Izifundo e-Afrika naseYurophu zenza iziphetho ezahlukene
NgoDisemba 2014, izifundo ezimbili zokuphenya ngokuqhathaniswa kwe- HIV eningizimu ye-Afrika naseYurophu, ngokulandelana, zenze iziphetho ezimbili ezihluke kakhulu.
Eyokuqala, eqhutshwa eBotswana naseNingizimu Afrika, iphakamisa ukuthi igciwane 'livumelaniswe nezinhlobo ezithile zegciwane elingenayo igciwane lesandulela ngculazi-elibizwa ngokuthi i- leukocyte antigen B (HLA-B) lomuntu - liyanciphisa amandla okwelapha' ngokuphindaphindiwe, futhi ngaleyo ndlela iqhubekele ukuqhubeka kwesifo.
Esesibili, esilandela iqembu leziguli zaseYurophu eminyakeni eminingana, libheke ngokulingana nesilinganiso segciwane lesandulela ngculazi kanye nesisindo se- CD4 ngemva nje kwesigaba esicacile sokutheleleka futhi saphetha ngokuthi, ngokuhambisana nokuguquka kwezifo yedwa, i-HIV iye yaba yingozi kakhulu ngokushesha ukuqhubeka kwesifo.
Kungenzeka kanjani ukuthi lezi zifundo ezimbili zaphela ngokuhunyushwa okungafani kahle? Kungabe kunjalo nje kuphela ukuklanywa kokucwaninga okungaqondakali, noma kungenzeka ukuthi ukuhlukahluka kwegciwane elivela ezwenikazi kuya kwezwekazi- noma ngisho nasezweni lonke-kuye kwaholela amaqembu ososayensi ngendlela ehluke ngokuphelele?
Ukulinganisa ukwelashwa kwe-HIV eBotswana naseNingizimu Afrika
Esifundweni sokuqala, ososayensi e-Oxford University, eholwa ngumphenyi oholele uRebecca Payne, bebuza ukuthi ukutholakala kwamagciwane athile e-HLA-B-okuhlotshaniswa kakhulu nokuthuthuka kwesifo se-slow and control control viral-kungase kubangele ukuguqulwa kwegciwane lesandulela ngculaza okungase linciphise "ukuqina komzimba."
Ucwaningo lwangaphambili lwalubonise ukuthi abantu abathile babenephesenti ephakeme yabantu abanalo ukuguquguquka okungavamile kwe-HIV, kusukela ku-75% eJapane kuya kuma-20% eNingizimu Afrika. Lapho bebheka ukungafani, abaphenyi baqala ukuzibuza ukuthi lokhu kungase kube nomthelela omkhulu ekuhlukeni okukhulu phakathi kwezizwe ezincane ezifana neJapane nezifunda ezithandwa kakhulu njenge-Afrika engaphansi kweSahara.
Njengoba izinga le-HIV lisalokhu liphansi kakhulu eJapane, abacwaningi bagxile ucwaningo lwabo eqenjini leziguli eBotswana, izwe lapho isifo se-HIV sifike khona ngo-2000, futhi saqhathanisa neqembu elifanelwe eNingizimu Afrika, elifinyelele kuphela ukuphakama kwalo ngo-2010.
Ucwaningo lokuqala lwembula ukuthi isilinganiso segciwane lesandulela ngculazi phakathi kweziguli ezingelashwa eBotswana, lapho lesi sifo "sisekhulile," sasincane kakhulu kunaseNingizimu Afrika, lapho lesi sifo sineminyaka eyishumi "esincane" (amakhophi angu-15,350 / mL amakhophi angu-29,350 / mL, ngokulandelana). Ngaphezu kwalokho, naphezu kokuba ne-CD4 count 50 cells / mL esingaphansi kwezwe laseNingizimu Afrika, abaseBotswanans ne-HIV bavame ukuhlala isikhathi eside, bebonisa ukuthi i-subtype encane kakhulu.
