Impilo Engcono, Ingozi Ephansi Yokudluliselwa Kwezingozi Phakathi Kwezinzuzo
Ngo-September 30, 2015, i-World Health Organization (WHO) ivuselele imihlahlandlela yayo yokwelashwa ye-HIV yonke ukuze iphakamise ukuqaliswa ngokushesha kwe- antiretroviral therapy (ART) ngesikhathi sokuxilongwa.
Kuze kube yamuva, kube khona impikiswano eqhubekayo phakathi kwabenzi bomgomo nabacwaningi mayelana nokuthi i-ART kufanele iqaliswe ngokushesha noma ibaleke kuze kube yilapho isikhathi isiguli somzimba sesiguli siwela ngaphansi kwesibalo esithile senombolo (njengoba kulinganiswa nomthamo we- CD4 womuntu).
Abasekeli be-ART esheshayo babhekisela emininingwaneni ebonisa ukuthi ukungenelela kwangaphambi kwesikhathi kwehlisa umonakalo wesikhathi eside i-HIV ingabangela isistimu yomzimba yomuntu-umonakalo ongase ukwandise amathuba okugula isikhathi eside. Abaqapheli baxwayisa ukuthi kwakungekho bufakazi bokuthi ukuqala i-ART ngaphezu kwesibambiso samanje njengamanje (ukubalwa kwe-CD4 ngaphansi kwamangqamuzana angu-500 / mL) kunanoma yiliphi inani langempela kwimithelela yesifo noma isikhathi sokuphila kwesiguli.
Ushintsho lwenqubomgomo ye-WHO luzophindaphinda kabili inombolo inani labantu abadinga i-ART, kusukela manje ezigidini ezingu-15 kuya ku-HIV emhlabeni wonke wezigidi ezingu-37.
ISIFUNDO SOKUQALA Shintsha Ukuguqula Inqubomgomo Yomgomo We-HIV
NgoMeyi 27, 2015, ososayensi e-National Institute of Allergies and Infectious Disease (NIAID) ekugcineni bafaka impikiswano ehlala isikhathi eside ukuphumula ngokuqeda Isikhathi Sesikhathi Sokulwa Ne-Antiretroviral Treatment (START) ngaphezulu konyaka ngenxa yokusula ubufakazi bokuthi ukwelashwa ngokuxilongwa, kungakhathaliseki ukuthi i-CD4 count, kwaba nenzuzo enkulu ezigulini ezine-HIV.
Ucwaningo olwalubhalisile amadoda nabesifazane abathintekayo abane-HIV abaneminyaka engu-18 ubudala nangaphezulu, lwaluhloswe ukuphetha ekupheleni kuka-2016 kodwa lwaphelelwa yisikhathi lapho imiphumela yesikhashana ibonisa ukunciphisa okungama-53% inani lezifo ezimbi phakathi kwalabo abaphethwe ngokushesha lapho bebhekene nalabo abane-ART eyasheshayo.
Ukuthola kwakungaguquguquki kuzo zonke izingalo zokutadisha, ngabe iziguli zazivela emazweni aphezulu, aphansi noma aphakathi kwamaphesenti.
Ekuphenduleni, ososayensi nabenzi bomgomo bakhipha isitatimende esisemthethweni ngoJulayi 19, 2015, babheka i-Vancouver Consensus, efuna ukuqaliswa ngokushesha kwe-ART kuzo zonke iziguli. Esitatimendeni sabo, leli qembu lichaze izizathu zokuthi i-ART ekuxilongweni yanikezwa imiphumela engcono kwiziguli ezine-HIV.
Ukwelashwa Kwangaphambili Kunciphisa Umthelela Wokuvuvuka Kwesikhathi Eside
Ngaphambi kokuhlolwa kwe-START, abacwaningi abaningi babeqaphele ngokuphatha i-HIV uma behlaselwa njengezinga lokufa kwabagulayo abaqala i-ART ngaphezu kwezibalo ezingama-CD ezingama-350 cells / mL babenempilo efanayo yokuphila njengabantu abaningi. Kungani bephikisana, kufanele sibeke engozini yokubhekana nokuhlukunyezwa okungalindelekile lapho siqala ngezibalo eziphakeme ze-CD4 asikhokhisi inzuzo eyengeziwe ngokulandela isandiso sokuphila?
Ngokwezisekelo zokufa kuphela, lokho kungase kubonakale kungukuphikisa okulungile. Ngokuqondene nokugula kwangempela, noma kunjalo, amaqiniso akhuluma ngokuhlukile.
