Ingabe ukwelapha i-HIV noma i-HIV kuyisicala?
Umzimba wamanje wezocwaningo ubonise ukuthi abantu abanesandulela ngculaza bangamaphesenti angama-50 amathuba okuba nesifo senhliziyo kunabantu abaningi. Ucwaningo olwenziwe iminyaka eyisithupha olwenziwa njengengxenye ye-Veterans Aging Cohort Study (VACS) lubonise ukuthi amaphesenti angu-41 emiphakamiso ye-myocardial (MIs) eyenzeka kubantu abane-HIV.
Uma kuqhathaniswa namazinga ka-MI eqenjini lobudala ( bheka ngezansi ), abaphenyi baphetha ngokuthi ingozi ye-MI "yayiyizinga eliphezulu kakhulu futhi ihlale iphakeme" phakathi kwabathintekayo abane-HIV futhi yanda ngokuqhubekayo ngokuhamba kwesikhathi, kungakhathaliseki ukuhlukunyezwa kabi kwezidakamizwa, ukugula okubangelwa yi-comorbid, noma enye ingozi ye-cardiovascular izici.
Inombolo yezimpahla zeMyocardial (MIs) Ngama-1000-Amuntu Aminyaka
| Uhlobo lobudala | Abadala be-HIV | Veteran abangenayo i-HIV |
| 40-49 | 2.0 amacala | 1.5 amacala |
| 50-59 | 3.9 amacala | 2.2 amacala |
| 60-69 | 5.0 amacala | 3.3 amacala |
Izinombolo zihambisana nokucwaninga kwangaphambilini okubonisa ukunyuka okuphindwe kabili kuma-MIs phakathi kwabantu abane-HIV, kanye nokunyuka okuphindwe kabili kweziguli ezine- HIV nokuhlanganiswa kwesifo se-hepatitis C.
I-HIV Igalela Kanjani Inhlekelele Yenhliziyo?
Ngenkathi izimbangela zalokhu kwanda zingekho ngokucacile, ubufakazi obukhulayo bubonisa ukuthi i-HIV ngokwayo ingaba nomthwalo wemfanelo, mhlawumbe ngenxa yokuphendula okuvuthayo okubangelwa ukutheleleka kwe-HIV okuqhubekayo.
Ucwaningo olwenziwa ngo-2012 oluvela eDolobheni leSibhedlela saseFrance nge-HIV (FHDH) luphetha ngokuthi i-HIV, kanye nesimo somzimba wesiguli sesiguli, yizici ezizimele zengozi eyengeziwe. Ukwengeza, ingozi yesiguli yokuhlaselwa kwenhliziyo ibonakala inganda ngokuhlanganyela ngokuqondile ukuze inciphise inani le- CD4 kanye nokwanda komthamo wegciwane .
I-CD4 nadir yesiguli (iphuzu eliphansi kunazo zonke inani le-CD4 liwile) libhekwa njengengxenye eyinhloko.
Yikuphi lokhu okubonakala kubonakala ukuthi ukutheleleka kwegciwane lesandulela ngculaza isikhathi eside kubeka umuntu ngaphansi komthwalo wokuvuvukala okuqhubekayo, okungasithinta kakhulu uhlelo lwesifo senhliziyo emzimbeni nasesimweni sezofuzo.
Ucwaningo oluqhutshwa eNyuvesi yaseCalifornia, eSan Francisco luchaza ukuhlangana phakathi kwe-CD4 count kanye nempilo yokuguqula, lapho iziguli ezinama-CD4 aphansi (noma ezingekho ukwelashwa kwe-HIV ) zathola ukuqina okukhulu komzimba nokuqina uma ziqhathaniswa neziguli ezinama-CD4 aqinile, ukwelashwa kwasekuqaleni, nokulawulwa kwegciwane eliqhubekayo.
Ingabe izidakamizwa ze-HIV zenza izinkinga zenhliziyo?
Nakuba ezinye izidambisigciwane, ikakhulukazi iZiagen (abacavir), ziye zabikwa ukuthi zandisa ingozi yokuhlaselwa kwenhliziyo, ucwaningo lwangoku luhlukaniswe kancane ngale ndaba. Ngokuvamile, ingozi ngokuvamile ibonakala ibe phezulu phakathi kwalabo abanesimo senhliziyo esivele sikhona noma labo abanezinkinga ezinobungozi ezinhlanu noma ngaphezulu ezisengozini yomzimba (njengokubhema, isifo sikashukela noma i-cholesterol ephezulu).
Nakuba ucwaningo oluthile luphinde lwaphakamisa ukuthi izidakamizwa ze-HIV inhibitor class (PI) zivame ukukhuphula ingozi ye-MI, abaningi manje bayavuma ukuthi noma yikuphi ingozi engase ibe khona ingase ihlotshaniswe ne-agent ngayinye kuneklasi lonke lezidakamizwa. Ucwaningo oluthile lwamuva luphelile ukuthi abathathu abakhulu abasolwa nge-PI-u-Reyataz (atazanavir), i-Viracept (nelfinavir), ne-Invirase (saquinavir) -Akunakho ukuzihlanganisa nanoma yikuphi ingozi.
