Amathiphu agulayo asebekhulile kubantu abaphila ne-HIV
Njengoba ukuhlolwa kokuqala kanye nokwelashwa kwe-HIV kuye kwandisa izinga lokuphila lokuphila kulo lonke labantu, ukugcizelela manje sekubekwa empilweni enhle kulabo abaneminyaka engama-50 nangaphezulu, abavame ukubhekana nokukhubazeka ngaphambi kwesikhathi eside nokugula ngenxa yesikhathi eside ukutheleleka kwe -term.
Ngokusho kwedatha evela e-US Centers for Disease Control and Prevention (CDC), abangaphezu kwamaphesenti angama-25 abantu baseMelika abaphila negciwane lesandulela ngculaza-noma abantu abangaba ngu-313,000-bawela kulokhu kukhula kwe-HIV.
Kulinganiselwa ukuthi, phakathi neminyaka embalwa, leso sibalo singakhuphuka cishe ngamaphesenti angu-50.
Ukugula Okungaphambi Kokuqala
Ukuvuvukala okungapheli okuhlotshaniswa negciwane lesandulela ngculaza kuye kwafakazwa emazingeni aphezulu ezinkinga ezihlobene ne-HIV-ezifana nesifo senhliziyo , amakhemikhali , ukuphazamiseka kwe-neuro-cognitive , kanye nohlobo lwesifo sikashukela 2 -vame kubonakala eminyakeni eyishumi kuya kwengu-15 ngaphambi kwalokho okungaba khona kulindeleke kubantu abaningi, abangenasifo. Ngisho nabantu ngabanye abaphumelele ukwelashwa kwegciwane lesandulela ngculaza, abakwazi ukugcina imithwalo engavamile engavamile engavamile iminyaka, ngesikhathi esithile kukhona inengozi enkulu kakhulu yale miphumela ehambisana nokuguga.
Nakuba izindlela zalesi simo-ezaziwa ngokuthi i- senescence ngaphambi kwesikhathi- ezingaqondakali ngokugcwele, kuvunywa kabanzi ukuthi ukuvuvukala okungapheli kunganciphisa amandla omzimba omuntu ngendlela engavumelani neyabantu asebekhulile, lapho umzimba " isikhathi saso. "
Futhi kubonakala sengathi kuthinta abaningi, uma kungenjalo wonke ama-organ systems ngezinga elithile. Ngisho nama-T-cell womuntu, okuyisisekelo ekuphenduleni kwe-immune, abe nomncane kakhulu ongakwazi ukukhomba nokunciphisa amanxusa angaphandle ngenkathi engaphansi komthwalo walokhu okuqhubekayo, ukuvuvukala okuvuthayo. Ukuze ucindezele izindaba ngisho nangaphezulu, kokubili i-HIV kanye nemithi eminingi ye-antiretroviral iye yaxhunyaniswa nokwanda kwamafutha e-visceral (intra-esiswini) kubantu abane-HIV, okwenza nje kube ngumthwalo ngokufihla amaprotheni angama-inflammatory ngqo egazini.
Ngakho-ke umuntu angenzani ukuze aphile kahle nge-HIV futhi agweme izifo nezimo ezihlobene nokutheleleka isikhathi eside?
Thola Uhlolo Lwanamuhla
Kungase kuzwakale kusobala, kepha cishe amaphesenti angama-20 aseMelika aphila ne-HIV abazange ahlolwe igciwane futhi, ngokusho kweWorld Health Organization (WHO), cishe abantu abangaba ngu-50 abalingana ne-HIV emhlabeni bafana nokungakafundiwe .
Isiqondiso samanje esivela e-US Preventive Services Task Force simema ukuhlolwa kwesinye isikhathi se-HIV kubo bonke abantu baseMelika abaneminyaka engu-15 kuya ku-65 njengengxenye yokuvakashela odokotela njalo. Amanye amaqembu aphezulu engozini, kuhlanganise namadoda asebenza ngokocansi abe nobulili namadoda (MSM), akhuthazwa ukuba avivinye njalo ngonyaka. Ngaphandle kokuhlola, ayikho indlela yokusebenzisa into eyodwa kunokuthi iqiniseke kahle impilo enhle yesikhathi eside kubantu abaphila negciwane lesandulela ngculazi, futhi lokho ...
Qala ukwelashwa kwe-HIV Namuhla
NgoJulayi 2015, isifundo esethulwa e-8th International Conference Society eVancouver sabiza ukuqaliswa ngokushesha kwe-antiretroviral therapy (ART) kubo bonke abantu abanesandulela ngculazi, kungakhathaliseki ukuthi isifo sesigaba noma i- CD4 count . Ucwaningo olwaziwa ngokuthi iSikimu Esiyisikhathi Sokuhlolwa Kwe-Antiretroviral Therapy (START), lwaqinisekisa ukuthi ukubeka i-ART ekuxilongweni kunciphisa amathuba okugula nokufa ngamaphesenti angu-53, ngenkathi kubeka ingozi yezimo ezingenalo i-HIV, njengezifo zenhliziyo (i-CVD ) nezinye izifo zomdlavuza, cishe izingxenye ezimbili kwezintathu.
