Ukuqaphela Izimbangela Nokukhetha Imithi Entsha Yezidakamizwa
Ukuhluleka kokwelashwa kwe-HIV kwenzeka uma kunqunywa ukuthi imishanguzo yakho ye- antiretroviral ayikwazi ukufeza imigomo yokwelashwa-okungukuthi ukucindezelwa komzimba wegciwane lesandulela ngculazi noma ukubuyiswa kwemisebenzi yokuzivikela ekuvimbeleni izifo ezingenayo amathuba . Ukuhluleka kokwelapha kungenziwa ngokuthi i- virologic (ephathelene negciwane), i-immunologic (ephathelene nesistimu yomzimba), noma kokubili.
Uma ukwehluleka kokwelashwa kwenzeka, isinyathelo sokuqala ukukhomba isici noma izici ezingase zibe negalelo ekuhlulekeni, okungafaka phakathi:
- Ukunamathela kwezidakamizwa ezingapheli
- Ukuphikiswa kwezidakamizwa ezitholakalayo
- Ukuhluleka kokwelashwa kwangaphambilini (s)
- Ukunamathela ngokungafanele emingceleni yokudla
- Ukubalwa kwe- CD4 esandulela ukwelashwa
- Ukwelashwa okufana ( isibindi se-hepatitis C noma isifo sofuba)
- Ukusebenzisana kwezidakamizwa
- Izinkinga ngokunakekelwa kwezidakamizwa noma imetabolism
- Imiphumela emibi yezokwelapha, engathinta ukunamathela
- Ukucindezeleka okungenakwenzeka noma ukusetshenziswa kwemithi, okungase kuthinte nokunamathela
Ukuhluleka kwe-Virologic
Ukuhluleka kwe-Virologic kuchazwa ngokuthi ukungakwazi ukufeza noma ukugcina umthamo wegciwane lesandulela ngculazi elingamakhophi angaphansi kuka-200 / mL. Lokhu akusho ukuthi umuntu kufanele ashintshe ngokushesha ukwelashwa uma ukwehla komthamo wegciwane lesandulela ngculazi kungaphansi kuka 200. Kumane nje kusebenza njengesilinganiso lapho udokotela angenza khona isahlulelo sokwaziswa komtholampilo uma ukunamathela kwesiguli kanye nemikhuba yokuqapha kuqinisekiswa.
Ngokufanayo, incazelo akufanele iphakamise ukuthi kuyamukeleka ukugcina okungaphansi kokunciphisa ukwelashwa okungcono. Ngisho noma "okungafinyeleleki" imithwalo yegciwane lengculazi (okungukuthi, amakhophi ama-50 -99 / mL) kufanele kube nokukhathazeka, ngezifundo zamuva ezikhomba ukuthi umsebenzi oqhubekayo wegciwane lesandulela ngculazi esikhathini esiyizinyanga eziyisithupha ungandisa ingozi yokuhluleka kwe-virologic phakathi nonyaka ngo-400%.
(Ngokuphambene nalokho, ngokuvamile "i-blips" yesandulela ngculazi ngokuvamile ayifuni ukubikezela kokuhluleka kwe-virological.)
Ukunamathela ngokweqile kwezidakamizwa nokuphikiswa kwezidakamizwa namuhla kubhekwa njengezimbangela ezimbili ezibalulekile zokuhluleka kwe-virologic, ikakhulukazi ekwelapheni kokuqala. Ngokusho kocwaningo, isilinganiso sesinye seziguli ezine sizobhekana nokuhluleka ngenxa yokunamathela kabi, kanti phakathi kuka-4% no-6% weziguli kuzohluleka ngenxa yokuphikiswa kwezidakamizwa.
Uma ukunamathela okungalungile kuyisimo senhliziyo yokuhluleka, kubalulekile kokubili udokotela nesiguli ukukhomba noma yikuphi okubangela imbangela. Ezimweni eziningi, ukwelashwa okulula (isib. Ukunciphisa umthamo wephilisi, imvamisa yokuguqula) kungasiza ukunciphisa izithiyo zokusebenza zokunamathela. Izinkinga zomzwelo noma izidakamizwa kufanele zibhekiswe, ngokudluliselwa ezenzelwe izikhungo zokwelapha noma abacebisi abesekelayo, uma kudingeka.