Ngenkathi noma yikuphi ukutheleleka, umzimba uzoba nesiphetho sokuvuvukala phambi kwesikhungo esiphelele njenge-HIV. Uma kushiywe kungalashwa, ukuqhuma okuqhubekayo, ukuvuvukala okuqhubekayo kungabangela ukulimala okungenakuqhathaniswa kwamaseli kanye nezicubu zomzimba.
Ngenxa yokuthi igciwane lesandulela ngculazi yisifo esingapheliyo, ngisho nokuphikisana okuphansi okuqhubekayo, kungabangela ukuguga kwangakapheli kwamangqamuzana -waziwa njenge- senescence engakapheli noma "ukuvuvukala" -ukuthi ama-akhawunti amazinga aphezulu enesifo senhliziyo namanomdlavuza kubantu abane-HIV, Eminyakeni engu-15 ngaphambili kunabalingani abangenalo igciwane.
Ngisho nabantu abane-genetic resistant to HIV-eyaziwa ngokuthi "abalawuli abakhulu" -imiphumela yokuvuvukala okungapheli imiphumela emibi kakhulu kanye nesilinganiso esiphakeme sezifo uma kuqhathaniswa nabantu ngabanye kuma ART abanegciwane eliqediwe ngokuphelele .
Kulula nje, ngokubeka umuntu ku-ART ezinyathelweni zokuqala zokutheleleka , ulondoloza lowo muntu impembelelo engadingekile yokuvuvukala okuhlobene nesifo esingaphenduliwe.
Ukulahla kuvumela kuphela ukuvuvukala ukuphikelela, ukungahloli, noma kuphi kusukela phakathi kweminyaka engu-5-10.
Izidakamizwa Ezintsha Zinikezela Ngokweqile, Ukuphikiswa Okuthuthukisiwe
Izimpikiswano eziningi ezihlobene nokutholakala kwezidakamizwa zesikhathi eside zisekelwe ekuhlangenwe nakho okubonwe ngezidambisigciwane zangaphambili, lapho ukusakazeka okuvame ukuholela emthelela omubi ongalindelekile esigulini.
Izidakamizwa ezinjenge-stavudine, njengesibonelo, zibonwe ukuthi zenza amanani aphezulu ezidakamizwa ezidakamizwa ezigulini, kusukela ku- lipodystophy (ukusabalalisa okungaqondakali kwamafutha omzimba) kuya kwe- neuropathy (umonakalo obuhlungu emangqamuzaneni wamangqamuzana) kuya ku-lactic acidosis (okungase kusongele ukuphila ukwakheka kwe-lactic acid).
Ngokufanayo, eziningi ze-antiretrovirals zangaphambili zazinamaphrofayli amancane okuphikisa izidakamizwa. Ukusetshenziswa kwe- nevirapine ekwenzeni i-monotherapy, ngokwesibonelo-umkhuba omfushane ngo-2002 ukuvimbela ukudluliselwa komama ukuya komntwana- okutholakala emazingeni aphezulu wokuphikiswa kwe-nevirapine, ngezinye izikhathi ngemuva kwesilinganiso esisodwa.
Lezi zinto ezikhathazayo ziye zanciphisa izidakamizwa ezishaya izizukulwane ezintsha, ezingabanikeli kuphela amaphrofayili omzimba ophansi kodwa amancane imithwalo yemithwalo yemiphilisi kanye "nentethelelo" enkulu (okungukuthi ikhono lokugcina amazinga omuthi wokwelashwa ngisho nangabe ukuphuza okungahle kwenzeke).
Ngaphezu kwalokho, ukwesaba mayelana nokuxilongwa kwezidakamizwa ezidluliselwayo -ukuphikiswa komuntu oyedwa kuya kwesinye-kuye kwaqedwa kakhulu, njengoba idatha yamanje evela kwi-World Health Organization iphakamisa izinga lokumelana nokukhishwa kwama-7% emazweni aphansi kuya kwaphakathi. cishe isigamu esabonakala e-US naseYurophu).
Emazweni aphezulu engenayo, ukumelana nezidakamizwa ezidluliselwayo kuvame ukuhlobene nezidakamizwa ezizukulwaneni zangaphambilini ezazisungulwa kulabo bantu eminyakeni engu-10-15 ngaphambi kwalokho emazweni amaningi asathuthuka.
Ucwaningo olunjalo luye lwabonisa ukuthi ukuvuthwa kwe-HIV emazweni aphansi angenayo , lapho kutholakala khona ukutheleleka kokutheleleka, kuncane kakhulu ngenxa yokuthi, ikakhulukazi, ngenxa yokuthi abantu abambalwa bebekwe ukwelashwa kuqhathaniswa ne-US neYurophu.
