I-Hepatitis C iyisifo esithathelwanayo esithinta isibindi, esasakazwa yi-virus ye-hepatitis C (i-HCV) futhi ingenye yezimbangela ezibangela ukwelashwa nokufa phakathi kwabantu abane-HIV.
I-American Association for the Study of Liver Diseases (AASLD) ibika ukuthi i-virus ye-hepatitis-efaka isibindi se-A, B , ne-C-yiyona eyimbangela yokuqala yokufa emhlabeni jikelele, ngokulahlekelwa ukuphila okungaphezu kwe- AIDS , isifo sofuba kanye ne-malaria .
Okwamanje akakho umgomo we-hepatitis C.
Ukwelashwa kwe-HIV / HCV
Ukusabalalisa okubikiwe kwe-HIV / HCV coinfection kuyahlukahluka ngokutadisha, kodwa ucwaninga ngokucacile ukuthi izinga lokutheleleka kwe-HCV kubantu abanesandulela ngculazi liphakeme ngamaphesenti angama-30 e-US naseYurophu. Emhlabeni wonke, umthwalo jikelele weHIV / HCV uphakathi kwabantu abayizigidi ezingu-4-5, noma phakathi kwamaphesenti angu-10-15 we-HIV.
Abasebenzisi bokusebenzisa izidakamizwa ezingenalutho (IDUs) banomngcipheko omkhulu kakhulu we-coinfection ye-HIV / HCV, ngokusakazeka kusuka kumaphesenti angu-82 kuya kuma-93%. Ngokuphambene nalokho, ukukhonjiswa kwe-coinfection ngendlela yokudlulisa ngokocansi kungamaphesenti angama-9.
Ngenkathi amadoda alala nabesilisa (MSM) engenawo engozini yokwanda kwe-HCV, ingozi ingakhuphuka ibe ngamaphesenti angama-23 ku-MSM enokuziphatha okubi kakhulu-njengabalingani abaningi bezocansi, ubulili beqembu, noma baze babelane ngezidakamizwa ezithathwe ngokuzwakalayo noma ngomlomo.
Abantu abathintekayo banomthwalo ophezulu wegciwane lesandulela ngculaza kunama-counterparts abo abathintekayo, okuholela ekuthuthukeni okusheshayo ku- fibrosis , i- cirrhosis , ne- hepatocellular carcinoma (uhlobo oluvame kakhulu lomdlavuza wesibindi).
Ngaphezu kwalokho, abantu abathintekayo banomngcipheko ophindwe kabili we-antipatroviral-ehlobene ne-hepatotoxicity (ubuthi obunobindi) kunelabo abane-HIV kuphela.
Lezi zibalo zibonisa isidingo sokuqhathaniswa okukhulu kwe-HCV phakathi kwabantu abane-HIV, kanye nokwelapha okuphumelelayo ukuze kutholakale ukutheleleka kwe-HCV noma, okungenani, ukuqhuma kwesifo se-slow.
Nini Ukuqala Ukwelashwa
Ukuqala nini i-HCV kungaba yinkinga eyinkimbinkimbi. Ngokuvamile, ukwelashwa kwe-HCV kuboniswa kubantu abanokukhubazeka okubangelwa yi-HCV-ehambisana naso. UMnyango WezeMpilo WezeMpilo wase-United States (DHHS) ukhuthaza ukuthi ukwelashwa kwe-HCV kuqalwe kubantu abathintekayo abanezinkinga ezinkulu ze-fibrosis futhi basengozini enkulu yokuthuthukiswa kwe-cirrhosis.
Ngenxa yokubaluleka okukhulu kwemiphumela emibi yezidakamizwa-kanye neqiniso lokuthi ukwelashwa akuqinisekisi ngokuphelele ukuthi imvume ye-HCV-isinqumo sokwelapha isekelwe kakhulu ekulungiseni isiguli, kanye nokuhlola izinkomba zokubikezela impumelelo yokwelapha (isib. I- HCV genotype , i- HCV umthamo wegciwane ).
Noma kunjalo, kubalulekile ukuqaphela ukuthi izidakamizwa eziphuthumayo ze-HCV ziyashesha ukunciphisa izithiyo zokwelapha, kanti izinzuzo zokwelashwa zidlula kakhulu imiphumela engaba khona.
I-DHHS iphinde iphakamise ukusetshenziswa kwe- antiretroviral therapy (ART) kubo bonke abantu abathintekayo kungakhathaliseki ukuthi i- CD4 count , ekhonjiswe ukuphuza ukuqhubekela phambili kwezifo ezihambisana ne-HCV. Ngaphezu kwalokho:
- Kubantu abanama-CD4 aphansi (ngaphansi kuka-200 amaseli / mL), ukwelashwa kwe-HCV kufanele kubambezeleka kuze kube isikhathi sokuthi i-CD4 ikhuphuke. Ukukhethwa kwemishanguzo ye- antiretroviral kuncike ngokuphelele ekusebenzisaneni kwezidakamizwa-izidakamizwa, kanye nezidakamizwa ezidakayo. (Ukukhathazeka okuyinhloko ukuthi ezinye izidakamizwa ezisetshenziselwa ukwelashwa kwe-HCV zihlanganiswa ngendlela efana neminye imishanguzo yegciwane lengculazi, ukunciphisa ukusebenza komuthi kokubili ngenkathi kukhula ingozi yecala elilodwa.)
- Kumuntu ngamunye osevele e-ART, kucatshangelwa ukuthi kubuyekezwe ukwelashwa ukuze kuncishiswe imiphumela emibi, kanye nezinzuzo zokuguqula futhi ukukhathazeka ngokweqile mayelana nokuthuthukiswa okungenzeka kwe- HIV ukumelana nezidakamizwa .
