Uma ukutheleleka ngegciwane lesandulela ngculaza kuye kwaqinisekiswa, ukuhlolwa kuvame kwenziwa ukuze kunqume isimo sesimiso somzimba somuntu kanye nezinga lomsebenzi wegciwane emzimbeni. Lezi zichazwe kulokho okubizwa ngokuthi i- CD4 count yakho kanye nomthamo wegciwane .
Yini i-CD4 Count?
Ukuhlolwa kwe-CD4 kungenye yezilingo ezijwayelekile zokuhlola eziziwa kubantu abane-HIV. Ukuhlolwa kulinganisa izinga le- CD4 umsizi we-T-cell ezingxenyeni zegazi ezingabalulekile kuphela ekuzivikelweni komzimba kepha yilokho okuyinhloko ekuthelelekeni nge-HIV.
Njengoba igciwane lesandulela ngculaza lisusa kancane kancane lawa maseli, umzimba uyahluleka ukuzivikela ngokwawo uhla olubanzi lwezifo ezithatha amathuba.
Isivivinyo senziwa ngokuthatha isampula segazi, imiphumela yokulinganisa inani lamaseli e-CD4 ku-microliter (μL) yegazi. Ukubala okuyisisekelo kusungula isimo samasosha omzimba wakho, kuyilapho ukuhlolwa okulandelwayo kusitshela kabanzi ngakho
- isiteji sokutheleleka kanye nokukhula kwesifo
- amathuba okuthi ezinye izifo zizokhula njengoba amangqamuzana e-CD4 ephela
- ukuthi uphendula kahle kangakanani ukwelashwa ngokugcina noma ukuvuselela umsebenzi wakho wokuzivikela omzimba
Izibalo ezijwayelekile ze-CD4 zikhona phakathi kwama-500-1,500 amaseli / μL. Ngakolunye uhlangothi, inani le-CD4 lamaseli angu-200 / μL noma ngaphansi libizwa ngokuthi yi- AIDS . Ucwaningo luye lwabonisa ukuthi ukuqala ukwelapha noma ngaphansi kwalesi sizinga kuyahambisana nemiphumela emitholampilo empofu nokunciphisa isikhathi sokuphila iminyaka engaba ngu-15.
Imikhombandlela yokwelapha yangaphambilini yanconywa ukuthi ukwelashwa ngezidambisigciwane (ART) kuqaliswe ezigulini ezine-CD4 count ngaphansi kwama-cell cells / μL ama-500 noma phambi kwesifo esichaza i- AIDS . Ngo-2016, imihlahlandlela ebuyekeziwe ivumela i-ART kuzo zonke iziguli ezinegciwane lesandulela ngculaza, kungakhathaliseki ukuthi i-CD4 count, indawo, imali noma isigaba sesifo.
Namuhla, inani le-CD4 lisetshenziselwa ukubikezela umphumela wesifo njengokulinganisela kwamandla omzimba omzimba omzimba. Ngomzekelo, i- CD4 nadir (iphuzu eliphansi kakhulu lapho inani le-CD4 liye lahla) libikezela ukugula okude isikhathi eside, ngamagugu aphansi abonisa ingozi ekhulayo yezifo ezihlobene ne-HIV kanye nokungenayo i-HIV, kanye ukunciphisa umzimba kancane kancane.
Kuyini Umthwalo Wemvamisa?
Ngenkathi isibalo se-CD4 sibonakaliso somzimba wokuzivikela omzimba kanye nokusebenza kahle kwezokwelapha, umthamo wesandulela ngculaza kuyisilinganiso esibaluleke kakhulu uma ukwelashwa kwe-antiretroviral kuqala.
Umthamo wesandulela ngculazi ulinganisa igciwane lesandulela ngculazi egazini, eyaziwa nangokuthi "umthwalo wakho wegciwane." Ama-Labs azosebenzisa ubuchwepheshe bokuhlola izakhi zofuzo-ngokuvamile, ukuphendula kwe-polymerase chain (PCR) noma i-bDNA (i-DNA ehlanganisiwe) -kulinganisa inani lezinhlayiya ze-viral in milliliter (mL) yegazi. Imithwalo yegciwane lesandulela ngculaza ingahle ivela ekungabonakali (ngezansi kwamazinga okuthola ukuhlolwa kwamanje) kumashumi ezinkulungwane zezigidi.
Umphumela ongatholakali awusho ukuthi ayikho igciwane egazini lakho noma "usuliwe" kokutheleleka. (Eqinisweni, ingaphansi kwe-5% ye-HIV emzimbeni ingatholakala egazini.) Ukungatholakali kusho nje ukuthi inani labantu abanegciwane liwile ngaphansi kwamazinga okuthola ukuhlolwa egazini kepha angabonakala nakwezinye izindawo, njengezimvu.
Imigomo Yokunciphisa I-Viral
Inhloso ye-antiretroviral therapy ukuvimbela ngokugcwele umsebenzi wegciwane kumazinga angatholakali, okuhlangene nawo, ahlobene
- ukwedlula ukwelashwa okukhulu
- ingozi ephansi yokuthuthukiswa kwegciwane lokulwa nezidakamizwa
- imiphumela emihle yemitholampilo ehambisana nokukhula kwesikhathi sokuphila,
- ukunciphisa ingozi yokudlulisela igciwane lesandulela ngculaza kumlingani ongathinteki ocansini (isu elibhekwa ngokubizwa ngokuthi ukwelashwa njengokuvimbela (TasP) .