Ngisho noma ukuhluleka kwe-virologic kuqinisekiswa ngendlela yokuhlola ukuvikelwa kwe-genetic , kubalulekile ukulungisa noma yiziphi izinkinga zokunamathela ngaphambi kokuqhubekela phambili ngemithi emisha. Ngaphandle kokubambelela kokubhekwa njengengxenye eqhubekayo yokuphathwa kwe-HIV, amathuba okuphindaphinda aphezulu.
Ukuguqula Ukwelashwa Ngemva Kokwehluleka Kwe-Virologic
Ukuhluleka kwe-virologic kusho ukuthi inani elincane legciwane ngaphakathi "echibini legciwane" lesiguli alinamathele kumuntu oyedwa noma amanxusa amaningi ezidakamizwa.
Uma kuvunyelwe ukukhula, igciwane eliphikisanayo lizokwakha ukumelana lapho kunqamuka kuze kube khona ukuhluleka kwezidakamizwa eziningi.
Uma ukuphikiswa kwezidakamizwa kukhishwa futhi umthamo wegciwane lesiguli ungaphezu kwamakhophi angu-500 / mL, ukuhlolwa kokuphikiswa kofuzo kunconywa . Ukuhlolwa kwenziwa ngenkathi isiguli sisathatha isimiso esihlulekayo noma phakathi kwamasonto amane ekuqedeni ukwelashwa. Lokhu, kanye nokubuyekezwa komlando wezokwelapha, kuzosiza ukuqondisa ukwelashwa okuqhubeka phambili.
Lapho ukuphikiswa kwezidakamizwa kuqinisekiswa, kubalulekile ukushintsha ukwelashwa ngokushesha ngangokunokwenzeka ukuze uvimbele ukushintshwa okungeziwe kwemithi ekuthuthukiseni.
Okungcono, lo mgomo omusha uzoqukatha okungenani ezimbili, kodwa mhlawumbe izidakamizwa ezintathu ezisebenzayo. Ukwengeza isidakamizwa esisodwa esisebenzayo akukhuthazwa ngoba kungandisa ukwanda kokumelana nezidakamizwa.
Ukukhethwa kwezidakamizwa kufanele kususelwe ekubuyiselweni okwebuchwepheshe ukuze kuhlolwe ukuphikiswa kwezidakamizwa ezingasetshenziswa, noma ukuthola ukuthi izidakamizwa ezithile kungenzeka yini zaqhubeka zisebenza ngaphandle kokumelana nokukhetha .
Ucwaningo luye lwabonisa ukuthi iziguli zivame ukuphendula kangcono emithonjeni yokwelashwa esilandelayo. Lokhu kungenxa yokuthi iziguli ngokuvamile zinenani eliphakeme le-CD4 / umthamo wegciwane elincane uma uqala ukwelashwa okusha, noma ukuthi izidakamizwa ezintsha zenzalo zilula kakhulu ekuphatheni iziguli ezinzulu ukumelana. Ucwaningo luye lwabonisa nokuthi iziguli eziye zahluleka ukwelapha ngenxa yokunamathela okungekho emthethweni zivame ukuthuthukisa izinga lokunamathela emitholampilo wesibili.
Noma kunjalo, kubalulekile ukuqaphela ukuthi ukucindezelwa okuphelele kwegciwane kungenakwenzeka kuzo zonke iziguli, ikakhulukazi labo abaye ezindaweni eziningi zokwelashwa ngokuhamba kwesikhathi. Ezimweni ezinjalo, ukwelashwa kufanele kuqhutshwe njalo ngenhloso yokuqinisekisa ukuthi izidakamizwa ezincane ezidakamizwa nokulondolozwa komzimba we-CD4 wesiguli.
Ezigulini ezinolwazi ezine-CD4 zibala ngaphansi kwama-cell / mL angu-100 kanye nezinketho ezimbalwa zokwelashwa, ukungezwa kwenye i-agent kungasiza ukunciphisa ingozi yokukhula kwesifo ngokushesha.
Ukuhluleka kwe-Immunologic
Incazelo yokuhluleka kwe-immunologic ikhululekile kakhulu, kanti abanye bayichaza ngokuthi
- ukungakwazi ukwandisa isibalo se-CD4 sesiguli ngaphezu kombuthano othize (isb., ngaphezu kwama-350 noma ama-cell / mL 500) naphezu kokucindezelwa kwamagciwane, noma;
- ukwehluleka ukwandisa i-CD4 yesiguli ngesilinganiso esithile ngaphezu kwamazinga okuphambi kokunakekelwa naphezu kokucindezelwa kwegciwane.
