I-Immune Recovery iyashintsha kusuka kumuntu ukuya kumuntu
Inani le- CD4 lichazwe, ngokumane nje, njengendlela yokukala amandla omzimba omzimba ophila ne-HIV. Luhlolo olusetshenziselwa kokubili ukuqapha ukuqhubekela phambili kokutheleleka ngegciwane lesandulela ngculazi nokubikezela umphumela okungenzeka (ukubikezelwa) kwalesi sifo.
Ukuqonda Ukubala kwe-CD4
Phakathi kwezimpendulo zokuzivikela ngomzimba yizici ezikhethekile zegazi elibizwa ngokuthi i- CD4 T-cells , enenjongo yakhe enkulu ukuzwakala uqaphile lapho izifo ezihlasela izifo ezinjenge-HIV zikhona.
Okumangalisa ukuthi nawo amaseli afanayo ahloselwe ukutheleleka nge-HIV. Ngokuhamba kwesikhathi, uma kushiywa kungalashwa, i-HIV izothatha kancane kancane lawa maseli, ishiya isimiso somzimba sokuzivikela siphumelele futhi singakwazi ukuzivikela ngokuqhubekayo.
Isibalo se- CD4 singakwazi ukuhamba noma yikuphi okuzobhekwa njengokujwayelekile kumuntu ongathintekile (800-1500 amaseli / mL) lapho isistimu yomzimba yomuntu ibhekwa khona (ngaphansi kwama-200 amaseli / mL). Njengoba inani lehla liqhubekela phezulu ezingaphansi kwamangqamuzana angama-100 / mL, isengozini sokutheleleka okuyinhlobonhlobo enkulu yandisa ngokukhululeka.
Enye yemigomo ye- antiretroviral therapy (ART) ukubuyisela amandla omzimba omuntu one-HIV. Ngokuvimbela igciwane ukuba lingabhekiseli ngenkuthalo, i-ART iyasiza umzimba ukuthi uphumelele, uvuselele abantu base-CD4, ngokuvumelana namazinga avamile.
Kodwa, iqiniso liwukuthi, lokho akukwenzeka njalo.
Kwezinye izimo, ukwehluleka ukuvuselela ukusebenza komzimba kungumphumela oqondile wokunamathela kwezidakamizwa, okubandakanya ukulinganisa okungahambisani nalokhu noma okungalungile.
Uma umsebenzi wegciwane uvunyelwe ukuphikelela futhi umthamo wegciwane lesandulela ngculazi awubonakali ngokuphelele, ama-CD4 amangqamuzana angaphinde aphelelwe amandla, alahlekise imigomo yokwelapha.
Kodwa kuthiwani uma umuntu ehambelana ngokugcwele futhi engakakwazi ukuthola isibalo sawo se-CD4? Ingabe lokhu kusho ukuthi izidakamizwa azisebenzi? Ingabe lokhu kuyinkomba yokuthi ukwelashwa kufanele kushintshwe?
Ngokuvamile kunalokho, impendulo ayikho.
Izithiyo ekubuyiseni kwamaseli e-CD4 T
Ekugcineni, inhloso ye-ART ukuvimbela umsebenzi we-viral-ukunciphisa umthamo wegciwane lapho kungekho igciwane elitholakalayo egazini. Lokho kuyisenzo esiqondile salesi sidakamizwa kanye nento evame ukufinyeleleka kubantu abahlala benamatherapy.
Ngokuphambene, ukubuyiselwa kwe-T-cell kunomthelela omkhulu wokucindezelwa kwegciwane kune-ART ngokwayo. Izidakamizwa azikho izenzo ngqo kwi-CD4 count ngaphandle kokususa amagciwane abulala ama-T-cell. Lokhu kusho ukuthi ukutakula kungahlukahluka ngokumangalisayo kusuka komuntu kuya komuntu, ngokunye kuvuselela ngokushesha futhi ngokugcwele, kuyilapho ezinye zizinzile emazingeni aphansi kakhulu esikhathini eside.
Esinye sezimbangela eziyinhloko zalomphumela yi- CD4 nadir . I-nadir imane nje iphuzu eliphansi kunazo zonke ukuthi inani le-CD4 liye lahla ngaphambi kokungenelela kwenziwa. I-CD4 nadir ayikwazi kuphela ukubikezela amathuba okugula okuthize, njengezinkinga zobuchopho ezihlobene ne- HIV , ngokuvamile ikwazi ukubikezela ukuqina komzimba womuntu ngemuva kokuthola ukwelashwa.
Ngokuvamile, abantu abane-CD4 nedir ephansi kakhulu (ngaphansi kwamangqamuzana angu-100 / mL) bazoba nesikhathi esinzima kakhulu sokubuyisela umsebenzi wokuzivikela ngaphandle komuntu onokuthi, ukulinganisela ukucindezelwa kwamagciwane (ngaphezu kuka-350 amaseli / mL).
Yingakho i- ART manje isinconywa ngesikhathi sokuxilongwa kubo bonke abantu abane-HIV. Ngokuqala ukwelashwa ekuqaleni kunokuba kamuva, ithuba lokuzivuselela ngokugcwele kwamagciwane liphuthukisiwe kakhulu, njengoba kunethuba lokuthola isikhathi esivamile, sokuphila okunempilo .
