Naphezu kokuthuthuka, ukukhubazeka phakathi kwabesifazane abane-HIV kuhlala kungashintshi
Abantu abanesandulela ngculaza banengozi ephakeme yokuthuthukisa ezinye ze-khansa, eziningana zazo ezingahlukaniswa njengezimo ezichaza i-AIDS. Phakathi kwabo kukhona umdlavuza womlomo wesibeletho (invasion) womdlavuza womlomo wesibeletho (ICC), isigaba sesifo lapho umdlavuza usakazeka ngaphezu komlomo wesibeletho kuya emathisini ajulile omlomo wesibeletho kanye nezinye izingxenye zomzimba.
Nakuba i-ICC ingahlakulela kokubili abesifazane abanegciwane lesandulela ngculazi nabangenalo igciwane lesandulela ngculaza, isenzakalo phakathi kwabesifazane abane-HIV singaba sikhulu ngokuphindwe kasikhombisa.
Kulaba besifazane abanesandulela ngculazi, ingozi ye-ICC ibonakala yanda ngokuncipha kwinani le- CD4 , ngokukhuphuka okuphindwe kasithupha kwabafazi abanezibalo ze-CD4 ngaphansi kwama-200 amaseli / mL uma kuqhathaniswa nalabo abanezibalo ze-CD4 ngaphezu kwamangqamuzana angu-500 / mL.
Mayelana nomdlavuza wesibeletho
I-papillomavirus yabantu (i-HPV) ibhekwa njengengxenye ekuthuthukiseni umdlavuza womlomo wesibeletho, ukubalwa cishe wonke amacala aqoshiwe. Njengezo zonke i-papillomaviruses, i-HPV isungula ukutheleleka kwamangqamuzana athile esikhumba kanye namagqabunga e-mucosal, eziningi zazo ezingenabungozi.
Ezingu-40 izinhlobo ze-HPV eyaziwa ukuthi zisakazwa ngokocansi futhi zingabangela izifo ezungeze i-anus nezitho zangasese, ngezikhathi ezithile zibonakala njengama-warts. Kulezi, izinhlobo ezingu-15 "ezinobungozi obukhulu" zingaholela ekuthuthukiseni izilonda ezinempilo. Uma ishiywe ingalashwa, izilonda ezinqandekile ngezinye izikhathi zingathuthuka emdlalweni wesibeletho somlomo wesibeletho. Ukuqhubekela phambili kwezifo kuvame ukuhamba kancane, kuthatha iminyaka ngaphambi kokuba izimpawu ezibonakalayo zikhule. Kodwa-ke, kulabo abanamasosha omzimba ahlaselwe (CD4 engaphansi kuka-200 amaseli / ml), ukuqhubeka kungase kube ngokushesha kakhulu.
Ukutholakala kokuqala ngendlela yokuhlola i-Pap smear ejwayelekile kuye kwancipha ngokuphawulekayo izifo zomdlavuza wesibeletho eminyakeni yamuva, kanti ukuthuthukiswa kwemigomo ye-HPV kuye kwaholela ekunciphiseni okuqhubekayo ngokuvimbela izinhlobo ezinobungozi obuphezulu ezihlobene namaphesenti angama-75 emdlavuza wesibeletho.
Ukuqhathaniswa kwe- HPV ukusabalala kwabesifazane base-US ngamaphesenti angu-26.8 kanti amaphesenti angu-3.4 anesifo se-HPV esengozini enkulu engu-16 no-18, okuyi-akhawunti engama-65% wegciwane lesandulela ngculaza.
Umdlavuza wesibeletho kwabesifazane abane-HIV
Naphezu kwale ntuthuko, umdlavuza womlomo wesibeletho usabhekwa njengomdlavuza wesibili ovamile kubantu besifazane emhlabeni jikelele, kubalwa cishe abangaba ngu-225 000 abafa njalo ngonyaka. Nakuba iningi lamacala libonakala ezweni elithuthukayo (ngenxa yobuthakathaka bokuhlolwa kwe-Pap nokugonywa kwe-HPV), umdlavuza womlomo wesibeletho usaqhubeka nokufa cishe abangaba ngu-4 000 eMelika minyaka yonke.
