Ingabe izidakamizwa ezintsha zenzalo zishintsha imithetho mayelana nokunamathela kwe-HIV?
Ukunamathela kwezidakamizwa kuyisici esiyinhloko sokuphatha nokuphatha ngempumelelo ukutheleleka nge-HIV. Ngokungafani nemithi engapheli esetshenziselwa ukwelapha izifo ezifana nesifo senhliziyo noma isifo sikashukela-okudinga ukunamathela okungenani ngo-70% ukufeza imigomo yomtholampilo- ukwelashwa kwama-antiretroviral (noma i-ART) kudinga ukunamathela okuphelele ukugcina ukucindezelwa kwegciwane nokuvimbela ukuthuthukiswa kwesikhathi esingakapheli kwezidakamizwa ukumelana .
Kodwa ngenxa yokuthi manje sinezizukulwane ezintsha, ngcono izidakamizwa ze- antiretroviral , ingabe imithetho iyalingana?
I-95% yokunamathela kweMantra
Imikhombandlela yokwelapha i-HIV ngokujwayelekile iyala ukuthi iziguli zidinga ukugcina ukunamathela okukhulu kunama-95% ukuze kuqinisekiswe ukucindezeleka okuqhubekayo kwegciwane. Ukuze uthole imithi yesikhashana esisodwa yemithi, ehumusha cishe ezinsukwini ezingu-14 ngezikhathi ezithile, ukulinganiselwa okungekho emkhatsini wonyaka.
Kodwa-ke, abanye baye baqala ukuphikisa ukuthi "i-mantra engu-95%" isekelwe kudatha eqoqwe ngasekupheleni kweminyaka yama-1990, lapho izidakamizwa zemithi zaziyinkimbinkimbi futhi izidakamizwa zazincane kakhulu. Ngenkathi kunabantu abambalwa abangamemezela ngokufanele ama-85% noma ngisho nama-90% njengezinga elisha lokunamathela, abaningi bakholelwa ukuthi isidingo sokuqhaqhazela noma ukugxila iziguli ngokungaphansi kokuphelela akukho ndawo eseduze nalokho okudingekayo njengoba sekuyiminyaka eyishumi edlule.
Noma kunjalo, kuneziningi ezikholelwa ukuthi ukunciphisa umthamo wokubambelela (noma ngisho nokuphakamisa ushintsho) kuyiphutha, okuvumela amazinga we-slippage azokwandisa ngaphezu kwesikhathi.
Kukhona ubufakazi bokusekela le mpikiswano. Ngokusho kwedatha eyenziwe yi-US Centers for Disease Control and Prevention (CDC), cishe ama-30% aseMelika ase-ART akakwazi ukufeza ukucindezelwa kwegciwane. Iningi liyavuma ukuthi ukubambelela okunamandla kudlala indima ebalulekile kulokhu, kuyilapho ezinye iziphakamiso zisho ukuthi ukunamathela ngokwemvelo kunqamuka ngemva kwenyanga yokuqala "yenyanga" emva kokuqaliswa kwe-ART.
Kodwa-ke, kunobunye ubufakazi obanele bokusekela ukuthi izidakamizwa ezintsha zokuzalwa zikhulu kakhulu "ukuthethelela" ngokumelana nokuphikiswa, ikakhulukazi izidakamizwa "ezikhuthazayo" ezikwazi ukusekela izingxube ezinkulu zemithi ye-plasma ngezikhathi eziningi.
Kodwa ingabe ubufakazi banele ngokwanele ukubiza ukuphumula kwemikhuba yokunamathela? Ngisho nemishanguzo engcono, ephumelela kakhulu ye-antiretroviral, ingabe ngempela sisesesiteji okwamanje?
Ukulinganisa Ubufakazi
I-Protease inhibitors (i-PIs) iyisibonelo esihle sokuthuthukiswa kwe-ART yesimanje. Namuhla, i-PIs cishe "iyathuthukiswa" yonke- isho ukuthi ilawulwa ngokuhambisana nezidakamizwa zesibili ezikwazi ukunweba i-serum isigamu sempilo ye-PI. Ukuhlaziywa kwemeta kwezifundo ezinhlanu ezinkulu kuphakamisa ukuthi isizukulwane esisha sivuselele i-PIs-njenge-Prezista (i-darunavir) -ngempela, sidinga ukulingana okungu-81% ukuze kutholakale ukucindezelwa kwegciwane.