Ukhathala kwe-HIV ne-T-cell
Ngesikhathi isibalo se-CD4 sehlele ngaphansi kwamangqamuzana angama-100 / mL, isimiso somzimba sokuzivikela samasosha sizobe sichazwe eminyakeni noma ngisho neminyaka emingcele yomonakalo, kokubili ngokuvuvukala okuqhubekayo okubangelwa ukutheleleka ngegciwane lesandulela ngculazi kanye nokulimala okuqondile kwamathisini namaseli yi-virus ngokwayo.
Kuyilo sikhathi ukuthi umphumela okuthiwa ukukhathala kwe-T-cell kungenzeka.
Ukukhathala kwamangqamuzana e-T kungenye yemiphumela yokutheleleka okunzima noma kwesikhathi eside, lapho isakhiwo kanye nekhodi yezofuzo zamaseli ziguqulwa ezingeni lemangqamuzana. Ngokuhamba kwesikhathi, ama-T-cell alahlekelwa amandla abo okusebenza nokuvimbela ukuqhubeka kwesifo.
Ngenkathi ukukhulelwa kwe-T-cell kuhlotshaniswa ngokuyinhloko namaseli e-CD8 T-cell-cell "cells killer" amaseli "omsizi" we-CD4-manje sesiyazi ukuthi ama-CD4 T-cell angase ahlushwe kabi.
Yini engingayenza ukuze ngithuthukise ukubala kwami kwe-CD4?
Izici zokubuyiswa komzimba omzimba kubantu abane-HIV ziningi futhi zihlukahlukene. Ayikho indlela eyodwa ongayithatha ngaphandle kokuhlala unamathele ku-ART futhi ugcine imithwalo engavamile engavamile.
Akunamakhemikhali noma ama-agent (okubandakanya izithako zokudla okunomsoco , imithi ephelele, amavithamini, noma okuthiwa "ama-immune boosters") anomthelela wokuhlanganisa kabusha kwe-CD4 T-cell. Naphezu kokusikisela okunye, akukho isifundo esiye sahlanganisa nanoma yimuphi ummeleli womlomo noma ojojayo ukuze kuthuthukiswe izibalo ze-CD4.
Ngalokho kuthiwa, ukukhetha okuhle kokuphila kungabalulekile emiphumeleni yomuntu, kungakhathaliseki ukuthi unegciwane lesandulela ngculaza noma cha. Ukuzivocavoca okufanelekile , ukudla okunempilo, ukuyeka ukubhema nokuncipha kotshwala kudla bonke banikeza izinzuzo eziqinile kubantu abane-HIV, noma ngabe inani le-CD4 yomuntu lihamba kahle ngaphansi kwamazinga avamile.
Uma unamathele ekwelashweni futhi unomthwalo ophezulu wegciwane-ngisho nokuphikelela, umsebenzi osezingeni eliphansi-khuluma nodokotela wakho. Kungase kusiphakamise ukuthi uthuthukisa ukumelana nezidakamizwa ze-HIV . Ezimweni ezinjalo, ukwelashwa kungadinga ukuguqulwa.
Kodwa-ke, abantu abanegciwane eliphethwe ngokugcwele kanye nezibalo ze-CD4 eziqhubekayo akufanele zishintshe i-ART ngokusekelwe ekucabangeni ukuthi kuzokwenza ngcono imiphumela ye-CD4. Ukushintsha kufanele kwenziwe kuphela uma kwenzeka ukwehluleka ukwelashwa noma ngenxa yemiphumela emibi yokwelashwa.
Kanjani Ngokujwayelekile Ngibheke Ukubala Kwami I-CD4?
Imikhombandlela yamanje iphakamisa ukuthi izibalo ze-CD4 zihlolwe ngokususelwa ekutheni umuntu angakwazi ukufeza futhi alondoloze umthamo wegciwane elingenakutholakali, kanje:
- Kubantu abasanda kutholakala, ukuhlolwa kwe-CD4 kufanele kwenziwe ngaphambi kokuqala i-ART, kuphindwe izinyanga ezintathu emva kokuqala ukwelashwa, bese kuthi emva kwezinyanga ezintathu kuya kwezinyanga eziyisithupha.
- Kulabo ababe be-ART okungenani iminyaka emibili futhi bebenemithwalo egazini engavamile, izivivinyo kumele ziphindwe njalo njalo ezinyangeni ezingu-12 kulabo abanezibalo ze-CD4 phakathi kwama-300 no-500 amaseli / mL. Kulabo abanama-CD4 amanani amangqamuzana angama-500 / mL, ukuqapha i-CD4 kufanele kuthathwe njengokuzikhethela.
Imithombo:
Crawford, C .; Angelosanto, J .; Kao, C .; et al. "I-Molecular and Transcriptional Basis ye-CD4 + T Cell Dysfunction ngesikhathi Sokugula Okungapheliyo." Ukungakhulelwe. Februwari 20, 2014; 40 (2): 289-302.
I-Negredo, E .; I-Massanella, M .; I-Puig, i-J .; et al. "I-Nadir CD4 T Cell Count njenge-Predictor kanye ne-High CD4 T Cell Intrinsic Apoptosis njengeMigomo Yokugcina Ye-CD4 T Cell Recovery Empofu Emaphilweni Aphethwe Ngculazi Aphethwe Ngculazi: Imiphumela Yomtholampilo." Izifo Ezithathelwanayo Emitholampilo. 2010; 50 (9): 1300-1308.
UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). " Imihlahlandlela yokusetshenziswa kwama-Antiretroviral Agents ku-HIV-1-Adult Adult and Adolescents." Bethesda, Maryland.