Ukwelashwa Ngokuxilongwa Kunganciphisa Ukusakazeka kwe-HIV
Ukwelashwa njenge-Prevention (TasP) kuyindlela yokuvikela ehlose ukunciphisa okuthiwa "umthamo wegciwane lomphakathi" ngokubeka iqembu labantu ku-ART. Ngokwenza kanjalo, amathuba okudluliswa kwe-HIV anciphisa kakhulu njengoba abantu abaningi bekwazi ukugcina ukucindezelwa okuphelele kwemisebenzi yegciwane .
Isu ngokuyinhloko lisekelwa ubufakazi obuvela eSan Francisco, idolobha elabonile ukuhlaselwa kuka-30-33% ekutheleleni kwegciwane lesandulela ngculazi kusukela ngo-2006-2008 ngenxa yokusabalalisa kabanzi kwezidambisigciwane. Ngokusekelwe kulezi ziphumo, izikhulu zedolobha zaletha inqubomgomo ye-ART ekuxilongweni ekuqaleni kuka-2010.
Ngokufanayo, isifundo se-2015 esivela esifundazweni saseHenan saseChina sabonisa ukuthi ingozi yokudluliselwa emibhangqweni ye-serodiscordant (okungukuthi, umlingani owodwa we-HIV kanye nomlingani oyedwa ongenawo igciwane lesandulela ngculazi) wehla ngo-67% kusukela ngo-2006-2009 njengoba cishe u-80% Abalingani abanegciwane lesandulela ngculaza babekwe ku-ART.
Ekusebenziseni inqubomgomo yomhlaba wonke ye-ART ekuxilongweni, izikhulu zezempilo eziningi zikholelwa ukuthi ukuzuza okufanayo kungenziwa ngisho nasezindaweni eziphakeme kakhulu ezifana neNingizimu Afrika, lapho izinga lamasha lokutheleleka liqhubeka likhula naphezu kokubhaliswa kwe-ART okwandayo.
Kungakhathaliseki ukuthi iziphathimandla zomhlaba zingakwazi ukufeza lezi zinhloso ezinikezwe ngemali eqhubekayo yezimali ezivela ezizweni ezinomnotho we-G8 kungenye indaba. Ngabantu abangaphezu kwezigidi ezingu-35 abanesandulela-ngculazi namuhla-futhi cishe abayizigidi ezingu-13 ku-ART-inselelo enkulu ingase yande ukwelashwa emazweni lapho izikhungo zengqalasizinda zezempilo zivame ukungaqiniseki, okungcono.
Imithombo:
Izikhungo Zempilo Zikazwelonke (NIH). "Ukuqala Ukwelashwa Kwe-Antiretroviral Kuqala Kwenyusa Imiphumela Yabantu Abathintekayo Nge-HIV." I-Bethesda, e-Maryland; ikhishwe ngoMeyi 27, 2015.
Hasse, B,; Ledergerber, B .; U-Egger, M., et al. "Ukuguga kanye (okungezona-okuhlobene ne-HIV) Ukubambisana nabantu abane-HIV: Isifundo seSwitzerland Cohort (SHCS)." I-18th Conference kwi-Retroviruses kanye nezifo ezithathelwanayo (CROI). IBoston, eMassachusetts; Februwari 27-Mashi 2, 2011; abstract 792.
I-Pantazis, i-N .; Porter, K .; I-Costagliola, D .; et al. "Amathrendi Okwesikhashana Emakhakheni Okuthungatha Okungenayo i-HIV-1 Virulence and Transmissibility: Isifundo Sezinhlangano Zokuqapha." I-Lancet HIV. December 2015; 1 (3): e119-126.
Smith, K .; I-Westreich, i-D .; U-Liu, H .; et al. "Ukwelashwa Ukuvimbela Ukudluliswa Kwegciwane Lesandulela Ngculazi Emibhangqweni YaseSerodiscordant eHenan, eChina, ngo-2006 kuya ku-2012." Izifo Ezithathelwanayo Emitholampilo. Ngo-Mashi 13, 2015; i-pii: i-civ200. [I-Epub ngaphambi kokuphrinta].
I-Human Sciences Resource Council (HSRC). "Inhlolovo yokuHlala kweSandulela-ngculazi yaseNingizimu Afrika, iNingizimu Afrika kanye noKuziphatha, 2012." EPitoli, eNingizimu Afrika; ikhishwe ngoDisemba 1, 2012.