Ukungaphumeleli komkhuba ongaphenduki kungaholela ekufeni kwabantu abangu-425,000
Phakathi neminyaka eyishumi eyedlule, iziphathimandla zempilo yomhlaba wonke zenze inzuzo emangalisayo ekulethwe kwezidakamizwa ezondla impilo ye-HIV kubantu abahlala emhlabeni jikelele. Ngokwe-United Nations Joint Program on HIV / AIDS (UNAIDS), cishe abantu abayizigidi ezingu-21 babekwe ukwelashwa ngezidambisigciwane ngasekupheleni kuka-2017, okuhambisana nokwehla kwamaphesenti angama-43 inani lokufa kwe-HIV kusukela ngo-2003.
Kodwa njengoba nje i-UNAIDS kanye nezinye iziphathimandla zempilo emhlabeni jikelele zizama ukuphela kwalesi sifo ngo-2030, umkhuba ophazamisayo usongela lezi zindlela: ukukhuphuka kwe-HIV engazimisele ukulwa nezidakamizwa ngaphambilini kwakucatshangwa ukuthi ayingavamile ngabaososayensi.
Kuyinkinga engathinti kuphela amazwe anqunyelwe yimithombo (njengalezo e-Afrika ezithwala umthwalo omkhulu wezokutheleleka nge-HIV) kodwa amazwe aphezulu kakhulu lapho izinga lokumelana nokutheleleka likhuphuka.
Izimbangela ze-Multi-Drug-Resistant HIV
Ukuphikiswa kwezidakamizwa eziningi kuyimbangela ebonakala kwezinye izimo zezokwelapha, njengesifo sofuba (TB) kanye nokutheleleka kwe-staphylococcal , lapho umuntu onegciwane ehluleka ukusabela ezinhlobonhlobo eziningi zokwelapha izidakamizwa. Kwezinye izimo, ukuphikiswa kungaba yingozi kakhulu, njenge-TB eminingi engaxilanga izidakamizwa (i-XDR TB) ebonweni kwezinye izingxenye zaseningizimu ye-Afrika, okuyizibalo zokufa eziphezulu kanye nokukhethwa kwezidakamizwa ezimbalwa.
Njengezinye izinhlobo zokumelana , ukuvela kwe-HIV-anti-anti-resistant virus kubangelwa ukuthi umuntu akakwazi ukuphuza imithi yakhe njalo noma ngokuqondiswa.
Uma kuthathwa ngokunembile, izidakamizwa zizovimbela umsebenzi we-viral kuze kube yilapho i- HIV ithathwa ngokuthi "ayitholakali. " Uma kuthathwe ngokungalungile, umsebenzi wegciwane kungaphikelela emazingeni lapho ukuguquguquka kwezidakamizwa okungenakukwazi ukukhula kuphela kodwa kukhula.
Ngokuhamba kwesikhathi, njengoba ukwehluleka kokwelashwa kwenzeka futhi umuntu evezwe emithini eminingi, imishintshi eyengeziwe ingathuthuka, yakha enye engaphezulu.
Uma lowo muntu ehlasela omunye, ukumelana nezidakamizwa eziningi kuzodlulela, kusakazeke ngokuqhubekayo kubantu ngokusebenzisa amanethiwekhi ocansi noma ukujova ukusetshenziswa kwezidakamizwa .
Isibalo Senkinga
Ngokusho kweWorld Health Organization (WHO), okubukeze idatha kusuka emitholampilo engu-12 000 emazweni angu-59, isilinganiso samaphesenti angu-20 abantu ashicilelwe ukwelashwa kwama-antiretroviral siphumile ngaphandle kokwelashwa ngaphandle konyaka owodwa. Kulabo ababesele ekwelapheni, abaningi abangamaphesenti angu-73 badala ngaphandle kokungahambisani, kanti cishe umuntu oyedwa kwabayisithathu uhlulekile ukufeza umthamo wegciwane elingenakulinganiswa oluhambisana nokuphumelela kokwelapha.
Lelizinga lomsebenzi wegciwane lesandulela ngculaza phakathi kwabantu landisa amathuba okumelana nezidakamizwa eziningi, ikakhulukazi emazweni aphezulu okukhukhumezeka lapho abaningi kubantu abahlanu banesifo. Ukwandisa lesi simo kukhona izidakamizwa ezivame ukwedlula izidakamizwa, ezishiya iziguli ngaphandle kwemithi futhi zithinta cishe imitholampilo engama-36% emazweni asathuthuka.
Ngisho emazweni afana ne-US, amazinga aphezulu okutheleleka okungatholakali (amaphesenti angu-20) kanye namazinga aphansi wokugcina isiguli (amaphesenti angu-40) aguqulelwe amazinga aphansi aphansi okucindezelwa amagciwane (amaphesenti angu-28).
Izimbangela Zokuhlukana Kwezidakamizwa Eziningi "Akunakwenzeka" Izinkathazo
Ucwaningo olwenziwa ngo-2016 oluvela eNyuvesi yaseLondon (UCL) lugcizelela ukukhathazeka okukhulayo phakathi kososayensi abesaba ukuthi ukuthuthukiswa kokumelana nezidakamizwa eziningi kungaholela ekunciphiseni okuningi okwenziwe ukulwa nokulwa ne-HIV emhlabeni jikelele.
Ekucwaningweni kwabo, ososayensi be-UCL benza uphenyo olubukeziwe lweziguli ezingu-712 ezithole ukwelashwa kwe-antiretroviral phakathi kweminyaka ka-2003 no-2013 futhi zahluleka ukwelapha okuqala.
