Ososayensi nabenzi beNqubomgomo bavumela ukuqala ngokushesha kwe-HIV Ukwelashwa Kwabo Bonke
Kukhona impikiswano emide phakathi kwabenzi bomgomo, abacwaningi, kanye nabahlengikazi ngokufanayo ukuthi ukuqala ukwelashwa kwe-HIV ngesikhathi sokuxilongwa kungase kube nezinzuzo kumguli, kokubili ngokwempilo engcono yesikhathi eside kanye nokugwema kokubili i-HIV-futhi engekho Izifo ezihlobene neHIV.
Ucwaningo oluphawulekayo olwakhululwa yi- New England Journal of Medicine ngo-July 20, 2015 lwalubeka impikiswano ngokuphetha ngokuthi ukwelashwa ngokushesha ngeke kunciphise amathuba okugula nokufa ngamaphesenti angu-57 kodwa kungakhathaliseki ukuthi uneminyaka yobudala, ubuhlanga, ubulili, umthamo wegciwane lesandulela ngculazi , indawo yomhlaba, isimo sezomnotho noma isimo se-immune (njengoba kulinganiswa nalokho okubizwa ngokuthi i-CD4 count).
Ngaphambi kokucwaninga, ukwelashwa kwama-antiretroviral (ART) kunconywa lapho inani le-CD4 yomuntu liwela ngaphansi kombuthano othize (ngokuvamile ngaphansi kwamaseli angu-500 / mL noma, kwamanye amazwe, ngaphansi kwama-350 cells / mL).
Ucwaningo olusha-olubizwa ngokuthi iSikimu Esiyisisekelo se-Antiretroviral Therapy (START) lwecala-lwaklanywa ukuthi ngabe ukwelashwa kuma-CD4 aphakeme kungabonisa imiphumela engcono yezempilo ngaphandle kokwandisa ingozi yesiguli yezinhliziyo ezinesifo senhliziyo, izinso noma ezinye izifo ezingenayo i-HIV.
Qala ukuklama kokufunda kanye nemiphumela
Imiphumela yokuqala yokugcina yecala le-START, eyethulwa kwiNgqungquthela Yonyaka ka-2015 Yengculazi eVancouver yiDkt. Jens Lundgren weCopenhagen HIV Programme, yayilindelwe kakhulu ngemuva kokumenyezelwa ngoMeyi ukuthi lolu cwaningo luzoqedwa ngaphambi kwesikhathi ngenxa yobufakazi obunzima izinzuzo ezinhle.
Ucwaningo olwenziwe ngo-2009, lwaqasha amadoda nabesifazane abangu-4,685 abane-HIV emazweni angu-35 emazweni angu-35, okubalwa kuwo wonke ama-CD4 amanani amangqamuzana angama-500 / mL. Iminyaka yobudala yayineminyaka engama-36, kuyilapho 27% yabahlanganyeli bebesifazane.
Iziguli zahlukaniswa zaba amaqembu amabili: eyodwa lapho i-ART yaqala khona ngokushesha futhi enye i-ART eyabuyiselwa kuze kube yilapho inani le-CD4 lomuntu liwela ngaphansi kwama-350 cells / mL noma kube nokuthuthukiswa kokugula okunzima okuhlobene ne-AIDS noma ukufa.
Ngesikhathi sokuqedwa kwesifundo, imicimbi engama-50 ehlobene ne-AIDS ephawulekayo phakathi kwengalo elandelwayo yocwaningo, cishe izikhathi ezine ngaphezu kokuphawula phakathi kweziguli ezinikezwa i-ART esheshayo (14). Ngokufanayo, kwakukhona izenzakalo ezingathí sina ezingezona ezesandulela ngculazi (29) ezingaphezu kokuphindwe kabili kunokuba zibonwe ngokushesha (i-ARM).
Isifo sofuba, i- lymphoma ne- Kaposi sarcoma (KS) yizenzakalo ezintathu ezihlobene kakhulu ne-AIDS ezitholakala kubathintekayo, kanti 62% kulabo abahlanganyeli base-Afrika. Izenzakalo ezingathí sina ezingezona ezengculazi kwakuyinhloko yomdlavuza , isifo senhliziyo (CVD) nokufa.
Ngesiqhema, iningi lezenzakalo ezimbi zabonwa kuziguli ezindala, okungase kubonakale kunengqondo zinikezwa amazinga aphezulu omdlavuza kanye ne-CVD phakathi kwabantu abadala asekudala. Okumangalisa ukuthi ukubhema kwakungabonakali ukushintsha imiphumela, okuphakamisa ukuthi i-ART esheshayo yayizuzisa kakhulu abantu ababhema kunabangabhemi.
Mhlawumbe ukutholakala okungavamile kunazo zonke kwakungenzeka ukuthi lezi zenzakalo ezimbi zazingekho phakathi kweziguli ezinama-CD4 aphansi, njengoba kulindeleke, kodwa phakathi kwalabo abanezibalo eziphakeme ze- CD4. Ngesikhathi abacwaningi behluleka ukuchaza ngokugcwele imiphumela, lokho okufunyenwe kubhekane nezifundo zangaphambilini ezaziphakamisile ukuthi izibalo ze-CD4 zodwa azikwazi ukunikeza isithombe esigcwele sokukhubazeka komzimba komuntu.
Enkulumweni yakhe, uDkt. Lundgren ufuna ukucwaninga ngezindlela ezintsha zokuqapha ukuzivikela komzimba ukuze ziqonde kangcono izindlela zalezi zenzakalo ezihlobene nesandulela ngculazi.
KUQALA Ucatshangelwa Umzuzu Ochaza Ngayo Ucwaningo Lwe-AIDS
Icala lokuqala le-START laqala ukubaluleka ngo-2011 lapho esinye isifundo, i-HPTN 052, sibonisa ukuthi ukuthatha i-ART ngokuphawulekayo kwanciphisa ingozi yokudlulisa igciwane kumuntu onegciwane lesandulela ngculazi kumlingani ongathinteki ocansini-isu elibizwa ngokuthi i- Treatment njenge-Prevention, noma I-TASP .
Ngenxa yale miphumela emibili, abaholi eNgqungqutheleni ka-2015 IAS bakhipha isitatimende okuthiwa iVancouver Consensus, bememezela ukuthi "(bonke) abantu abaphila negciwane lesandulela ngculaza kumele bathole ukwelashwa ngezidambisigciwane uma bexilongwa."
Ngesikhathi abaholi bevuma izithiyo eziningi ekusetshenzisweni kokusebenza-okungenani okungenani kuhlanganisa ukukhushulwa kwezigidi eziyizinkulungwane eziyisishiyagalolunye zamaRandi eziyizigidigidi ezivela emazweni abalingani bomhlaba wonke kanye namazwe abanikeli-baqinisa leli qhinga bangakwazi "ukuqeda" isifo sengculazi njengoba siyazi ngokuqala ngo-2030.
Lapho ekhuluma ngemiphumela ye-START, uKatts Thomson we- Global Fund wamemezela ukuthi lolu cwaningo lubekwe "isikhathi esichazayo" empini yokulwa ne-HIV, enye esabona izifo ezintsha ezingaphezu kwezigidi ezimbili kanye nokufa kwezigidi ezingu-1.2 ngonyaka.
Imithombo:
I-INSIGHT START Study Group. "Ukuqaliswa Kwethemishana Ye-Antiretroviral In HIV Early Infection." I-New England Journal of Medicine. Julayi 20, 2015; I-DOI: 10.1056 / NEJMoa1506816.