Ngokuphathelene nokunye okwamanje ukuthi izifo zomdlavuza womlomo wesibeletho phakathi kwabesifazane abanegciwane lesandulela ngculaza ziye zahlala zingashintshi kusukela kokuletha ukwelashwa kwama-antiretroviral (ART) ngasekupheleni kwawo-1990. Lokhu kuhluke kakhulu ku- Kaposi's sarcoma kanye ne-non-Hodgkin lymphoma, kokubili izimo ezichaza i-AIDS eziye zawela ngamaphesenti angaphezu kuka-50 ngesikhathi esifanayo.
Nakuba izizathu zalokhu zingaqondakali ngokugcwele, isifundo esincane kodwa esifanele isikhungo se-Fox Chase Cancer eFiladelphia sikisela ukuthi abesifazane abanesandulela ngculazi bangakwazi ukuzuza emigodlweni ye-HPV evame ukusetshenziswa ukuvimbela izinhlobo eziningana zegciwane (izinhlobo ezingu-16 18). Phakathi kwabesifazane abanesandulela ngculaza, izinhlobo ezingu-52 no-58 zivame ukubonakala, zombili zazo zibhekwa njengengozi enkulu futhi zingenakuthola okukhethwa kwamanje okugoma.
Izimpawu Zomdlavuza Wesibeletho
Kuvame ukuba nezimpawu ezimbalwa kakhulu ezinyathelweni zokuqala zomdlavuza wesibeletho .
Eqinisweni, ngesikhathi ukuphuma kwegciwane kanye / noma ukuxhumana nokuphuma kwegazi kwenzeka-izimpawu ezimbili ezivame ukuphawula-kungenzeka ukuthi isifo esibi sesivele sithuthukile. Ngesinye isikhathi, kungase kube nesisindo sangasese, kanye nokukhulelwa kwamagciwane, ubuhlungu be-pelvic, ubuhlungu obuphansi besisu, nobuhlungu ngesikhathi sokulala ngokocansi.
Ezigabeni eziphambili zesifo, ukuphuma kwegazi okwesibindi, ukulahlekelwa isisindo, ubuhlungu be-pelvic, ukukhathala, ukuphelelwa yifiso, kanye nokuphuka kwamathambo yizimpawu eziqashelwa kakhulu.
Ukuxilongwa Ngomdlavuza Wesibeletho
Nakuba ukuhlolwa kwe-Pap smear kunconywa ngezinjongo zokuhlola, amanani angamanga angalungile angaba ngaphezu kwama-50%. Ukuqinisekiswa komdlavuza womlomo wesibeletho noma i- dysplasia yomlomo wesibeletho (ukuthuthukiswa okungavamile kwamaseli umshini wesibeletho) kudinga i-biopsy yokuhlolwa ngumuntu we-pathologist.
Uma i-dysplasia yomlomo wesibeletho iqinisekiswa, ihlukaniswa ngokususelwa ekungenikeni kokuqina . I-Pap smear classifications ingahluka kusuka ku- ASCUS (amangqamuzana angama-atypical squamous okungenakuqinisekiswa) kuya ku- LSIL (i- lower -grade grade squamous intraepithelial lesion) ku- HSIL (i-high-grade squamous intraepithelial lesion). Amangqamuzana noma izicubu eziphathekayo ngokufanayo zihanjiswa ngendlela elula, ejwayelekile noma enzima.