Ngokuphambene nalokho, ama-PI akhudlwana ama-PI afana ne-Kaletra (lopinavir + ritonavir) aboniswa ukuthi ayasebenza kangako uma ukunamathela kwehla kwehla ngaphansi kuka-95%, ngokuhlola okukodwa okuphakamisa ukuthi iziguli ezingama-53 kuphela ezikwazi ukuthola imithwalo engavamile engavamile engaphansi kwezinga lokunamathela.
Ucwaningo alucaci kakhulu ngomthelela wokunamathela kwamanye amakilasi ama-antiretrovirals. Ngenkathi ezinye izifundo zikhonjisiwe ukuthi izidakamizwa ezingenayo i-nucleoside reverse transcriptase inhibitors (NNRTI) njengeSusvava (efavirenz) zingadinga kuphela ukunamathela kuka-80% kuya kwezingu-90% uma zisetshenziselwa ukuhlanganiswa ne-PI ekhuthaziwe, abanye bathi amazinga aphezulu okunamathela ayadingeka ngenxa ukuze kube khona amandla okumelana nokuphikisana nezinye izidakamizwa ze-NNRTI.
Ngokufanayo, i-CPCRA FIRST Study ithole ukuthi amanani okumelana phakathi kwezidakamizwa ze-nucleoside reverse transcriptase inhibitor (NRTI) njenge Retrovir (AZT, zidovudine) ukwanda ngokuvumelana ngokunciphisa ukunamathela kwezidakamizwa.
Kukhona okwamanje izifundo ezimbalwa ezitholakalayo zokuhlola ubuhlobo phakathi kokunamathela kanye nezidakamizwa ezintsha ezizukulwaneni ezifana ne-Intelence (etravirine) noma ngisho ne-nucleotide analog ethandwayo, i-Viread (i-tenofovir). Ngokufanayo, i-integrase inhibitors evunyelwe ukusetshenziswa, isifundo esisodwa esisodwa se- Isentress (raltegravir) siphakamisa ukuthi amazinga okunamathela angama-90% angamukeleka .
Ingabe Kufanele Ulahlekelwe Ngamanye Omunye (noma Amaningana) Amanani Angikhathazekile?
Ukungabi nesilinganiso somthamo noma ukwehluleka ukuthatha umthamo ngesikhathi kunento eyenzeka kuwo wonke umuntu onomuthi ongapheli.
Ngokuyinhloko, lokhu akufanele kubangele ukukhathazeka okungadingekile. Kodwa-ke, isikhathi eside noma ngaphezulu lokhu kuphelelwa yisikhathi kwenzeka, abancane abakwaziyo ukuthi izidakamizwa zigcine ukucindezelwa okungavumelekile kwegciwane.
Ucwaningo olwenziwe yiNational Institute of Infectious Diseases eRoma lubonise ukuthi izikhala zokwelashwa kwezinsuku ezimbili nje phakathi nenyanga zaholela ekukhuleni okuphindwe kabili emiphumeleni yomsebenzi wegciwane elibonakalayo. Ukusekela ucwaningo ngo-2013 kuye kwabonisa ukuthi ngisho nokugcinwa, "imithwalo yegciwane eliseduze" etholakalayo (phakathi kwama-50 no-199 amakhophi / mL) kungaholela engozini engaphezulu kuka-400% yokuhluleka kwe-virologic.
Ngokufanayo, ucwaningo oluvela e-Côte de Nacre University Hospital eFrance lwabonisa ukuthi izikhala ezinengi ku-ART zandisa amathuba okuhluleka ukwelashwa , nokuphazanyiswa kwezinsuku ezingu-15 ezifaka amathuba okuba ngu-50% we-rebound rebound.
Ngokufanayo, ukuhambisana nokusebenza kwezinguquko ze-Protease Inhibitor Therapy (AEPIT) zihlolisise umthelela weziphutha zokwenza ama-dose ngesikhathi somsebenzi wegciwane. Ngokusho kocwaningo, iziguli ezavumela amahora amathathu ama-leeway ngakwesinye isikhathi sezikhathi zabo zokuvota zivamile ukwenza umsebenzi wegciwane lesandulela ngculazi ngaphezulu kuka-300% kunabo ababethathe imithi yabo ngesikhathi.
Ngakho Lokho Kusho Ngami?
Akungabazeki ukuthi izidakamizwa ezintsha zokuzalwa zilula ukusebenzisa futhi zibekezelela, ukunikeza "intethelelo" enkulu uma isiguli singaphuthelwa umthamo ongaqondakali. Futhi ngenkathi sibheke ngokucacile ekudleni izidakamizwa ezinde isikhathi eside okudinga ukuphindaphindiwe, ijaji lisekhona ukuthi ngabe lokhu kubonisa ukuthi ushintsho lwangempela luyizincomo zokunamathela.
