Izinguquko zeHarmonal Kungenzeka Zibeke Abesifazane Emngciphekweni Ophezulu We-HIV
Ingozi ye- HIV iphakeme kakhulu kusuka kwabesilisa kuya kwabesifazane kunabesifazane kuya emadodeni ngenxa enkulu ekungeneni kwesifazane, umlomo wesibeletho kanye (mhlawumbe) nesisu. Akukhona nje kuphela ukuthi kunezicubu ezinkulu ezithinta isisu (FRT) uma kuqhathaniswa ne-penis, izinguquko ze-biology ngokuvamile zingenza izicubu ze-mucosal ezenza i-FRT ibe yingozi kakhulu ekutheleleni.
Ngenkathi izimbungulu ze-mucosal ze-vagin zikhulu kakhulu kune-rectum, zinezingxenye eziphindwe kabili ezihlanganisa izicubu ze-epithélial ezinikezela isivinini esilungele ukutheleleka, i-HIV ingakwazi ukufinyelela emzimbeni ngamaseli anempilo. Ngaphezu kwalokho, umlomo wesibeletho, onomzimba obuncane obuncane kakhulu kunomuntu wesifazane, uhlanganiswe nama- CD4 + T-cell , amangqamuzana omzimba omzimba anemigomo yokukhetha i-HIV.
Izinto eziningi zingathuthukisa ukuhlukunyezwa kwabesifazane ku-HIV, kuhlanganise ne- bacterial vaginosis (engakwazi ukuguqula izitshalo zangasese) kanye ne- ectopy yomlomo wesibeletho (owaziwa nangokuthi "umlomo wesibeletho").
Kodwa ubufakazi obukhulayo buye kwabonisa nokuthi izinguquko ze-hormone, ezenzeka ngokwemvelo noma ezithonywayo, zidlala indima ebalulekile ekwandiseni amathuba okuthola abesifazane nge-HIV.
Ukuya esikhathini kanye neHIV
Ucwaningo luka-2015 oluvela kubaphenyi e-Dartmouth University Geisel School of Medicine lwaphakamisa ukuthi ushintsho lwe-hormonal ngesikhathi sokuhamba esikhathini esijwayelekile lunikeza i-HIV nezinye izifo ezithathelwana ngocansi (i-STIs) "ithuba lokuthelela".
Ukuzivikela komzimba, kokubili okungokwemvelo (kwemvelo) nokuguquguqukayo (okutholakala ngemuva kokutheleleka kwangaphambilini), kuyaziwa ukuthi ilawulwa ama-hormone. Ngesikhathi sokuya esikhathini, ama-hormone amabili ahlose ukwandisa izimo zokukhulelwa kanye nokukhulelwa-estradiol kanye ne- progesterone- kuthinta ngokuqondile amangqamuzana e-epithelial, fibroblasts (amangqamuzana atholakala ezinhloboneni ezixhumeneyo), namaseli omzimba ahambisana ne-FRT.
Ngokwenza njalo, ukuphendula kwamagciwane okunciphisa umzimba kuyancipha, futhi ingozi yokuthola i-HIV yanda kakhulu.
Uma kuqinisekisiwe, ukucwaninga kungasiza ukuvula indlela yokwelapha okungcono ngcono umsebenzi olwa namagciwane kanye / noma ukuthinta imikhuba yobulili (okungukuthi, ukukhomba izikhathi eziphephile zokulala nobulili) phakathi nalokhu okuthiwa "iwindi lithuba."
Ukunqamuka kokumisa kanye neHIV
Ngakolunye uhlangothi, esinye isifundo se-2015 esikhungweni sezokwelapha sase-University of Pittsburgh sesiphakamise ukuthi izinguquko ku-FRT zingabangela ingozi eyengeziwe yegciwane lesandulela ngculaza kumama-post-menopausal.
Kuyaziwa ukuthi umsebenzi wokuzivikela omzimba wegciwane lesandulela ngculaza ngokushesha uyanqamuka ngokushesha ngesikhathi nangemva kokuya esikhathini, ngokunciphisa izicubu ze-epithelial nokuncipha okuphawulekayo emkhakheni we-mucosal. (I-mucosa, eyaziwa ukuthi iqukethe i-spectrum yama-antimicrobial, isekelwa yimfihlo evela ku-FTR engenhla ehlinzeka ngokuvikela okuphansi emkhakheni wezansi ophansi.)
