Izindlela zokuzivikela ezingcono zokunciphisa ingozi yokudlulisela i-HIV
Ngokwe-United Nations Joint Program on HIV / AIDS, cishe isigamu sabo bonke imibhangqwana ethintekayo nge-HIV emhlabeni, isho ukuthi umlingani oyedwa unesandulela ngculaza kanti omunye unengculaza. Namuhla, e-US kuphela, kulinganiselwa ukuthi kunamabhangqwana angaphezu kuka-140 000 abesilisa nabesifazane abesilisa nabesifazane, abaningi babo abaneminyaka yobudala obubeletha izingane.
Ngokuthuthukiswa okukhulu kwe- antiretroviral therapy (ART) , kanye nokunye ukungenelela kokuvimbela, imibhangqwana e-serodiscordant inamathuba amakhulu kakhulu okukhulelwa kunanini ngaphambili -kuvumela ukukhulelwa ngenkathi kuncishiswa ingozi yokudluliselwa kokubili kwengane nomlingani ongathintekile.
Ukucabangela kwangaphambili
Namuhla, kuyamukelwa kabanzi ukuthi ukusebenzisa kahle imishanguzo ye- antiretroviral kunganciphisa kakhulu ingozi yokutheleleka phakathi kwabalingani be-HIV abangenayo i-HIV:
- ukuqinisekisa ukuthi umlingani we-HIV uye wanciphisa ukutheleleka ngokugcina umthamo wegciwane ezingeni elingenakulinganiswa (isu elibizwa ngokuthi ukwelashwa njengokuvimbela, noma i-TasP)
- ukuhlinzeka ngomlingani ongenawo igciwane lesandulela ngculaza ngethotho lokuvikela okungeziwe ngokusetshenziswa kokuqala kokuvezwa kwe-prophylaxis (i-PrEP)
Emibhangqwana esebenzisa i-TasP ne-PrEP, ingozi yokudluliselwa kubonakala sengathi iyancipha kakhulu. Ucwaningo olusuka ekuhloleni oluqhubekayo lwama-PARTNERS lubonise ukuthi imibhangqwana engu-1,166 ebhalisiwe esilingweni kusukela ngoSepthemba 2010 kuya kuMeyi 2014, abalingani abangu-11 kuphela abangenayo igciwane lesandulela ngculazi basulelekile.
Kodwa-ke, ukuhlolwa kofuzo kuye kwaveza ukuthi bonke abayishumi nanye bahlaselwe ngumuntu ongaphandle kobudlelwane, okusho ukuthi akekho oxhumana naye oyedwa ongathandana naye.
Nokho, kubalulekile ukuqaphela ukuthi nakuba lezi zingenelelo zinganciphisa kakhulu ingozi-ngamaphesenti angaba ngu-96 namaphesenti angama-74, ngokulandelana-aziqedi ngokuphelele.
Ezinye izici eziningana, kubandakanya ukutheleleka kwezidakamizwa ze-HIV kanye nokutheleleka kwegciwane lesandulela ngculazi, kungabuyisa eziningi ezizuzwa yi-TasP noma i-PrEP uma zingakhulumi kahle futhi ziphathwe kahle.
Ucwaningo lwamuva luye lwabonisa nokuthi umuntu onomthamo wegciwane lesandulela ngculazi ongatholakali kungenzeka ukuthi awunalo ngempela umthamo wesandulela ngculazi ongabonakali. Ngakho-ke, ngenkathi ukuhlolwa kwegazi kungase kusiphakamise ingozi ephansi yokutheleleka, kungase kube khona ingozi eqhubekayo ezingeni ngalinye. Ngakho-ke, kubalulekile ukufuna ukwelulekwa kwangaphambili ngososayensi oqeqeshiwe ngaphambi kokuqala noma yikuphi ukuziphatha. Amaphilisi yodwa akuyona ikhambi.
Uma umlingani wesifazane ephethe i-HIV
Ebudlelwaneni lapho owesifazane ephilile futhi indoda ingalungile, inketho ephephile yindlela yokuvikela insemination (eyaziwa nangokuthi i-insemination, noma IUI). Iqeda isidingo sokulala ngokobulili futhi ivumela ukuziqeda ngokusebenzisa isidoda somlingani.