Kukhona nokungabaza ukuthi ngabe ezinye i-PI, njenge-Kaletra (lopinavir) ne-Crixivan (i-Invirase), inomthelela kusukela ekusetshenzisweni kwama-PI ayithathwa njengento eyodwa kuphela yamazinga e-lipid aphezulu kakhulu abonakala kwiziguli ze-HIV ezihlaselwa yinhliziyo.
Kodwa-ke, uhlobo oluphikisanayo locwaningo-ngokusekela okunye nokunye ukuxosha izimangalo-kushiya indawo yokuqapha uma ukhetha ukuhlanganiswa kwezidakamizwa ezifanele iziguli ezinegazi eliyingozi yempilo. Ibuye igcizelele isidingo sokuqapha ukuhlolwa kwenhliziyo emzimbeni kuzo zonke iziguli ezinegciwane lesandulela ngculazi, ngokungenelela kwangaphambili ukuze kunciphise izinto ezinobungozi ezingaguquki njengokubhema, ukudla nokucindezeleka komfutho wegazi.
Ukwelapha Izifo Zesifo Sezinhliziyo kubantu abane-HIV
Ezigulini ze-HIV ezinezifo noma izivivinyo zokuqala ezibonisa ukuthi isifo, ukudluliselwa ku-cardiologist kunconywa kakhulu. Ukucatshangelwa kufanele kwenziwe ekuqaliseni noma ekuguquleni ukwelapha ukubandakanya ama-antiretroviral agents onomthelela omncane kumazinga we-serum lipid.
Ngaphezu kwalokho, ukuhlolwa kufanele kubhekwe ukuthi zonke iziguli ze-HIV zizinakekelwa ukuze zihlole ngokugcwele ingozi yomzimba yomuntu, kuhlanganise nokuhlolwa okunjengokuthi:
- iphrofayili yokuzila ukudla (kufaka phakathi i-LDL cholesterol, i-cholesterol ye-HDL, ne-triglycerides)
- ukuhlolwa kwesifo sikashukela (ngaphambi kokuqala ukwelashwa, ngokuqapha okulandelayo emva kwalokho)
- isisekelo se-electrocardiogram (ECG) yeziguli ezinezifo ezibangelwa ingozi yomzimba
- ukuqapha kwegazi njalo
- ukungenelela okugulisayo ezigulini ezinengozi yengqondo ukuze kunciphise ukubhema, ukukhuluphala, nezinye izingozi ezingaguquguqukayo
Nakuba zingekho amasu okuvimbela isifo senhliziyo nge-HIV endaweni, amasu okunciphisa izindleko zendabuko aphakanyiswa-hhayi kuphela kwiziguli ezinengozi yempilo yengqondo kodwa njengendlela ephelele yokunakekelwa kwesikhashana kuzo zonke iziguli ze-HIV. Kumele kugcizelelwe ukuqinisekisa ukuthi:
- ukuvivinya umzimba njalo, kuhlanganise nokufaneleka komzimba we-aerobic
- ukusetshenziswa okunciphise amafutha agcwele
- Ukuyeka ukubhema okuqondene ne-HIV
- ukuncipha kokusetshenziswa kotshwala kumayunithi amathathu ngosuku noma ngaphansi
- ukunamathela ngokugcwele emithwalweni ye-antiretroviral
Imithombo:
Freiberg, M .; Chang, C .; I-Kuller, L .; et al. "Ukutheleleka ngegciwane lesandulela ngculazi kanye nengozi ye-infarction eyingozi ye-myocardial." I-Journal of the American Medical Association (JAMA) Imithi yangaphakathi. Ngo-Ephreli 22, 2013; 173 (8): 614-622.
Freiberg, M .; Chang, C .; I-Skanderton, M .; et al. "Ingozi yesigameko se-coronary heart among the veterans ne-HIV ne-hepatitis C." Ukujikeleza: Ikhwalithi ye-Cardiovascular and Outcomes. Julayi 2011; 4 (4): 425-432.
I-Lang, iS .; UMary-Krause, M., Simon, A., et al. "Ukuphindaphinda kwe-HIV kanye nesimo somzimba sokuzivikela ngukuzivikela okuzimele kwengozi ye-infarction ye-myocardial kubantu abathintekayo nge-HIV." Izifo Ezithathelwanayo Emitholampilo. Agasti 2013; 5 (4): 600-607.
Hsue, P .; Bheka, J .; UFranklin, A .; et al. "Ukwandiswa kwe-atherosclerotic ezigulini ezinegciwane lesandulela ngculaza: Indima yemikhuba yendabuko kanye ne-immunological engozini." Ingqungquthela yeshumi kwi-Retroviruses kanye nezifo ezithinta amathuba (CROI 2003); IBoston, eMassachusetts; Ngo-February 10-14, 2003; abstract 139.
I-Monforte, A .; Hamba, P .; Ryom. L .; et al. "I-Atazanavir ayihlotshaniswa nengozi eyengeziwe yemicimbi ye-cardio- noma ye-cerebrovascular disease." AIDS. NgoJanuwari 28, 2013; 27 (3): 407-415.