Uma kukhona ukulimala okuqinisekisiwe, kubalwa ngesiteji sesifo esekelwe ekuhlolweni kwesilonda kwesiguli, kusukela ku-Stage 0 kuya eSiteji IV kanje:
- Isigaba sesi-0: I- carcinoma in situ (ukulimala okwenziwe okwamanje okungakafiki)
- Isigaba I: Umdlavuza womlomo wesibeletho okhulile esibelethweni, kepha awusakazeli ngaphezu kwawo
- Isigaba II: Umdlavuza womlomo wesibeletho osakazekile, kodwa hhayi ngaphesheya kwezindonga zesikhumba noma ingxenye yesithathu engezansi kwesifazane
- Isigaba III: Umdlavuza womlomo wesibeletho osakaze ngaphezu kwezindonga zesikhumba noma isisindo esingaphansi kwesiswini, noma kubangele i-hydronephrosis (ukuqoqa umchamo ezinso ngenxa yokuvinjelwa kwe-ureter) noma ukungasebenzi kwezinso
- Isigaba IV: Umdlavuza womlomo wesibeletho osakaze ngaphesheya kwesikhumba kuya ezithombeni ezikude noma ezikude, noma uhilelekile izicubu ze-mucosal zesibindi noma i-rectum
Ukwelapha Umdlavuza Wesibeletho
Ukwelashwa komdlavuza wangaphambi komdlavuza noma umdlavuza womlomo wesibeletho kunqunywa ngokuyinhloko ngokubamba noma isiteji sesifo. Iningi labesifazane abane-dysplasia elincane (eliphansi-grade) dysplasia bazothola ukulungiswa ngokuzenzekelayo kwalesi simo ngaphandle kokwelashwa, okudingeka kube nokuqapha okujwayelekile.
Kulabo abadinga i-dysplasia, ukwelashwa kungadingeka. Lokhu kungathatha uhlobo lokubhujiswa kwamaseli nge-electrocautery, laser, noma cryotherapy (iqhwa lamaseli); noma ngokukhipha (ukususwa) kwamaseli ngokusebenzisa ukuchithwa kwe-electrosurgical (eyaziwa nangokuthi inqubo ende yokugada kagesi, noma i-LEEP ) noma i- conization (i-conical biopsy of tiscues).
Ukwelashwa komdlavuza womlomo wesibeletho kungashintsha nakuba kugcizelelwa kakhulu ekukhuliseni ukwelashwa kwemithi. Ukwelashwa kungathatha ifomu elilodwa noma okunye kwalokhu okulandelayo, ngokusekelwe ebucayi besifo:
- i-chemotherapy
- ukwelashwa kwemisebe
- izinqubo zokuhlinzwa, kuhlanganise ne-LEEP, conization, hysterectomy (ukususwa kwesibeletho), noma i-trachelectomy (ukususwa komlomo wesibeletho ngenkathi kulondolozwa isisu kanye nama-ovari).
Ngokuvamile, 35% yabesifazane abanomdlavuza wesibeletho bayoba nokuphindaphindiwe ngemuva kokwelashwa.
Ngokufa, amazinga okusinda asekelwe esigabeni sesifo ngesikhathi sokuxilongwa. Ngokuvamile, abesifazane abatholwe e-Stage 0 banamathuba angu-93 okuphila, kanti abesifazane eSiteshini IV banesilinganiso samaphesenti angu-16 okusinda.
Ukuvimbela Umdlavuza wesibeletho
Imikhuba yobulili ephephile yasendlini, ukuhlolwa kwe-Pap smear, kanye nokugoma kwe-HPV kubhekwa njengendlela ezintathu eziholela ekuvimbeleni umdlavuza wesibeletho. Ngaphezu kwalokho, ukuqaliswa kwe-ART ngesikhathi esifanele kubhekwa njengokubalulekile ekunciphiseni ingozi ye-ICC kubantu besifazane abane-HIV.
Ama-US Preventive Services Task Forces (USPSTF) njengamanje ancoma ukuhlolwa kwePap njalo eminyakeni emithathu kwabesifazane abaneminyaka engama-21 no-65, noma ngenye iminyaka emihlanu yabesifazane abaneminyaka engama-30 kuya ku-65 ngokubambisana nokuhlolwa kwe-HPV .
