Ukulinganisela Ubudlelwano Phakathi Kwezindleko Nokunakekelwa Kwekhwalithi
Izifundo eziningi zamuva azizange zibheke kuphela izindleko zokuphila kwegciwane lesandulela ngculaza kodwa ukusebenza kwezindleko ngezikhathi ezahlukene zokutheleleka.
Esinye isifundo esinjalo esivela e-US Centers of Disease Control and Prevention (CDC) sihlose ukulinganisa izindleko zokuphila kwe-HIV-kokubili kubantu abaqala ukwelashwa kwe-antiretroviral (ART) ekuqaleni ( isibalo se-CD4 samaseli angu-500 / mL noma ngaphansi) nalabo abaqala ngasekupheleni kwesikhathi (200 amaseli / mL noma ngaphansi).
Imiphumela iqinisekisile ukuthi yiziphi izifundo ezincane eziye zaphakamisa isikhathi eside: ukuqala kokuqala kwama-ART okuhambisana nezindleko zokuphila okuphansi kakhulu.
Ngokusho kocwaningo, kulabo abaqala ukwelashwa ngezibalo eziphakeme ze-CD4, izindleko ezilinganiselwayo zokuphila zingu-250,000. Ngokuphambene nalokho, labo abaqala ngamangqamuzana angu-200 / mL noma ngaphansi kungenzeka basebenzisa kabili lelo nani-kusuka kuphi phakathi kuka-$ 400,000 no-$ 600,000.
Phakathi kwezizathu ezichazwe izindleko eziphakeme yingozi enkulu yokwelashwa okuhlobene ne-HIV kanye nokungenayo i-HIV kulabo abanamasosha omzimba okwehlisiwe. Ngaphezu kwalokho, amathuba okuthi umuntu uzokwazi ukubuyisela amandla omzimba kumazinga aseduze-okuvamile (isib. Ama-CD4 amanani angu-500-800 amangqamuzana / mL) abe yinto encane esikhathini esizayo emva kokuqala ukwelashwa.
Ukuhlaziywa okubukeka okuvela ku-Weill Cornell Medical College kwasekelwa ngokuqhubekayo neziphetho. ukulandelela abantu abanesandulela ngculazi baneminyaka engama-35 kuze kube sekufeni.
Ngenkathi izindleko zokwelashwa kulabo abaqala ukwelashwa ekuxilongweni ($ 435,200) zaziphakeme kakhulu kunelabo abayephuza ukwelashwa ($ 326,500), ukusindisa ngokwezinkinga nokugwema izifo ezibucayi kwakubhekwa njengento enkulu.
Abaphenyi baphinde bakwazi ukuphetha ngokuthi isikhathi sokuphila esindleko sokugwema ukutheleleka ngegciwane lesandulela ngculaza kumuntu oyedwa kwakuphakathi kuka-$ 229,800 kuya ku-$ 338,400.
Ukubeka Izindleko Zesikhathi Sokuphila kwegciwane lesandulela ngculaza zibe ngeso lengqondo
Yize izindleko zokwelapha zesikhathi sokuphila zingase zivele zivelele-ziphakamisa izindleko zezidakamizwa ze-HIV noma izindleko zezempilo zaseMelika-kubalulekile ukubheka izindleko maqondana nezinye izinto eziphathekayo zezempilo.
Ngokwesibonelo, cabanga ukuthi isilinganiso sokuphila sokubhema komuntu oneminyaka engu-24 ubudala, u-$ 183,000, kanti owesifazane oneminyaka engu-24 ubudala angalindela ukuchitha u-$ 86,000. Ngaphandle kwezindleko zegwayi ngokwabo, izindleko zezenhlalakahle zeMediare, Medicaid, Social Security, kanye nomshuwalense wezempilo kubonakala sengathi zikhulu kakhulu-kungakhathaliseki ukuthi ukuyeka ukubhema , ukuphefumula komdlavuza, umdlavuza wamaphaphu, njll.
(Lezi zibalo zithuthukiswa ukuthi ukubhema, njengesici esizimele, kuyaziwa ukunciphisa isikhathi sokuphila okungenani iminyaka eyi-12.3 kubantu abane-HIV.)
Ngesikhathi esifanayo, izindleko zokuphuza utshwala ezintathu ngosuku zifika kumaRandi angu-263,000 emangalisa impilo yonke, ehambisana nengozi engama-41% yomdlavuza emadodeni, kungakhathaliseki ukuthi une-HIV noma i-HIV.
Izindlela Zokuqeda Izindleko
Akukho okunye kulokho okuhloswe ngakho ukwehlisa umthelela wezezimali we-HIV, kokubili kumuntu ngamunye kanye nesistimu yezempilo yonkana.
