka kusuka ku-HCV:
- I-Vitamin K: I-vithamini enamandla esiza igazi lakho ukuba livalwe, lingabangela ukugqamuka kwegazi ngokweqile ngenxa yokungalingani kwemisebenzi yokugaya igazi okubangelwa ukuhluleka kwesibindi.
- I-Ginkgo Biloba: Imifino edala igazi elincane, lokhu kungabangela ukuphuma kwegazi uma unesibindi sokuhluleka kwesibindi, ngoba ukuhluleka kwesibindi kubangele kubangele ukubola kwegazi okungavamile.
- I-Herbs Mixed: Ucwaningo lwamuva lubonisa ukuthi ukwelashwa kwamagciwane kungabangela ukulimala kwesibindi. Lokhu kusho ukuthi kufanele uqaphele uma unayo i-HCV. Kungcono ukuhlola nodokotela wakho noma ummithi ngaphambi kokuba uthathe isamba semithi, ngisho noma usuvele uthatha isikhashana.
> Imithombo:
> I-Beig J, i-Orr D, i-Harrison B, i-Gane E. i-HCV Ukuqedwa nge-New IFN Free Treatment Kuthuthukisa I-Profile Metabolis In Abamukeli Be-Transplant Abahlobene Ne-HCV. I-Transpl yesibindi. 2018 Mashi 25. kuthatha: 10.1002 / lt.25060. [I-Epub ngaphambi kokuphrinta]
> Buonomo AR, Zappulo E, Scotto R, et al. Ukuntuleka kwe-Vitamin D kuyisici esingozini yokutheleleka kweziguli eziphethwe yi-cirrhosis ehlobene ne-HCV. I-Int J I-Dis Infect. 2017 Oct; 63: 23-29. i-doi: 10.1016 / j.ijid.2017.07.026. I-Epub 2017 Aug 10.
> Caicedo LA, Delgado A, Garcia VH, et al. Ukufakelwa kwesibindi ku-Hepatitis C-Iziguli ezithintekile: Okuhlangenwe nakho Isikhungo Sokutshala iSouth America. Ukufakelwa kwe-Proc. 2018 Mar; 50 (2): 493-498. doi: 10.1016 / j.transproceed.2017.11.046.
> Jing J, Teschke R. Udokotela wezokwelapha waseShayina kanye neHrub-induced Liver Injury: Ukuqhathaniswa ne-Liver-induced LiverInjury. J Clin Transliter Hepatol. 2018 Mar 28; 6 (1): 57-68. doi: 10.14218 / JCTH.2017.00033. I-Epub 2017 Oct 27.
> Nookala AU, Crismale J, Schiano T, et al. Ukulawulwa kwama-antiviral ngokuqondile okusebenza ngokuqondile kuphephile futhi kuphumelele ekwelapheni kwesifo sofuba esibhedlela se-hepatitis C. Ukuguqulwa komtholampilo. 2018 Mar; 32 (3): e13198. doi: 10.1111 / ctr.13198. I-Epub 2018 Feb 1.