Ngakolunye uhlangothi, ukwanda komthamo wegciwane kungaba yisibonakaliso sokuhluleka kokwelashwa , ukunamathela kwezidakamizwa, noma kokubili.
Kubalulekile ukuqaphela ukuthi ukunamathela kwezidakamizwa okungenani ama-95% kuyadingeka ukuqinisekisa ukucindezelwa kwegciwane kumazinga angatholakali.
Ukunamathela okungavumelekile kungagcini nje ukunciphisa ikhono lomuntu lokufeza lokhu, kwandisa amathuba okuhluleka ukwelashwa ngokuvumela igciwane elingenwa izidakamizwa ukuthuthukisa. Ubuhlobo bomphumela obangela imbangela yindlela yokunamathela kufanele ihlolwe ngaso sonke isikhathi ngaphambi kokuba ukwelashwa kushintshwe.
Lokho kusho ukuthi ukuhluka okungafani emthamo wegciwane (noma "blips") kungenzeka ngisho naphakathi kwalabo abanamathelomu angu-100%. Lokhu ngokuvamile kuvamile futhi akufanele kube imbangela ye-alamu.
Ukuqapha njalo kwe-CD4 count kanye nomthamo wesandulela ngculaza kunconywa, ngokuvamile njalo emva kwezinyanga ezintathu kuya kweziyisithupha emva kwalokho i-CD4 ingahlolwa njalo ezinyangeni ezingu-6 noma ezingu-12 uma phakathi kwama-350 no-500 amaseli / μL. Iziguli ezikwazi ukugcina izibalo ze-CD4 ezingaphezu kwamangqamuzana angu-500 / μL zingahlolwa njalo ngezikhathi njengoba ziqondiswa ngokuphatha udokotela.
Izinzuzo Zokulawula I-Viral
Ngokusho kocwaningo oluvela e-UK Collaborative Cohort Study (UK CHIC), abantu abanemithwalo engavumelekile yegciwane lengculazi abazuze inani le-CD4 lama-350 / μL noma ngaphezulu konyaka wokuqala ukwelashwa kungenzeka ukuthi babe nokuphila okuvamile.
Ehlangothini lwe-flip, ukuhluleka ukufeza ukwelashwa kwegciwane kunganciphisa isikhathi sokuphila iminyaka engaba ngu-11-kufana nokubhema ugwayi 40 ngosuku.
Ukuhlaziywa okuphindaphindiwe okwenziwa ngo-2013 yiNyuvesi yaseMontreal kwaphetha ngokuthi abantu ababenesisindo esingenakutholakali segciwane lengculaza isikhathi esingangezinyanga eziyisithupha (okungukuthi, amakhophi angama-50 no-199 / i-mL) bebelokhu besengozini enkulu ye-virologic engaba ngu-400%. kungakapheli unyaka kunalabo abakwazi ukufezekisa ukucindezelwa okuphelele kwegciwane.
Ucwaningo oluhlolisisa amadoda angu-1,357 abane-HIV kusukela ngo-1999 kuya ku-2011, lwaqhubeka lwabonisa izinga lokuhluleka kwe-virologic cishe ngamaphesenti angu-60 kubantu abanezinkinga ezibangelwa amagciwane eziphakathi kuka-500 no-999 amakhophi / mL.
Imithombo:
UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). "Imihlahlandlela yokusetshenziswa kwama-Antiretroviral Agents kubantu abadala abathintekayo nge-HIV kanye nezingane ezisakhulayo." Ukuvuselelwa kwe-AIDSinfo. I-Rockland, MD; Ngo-February 12, 2013: C9-C21.
Kwangathi, M .; Gompels, M .; no-Sabin. C. "Ukulinda kokuphila kwabantu abane-HIV-1-emihle kuvamile ngokwemibandela ekuphenduleni ukwelashwa kwama-antiretroviral: Isifundo se-UK Cohort of the Cohort." I-Journal ye-International AIDS Society. NgoNovemba 11, 2012; 15 (4): 18078.
I-Baligh, i-Y .; Fleishman, J .; I-Metlay, i-J .; et al. "Ukwelashwa Okusondelene Ne-Viral ku-HIV-Aphethwe Iziguli Ezithola Ukwelashwa Kwe-Antiretroviral." I-Journal ye-American Medical Association. Julayi 25, 2012; 308 (4): 339-342.
I-Laprise, iC .; de Pokomandy, A .; I-Baril, J .; et al. "Ukungaphumeleli kwe-virologic ngemuva kwe-viremia eqhubekayo yezinga eliphansi eqenjini leziguli ezinegciwane lesandulela ngculazi: imiphumela evela eminyakeni engu-12 yokubona." Izifo Ezithathelwanayo Emitholampilo. Novemba 2013; 57 (10): 1489-96.
I-INSIGHT START Group Study. "Ukuqala Ukwelashwa Kwe-Antiretroviral Ekukhuleni Kwangaphambi Kwesandulela Ngculaza." I-New England Journal of Medicine. Julayi 20, 2015; I-DOI: 10.1056 / NEJMoa1506816.