Njengoba lobu bufakazi bukhona, abaphenyi base bebuka isakhiwo sezakhi zofuzo zegciwane lesandulela ngculazi futhi bathola ukuthi inani eliphakeme lamaBotswanans lalinguquko ye-HLA-B "yokuphunyuka" (okusho ukuthi igciwane liye lashintshela ukuba khona kwe-molecule ye-HLA ukubalekela ukuthola). Ngokwenza kanjalo, ososayensi babekholelwa ukuthi "ukuqina" kwegciwane kungenzeka kube buthakathaka, kunciphise amandla okuphindaphinda kanye nokulimaza ikhono lomzimba wesiguli.
Konke okukhulunywe ngakho, i-46% yeqembu lamaBotswanan lalinomsindo omkhulu we-HLA-B uma kuqhathaniswa nama-38% kuphela aseNingizimu Afrika.
Izivivinyo ze-tube test zibonakala zisekela i-hypothesis, ne-HIV esampula yaseBotswanan iveza u-11% kancane kunalokho eNingizimu Afrika.
Ngokusekelwe kwedatha yezibalo ezivela emitholampilo yokubeletha, i-Payne kanye neqembu lakhe baphinde baphakamise ukuthi ukutheleleka kwesandulela ngculazi kungenzeka ukuthi sekuqale ukuqhutshwa eNingizimu Afrika, futhi isilinganiso samaphesenti amantombazane phakathi kwabesifazane abangaphatheki kahle sinciphisa kusuka ku-13,550 ngo-2002 kuya ku-5 kuya ku-5 750 ngo-2012- 2013.
Ukulinganisa ukwelashwa kwe-HIV e-European CASCADE Cohort
Ucwaningo lwaseYurophu lwathatha indlela elula kakhulu, yezwe langempela, lapho idatha yesiguli evela eqenjini elide elide, lase-European CASCADE lihlaziywa kusukela ngo-1979 kuya ku-2002.
Ekucwaningweni kwabo, abaphenyi beCASCADE bagxile ezintweni ezimbili ezibalulekile:
- isilinganiso se-CD4 esivela ngemva kwesisoconversion (esinquma indlela ukutheleleka kakhulu kwegciwane lesandulela ngculazi kuye kwehlisa isimiso somzimba somzimba), futhi;
- isilinganiso segciwane "isethi yokubeka" (lapho umthamo wegciwane uhlala ngemva kwesigaba esicacile sokutheleleka, nemithwalo ephezulu yegciwane lengculaza ngokuvamile ehambisana nokuqhubekela phambili kwesifo ngokushesha).
Ekuhlaziyweni kwabo okuphindaphindiwe, abacwaningi bathola ukuthi isilinganiso se-CD4 esilinganisweni sehla kusukela ku-770 cells / mL ngo-1979 kuya ku-570 cells / mL ngo-2002, kanti isilinganiso se-viral set set cishe kathathu kusuka ku-11 200 ngo-1979 kuya ku-31,000 ngo-2002.
Okunye okuphathelene nokuthi lesi sifo sibonakala sithuthuka kangakanani, unyaka nonyaka, kubantu abane-HIV. Ngokusho kocwaningo, isikhathi esilinganisiwe sithatha isibalo se-CD4 sesiguli ukuwela phansi ngezansi 350-isigaba lapho kunconywa khona ukwelashwa kwama-antiretroviral- kuncike eminyakeni eyisikhombisa ngo-1979 kuya eminyakeni engama-3.4 ngo-2002.
Ukwahlukana Kwokhiye KuCwaningo
Zombili izicucu zocwaningo ekugcineni zinezilinganiso zazo, ngezinhlelo zokutadisha ezingase zenze ukuphikisana phakathi kososayensi kanye nabakhiqizi ngokufanayo. Phakathi kokungafani okubalulekile:
- Ngenkathi isifundo se-Afrika sihlaziya idatha yezibalo ezivela ezingaphezu kuka-2,000 iziguli eBotswana naseNingizimu Afrika, inani langempela leziguli ezifakwe kwisampula yamandla okuphindaphinda akulona nje kuphela amancane (16 aphuma eNingizimu Afrika nabangu-63 abavela eBotswana) kodwa athathwa ngesikhathi esisodwa ngesikhathi . Ngokuphambene, iziguli ezingaba ngu-16 000 zifakwe kuqembu le-CASCADE, bonke abaphenywe isikhathi eside kakhulu.