Noma kunjalo, lokhu kungase kungabi yindlela ekhethwa ngabanye, noma ngenxa yezindleko noma ezinye izici. Ngakho-ke, akuyona into engacabangeki ukuhlola ukukhulelwa ngokusebenzisa ubulili obungavimbelwe ukuthi izinyathelo zisezingeni lokunciphisa ingozi yokudlulisela.
Ezimweni ezinjalo, lona wesifazane uzobekwa kwi-ART efanele uma engakaqashiwe, ngenhloso yokufeza umthamo wegciwane elingenakulinganiswa.
Lokhu akugcini nje ukuthi kunciphise ukutheleleka kwamantombazane kwabesifazane, futhi kunciphisa ingozi yokutheleleka komama nomntwana.
Uma ukucindezelwa kwe-viral maximal kuye kwafinyelelwa, ukuziphatha okungavikelekile okuphelelwe yisikhathi ngokusebenzisa izindlela zokuthola i-ovulation kungaphinde kunciphise ingozi. Amakhondomu kufanele asetshenziswe ngazo zonke izikhathi. Ukusetshenziswa kwe-PrEP kumlingani wesilisa kunganikeza nokuvikeleka okungeziwe, nakuba imiphumela isalindile kusukela ezifundweni zokuphenya ukusetshenziswa kwe-PrEP ekukhulelwe.
Ngaphambi kokuqala i-PrEP, umlingani wesilisa kufanele ahlolwe nge-HIV, isibindi sesibindi B, nezinye izifo ezithathelwana ngocansi, kanye nokuhlaziywa okuyisisekelo kwezinsolo zezinso .
Ukuqapha njalo kufanele kwenziwe ukuze ugweme imiphumela yocwaningo lwezokwelapha, kufaka phakathi ukungasebenzi komzimba kanye nezinye izinto ezinobuthi ezikhona. Ukwengeza, bobabili abalingani besilisa nabesilisa kumele bahlolwe izifo ezithathelwana ngokocansi. Uma ukutheleleka kutholakala, kufanele kuphathwe futhi kuxazululwe ngaphambi kokuba kwenziwe umzamo wokukhulelwa.
Uma ukukhulelwa sekuqinisekisiwe, i-ART izoqhubeka nokulingana nomfazi, kanye neziqondiso zamanje zikhuthaza ukwelashwa okuhlala unomphela, kungakhathaliseki ukuthi i- CD4 count . Zonke ezinye izinhlinzeko zokuvimbela ukudluliselwa komama kuya kwengane zizosetshenziswa, kuhlanganise nokukhethwa kwesikhashana esinqunyiwe kanye nokuphathwa kwemithi yokwelapha emva kokuzalwa komntwana osanda kuzalwa.
Uma uMlingani Womshado enesandulela ngculaza
Ebudlelwaneni lapho indoda enhle khona futhi owesifazane engalungile, ukuhlanza izidakamizwa kuhlanganise ne-IUI noma i-vitro fertilization (IVF) kungase kuhlinzeke izindlela zokuphepha zomzimba eziphephile. Ukuhlanza izidakamizwa kufezwa ngokuhlukanisa isidoda esivela ku-fluid umthamo osulelekile, owokuqala owabekwa kuwo esibelethweni ngemuva kokunquma isikhathi sokuvuthwa.
Uma ngabe i-IUI noma i-IVF ayiyona inketho-nge-IUI ebiza u-$ 895 futhi i-IVF idla imali eyizigidi ezingu-12,000, ngokwesilinganiso-khona-ke kufanele kucatshangelwe ukuthi kuhlolwe izindlela zokuphepha, "zemvelo" eziphephile.
Kunconywa kakhulu ukuthi ukuhlaziywa kwesilisa kwenziwe ekuqaleni. Ucwaningo oluthile luphakamisa ukuthi i-HIV (futhi mhlawumbe ukwelashwa kwe-antiretroviral) ingase ihlotshaniswe nokusabalalisa okuphezulu kwesidoda esingavamile, kufaka phakathi isibalo esincane se-sperm kanye ne-motility ephansi. Uma ukungajwayelekile okunjalo kushiywe kungatholakali, owesifazane angase abekwe engozini engadingekile ngekhono elincane noma engekho langempela lokukhulelwa.
