Izakhi zofuzo, ezitholakala emitholampilo nasezikhungweni zomuntu siqu Dlala Ingxenye Ekukhetheni Ngokuhlakanipha
Ngokuletha izidakamizwa ezintsha zokuzalwa , ukukhetha ukwelashwa okuhambisana ne-HIV kaningi kuvamile njengokukhetha eyodwa yansuku zonke, konke okukodwa kwithebhulethi ngokunye okunye kwansuku zonke, ithebhulethi yonke. Futhi kwezinye iziguli eziningi ezisanda kuphulukiswa, kulula njengokuthi-okudinga okungaphezu kokuhlolwa kwegazi ezimbalwa nokubuyekezwa okuphelele komlando wezokwelapha ukuze uqinisekise ukuthi iyiphi i-combo yezidakamizwa ezosebenza kangcono kuwe njengomuntu ngamunye.
Noma kunjalo, ukwenza isinqumo esifanele akuzona ngaso sonke isikhathi ngokulula. Nakuba isisombululo sonke-in-one njengo- Atripla , i- Complera noma i- Genvoya ingenza ukuphila kube lula kusukela ekubambeni kwezinto zokubheka, izakhi zofuzo, izifo noma izici ezivamile zivame ukuphakamisa ezinye izindlela zokwelashwa.
Ekugcineni inhloso yokwelashwa okunolwazi ukuhlinzekela ukwelashwa ngezifiso ukuze izidakamizwa zakho zisebenze iminyaka eminingi ngangokunokwenzeka ngemiphumela emibi kakhulu kanye nokucindezelwa okungagcini kwegciwane (njengoba kulinganiswa umthamo wegciwane lesandulela ngculaza ). Ukwenza kanjalo kudinga ukuhlola lezi zici ezilandelayo zokwelapha:
Izinhlobo Zezidakamizwa Ezikhethwe Ngokwelapha Okokuqala
Imikhombandlela yokwelashwa ishintshile kakhulu eminyakeni eyishumi eyedlule, isuka kwezinye izidakamizwa (noma amakilasi ezidakamizwa) ezaziwa ukuthi ziyingozi kakhulu noma zijwayele ukuthuthukisa ukumelana nezidakamizwa .
Emikhombandlela yamanje yase-US , kugcizelelwe kakhulu ekusetshenzisweni kwe-integrase inhibitors (ISTIs) ekulashweni kokuqala, ngezinhlelo ezine ezikhethwayo ezithandwayo ezihlanganisa izidakamizwa ze-ISTI i-darunavir (etholakala ku- Triumeq naseTivicay ), i-raltegravir (i-Isentress) noma i-elvitegravir (etholakala ku- Vitekta , Stribild , nase- Genvoya ).
Isizathu sesimo esikhethiwe sihlanganisa ukubekezelelana kangcono, imiphumela emincane yokwelashwa, kanye namaphrofayli amaningi okuphikisa okuthuthukisiwe (okusho ukuthi angakwazi ukunqoba noma yikuphi ukuphikiswa kwezidakamizwa ezandulele ukuthi igciwane lakho lingase libe nalo). Zonke izindlela zokwelapha ezithandwayo zithathwa ngokuphindaphindiwe nsuku zonke, ukuvuma ukuthi ukulula ukusetshenziswa kuyisici esibalulekile ekulondolozeni ukunamathela kokwelashwa okungcono .
I-Makeup Genetic ye-Virus yakho
Ayikho into efana neyodwa uhlobo lwegciwane lesandulela ngculaza. Esikhathini sokuthi ukwelapha i-HIV, igciwane lizoqhubeka liguquguquka njalo, okunye okwenza kube nokuphikiswa kwezidakamizwa. Njengoba le gciwane eliguquguqukayo lidlulile kusuka kumuntu kuya komuntu, ukumelana nakho kuyadluliselwa (isimo esibizwa ngokuthi ukuguqulwa noma ukuthola ukumelana).