- Ngenkathi i-Payne neqembu lakhe ligxile emthethweni wokuguqulwa kwe-HLA-okubangelwa ukuguqulwa komthamo wegciwane lesiguli, abakwazanga ukukhombisa ukuthi ukutholakala kwalezi zinguquko kuye kwaba nomthelela ekunciphisweni kwe-CD4. Ngokuphambene, abacwaningi be-CASCADE babheka ukuthi i-CD4 / umthamo wesandulela ngculazi iyingqayizivele phakathi kokusungula ukwanda kwe-HIV. Futhi banciphisa ukufakwa kuphela kulabo abagulayo abaye bathola ukuthi zingakapheli izinyanga ezintathu zokutheleleka, banikeze iphuzu lokuqala elicacile lokukala ukuhlwithwa kwesifo / ukuguqulwa kwe-CD4.
- Kubalulekile ukuthi uqaphele ukuthi ithimba le-CASCADE lenze kuphela ukuhlaziywa kobuzwe kumadoda amhlophe, abesilisa abesilisa abesilisa abathandanayo (ukuze baqinisekise kangcono umlando wokwelapha kanye ne-subset viral). Ngenkathi ukuhlaziywa kuphakamisa ukuthi ukuvuthwa kwemvelo kungase kube ukulinganisela eYurophu njengamanye-nomthwalo wegciwane lomphakathi wehla kusuka ku-31,000 ngo-2002 kuya ku-25 500 ngo-2008-okufanayo akunakusho kubantu besilisa. Njengoba sekuyaziwa ukuthi ukusabalalisa okusheshayo kwegciwane lesandulela ngculaza kubantu besilisa abathandanayo ( okuhambisana namazinga aphezulu okutholakala kokwelashwa) kuye kwabangela ukuhlukahluka kofuzo kanye nokwehluleka okudlulisiwe , kungenzeka ukuthi i-subset yegciwane elichaphazela leli qembu lingase libe ngaphezulu i-virulent.
- Ngokuphambene nalokho, ucwaningo lwama-Afrika lwaluqhutshwa emazweni lapho ubulili bobulili obungqingili bekungewona kuphela indlela yokudlulisela phambili kodwa lapho, kuze kube maduzane, abantu abambalwa abatholwa yi- HIV yokwelapha . Ngenxa yalokho, ukuhlukahluka kofuzo lwe-HIV eNingizimu ye-Afrika kubhekwa njengento encane kakhulu, kanti olunye ucwaningo lukhomba ukuthi ukuhlukahluka kwesifunda segciwane kungavumela ukungezwani okukhulu kwe-HIV.
Ngamafuphi, naphezu kokungaphumeleli kokucwaninga kwe-Afrika nokulinganiselwa kocwaningo lwe-CASCADE, zombili iziphetho zingase zilungile kahle. Uphenyo oluqhubekayo kulindeleke kuzo zombili amaqembu.
Imithombo:
Payne, R .; Muenchhoff, M .; Mann, J .; et al. "Impikiswano yokuguquguquka kwe-HIV eqhutshwa yi-HLA ekukhusheni kwesimo se-HIV ephezulu." I-PNAS. Disemba 16, 2014; 111 (50): E5393-5400.
I-Pantazis, i-N .; Porter, K .; I-Costagliola, D .; et al. "Amathrendi wesikhashana kubamemezeli bokubikezela kwe-HIV-1 ukuhlukumezeka nokudluliselwa komzimba: isifundo sokubheka izinhlobonhlobo." I-L ancet HIV. Disemba 2014; 1 (3): e119-126.