Ukuthi Ukwelashwa Okuyisithathu Kwashintsha Kanjani Ubhubhane Lwe-HIV
I-HAART yizwi elibizwa ngokuthi "ukwelapha okulwa negciwane lesandulela ngculaza," igama elihlanganisiwe ngasekupheleni kweminyaka yama-1990 ukuchaza ukusebenza kwezinto zokwelashwa ezihlangene ezisebenzisa ukuphatha i-HIV.
Ngaphambi kwe-HAART, ukusebenzisa imithi eyodwa noma emibili ye-antiretroviral bekuyekelelwe ukuphumelela kwiziguli ezine-HIV, okuholela ekuhlulekeni kokwelapha okusheshayo kanye nokungakwazi ukuvimbela ngokugcwele umsebenzi wegciwane.
Kwakukhona ukwethulwa kwama-protease inhibitors ngo-1996 ukuthi odokotela bakwazi ukuhlanganisa amanxusa amathathu noma ngaphezulu kwezidakamizwa ngendlela eyenza ukuthi i-HIV iqede ukuphindaphinda ngamaphuzu ahlukene emjikelezweni wayo wokuphila. Lapho kufika i-HAART, odokotela kanye nososayensi bakwazi ukufaka ukwehla okudabukisayo kwe-50% kwinani lezifo ezihlobene ne-AIDS e-US naseYurophu ngesikhathi seminyaka emithathu (1995-1999).
Ngaphezu kwe-HAART, indlela eminingi yezidakamizwa nayo yaziwa ngokuthi "ukwelapha kathathu" noma "i-cocktail kathathu yezidakamizwa."
Namuhla, leli gama liye lafakwa ezinye izikhonkwane, kuhlanganise neKART (inhlanganisela yokwelashwa ngezidambisigciwane) noma, ngisho nangaphezulu, i-ART (ukwelashwa kwama-antiretroviral).
Isebenza kanjani i-HAART
Ngokuphambene nomuthi oyedwa noma izidakamizwa ezimbili zomuthi, inhlanganisela ye-antiretroviral emithathu noma ngaphezulu ingasebenza njengethimba lamathegi, igweme ngokuphumelelayo izinhlobo ezihlukahlukene ze- HIV ezingaba khona phakathi kwabantu abanegciwane elilodwa.
Uma isidakamizwa esisodwa singakwazi ukuvimbela uhlobo oluthile lwegciwane, omunye noma bobabili omunye u-agent bazoba ngaphezu kokungenza kanjalo.
Kanti, ngokugcina inani legciwane lesandulela ngculaza likhungathekile ( lingabonakali ), kunezindlela ezimbalwa zokujikeleza amagciwane egazini futhi ambalwa amathuba okuthi igciwane lingene ekucindezelweni kokumelana.
Yingakho izindlela zokwelashwa zangaphambi kwe-HAART zivame ukwehluleka ngokushesha: izibalo ezincane eziguquguqukayo zavunyelwa ukuphikelela futhi ekugcineni zandise kwinombolo ukuze zibe yinkinga enkulu yegciwane lesandulela ngculaza. Uma lokhu kwenzeka, izidakamizwa azisekho ukukwazi ukuvimbela i-HIV ekuphenduleni, isimo esichaza ngokuthi "singamelana nezidakamizwa."
Izidakamizwa ezisetshenziswa ku-HAART
Kukhona okwamanje amakilasi amahlanu omuthi we-antiretroviral , okuyilowo nalowo okuvimbela isigaba esithile kumjikelezo wokuphila nge-HIV:
- ukungena noma ukuhlanganiswa kwe-fusion (okubandakanya abaphikisi be-CCR5)
- i-nucleoside ne-nucleotide reverse transcriptase inhibitors (i-NRTI / i-NtRTI)
- ama-non-nucleoside reverse transcriptase inhibitors (i-NNRTI)
- integrase inhibitors
- protease inhibitors
Ezinye izigaba ze-antiretrovirals ziyaphenywa, kanti izidakamizwa ezintsha zenzalo zihlose ukuthuthukisa ukubekezelelana, ukunciphisa imiphumela emibi futhi lula ukulandelela kulabo abakwelashwa.