Okwamanje, ukugoma kwe-HPV okwamanje kunconywa kunoma yimuphi intombazane noma owesifazane osemusha oye waxhumana naye ngokocansi. IKomidi Elilulekayo Lokuzivocavoca (ACIP) lisikisela ukugonywa okujwayelekile kwamantombazane eneminyaka engu-11 kuya kweyishumi nambili, kanye nabesifazane abaneminyaka engama-26 abangakaze baqede noma baqede uchungechunge lokugoma.
Imithi emibili okwamanje ivunyiwe ukusetshenziswa: umuthi ophethwe yi-quadrivalent ongavimbela izinhlobo 6, 11, 16 no-18 (Gardasil) kanye nemigomo ye-bivalent engavimba ngokumelene nezinhlobo ezingu-16 no-18 (i-Cervarix). Ngamunye udinga uchungechunge lwezibhamu ezintathu ezinikezwe ngaphezu kwezinyanga eziyisithupha.
Ngenkathi imishanguzo ingakwazi ukuvikela kuzo zonke izinhlobo ze-HPV, abacwaningi esikhungweni se-Fox Chase Cancer baqinisekisa ukuthi abesifazane abane-HIV ngama-ART abanamathuba amaningi kakhulu okuba nezinhlobo ze-HPV ezinobungozi ezingama-52 no-58 ezingaphezu kwamalungu abo angaphathiswa. Lokhu kugcizelela ukuphikisana ukuthi i-ART yokuqala iyisihluthulelo sokuvimbela kokubili umdlavuza we-HIV ohlobene ne-HIV nabantu abangenayo i-HIV.
Izindlela zokwelapha ezizayo kanye namasu
Ngokuqondene namasu okuthuthukisa, izifundo zamuva ziphakamise ukuthi imithi ejwayelekile ebizwa ngokuthi i-antiretroviral, i-lopinavir (etholakala emthamo ohlanganisiwe wezidakamizwa i-Kaletra), ingakwazi ukuvimbela noma ngisho nokuguqula i-high grade grade dysplasia. Imiphumela yokuqala yabonisa izinga eliphakeme lokuphumelela uma lihanjiswa ngokuphindaphindiwe kabili-ukukhishwa kwansuku zonke ngaphezu kwezinyanga ezintathu.
Uma imiphumela ingaqinisekiswa, abesifazane bangase bakwazi ukuphatha ukwelashwa komlomo wesibeletho ekhaya ngomunye usuku, kanti labo abane-HIV bangakwazi ukuvimbela i-HPV njengengxenye ye-ART yabo evamile.
Imithombo:
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Adler, D. "Umthelela we-HAART we-HPV ephathelene nesifo somlomo wesibeletho." Ucwaningo lwe-HIV lwamanje. Okthoba 8, 2010; 8 (7): 493-7.
AmaDames, D .; I-Blackman, E .; Butler, R .; et al. "Ukutheleleka Kwesifo Sezinsana Zesifo Sezinsana Zase-Papillomavirus Emndenini Wase-High Risk phakathi Kwabesifazane Abanempilo Enamandla E-Virus-Virtual Women in the Bahamas." PLoS | Enye. NgoJanuwari 23, 2014; 9 (1): e85429. i-doi: 10.1371.
I-US Preventive Services Task Force (USPSTF). "Izinkinga Zezinsizakalo Ze-Preventive Services ze-US Zokuvimbela Amakhanda Amasha Amakhanda Okuhlola Ukuqapha I-Cancer: Ubufakazi bubonisa ukuthi ukuhlolwa komdlavuza kuphumelela." I-Rockville, e-Maryland; ikhishwe ngo-Mashi 15, 2013.
Amasevisi Okulawula Nokuvimbela Izifo (CDC). "Umuthi Wokuphefumula We-Papillomavirus Owenziwe nge-Quadrivalent Human: Izincomo zoMkhandlu Weluleka Emisebenzini Yokugoma (ACIP)." Ukubukezwa Kwamaviki Ukufa Kwempelasonto (MMWR). Mashi 23, 2007; 56 (RR02) .1-24.