Imiphumela yimbi kakhulu kubantu abane-HIV
Nakuba izingozi zokubhema ziyaziwa kalula noma ubani okhanyisa ugwayi, cishe zibi kakhulu kubantu abaphila negciwane lesandulela ngculaza.
Cabanga, ngakolunye uhlangothi, ukuthi i- HIV ibangela ukuvuvukala okuqhubekayo okuguqula amazinga aphezulu kokubili kwegciwane lesandulela ngculazi kanye nokungenalo i-HIV. Manje engeza umthwalo wokubhema kanye nomthelela wayo emaphashini, enhliziyweni, nakwezinye izinhlelo zesitho, futhi kulula ukubona ukuthi kungani ugwayi namuhla ubhekwa njengengxenye enkulu ekuguleni nasekufeni kwangakabantu kubantu abanegciwane lesandulela ngculaza-ngisho nalawo ukwelashwa kwama-antiretroviral ngokugcwele.
Yini eyenza lokhu kube okunye okuphathelene nokuthi izinga lokubhema phakathi kwabantu abanesandulela ngculaza e-US liphindwe kabili kulo lonke labantu. Futhi nakuba izizathu zalokhu ziningi, esinye sezimbangela eziyinhloko ukuhluleka ukwelapha i-HIV njengesigaba sokunakekelwa okuyinhloko.
Ngokuvamile igciwane lesandulela ngculaza liphathwa ngokuzihlukanisa, kokubili iziguli nodokotela bavame ukubeka zonke izinyathelo zezempilo ezivimbela ohlangothini olulodwa. Ngakho esikhundleni sokufaka ukuyeka ukubhema eceleni kwendlela yokwelashwa nokuphathwa kwe-HIV, sigxila ekwenzeni umthamo wegciwane lesandulela phansi emazingeni angabonakali futhi ushiye inkinga yokubhema komunye usuku.
Asikwazi ukwenza lokho. Namuhla, ukutadisha ngemva kokutadisha kubonise ukuthi ukubhema akugcini nje ekunciphiseni izinga lokuphila kubantu abane-HIV, kwandisa ingozi yokugula ngisho nokudluliswa kwezifo.
1. Abantu abanegciwane lesandulela ngculaza belahlekelwa iminyaka eminingi ekubhemeni kune-HIV
Kungakhathaliseki ukuthi unesifo se-HIV noma cha, ucwaningo oluvela eNyuvesi yaseCopenhagen seluphelile ukuthi ukubhema njengengozi yokuzimela ozimele kuhlobene nokulahlekelwa ukuphila okungaphezu kweminyaka engu-12.3 uma kuqhathaniswa nabokubhema kubantu abaningi.
Ucwaningo olwalubandakanya abantu abangu-2 921 abane-HIV nabangu-10 642 abangenalo igciwane, baphinde baphetha ngokuthi izinga lokufa kwababhemayo abanegciwane lesandulela ngculazi laliphindwe kathathu kunelabo abangenalo igciwane.
Uma kuqhathaniswa nabokubhema nabangewona ukubhema abanegciwane lesandulela ngculazi, ukungafani kuya kuba mkhulu nakakhulu.
Ngokwalesi sifundo, isikhathi sokuphila somuntu oneminyaka engu-35 ubudala sokubhema ne-HIV sasiyiminyaka engama-62.6 uma kuqhathaniswa neminyaka engu-78.4 yomuntu ongabhemi ne-HIV-ukulahleka okungaphezu kweminyaka engu-16.
2. Ukubhema Kwenyuka Kakhulu Ingozi Yomdlavuza We-Lung
Umdlavuza we-emphysema kanye nomdlavuza wamaphaphu sekuyisikhathi eside uhlotshaniswa nokubhema ugwayi, futhi umthelela wayo kubantu abane-HIV kubonakala sengathi uyingozi nakakhulu kunalokho okucatshangwa ngaphambili.
Ucwaningo olukhulu oluqhutshwa uMnyango wezeMpi we-Veteran lwe-US lubheke izinga lomdlavuza wamaphaphu phakathi kwabangu-7,294 ababhemayo abane-HIV nabangu-75 750 ababhemayo ngaphandle kwe-HIV. Embikweni wabo, abacwaningi baphetha ngokuthi izinga lomdlavuza wamaphaphu laliphindwe kabili ekubhemeni kwesandulela ngculazi uma kuqhathaniswa nokubhema kwabantu abaningi, nokuthi kwakukhona ukwanda okumangalisa, okuphindwe ngama-14 emdlalweni wamaphaphu emaphaphu phakathi kwababhemayo abane-HIV.