Nakuba idatha ihlala iguqukile kakhulu, ezinye izifundo zishicilele ukuthi inani leziguli ezinezinombolo ezingavamile ze-CD4 naphezu kokucindezelwa kwegciwane kungaba ngaphezulu kwama-30%.
Ukubunzima ekubhekaneni nokuhluleka kwe-immunologic yilokhu okuvame ukuhlotshaniswa nesibalo se-CD4 esandulela ukwelashwa noma inani eliphansi le-CD4 count (okungukuthi, inani eliphansi kunazo zonke, i-CD4 yomlando erekhodini). Kulula nje, lapho isimiso somzimba sokuzivikela sesiguli sesisetshenziselwe ukuguqulwa ngaphambi kokwelashwa, kunzima kakhulu ukubuyisela lowo msebenzi wokuzivikela omzimba.
Yingakho imihlahlandlela ye-HIV yamanje iphakamisa ukuqala kokuqala kokwelashwa lapho umsebenzi wokuzivikela wesisu ungasebenzi.
Ngakolunye uhlangothi, ukwehluleka kwe-immunologic kungenzeka ngisho nangokwezibalo ezingaphezulu kokwelashwa kwe-CD4. Lokhu kungaba umphumela we-co-infections esedlule noma esebenzayo, ubudala, noma ngisho nomthelela wokuvuvukala okuqhubekayo obangelwa i-HIV ngokwayo. Ngezinye izikhathi, asikho isizathu esicacile esenza lokhu kwenzeke.
Okubaluleke nakakhulu ukuthi akukho ukuvumelana kwangempela mayelana nendlela yokuphatha ukwehluleka kwe-immunologic. Abanye abahlinzeki basikisela ukushintsha ukwelapha noma ukwengeza i-antiretroviral agent, nakuba kungekho bufakazi bokuthi lokhu kunomthelela wangempela.
Kodwa-ke, uma kutholakala ukuhluleka kwe-immunologic, iziguli kufanele zihlolwe ngokugcwele ukuthi zikhona yini
- noma yimiphi imithi ehambisanayo enganciphisa ukukhiqizwa kwamangqamuzana egazi elimhlophe (ikakhulukazi ama- CD4 + T cells ), ukufaka esikhundleni noma ukuyeka izidakamizwa noma nini lapho kungenzeka, noma;
- noma yiziphi izifo ezithathelwanayo ezingelashwa noma izimo zempilo ezingathí sina ezingase zibe nomthelela ekuphenduleni okuncane kwe-immunologic.
Kuhlolwa uphenyo oluthile olususelwa emzimbeni, nakuba kungekho okwamanje okunconywa ngaphandle komongo wesilingo somtholampilo.
> Imithombo:
> UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). "Ukwengamela Ukwelashwa-Isiguli Esihlangenwe nakho: Ukuhluleka Kwe-Virologic ne-Immunologic." I-Rockville, Maryland; kufinyelelwe ngoFebhuwari 21, 2014.
> Paredes, R .; I-Lalama, iC .; I-Ribaudo, i-J .; et al. "Izinguquko ze-HIV-1 ezincane ezingaphikisani nezidakamizwa, ukunamathela, kanye nobungozi bokuhluleka kokwelashwa kwe-antiretroviral." Journal of Infectious Diseases . Mashi 2010; 201 (5): 662-671.
> Laprise, C .; 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.
> Hammer, S .; Vaida, F .; Bennett, K .; et al. "I-inhibitor therapy ye-Dual vs single single inhibitor therapy elandela ukuhluleka kokwelashwa kwe-antiretroviral: isilingo esingenasici." I- Journal of the American Medical Association (JAMA) . NgoJulayi 10, 2002; 288 (2): 169-180.
> Gazzola, L .; Tincati, C .; I-Bellistri, G .; et al. "Ukungabi khona kwe-CD4 + T cell recovery ye-cell naphezu kokwamukela ukwelashwa kwama-antiretroviral kakhulu okucindezelayo okucindezelayo: ukulimala emtholampilo, izikhala zokuzivikela, kanye nokukhethwa kwezokwelapha." Izifo ezithathelwanayo emitholampilo . Februwari 2009; 48 (3): 328-337.