Abaningi kwabayisithupha abasanda kutholakala e-US bayothola ukuphikisana okungenani igumbi elilodwa lemithi ye-HIV. Ukuphikisana kwezidakamizwa eziningi ezitholakalayo kubuye kuvamile.
Ukuze kuqinisekiswe ukuthi ukwelashwa kwakho komugqa wokuqala uyakwazi ukunqoba izithiyo ezinjalo, ukuhlolwa kofuzo (okuvame ukubizwa ngokuthi i-genotyping) kwenziwa ukuze ubone ukuthi yiziphi izinguquko ezithinta igciwane lakho nokuthi ngabe lezo zinguquko ziphikisa yini. Ukukhethwa kwezidakamizwa kusekelwe ekuhloleni ngokucophelela kwemiphumela ye-genotypic.
Ezisimweni ezilinganiselwe yimithombo lapho ukuhlukunyezwa kungenzi njalo, ukukhetha izidakamizwa kusekelwe ekuhloleni okufundisiwe (a) okuhlukile okuyaziwayo noma okunqatshelwe okukhona endaweni ethile futhi (b) izidakamizwa ezitholakalayo ezikwazi ukunqoba kangcono ukumelana nalokhu.
Izici ezingokoqobo nezengqondo
Ngokusobala, impilo yonke yesiguli ihola indlela ukwelashwa okuvame ukushiwo kubantu abane-HIV.
Isimo somzimba somzimba wesiguli (njengoba kulinganiswa isibalo se-CD4 ) singashukumisela ukusetshenziswa komuthi owodwa phezu komunye. Ezinye izimo zezokwelapha nazo zingabandakanyi ukusetshenziswa kwezinye izidambisigciwane, mhlawumbe ngoba izidakamizwa zingasusa isimo esivele sikhona noma kubangele ukuphazamisa izimpawu.
Phakathi kwezibonelo:
- Ukusetshenziswa kwe-tenofovir kunqatshelwe kubantu abanezinkinga ezinzima ze-kidney (renal) njengoba kungabangela ukwehluleka kwezinso kwezinye iziguli. Isimo esinjalo singase singabandakanyi ukusetshenziswa kwezidakamizwa ezine-tenofovir ezine-Viread, iTruvada, Stribild, Complera, ne-Atripla.
- Iziguli ezinenkinga yokucindezeleka, ukukhathazeka, isifo schizophrenia, ukucindezeleka kwe-bipolar, noma yisiphi esinye isimo esingathí sina kwengqondo / yengqondo singase sixwayiswe ngokusetshenziswa kwe-efavirenz, isidakamizwa esiyaziwa ukuthi sithinte ngqo uhlelo lwezinzwa (kubangela amaphupho acacile, izinkinga zokuhlushwa nokuphazamiseka kokulala) . Noma iyiphi yalezi zimo ingase ihluke ukusetshenziswa kukaSustiva kanye nomuthi we-efavirenz oqukethe i-Atripla.
- Abantu abanokukhubazeka kwesibindi (ehlanganisa labo abanesifo sofuba) kufanele bagweme noma yikuphi izidakamizwa ezingasusa isimo. Lokhu kubangelwa ukusetshenziselwa kwezidakamizwa kulezi zidakamizwa esibindi, okungaholela ekwakheni amakhemikhali anobuthi (isimo esibizwa ngokuthi i-hepatotoxicity). Ukusetshenziswa kwe-Aptivus (tipranavir) kunqatshelwe ezimweni ezinjalo, njengamanye ama-antiretroviral amanxeba ekubonakalweni okungathí sina kokwehluleka kwesibindi.
Ukusebenzisana kwezidakamizwa
Ukusebenzisana kwezidakamizwa kuyisimo esivamile esigulini sokwelashwa kwegciwane lesandulela ngculaza, kanti ukuxhumana okudinga ushintsho emthamo kanye nabanye kudinga ukuqeda i-HIV noma izidakamizwa ezihlobene.