Abacwaningi baqasha abesifazane abangaba ngu-165-kuhlanganise nabesifazane be-postmenopausal; abesifazane besandulela ngculaza hhayi ngezokwelapha; kanye nabesifazane ngokuvimbela ukuvimbela isandulela-ngculazi nokulinganisa i-HIV ngokuqhathanisa uketshezi oluthile olutholakala ngokunisela. Ukusebenzisa izivivinyo zokuhlola eziqondene ne-HIV, bathole ukuthi abesifazane basemuva-besilisa babenomsebenzi omncane wokulwa negciwane lesandulela ngculaza "wemvelo" (11% vs 34%) kunamanye amaqembu amabili.
Nakuba iziphetho zilinganiselwe ukuklanywa kobucayi nosayizi, kuphakamisa ukuthi izinguquko ze-hormonal ngesikhathi nangemva kokuya esikhathini sokumisa kungabeka abesifazane asebekhulile ekwandeni ingozi ye-HIV. Ngakho-ke, kugcizelelwe kakhulu kufanele kubekwe emfundweni ephephile yezocansi kwabesifazane asebekhulile, kanye nokuqinisekisa ukuthi i- HIV kanye nezinye izifo ze-STI azigwemeki futhi azibambezeli.
Ukwelashwa kwe-hormonal kanye neengozi ye-HIV
Ubufakazi bokuthi izisu zokuvimbela i-hormonal zingandisa ingozi yowesifazane we-HIV iye engavumelani, kungaba ngomlomo noma ngezidakamizwa zokulawula ukubeletha. Ukuhlaziywa okunamandla kwezibalo ezingu-12-okuyisishiyagalombili okwenziwa kubantu abaningi kanye nabangu-4 phakathi kwabesifazane abengozi kakhulu -kubonise ukwanda okulinganiselwe, okwenyuka kwegciwane lesandulela ngculaza kulabo abasebenzisa i-acetate ye-depot medroxyprogesterone (DPMA, aka Depo) -Provera ).
Kwabesifazane kubantu abaningi, ingozi yabonakala ibe encane.
Ukuhlaziywa, okubandakanya abahlanganyeli abangaphezu kuka-25 000 besifazane, akubonisi ubudlelwane obubonakalayo phakathi kokukhulelwa komlomo kanye nengozi ye-HIV.
Ngenkathi idatha ibhekwa njenganele ngokwanele ukuphakamisa ukusetshenziselwa ukusetshenziswa kwe-DPMA, abacwaningi bayeluleka ukuthi abesifazane basebenzisa ama -jectject progestin-kuphela kuphela mayelana nokungaqiniseki ngokuphathelene ne-DPMA ne-HIV, futhi ukuthi bakhuthazwe ukusebenzisa amakhondomu nokuhlola amanye amasu okuvikela I-HIV pre-exposure prophylaxis (i-PrEP ).
Imithombo:
> Chappell, C .; Isaacs, C .; Xu, W .; et al. "Umphumela Wokunqamuka Kwesisu Ngomsebenzi Wokuvimbela Ukuvimbela Umkhuhlane Wase-Anti-Viral Umsebenzi Wokuhlanzwa Kwe-Cervicovaginal." Journal American of Obstetrics and Gynecology. Mashi 20, 2015; I-DOI: http://dx.doi.org/10.1016/j.ajog.2015.03.045.
U-Ralph, uL .; UMcCoy, uS .; I-Shiu, K .; et al. "Ukusetshenziswa kokuvimbela ukwelashwa kwe-Hormonal kanye Nengozi Yabesifazane Yokutholakala kwe-HIV: Ukuhlaziywa Kwe-Meta-Analysis of Studies Observational." Izifo ezithathelwanayo zeLancet. NgoJanuwari 8, 2015; 15 (2): 181-189.
I-Wira, i-C.; U-Rodriguez-Garcia, uM .; kanye nePatel, M. "Indima Yezolimo Zama-Hormone Ekuvikelweni Ngokuzivikela Emzimbeni Wendlela Yokukhiqiza Kwabesifazane." Ukubuyekezwa Kwemvelo Immunology . Mashi 6, 2015; 15: 217-230.