Uma sekukhona ukuqina kokuzala, ukukhathazeka kokuqala nokuqakathekile kungaba ukubeka umlingani wesilisa ku-ART ngenjongo yokufeza umthamo wegciwane olungapheli, ongatholakali. Umlingani wesifazane angase ahlole ukusetshenziswa kwe-PrEP ukuze aqhubeke nokunciphisa ingozi, ngezincomo ezifanayo zokuhlolwa kwangaphambi kokwelashwa nokulandelwa.
Ukuziphatha okungavikelekile kufanele kulungiswe ngokunembile ekuthunjweni, ngokusebenzisa izindlela ezijwayelekile zokuthola kanye / noma ukukhishwa kwe-ovulation predictor kits njengohlolo lwe- Clearblue Easy noma lwe- First Response urine. Amakhondomu kufanele asetshenziswe ngazo zonke izikhathi.
Uma ukukhulelwa sekuqinisekisiwe, umlingani wesifazane kufanele ahlolwe i-HIV njengengxenye yephaneli yesikhashana yokuhlolwa kwe-perinatal. Kufanele futhi alulekwe mayelana nokusetshenziswa kokusetshenziswa kwekhondomu kanye nezimpawu ze- acute retrovirus syndrome (i-ARS) ukuze kusize kangcono ukuthi kungenzeka yini ukutheleleka nge-HIV.
Kunconywa ukuthi ukuhlolwa kwesivivinywa kwesibili kwegciwane lesandulela ngculaza kwenziwe ngesikhathi sesithathu sokukhulelwa, okungcono ngaphambi kwamasonto angama-36, noma ukuthi ukuhlolwa kwe-HIV okusheshayo kunikelwa ngesikhathi sokubeletha kulabo abangazange bahlolwe ngesikhathi sesithathu. Uma kwenzeka ukuthi ukutheleleka nge-HIV kwenzekile, kufanele kwenziwe izinyathelo ezifanele zokunciphisa ingozi yokudluliselwa kwesandulela ngculazi, kuhlanganise nokuqaliswa kwe-antiretroviral prophylaxis efanele kanye nokucubungula isigaba sokukhethwa kwezidakamizwa.
> Imithombo:
> I-United Nations Joint Program nge-HIV / AIDS (UNAIDS). "I-UNAIDS World Day Day Report 2011." I-Geneva, eSwitzerland; I-ISBN: 978-92-9173-904-2.
> Isibani, M .; Smith, D .; U-Anderson, G .; et al. "Ukufeza ukukhulelwa okuphephile emibhangqwaneni engavumelani ne-HIV: indima engenzeka yomlomo we-preexposure prophylaxis (i-PrEP) e-United States." Journal American of Obstetrics and Gynecology . 2011; 204 (6); 488.e1-488.e8.
> Baeten, J .; Donnell, D .; Ndase, P .; et al. "I-Antiretroviral Prophylaxis Yokuvimbela I-HIV Emadodeni Nabesifazane Abesilisa Nabesifazane," i- New England Journal of Medicine. Ngo-Agasti 2, 2012; 367 (5): 399-410.
> UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). "Izincomo zokusetshenziswa kwezidakamizwa zokulwa negciwane lesandulela ngculaza abakhulelwe abanegciwane lesandulela ngculazi nengculazi abakhulelweyo ngenxa yokugula komama kanye nokunciphisa ukunciphisa ukuhanjiswa kwe-HIV e-United States." NgoJanuwari 16, 2014.
> Rodger, A .; I-Cambiano, i-V .; I-Bruun, T .; et al. "Umsebenzi Wocansi Ngaphandle Kwamakhondomu Nengozi Yokudluliswa Kwegciwane Lesandulela Ngculaza Emibhangqwaneni Ehlukeneyo Uma umlingani ophikisana negciwane lesandulela ngculaza esebenzisa ukwelapha okudambisa i-antiretroviral." Umagazini we-American Medical Association. NgoJulayi 12, 2016; 31 (2): 171-181.