Enye yezokuxhumana okuvame ukubandakanya izidakamizwa ezisetshenziselwa ukwelapha isifo sofuba (i-TB), ngaphandle kwama-molecule wezidakamizwa ezingekho ngaphansi kuka-13 okungahambisani nemithi ye-TB rifampin ne-rifapentine.
Ngokufanayo, izidakamizwa eziyi-12 ze-HIV azisetshenziswa kanye nezinye izidakamizwa ze-hepatitis C , ukusetshenziswa kwazo okuhlangene ukunciphisa ukusebenza nokuphumelela komunye noma kokubili izidakamizwa. Kuyafana nokusetshenziswa kwezidakamizwa ezinciphisa i-lipid i-Mevacor (lovastatin) ne-Zocor (simvastatin), okungafanele ithathwe yi-H.IV protease inhibitor yezidakamizwa zesigaba s .
Okumangalisa ukuthi mhlawumbe, ukwelashwa ngokweqile kwe-herbal St. John's Wort kunqatshelwe ukuthi kusetshenziswe yonke imishanguzo yegciwane lesandulela ngculaza njengoba kwaziwa ngokunciphisa kakhulu ukuhlushwa kwezidakamizwa egazini.
Kubalulekile ukuthi uhlale utshela udokotela wakho nganoma yiziphi izidakamizwa, kokubili okunqunyiwe futhi okungenqunyiwe, ukuthi uthatha ukuthi njalo noma cha.
Izindlela Zokuphila Nezinye Ukucabangela
Ukwelashwa kwe-HIV okwehlukanisiwe kucabangela indlela yokuphila komuntu nokuthi ukwelashwa kungathinta kanjani indlela yokuphila. Futhi ngokuvamile kuvama ukulula. Ngisho nasezinkantolo ezibonakala kakhulu "ezilula" -ukuthi, isibonelo, umsebenzi ongashintshi wokushintsha umsebenzi kungenza imiphumela yezinzwa ze-efavirenz ingenakulinganiswa-kunakekelwa okunye okumele kwenziwe ukuze kuqinisekiswe ukuthi ukwelashwa kufanelana nomqondo wesiguli wenhlalakahle njengoba imiphumela yomtholampilo.
Abesifazane abaneminyaka yobudala bezingane, isibonelo, kufanele banikwe iseluleko ngengozi ye-efavirenz ekuthuthukiseni ukukhula komntwana futhi kunqunywe ukwelashwa okunye uma kufanele kube khona ukukhulelwa.
Kuziguli ezikhulile, njengabantu abanamathuba amaningi okukhubazeka kwezinso, i-tenofovir ingathathwa indawo ukuze igweme ukukwazi ukuhluleka kwenkunzi.
Iziguli ezithinta imithi ye-methadone (esetshenziselwa ukwelapha izidakamizwa ze-opioid) zingabuye zeluleka ukuba zigweme i-efavirenz, kanye ne- Viramune (i-nevirapine) ne- Kaletra (lopinavir / ritonavir) , njengoba zinganciphisa ukusebenza kwazo zombili zokwelapha. Ngokuphefumula okufanayo, kucatshangelwa ukuthi kusetshenziswe ngokusetshenziswa kwezinketho zokwelashwa ezilula emphakathini lapho ukunamathela kokuhambisana okuvamile kuyinkinga.
Imithombo:
UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi (DHHS). "Imihlahlandlela yokusetshenziswa kwama-Antiretroviral Agents ku-HIV-1-Adult Adult and Adolescents." I-Rockville, e-Maryland; kufinyelelwe ngoFebhuwari 15, 2016.
U-Li, J .; Kim, D .; Linley, L .; et al. "Ukuhlolwa okubucayi kwembula ukungaqapheli kokubanzi kokuncintisana kwezidakamizwa ze-HIV." Ingqungquthela ye-2014 kwi-Retroviruses kanye nezifo ezithinta amathuba (CROI); IBoston, eMassachusetts. Mashi 3-7, 2014; abstract 87.