Okubangela ukuthi lezi zibalo zikhungatheke nakakhulu ukuthi lokhu kwanda kwenzeka kungakhathaliseki ukuthi inani le- CD4 yomuntu, umthamo wegciwane lesandulela ngculaza , umlando wesifo, noma ngabe ngabe umuntu wayengaye yini ukwelashwa ngezidambisigciwane .
Izinga lokushona phakathi kwababhemayo abanegciwane lesandulela ngculazi nalo liphakeme, ngezinga elingamaphesenti angu-10 kuphela lokusinda komdlavuza wamaphaphu uma kuqhathaniswa namaphesenti angu-40 abantu ababhema kubantu abaningi.
3. Ingozi Yakho Yokuhlaselwa Yenhliziyo Ne-Stroke Iphindwe kabili
Kungakhathaliseki ukuthi ukubhema noma cha, isifo senhliziyo sisalokhu sikhathazeke kakhulu kubantu abane-HIV isikhathi eside. Ngokusho kwe-US Veterans Administration, ukubhema njengengozi yokuzimela kuyabandakanya ukukhuphuka kabili engozini yokuhlaselwa kwenhliziyo kubantu abane-HIV uma kuqhathaniswa nomphakathi jikelele.
Lokhu kubonakala kuyiqiniso ngisho nangabantu abaphumelele ukwelashwa kwama-antiretroviral (ART) , ngokucwaninga ngo-2016 ngabacwaningi eMassachusetts General Hospital baphetha ngokuthi i-ART kuphela ayanele ngokwehlisa ukuvuvukala okuphezulu okuhambisana nesifo senhliziyo.
Uma ungumuntu onesandulela ngculaza ophuza, imiphumela iyingozi nakakhulu, ingozi engaphezu kokuphindwe kabili kwesifo senhliziyo noma isifo sohlangothi uma kuqhathaniswa nabantu abane-HIV abangazange baphuze.
Kodwa lokho akusho ukuthi izinto azikwazi ukuguqulwa. Ucwaningo olufanayo luye lwabonisa ukuthi ngokuyeka ugwayi, ingozi yesifo senhliziyo esiphuthumayo ihlelwe cishe cishe isigamu phakathi neminyaka emithathu.
4. Ababhemayo abahlukumezekile Abathintekayo ngamakhansela omlomo wesibeletho nobandlululo
Umdlavuza womlomo wesibeletho, umdlavuza womlomo womlomo wesibeletho (ICC) , osekudala ubekwa njengesifo esichaza i-AIDS yizikhungo zokuLawula nokugula. Ngokufanayo, umdlavuza wesibeletho , obonakala njalo emphakathini jikelele, uvela emazingeni aphakeme ngokumangalisayo phakathi kwamadoda anegciwane lesandulela ngculaza abenza ubulili namadoda (MSM) .
I- papillomavirus yomuntu (i-HPV) ihlotshaniswa nomibili yalezi zomshukela, ngenkinga ethize "engozini enkulu" ekukhuthazeni ukuthuthukiswa kwezilonda zangaphambi komdlavuza-okungathi futhi, ingaqhubekela phambili ku-ICC nasezikhunjini zangaphambili.
Ukubhema akubonakali nje ukuguqula inkambo yemvelo ye-HPV nokwandisa ingozi yazo zombili lezi zifo, kuhlanganisa izinga lala makhankaso kubantu abanegciwane lesandulela ngculaza-ngokuphakama okuphindwe kabili engozini yomdlavuza wesibeletho kubesifazane kanye nokwanda kwama-40 engozini yomdlavuza wesibeletho ku-MSM uma kuqhathaniswa nomphakathi jikelele wase-US.
Ngaphezu kwalokho, ingozi yokuthuthukisa i-HPV yezimpawu (isib. Ama-warts anal, izilonda ezingaphambi komdlavuza) kubonakala sengathi ivutha kakhulu ngokubhema kubantu abane-HIV. Ucwaningo olwenziwa ngo-2013 oluvela kubacwaningi eNyuvesi yaseWashington e Seattle selusikisela ukuba kube nokuphakama okuphindwe kathathu kokutholakala kwe-HPV phakathi kwe-MSM enegciwane lesandulela ngculaza obhema ngokumelene ne-MSM enesandulela ngculazi engazange afune ukubhema.