Ekugcineni, i-ART isekelwe kwinhlanganisela yama-antiretroviral agents, ngamunye anezimpikiswano ezahlukeneyo kanye ne-pharmacokinetics. Ezinye zezinhlawulo zinamaphezu amancane amaphutha; amanye amakhulu. Ngokombono osebenzayo, kungaba yinto engavumelani ukushintsha umgomo wokulondlobala ngawo wonke umuthi wokwelashwa.
Esikhundleni salokho, izinkinga zokunamathela kufanele zihlangane ngokubekezelelana okukhulu kunabathengisi nokukhathazeka okuncane ezivela ezigulini ezesaba ukuvuma ukwehluleka kwazo. Uma ngabe kukhona, kudinga ukusebenzisana okukhulu nomhlinzeki wokubekezela, ngezinhloso ezithile kanye nokungenelela ukuqinisekisa ukunamathela kwangempela nokuphila kwangempela. Lezi kufanele zifake:
- Ukuhlola okuqhubekayo kwemingcele yokunamathela ngaphambi kokuqaliswa kwe-ART (isb., Uhlelo lokusebenza, izingane, ukudalulwa, ukuhlukaniswa, njll)
- Ukuhlola okuqhubekayo nokubambisana ukubhekana nanoma yiziphi izinkinga ezintsha noma ezikhona (kufaka phakathi imiphumela yokwelashwa, izinkinga zomndeni, izinkinga zomzwelo, njll)
- Ukunciphisa umgomo wokwelapha, lapho kuboniswe khona
- Ukubhekana nezimo eziguquguqukayo ezihambisana nokunamathela kabi (isib. Ukusetshenziswa kabi kwezidakamizwa, ukucindezeleka, ukungabi namakhaya, njll)
- Ukusebenzisa amadivaysi okunamathela (isib. Abahleli bemithi, amadivaysi okukhumbuza) noma izinhlelo zokusekela ukunamathela.
Ngamafuphi, kusebenza kakhulu ukubhekana nokunamathela okungaka kakhulu ngokwemigomo ethi " Ngakanani okwanele ?," kodwa kunendlela yokubona amathuluzi ukuqinisekisa ukuthi i-ART iyasebenza, ingxenye yokucindezeleka yendlela yomuntu yansuku zonke .
Uma lokhu kungafinyelelwa, umbuzo othi "kungakanani" ungawa ngokuphelele.
Imithombo:
Kobin, A. kanye neSheth, N. "Amanothi Wokuvumelana Adingekile Ukuxoshwa Ngezidakamizwa Phakathi Kwemishanguzo Emisha Ye-Antiretroviral." The Annals of Pharmacology. 2011; 45 (3): 372-379.
UMartin, uM .; I-Del Cacho, E .; Codina, C .; et al. "Ubuhlobo Phakathi Kwezinga Lokuvumelana, Uhlobo Lwe-Antiretroviral Regimen, ne-Plasma I-HIV Uhlobo 1 I-RNA Viral Load: Isifundo Samaqembu Esiphambili." I-AIDS Research Retroviruses Abantu. Okthoba 2008; 24 (10): 1263-1268.
I-Mena, A .; U-Blanco, F .; I-Cordoba, M; et al. "Isifundo Sezindiza Ukuhlola i-Raltegravir QD neBID ku-HIV Abaguli Ababandakanyekile Ekulinganisweni Okulula." Kuthulwe kwi-49th Interscience Conference mayelana nama-Antimicrobial Agents kanye ne-Chemotherapy (ICAAC). I-San Francisco, eCalifornia; Septemba 12-15, 2009.
I-Laprise, iC .; de Pokomandy, A .; I-Baril, J .; et al. "Ukuhluleka Kwe-Virologic Ukulandela I-Viremia Yezinga Eliphansi Elisezingeni Eliphansi Kweziguli Ezithathelwana Negciwane lesandulela ngculazi: Imiphumela Evela Eminyakeni Eyishumi Nambili Yokubheka." Izifo Ezithathelwanayo Emitholampilo. Novemba 2013; 57 (10): 1489-96.
Ammassari, A .; ITrotta, uM .; UZaccarelli, M .; et al. "Umthelela Wezinhlobo Ezihlukene Zokuhambisana Nezinto Ezihambisana Nayo I-CART Izici ezibhekene ne-Plasma HIV-1 I-RNA Detection Ngaphansi Kwemingcele Engaphansi Ye-Quantification E-Assay Real Time." Kuthulwe kwi-12 ye-European Conference Conference. I-Cologne, eJalimane; Novemba 11-14, 2009.