Ngombono womuntu ngamunye, izindleko zokunakekelwa kwegciwane lesandulela ngculazi zihlobana ngokuqondile nendlela isiguli esigcinwa ngayo ekunakekeleni nokuthi ukuthi lowo muntu angakwazi kanjani ukunamathela ekwelapheni okunqunyiwe. Emhlahlandlela wabo kaMeyi 2014 wezinkombandlela zezokwelapha ze-US, i-Mnyango WezeMpilo kanye Nezinsizakalo Zabantu (DHHS) ikhulume ngalokhu okukhathazayo ngokuncoma ukuthi odokotela "bancishiswe izindleko ezihlobene nezidakamizwa ezingekho emphakathini uma kunokwenzeka."
Lokhu kufaka phakathi ukusetshenziswa kwezidakamizwa ezivamile uma kunokwenzeka noma kunengqondo. Noma kunjalo, isinqumo kufanele sihambisane nokuhlola ngokucophelela ukuthi izindleko ezincishisiwe zingakwandisa umthwalo wepilisi kumguli.
Ezimweni ezinjalo, ukusetshenziswa kwama-generics kunganciphisa izindleko zomhlaba jikelele kodwa ngenxa yokunamathela kwesiguli . Ngaphezu kwalokho, izingxenye ezijwayelekile zomuthi wezidakamizwa eziningi zingabangela umshwalense ophezulu wokukhokhela umshwalense, okwandayo kunokunciphisa izindleko ezingaphandle kwezindleko.
Ngendlela efanayo, i-DHHS inconywe ukunciphisa izinga lokuqapha kwe-CD4 iziguli eziye ku-ART okungenani iminyaka emibili futhi zinezinkinga ezingavamile ezingavamile. Nakuba lokhu kubonakala sengathi kungathinteki kakhulu ngokuhambisana nokubiza okuyizindleko zangempela, izivivinyo ezihambisana ne-CD8 ne-CD19, empeleni, ziyabiza; akukho cishe okungenani inani lomtholampilo; futhi akukhuthazwa njengenkambo yokunakekelwa kwe-HIV ephethwe.
Kulabo abaye babonisa ukukhishwa kwegciwane lesikhathi eside ku-ART, i-DHHS njengamanje iphakamisa lokho
- Ukuqapha kwe-CD4 kwenziwa njalo ezinyangeni ezingu-12 kulabo abanezibalo ze-CD4 phakathi kuka-300 no-500 amaseli / mL, futhi;
- Ukuqapha kwe-CD4 kubhekwa njengokhetho kulabo abanezibalo ze-CD4 ezingaphezu kwamangqamuzana angu-500 / ml.
Ngokweziqondiso, izibalo ze-CD4 ziqondisa lapho ziqala noma zimisa ukwelashwa kwe-prophylactic eklanyelwe ukuvimbela izifo ezithatha amathuba , noma ukuhlola ukuthi isifo sengculazi sempendulo ye-immunological yanele yini. (Impendulo "eyaneleyo" ichazwa njengokwanda kwe-CD4 count ngamasenti angu-50 kuya kwangu-150 phakathi nonyaka wokuqala wezokwelapha, okukhulisa okufanayo njalo ngonyaka kuze kutholakale isimo esifanele.)
Ngokuphambene, ukuhlolwa kwe-viral load kufanele kuthathwe njenge-barometer eyinhloko yokwenza impatho. Ngenxa yalokho, i-DHHS iphakamisa ukuqapha kwegciwane lesandulela ngculaza njalo ezinyangeni ezingu-3-4 ezigulini ezinokucindezela okuqhubekayo, okunomsoco we-virus.
Imithombo:
Farnham, P .; I-Gopalappa, iC .; Isihlengo, S .; et al. "Ukubuyekezwa Kwezindleko Zesikhathi Zokuphila Zokunakekelwa Nezinga Lokuphila Lokulinganiselwa Kwabantu Abathintekayo Nge-HIV e-United States: Ukuhamba Ngesikhathi Esizayo Nokuthola Ukuhlolwa Okuqala Nokungena Ekunakekelweni." I-Journal ye-Immune Deficiency Deficiency Syndromes. Okthoba 2013: 64: 183-189.
Schackman, B .; Fleishman, J .; Su, A ..; et al. "Ukulondolozwa kwezindleko zezokwelapha zesikhathi esigcwele zokuvimbela i-HIV e-United States." Ingqungquthela ka-2015 nge-Retroviruses kanye nezifo ezithinta amathuba (CROI). Ngo-February 23-26, 2015; Seattle, Washington, abstract 1104.
UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). "Imihlahlandlela yokusetshenziswa kwama-Antiretroviral Agents ku-HIV-1-Adult Adult and Adolescents." I-Bethesda, e-Maryland; kufinyelelwe uMeyi 6, 2016.