Zombili izifo zokwelashwa ezihambisana ne-HIV ne-HIV eziboniswe ekwandiseni ingozi
Uhlobo lwe-2 lwesifo sikashukela luvame ukuhlotshaniswa nokutheleleka kwegciwane lesandulela ngculaza isikhathi eside, imbangela yalo okuye yaxhunyaniswa esikhathini esidlule ukusebenzisa imithi ethile ye- antiretroviral (ama-ARV) - ikakhulukazi "omdala" i- protease inhibitor- izidakamizwa zamagciwane njenge- Crixivan (indinavir) namandla aphelele I-Norvir (i-ritonavir) .
Ngenkathi kungacacile ukuthi imishanguzo ye-ARV inikela kangakanani, siyazi ukuthi ingozi yesifo sikashukela yomuntu ophila negciwane lesandulela ngculazi kaningi isekelwe eziningana ezibangela izinto, kubandakanya:
- Iminyaka yobudala (ngokuvamile engu-40 nangaphezulu)
- Umlando womndeni
- Ukukhuluphala
- I-Hepatitis B (HBV) ne- hepatitis C (HCV) coinfection
- Umfutho wegazi ophezulu
- I-cholesterol ephakeme
- Ukukhulelwa kwamanje
- Ubuhlanga (ama-Asian, ama-American-American, amaSpanishi)
Eminyakeni yamuva, ucwaningo luye lwaphakamisa ukuthi kokubili ukuvuvukala okungapheli okuhlobene nokutheleleka kwesikhathi eside kanye nemithi engapheli esetshenziselwa ukuphatha izimo ezihlobene ne-HIV, empeleni ingakhuphula ingozi yesifo sikashukela.
Isifo sikashukela kanye nokuvuvukala okungapheli kwe-HIV
Ngisho noma ngabe i-HIV ihlala isikhathi eside noma igxiliwe ngokugcwele nge- antiretroviral therapy (ART) , ukutholakala kwegciwane elilindile kubangela impendulo eqhubekayo yokuvuvukala njengoba isistimu yomzimba yomzimba ishiywe ekuqaphelweni okuphezulu.
Ngesikhathi sokuvuvukala okungapheli okuhambisana negciwane lesandulela ngculaza, ezinye izimpawu zokuvuvukala okuthiwa i -protein-C esebenzayo (CRP) ne-interleukin-6 (i-IL-6) -yaziwa ukuthi iyanda. Ucwaningo lwakamuva lubonisa ukuthi ukukhuphuka kwalezi zimakethe kwandisa kakhulu amathuba okuba nesifo sikashukela kubantu abakwi-ART.
Ososayensi abanamaqembu e-INSIGHT SMART ne-ESPIRIT baphenye umphumela wesifo sikashukela phakathi kweziguli ezingu-3,695 ezinegciwane lesandulela ngculazi ku-ART eminyakeni engaba ngu-4.6. Isibalo sama-CD4 esiphezulu phakathi komhlanganyeli sabhekwa njengezinga eliphezulu ku-523 cell / mL.
Ngokusekelwe kwedatha, iziguli ezine-CRP ephakeme kanye ne-IL-6 zenzeka amathuba okuthuthukisa uhlobo lwesifo sikashukela sohlobo lwe-2, ngokuphindaphindiwe kwe-CRP kanye ne-IL-6 kusukela esisekelo esenza kube nengozi enkulu engama-20% no-33%, ngokulandelana.
Konke okukhulunywe ngakho, abantu abangu-137 bahlaselwe yisifo sikashukela ngesikhathi sokuvivinywa ngesilinganiso sika 8.18 ngonyaka weziguli-1 000.
Ngenkathi izingqinamba zendabuko zibonakala zifaka isandla ekwakhiweni kwesifo sikashukela phakathi kwabahlanganyeli bokucwaninga-kuhlanganise nenani eliphakeme lomzimba (BMI), iminyaka yobudala, i-hepatitis coinfection nezidakamizwa zesimanje-iqiniso lokuthi ngisho nokuvuvukala kwesibalo esingaphansi kungabonakala kubalulekile , ukuhlinzeka ngohlaka lokuhlonza kangcono abantu abasengozini enkulu yohlobo lwe-2 lwesifo sikashukela nokuqinisekisa ukungenelela okufanele ngaphambi kokuqala kwe-ART.