Ngokuphambene nalokho, ngisho nalabo bantu abangavamile abangakwazi ukusekela imithwalo engavamile engavimbayo ngaphandle kwama-ART-abantu abaziwa ngokuthi "abalawuli be-elite" -baphindwe kabili ukungena esibhedlela, kathathu amathuba okubanjelwa esibhedlela ngenxa ye-CVD, futhi izikhathi ezine kungenzeka ukuba zivunyelwe ngenxa yezimo zengqondo uma kuqhathaniswa nabalawuli abangewona abalingani nge-ART ngokucindezela ngokugcwele. Uma kukhona "okumelwe" ukuba aphile isikhathi eside futhi enesandulela ngculaza, yilokho. Yindawo eyodwa kuphela okuzoqala.
Yeka Ukubhema
Lokhu akuyona nje esinye isimemezelo senkonzo yomphakathi. Iqiniso elimangalisa namuhla ukuthi abantu abaphila negciwane lesandulela ngculazi banamathuba amabili okubhema njengabantu abangenalo igciwane (amaphesenti angu-42 no-21% ngokulandelana), okuholela ekuphindeni kabili ingozi yesifo senhliziyo esiyingozi, kabili amathuba okufa ngokugula okuphefumulayo , kanye nokwanda kwamaphesenti angu-14 engozini yomdlavuza wamaphaphu.
Eqinisweni, ucwaningo oluningi luye lwaphetha ngokuthi ukubhema kuyisici esikhulu kunazo zonke ekuthuthukiseni ukulimala nokufa kubantu abaphila negciwane lesandulela ngculaza, ukunciphisa isikhathi sokuphila iminyaka engu-12.3 emanganisa uma kuqhathaniswa nabangenayo igciwane le-HIV.
Nakuba izinhlelo zokuyeka ukubhema akuzona lula ngaso sonke isikhathi-ezidinga imizamo eyisishiyagalombili ngaphambi kokuyeka ukuphumelela-ukufinyelela kokwelashwa kuye kwaba lula kakhulu ngaphansi koMthetho Wokunakekelwa Okunenzuzo , onemizamo emibili yonyaka yokuyeka ukuvunyelwa ngemithi kanye nezinhlelo ezihlukahlukene zokwelapha ezinikezwa nge-Medicaid in konke okushiwo ngu-50.
Thola ama-Shots wakho
Kuyamangaza inani labantu abanegciwane lesandulela ngculazi abagwema, abangaziboni, noma abaqapheli nje uhlobo lwezinhlamvu noma izigomo zomlomo ezingase zidingeke . Lokhu kufaka phakathi uchungechunge olunjalo lokugoma njengalabo abesifo sofuzo lwe-hepatitis B, i- papillomavirus yabantu (i-HPV) , i-pneumonia pneumococcal, futhi (yebo) i- quadrivalent fri shot shot yonyaka.
I-ounce yokuvimbela ithatha incazelo entsha uma, isibonelo, ingozi yomdlavuza wesibeletho (ehlobene kakhulu ne-HPV ukutheleleka) iyaziwa ukuthi iyinkulu ngaphezu kwezikhathi ezingu-25 kubantu abane-HIV, kanti umdlavuza womlomo wesibeletho ukhula ngokuphindwe kabili. Imithi yokugoma i-HPV elula, enezinyathelo ezintathu ingathatha ukusika ingozi yalezi zomshukela ngamaphesenti angama-56.
Ngaphambi kokuqala uchungechunge lwegciwane, qiniseka ukuthi uhlangana nodokotela wakho ukuze uxoxe ngezinketho nezingozi. Nakuba abaningi banciphisa kakhulu ingozi ye-comorbidities ehlobene ne-HIV, abanye bangakusiza ngempela , ikakhulukazi uma amasosha omzimba wakho ehlaselwa kakhulu.
Xoxani Ngezitembu NeDokotela Wakho
Ngokwesifundo esivela kuJohns Hopkins University School of Medicine, ukusetshenziswa kwezidakamizwa ze-cholesterol-ukwehlisa izidakamizwa ze-statin, kuhlangene nama-ART, kunganciphisa ingozi yokufa kubantu abane-HIV ngamaphesenti angu-67. Abaphenyi babika ukuthi, ngaphezu kokunciphisa amazinga e-cholesterol ayingozi, izitembu nazo zibonakala zinciphisa kakhulu ukuvuvukala okungapheli.