Kulaba, iziguli eziyi-115 (16%) zinezinkinga zokulwa negciwane lesandulela ngculazi elinomdlavuza we-thymidine, uhlobo oluthile oluhambisana nezidakamizwa zakudala ezifana ne-AZT ne-3TC. Ngokumangazayo, ama-80% alaba baguli nawo ayenokuphikisana ne-tenofovir, isizukulwane esisha esilandelayo esidakamizwa esivela kabanzi emhlabeni jikelele.
Lokhu kwabethusa abantu abaningi emphakathini wocwaningo, owabheka ukuthi lolu hlobo lokumelana nezidakamizwa eziningi aluvamile, uma kungenakwenzeka.
Ngenkathi beyaziwa isikhathi esithile ukuthi izinga lokumelana ne-tenofovir liye landa-kusuka ku-20% e-Yurophu nase-US kuya ezingamaphesenti angaphezu kwangu-50 ezingxenyeni ze-Afrika-abaningi bakholelwa ukuthi lezi zinhlobo ezimbili zokushintshashintsha okungahambisani nazo zazingekho.
Uma lo mkhuba uqhubeka, njengoba umsolwa abaningi, imiphumela ingaba enkulu kakhulu. Ucwaningo oluthile luye lwasikisela ukuthi izinkinga ze-HIV ezingamelana nezidakamizwa zingabangela ukufa kwabantu abangaphezu kuka-425,000 kanye nezifo ezintsha ezingu-300 000 eminyakeni emihlanu ezayo.
Njengamanje, amaphesenti angaphezu kuka-10 abantu abaqala ukwelashwa kwe-HIV enkabeni naseningizimu ye-Afrika abamelana nezidakamizwa zokuqala, kuyilapho amaphesenti angu-40 azoba nokuphikisana okufanayo emigqeni yesibili kanye nemithi yokwelapha elandelayo. Inhlanganisela ye-tenofovir ne-antimidine anti-analog imane yandisa inkinga ngokunciphisa ubuzwe bomuntu hhayi kuphela kumuthi owodwa noma amabili, kodwa zonke izigaba zemithi.
Ukuguqula i-Trend
Ngenkathi ukwandiswa kwe-HIV yokwelapha-ngokuhambisana necebo leZizwe Ezihlangene '90-90-90 - okubalulekile ekuqedeni ubhubhane, okubaluleke kakhulu isidingo sethu sokutshala imali kwezobuchwepheshe nokuthola izixazululo zokunqoba izithiyo ezihleliwe ezidakamizwa ezisekelwe ngabanye ukunamathela. Lesi yisixwayiso esibhalwe yizikhulu ku-WHO, osho ukuthi ngaphandle kwezinsiza zokuqinisekisa ukugcinwa kwesiguli ekunakekeleni, ukwandiswa okusheshayo kwezinhlelo zezidakamizwa ngeke kube khona ngokwanele ukuba kuqukethe isifo.
Amathemba, okwamanje, atholakala emzimbeni wokuhlola obizwa ngokuthi i-ibalizumab, eyanikezwe isimo sokuphumelela yi-US Food and Drug Administration ngonyaka ka-2015. Isidakamizwa esijovayo sivimbela i-HIV ukungena esitokisini futhi siboniswe ukunqoba eziningi eziningi ezidakamizwa- izinkinga ezingamelana nokuvivinywa kwabantu. Ngenkathi ingakavunyelwe ngokomthetho yi-FDA, isimo sokuphumelela sivame ukuvunywa ngokushesha kunoma yikuphi kusukela ezinyangeni eziyisithupha kuya ngonyaka.
Olunye ucwaningo luye lwaphakamisa nokuthi ifomu elisha le- tenofovir (ebizwa ngokuthi i-tenofovir AF) lingakwazi ukunqoba ukumelana okuhlobene nefomu "elidala" lomuthi (obizwa ngokuthi i-tenofovir DF).
Ngombono womuntu ngamunye, ukuvimbela kuyisisekelo sokugwema ukusabalalisa okuqhubekayo kokumelene nezidakamizwa eziningi. Ifuna amazinga aphezulu okunamathela ekwelashweni kubantu abaphila negciwane lesandulela ngculazi kanye namasu okunciphisa okulimaza okuvimbela kokubili ukuthola nokudluliswa kwegciwane elingenakudliwa yizidakamizwa.
> Imithombo:
> Gregson, J .; Kaleebu, P .; I-Marconi, i-V .; et al. "Ukuphikisana nemithi ye-HIV-1 ye-thymidine elandela ukuhluleka kwe-tenofovir yokuqala ye-line kuhlanganiswe ne-analogue ne-nevirapine noma i-efavirenz e-Afrika engaphansi kweSahara: isifundo se-multi-center esiphezulu esiphezulu." Izifo ezithathelwanayo zeLancet. NgoNovemba 30, 2016; S1473-3099 (16) 30469-8.
> I-TenoRes Study Group. "I-epidemiology yomhlaba wonke yokumelana nezidakamizwa ngemuva kokuhluleka kwe-WHO ukuphakamisa izigaba zokuqala zokutheleleka kwe-HIV-1: isifundo sezinhlobonhlobo eziphindaphindiwe ze-HIV." Izifo ezithathelwanayo zeLancet. NgoJanuwari 28, 2016; eshicilelwe ku-inthanethi