5. Ukubhema kukhulisa ingozi yokudlulisela i-HIV kumntanakho
Kokubili emazweni athuthukile futhi athuthukayo, ukungenelela kwezokwelapha ukuvimbela ukudluliselwa kwegciwane lesandulela ngculaza (PMTCT) kuye kwaphumelela kakhulu.
E-US, lesi sigameko siye safika emazweni amasha angu-100 ngonyaka, kanti ngisho naseNingizimu Afrika-izwe elinenani eliphakeme kakhulu lokutheleleka ngegciwane lesandulela ngculaza emhlabeni wonke-sibonile izinga lokungena kwesilinganiso kusuka kumaphesenti angu-30 ngaphambi ukuqaliswa kwe-PMTCT ngo-2001 kuya kuma-2.7% kuphela ngo-2010.
Noma kunjalo, impumelelo ebonwayo esilinganisweni sabantu akubonakali okwenzekayo ngesinye isikhathi uma umama one-HIV ephuza. Uphenyo olukhulu oluqhutshwa abacwaningi eSifundweni Sezingane ZamaMama Nezingane Abantwana (Ucwaningo lweminyaka emine olwenziwe eBrooklyn naseBronx, eNew York) luphenye ukuthi kusho ukuthini ukubhema ngesikhathi sokubeletha kwe-HIV ngaphambi kokubeletha.
Lokho abakutholile ukuthi omama abakhulelwe abanesandulela ngculaza ababhemayo ngemuva kokuqala kwe-trimester bekhuphuka kathathu engozini yokudlulisela i-HIV ezinganeni zabo uma kuqhathaniswa nabalingani abangabhemi emva kokuqala kwe-trimester.
Lokhu kwenyuka kwakuhlotshaniswa nokuqhekeka kwangaphambili kwesikhumba. Ikakhulukazi kunomama abangazange baphathwe nge-HIV ngaphambi kokulethwa kwezidingo (noma bengenalo umthamo wegciwane elivinjelwe ngokugcwele ngenkathi belashwa), ukuphuka okunjalo kungandisa kakhulu amathuba okudlulisela ingane engakazalwa.
Imithombo:
I-Helleberg M .; U-Afzal, uS .; I-Kronborg, G .; et al. "Ukufa okubangelwa ukubhema phakathi kwabantu abanegciwane lesandulela ngculazi-1: isifundo somphakathi esivela kubantu abaningi." Izifo Ezithathelwanayo Emitholampilo. Mashi 2013; 56 (5): 723-734.
I-Sigel, K .; Wisnivesky, J .; Ubulungiswa, A .; et al. "Ukutheleleka nge-HIV kuyisici esiyingqayizivele somngcingo we-Lung Cancer." I-17th Conference kwi-Retroviruses kanye nezifo ezithinta amathuba (CROI 2010). I-San Francisco; NgoFebhuwari 16-19, 2010: Abstract 30.
I-Petoumenos, K .; Worm, S .; Hamba, P .; et al. "Izinga lezifo zenhliziyo ngemuva kokuyeka ukubhema kweziguli ezine-HIV: imiphumela evela kuD: A: D isifundo (*)." I-HIV Medicine. Agasti 2011; 12 (7): 214-421.
I-Minkoff, i-H .; Feldman, G .; I-Strickler, H .; et al. "Ubudlelwane phakathi kokubhema ne-Human Papillomavirus Infections kubesifazane abathintekayo ne-HIV abangenalutho." Journal of Infectious Diseases. 2004; 189 (10): 1821-1828.
Ukushisa, D .; I-Landesman, iS .; Muenz, L .; et al. Ukubhema Ukubhema, Ukukhishwa Kwemfucuza Ngaphambi Kokuqala, Nokudluliswa Okungenayo Kwe-HIV-1 Phakathi Kwabesifazane Abanamazinga E-CD4 +. " I-Journal of Immune Deficiency Deficiency Syndrome. Julayi 1994; 7 (7); ukushicilelwa ku-inthanethi