Isifo Sikashukela Sixhunywe Nge-Statin Ukusetshenziswa Kwezidakamizwa?
Enye ye-conundrum yokuvimbela isifo sikashukela kubantu abane-HIV ingumthelela wezidakamizwa ze-statin ekuthuthukiseni izifo. Izidakamizwa, ezisetshenziselwa ukwelapha i-lipids eliphezulu (ikakhulukazi i-LDL cholesterol ephakeme), zibhekwa njengezibalulekile ekugwemeni izifo zenhliziyo emphakathini lapho kungenzeka khona ukuhlaselwa kwenhliziyo cishe okuphindwe kabili komphakathi jikelele.
Kodwa-ke, ucwaningo olusha oluvela kwi-HIV Outpatient Study (HOPS) oluqhubekayo olubonisa ukuthi ukusetshenziswa kwezidakamizwa ze-statin kubantu abanesandulela ngculazi kungandisa ingozi yesifo sikashukela ngamaphesenti angu-10 njalo ngonyaka.
Ukuhlaziywa kweminyaka eyishumi, okwalandela iziguli ezingu-4,962 ezinegciwane lesandulela ngculaza kusukela ngo-2002 kuya ku-2011, kubheka izifo zohlobo lwesifo sikashukela phakathi kwabantu abanikezwa izidakamizwa ze-statin (590) ngokungafani nalabo ababengekho (4,372).
Ukulungisa imodeli yobudala, ubulili, ubuzwe, ukusetshenziswa kwama-ARV kanye ne-BMI, abaphenyi bakwazi ukuphetha ngokuthi ingozi yesifo sikashukela yanda kancane isikhathi eside.
Kodwa-ke, basheshe baqaphele ukuthi ukukhuphuka kwakuhlobene ngqo nokudala kanye ne-BMI ephakeme, kanye nobuhlanga / ubuhlanga (ngamazinga angama-50% aphezulu phakathi kwabantu abamnyama futhi ngaphezulu kabili phakathi kwe-Hispanics). Akumangalisi ukuthi, amacala ambalwa abikwa phakathi kweziguli ezincane, kanti umthelela we-protease inhibitors ubonakala ungenasibalo.
Kusukela ekuboneni okululekayo, abacwaningi be-HOPS banxusa kakhulu ukuthi i-statin "ingagwenywa uma kuboniswa ngemitholampilo" ngenxa yezinzuzo zabo ezibonisiwe zokuvimbela isifo senhliziyo. "
Ngakho-ke ngenkathi izidakamizwa ze-statin zihlala zibalulekile njengendlela yokunciphisa i-lipids kubantu abane-HIV, akufanele zisetshenziswe ngokwahlukana. Ukunciphisa impela ingozi kudinga indlela ephelele, okubandakanya ukudla okunciphise amafutha , ukuvivinya umzimba njalo , ukuqeda ukubhema , kanye nokuqaliswa kwe-ART ngesikhathi esifanele ukunamathela ngokuqinile ukuqinisekisa ukucindezelwa kwamagciwane (ukuze unciphise kangcono impendulo yokuvuvukala kwesifo esingenalo i-HIV).
Imithombo:
Béténé A Dooko, C .; De Wit, S .; Neuhaus, J .; et al. "I-Interleukin-6, iProtheni Ephakeme Yokwenza Ukuzwela C-Reactive, nokuthuthukiswa kohlobo lwe-2 lwesifo sikashukela Phakathi kweziguli ezithathelwana ne-HIV ezithatha ukwelashwa kwe-antiretroviral." I-Journal ye-Immune Deficiency Deficiency Syndromes. Disemba 15, 2014; 67 (5): 538-546.
Lichtenstein K .; AmaDebe, R .; Izinkuni, K. et al. "Ukusetshenziswa kwe-statin kuhlotshaniswa nesigameko soshukela esivela phakathi kweziguli esiFundweni seSandulela ngculaza." Ingqungquthela ye-20 ye-Retroviruses kanye nezifo ezithathelwanayo (CROI). Mashi 3-6, 2013; I-Atlanta, Georgia; abstract 767.
Freiberg, M .; Chang, C .; I-Kuller, L .; et al. "Ukutheleleka ngegciwane lesandulela ngculazi kanye nengozi ye-infarction eyingozi ye-myocardial." I-Journal of the American Medical Association (JAMA) Imithi yangaphakathi. Ngo-Ephreli 22, 2013; 173 (8): 614-622.