Nakuba lokhu akusho ukuthi izidakamizwa ze-statin ziboniswa kubo bonke abantu abaphila negciwane lesandulela ngculazi, liphakamisa ngokuqinile izinzuzo zokuqapha i-lipid njalo nezinye izinkomba zesifo senhliziyo-ikakhulukazi ezigulini ezindala noma kulabo abanezici eziyingozi (isibonelo, umndeni umlando, ukubhema, njll).
Cabanga nge-Vitamin D & Calcium Supplementation
I-low-bone amaminerali (BMD) ihlonishwa njalo kubantu abane-HIV, okwenza kube namazinga aphakeme okwehlukana kwamathambo namaqabunga, kanye nokuthuthukiswa kwesifo se- osteoporosis ngaphambi kwesikhathi. Ukulahleka kwe-BMD phakathi kwamaphesenti amabili namaphesenti ayisithupha kuvame ukubonakala eminyakeni emibili yokuqala yokuqala i-ART, izinga elilingana nelomama phakathi neminyaka emibili yokuqala kokuya esikhathini.
Ngenxa yalezi zibalo kanye nezinye izibalo, okwamanje kunconywa ukuthi bonke abesilisa abanezandulela ngculaza abane-HIV banikezelwe i- DEXA (ukuskena kwe- double-ray x ray ray absorptometry) ukuhlola ukulahleka kwamathambo okungenzeka, kanye nabo bonke abesilisa abane-HIV ngaphezulu uneminyaka engama-50.
Ngokuphathelene nesondlo, ucwaningo oluthile luye lwasikisela ukuthi ukubambisana ngokubambisana kwevithamini B kanye ne-calcium isithasiselo kungasiza ukunciphisa ubungozi bokuphuka kwamathambo. Ngesikhathi ucwaningo luhlala lukhulu kakhulu, izikhombisi-ndlela zamanje zase-US zincoma phakathi kuka-800 kuya ku-1000 mg we-vitamin D ngomlomo ngosuku kanye no-1000 kuya ku-2000 mg we-calcium ngomlomo ngosuku. Iziguli ezine-osteoporosis zingase zizuze kulezi zidakamizwa zokuqala njenge-alendronate (i-Fosomax) ne-zoledronic acid (i-Zometa) ezingasiza ekuvimbeleni ukwehlukana kwe-osteoporotic fragility.
Ukudla nokuzivocavoca
Mhlawumbe ngisho nangaphezu kokubhema, amagama athi "ukudla" kanye "nokuzivocavoca" athambekele ekwenzeni i-grins grins (ngisho nokuvuthwa kwamehlo okwezinye izikhathi) kusuka ezigulini, njengokungathi beyizimpendulo ezingezansi ekhaya kunokuba zithole iseluleko sezokwelapha kukhona.
Kodwa cabanga ngalokhu-abantu abaphila negciwane lesandulela ngculaza bajwayele ukukhuphuka okunamandla emanzini omzimba okwenzelwe i- HIV kuphela kodwa izidakamizwa ezisetshenziswa ukuphatha lesi sifo. Ngisho nalabo abasebenzisa i-ART ngokucindezela ngokugcwele, kuyinto engavamile ukubona amaphesenti angu-40 athola amafutha emilenze futhi amaphesenti angama-35 athola amafutha esiswini, ngokunyuka kokuhambisana kokubili kwe-CVD kanye nohlobo lwesifo sikashukela sesi-2.
Ngaphandle kokuhlinzekwa kwezidakamizwa ze-statin, ukuphathwa kwansuku zonke kwe-HIV kumele kufake ukudla okulinganiselayo, okuncishisiwe okunomsoco kanye nokuhlanganiswa okunolwazi kokuqeqeshwa kwe-aerobic nokumelana , kungakhathaliseki ubudala, inani le-CD4 noma isigaba sesifo. Ngaphambi kokuqala i-ART, kokubili i-lipids kanye namazinga e-glucose wegazi kufanele ahlolwe ngokuqapha okuqhubekayo emva kwalokho ukulandelela ukuthuthukiswa okungenzeka kwe-CVD kanye / noma isifo sikashukela.
Ngezansi: ungathembeki kumathebulethi noma ukudla okuwukuphela kokubhekana nezindinganiso zesisindo noma uthathe indlela yokwelapha i-aerobics kuphela yokulungisa ukulahlekelwa kwesisindo esincane. Sebenza nodokotela wakho bese ucela ukuthunyelwa kubanikazi bokudla okunempilo kanye nabachwepheshe bokufaneleka emphakathini wakini, ikakhulukazi uma ukhuluphele ngokweqile, empilweni engafanele, unenkinga yokukhathazeka kwengqondo noma isifo sikashukela, noma ufuna nje isiqondiso.