Ikusasa le-HAART
Ngaphezu kokuhlinzekela ukucindezelwa okuqhubekayo kwegciwane lesandulela ngculaza kubantu abathintekayo, i-HAART isetshenziselwa njengendlela yokuguqula izinga lokutheleleka emiphakathini eminingi engcupheni. Isu, esaziwa njenge- reatment njenge-prevention (TasP) , liboniswe ukunciphisa "umthamo wegciwane lomphakathi" ngaphakathi komphakathi, okwenza kube nzima kakhulu ukudlulisa igciwane kumuntu onegciwane kumuntu ongenalo igciwane.
Ngaphezu kwalokho, i-HAART ikhonjisiwe ukunciphisa ingozi yokuthi izifo ezihlobene ne-HIV-nezingahlolelwa i-HIV (kubandakanya umdlavuza kanye nesifo senhliziyo) okungenani ngo-58% uma ziqala ngesikhathi sokuxilongwa. Ngenxa yalokho, manje kunconywa ukuthi i-HAART iqaliswe kubo bonke abantu abanesandulela ngculaza , kungakhathaliseki isimo se-immune, imali, indawo, ubuhlanga, noma umthamo wegciwane lesandulela ngculaza.
Umqondo we-HAART nawo ungashintsha ngokuthuthukiswa kwama -agent e-antiretroviral yezidakamizwa ezihlala isikhathi eside (okungenzeka ukuvumela ukujola njalo ngenyanga noma ngekota) nezidakamizwa ezilandelayo ezihlose ukwehlisela i-cocktail yesidakamizwa esilandelayo emidlalweni embalwa nje.
Izivivinyo ezimbili ezinkulu zeSigaba III, ezibizwa ngokuthi i-SWORD-1 ne-SWORD-2, zibonisa ukuthi ukusetshenziswa kweTivicay (dolutegravir) ne-Edurant (rilpivirine) kwabangele ukucindezelwa okunamandla kwamaviki angu-48 ngemiphumela emibi kakhulu. Esinye isilingo esincane, esibizwa ngokuthi isifundo se-LAMIDOL, sibonise ukuthi i-Tivicay esetshenziselwa i-lamivudine (isidakamizwa esizukulwaneni esidala) yayikwazi ukufezekisa imiphumela efanayo ezigulini eziphathwa ngaphambilini.
Imithombo:
> Sansone, G. kanye neFrengley, J. "Impumelelo ye-HAART emibangela yokufa kwabantu abane-AIDS-Stage-Stage." I-Journal ye-Urban Health. Juni 2000; 77 (2): 166-75.
> Cohen, M .; I-Chen, i-Y .; UMcCauley, uM .; et al. "Ukuvimbela ukutheleleka nge-HIV-1 nge-antiretroviral yokuqala yokwelapha." I-New England Journal of Medicine. Agasti 11, 2011; 365 (6): 493-505.
> I-INSIGHT START Study Group. "Ukuqaliswa Kwethemishana Ye-Antiretroviral In HIV Early Infection." I-New England Journal of Medicine. Julayi 20, 2015; I-DOI: 10.1056 / NEJMoa1506816.
> Llibre, J .; Hung, C .; Brinson, C .; et al. "Isigaba III SWORD 1 & 2: ukushintshela ku-DTG + RPV igcina ukususwa kwe-virologic ngama-48 wks." Ingqungquthela ka-2017 nge-Retroviruses kanye nezifo ezithinta amathuba (CROI); Ngo-February 13-16, 2017; Seattle; abstract 44LB
> Joly, V .; Burdet, C .; I-Landman, i-R .; et al. "Imiphumela ethembisayo ye- dolutegravir > + maintenance ye-lamivudine ku-ANRS 167 > LAMIDOL > ukuhlolwa." Ingqungquthela ka-2017 nge-Retroviruses kanye nezifo ezithinta amathuba (CROI); Ngo-February 13-16, 2017; Seattle; abstract 458.