Thola njalo izivivinyo ze-Pap nama-Mammograms
Ukucatshangelwa okukhethekile kufanele kwenziwe kubantu besifazane abaphila negciwane lesandulela ngculazi, hhayi kuphela ukuqinisekisa ukuvimbela umdlavuza womlomo wesibeletho kanye nezinye izidakamizwa ezihlobene, kodwa ukuxazulula izinkinga eziphathelene nokukhulelwa , i- HIV serodiscordancy (okungukuthi, lapho umlingani oyedwa enesandulela ngculaza kanti enye i-HIV -negative), nokuvimbela ukudluliselwa kwe-HIV kumama nengane .
Abesifazane kufanele bakhulume ngenkuthalo noma yiziphi izinhlelo noma izinhloso ezingase zibe nazo mayelana nokukhulelwa ekuqalisweni kokunakekelwa, ngenkathi kuqinisekiswa ukuhlolwa kokuhlolwa kwamammogram okuvamile njengoba kubonisiwe (minyaka yonke kwabesifazane abangaphezu kuka-50 futhi ngabanye besifazane abaneminyaka engama-40 no-49). Abesifazane abane-HIV kumele banikezwe i-Pap smear yomlomo wesibeletho, futhi lapho beqala ukunakekelwa, ngokuhlolwa okuphindaphindiwe njalo ngemva kwezinyanga eziyisithupha emva kwalokho.
Ungalokothi Uphathe I-HIV Ekuhlukanisweni
Enye yezinkolelo ezingalungile mayelana nokuphathwa kwe-HIV ukuthi iboshiwe ngenombolo ehleliwe yokuhlolwa kwelebhu (isibalo se-CD4, umthamo wegciwane) kanye nokuhlolwa kwesimiso (ama-STD, i-hepatitis) futhi kuhlangene nokuvakashelwa okuhleliwe njalo kuchwepheshe we-HIV. Futhi lokho kuhle kakhulu.
Njengoba kugcizelele kakhulu ekufakwe esikhathini esidlule, abaningi baye baqala ukubiza ukujwayelekile kwegciwane lesandulela ngculazi, beliphatha njengeqhaza lokunakekelwa okuyinhloko kunokuba babe yizici ezikhethekile. Lokhu kusho ukushintsha indlela esibheka ngayo i-HIV namuhla, kokubili iziguli nodokotela. Kusho ukuqonda ukuthi i-HIV ayikwazi ukuphathwa yodwa, kodwa njengengxenye ehlanganisiwe yezempilo yethu yesikhathi eside.
Ngenxa yalokho, kubalulekile ukuthi uhlale uneluleka udokotela wakho we-HIV mayelana nanoma yikuphi ukunakekelwa okhethekile okungenzeka ukwemukele, kuhlanganise nanoma yikuphi ukuvakasha noma ukuvakashela iziguli. Futhi ungacabangi ukuthi into ethize "ayihambisani" negciwane lesandulela ngculaza, ikakhulukazi njengoba lesi sifo singabonakalisa nganoma yisiphi isibalo sezinkinga ezihambisanayo, kusukela ezinkingeni zamehlo kuya ezifweni zomlomo / zamazinyo ezinkingeni ze-neurologic.
Uma udokotela wakho wokunakekelwa oyinhloko uhlukile kunodokotela wakho we-HIV, qiniseka ukuthi bahlanganyela njalo imiphumela, kuhlanganise nokuhlolwa kwelebhu kanye neminye imibiko ebalulekile ekunakekeleni kwakho kwesikhathi eside.
> Imithombo:
> Amasevisi Okulawula Nokuvimbela Izifo (CDC). "I-HIV Phakathi Kwabantu Abagugile 50 no-Older." I-Atlanta, Georgia; Agasti 3, 2015.
> 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.
> Mdodo, R .; I-Frazier, E .; UMattson, C .; et al. "Ukubhema ugwayi phakathi kwabantu abadala abane-HIV: ukunakekelwa kwezokwelapha, i-US, 2009." Ingqungquthela ye-20 yama-Retroviruses kanye nezifo ezivame ukubhekana nazo (CROI 2013). I-Atlanta, Georgia; Mashi 3-6, 2013: Abstract 775.
> UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu (DHHS). "Ukugonywa Kunconywe Ngezifo Eziphezulu Zengculazi." Washington, DC; Agasti 3, 2015.
> Cannon, J. "Ukugcina Ufanelekile ngeHIV - Izikhombandlela ze-ACSM Yenza Ukuzivocavoca Kungenzeka Ezigulini." I-Dietician yanamuhla. Okthoba 2011; 13 (10): 86.