- Kubantu abangaphathwa kabi abane-CD4 babalwa ngamaseli angaphezu kuka-500 / mL, odokotela bangakhetha ukulibazisa i-ART kuze kugcwaliswe ukwelashwa kwe-HCV.
Sibutsetelo Izinketho ZeMithi Ye-HCV
Umhlane we-HCV ukwelashwa sekuyisikhathi eside ukuhlanganiswa kwe- pegylated interferon alpha (noma i-PEG-IFN) ne- ribavirin . I-PEG-IFN iyinhlanganisela ye-antiviral emithathu ecela amangqamuzana ukuba akhiqize inqwaba ye-enzyme ekwazi ukubulala kokubili igciwane kanye namaseli omthelela onegciwane.
I-Ribavirin, enye i-agent e-anti-virus, iphazamisa i-RNA metabolism edingekayo ekuphindaphindiwe kwegciwane.
Izandulela-ngculaza ezishaya ngokuqondile ezishaya (DAAs) zikwazi ukwelapha izinhlobo eziningi ze-genotypes C ngaphandle kokusetshenziswa kwe-PEG-INF futhi, ezimweni eziningi, i-ribavirin. Ngokwenza kanjalo, imiphumela emibi ehambisana ne-HCV yokwelapha incishiswe kakhulu, njengesikhathi sobude be-treament.
Phakathi kwama-DAA avunyelwe njengamanje asetshenziswa ekwelapheni ukutheleleka okungapheli kwesifo se-hepatitis C (ngomyalelo we-FDA imvume):
| Isidakamizwa | Kuvunyelwe | Okushiwo | Ukuzikhohlisa | Isikhathi |
| I-Epclusa (sofosbuvir + velpatasvir) | ama-genotypes 1, 2, 3, 4, 5, no-6 kanye nathi ngaphandle kwe-cirrhosis | i-ribavirin ezimweni ze-cirrhosis ezonakele futhi ngaphandle kwe-ribavirin kuzo zonke ezinye izimo | i-tablet eyodwa nsuku zonke noma ngaphandle kokudla | 12-16 amasonto |
| I-Zepatier (elbasvir + grazoprevir) | i-genotypes 1 neyine noma ngaphandle kwe-cirrhosis | i-ribavirin noma ngaphandle kwe-ribavirin, kuye ngomlando we-genotype nomlando wezokwelapha | i-tablet eyodwa nsuku zonke noma ngaphandle kokudla | 12-16 amasonto |
| I-Daklinza (daclatasvir) | i-genotype 3 ngaphandle kwe-cirrhosis | I-Sovaldi (sofosbuvir) | i-tablet eyodwa nsuku zonke nokudla | Amaviki angu-12 |
| I-Technivie (i-ombitasvir + paritaprevir + ritonavir) | i-genotypes 4 ngaphandle kwe-cirrhosis | ribavirin | amaphilisi amabili nsuku zonke nokudla | Amaviki angu-12 |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, ehlanganiswe ne-dasabuvir) | i-genotype 1 ene-cirrhosis noma ngaphandle | i-ribavirin noma ithathwe yedwa, lapho kuboniswe khona | amaphilisi amabili e-ombitasvir + paritaprevir + ritonavir athathwa kanye nsuku zonke nokudla, kanye nephebulethi eyodwa ye-dasabuvir ethathwe kabili nsuku zonke ngokudla | Amaviki angu-12-24 |
| I-Harvoni (i-sofosbuvir + ledipasvir) | i-genotype 1 ene-cirrhosis noma ngaphandle | kuthathwe yedwa | i-tablet eyodwa nsuku zonke noma ngaphandle kokudla | Amaviki angu-12-24 |
| I-Sovaldi (sofosbuvir) | i-genotypes 1, 2, 3 no-4 nge-cirrhosis, kuhlanganise nalabo abane-cirrhosis noma i- hepatocellular carcinoma (i-HCC) | i-peginterferon + ribavirin, i-ribavirin yedwa, noma u-Olysio (simeprevir) noma ngaphandle kwe-ribavirin, lapho kuboniswe khona | i-tablet eyodwa nsuku zonke noma ngaphandle kokudla | Amaviki angu-12-24 |
| I-Olysio (simeprevir) | i-genotype 1 ene-cirrhosis noma ngaphandle | i-peginterferon + ribavirin, noma iSovaldi (sofosbuvir), lapho kuboniswe khona | i-capsule eyodwa nsuku zonke nokudla | Amaviki angu-24-48 |
Imiphumela Ejwayelekile Ejwayelekile
Esinye sezikhathazo eziyinhloko mayelana nokwelapha i-HIV / HCV coinfection yimiphumela emibi engase ibe khona njengomphumela wezokwelapha. Ngenkathi ukwethulwa kwezidakamizwa ezintsha kulesi sizukulwane kuye kwashintsha ukwelashwa kwe-HCV, akukho muntu odlala izinselele ezinye iziguli ezibhekana nazo.
Kubantu abaqala ukwelapha okokuqala, imiphumela emibi kakhulu ye-HCV yokwelashwa (okwenzeka okungenani ama-5% wamacala) yi:
- I-Epclusa: ukukhathala, ikhanda
- I-Zepatier : ukukhathala, ukukhanda ikhanda, isicanucanu
- I-Daklinza : ukukhathala, ukukhanda ngamakhanda , isicashu, isifo sohudo
- I-Technivie : ubuthakathaka obungokwenyama, ukukhathala, isicashu, ukulala
- Viekira Pak : ukukhathala, ukucwenga, isikhumba esibuhlungu, ukusabela kwesikhumba, ukuleleka, ubuthakathaka, ukukhathala
- I-Harvoni : ukukhathala, ikhanda
- I-Sovaldi + PEG / INF + i-ribavirin: ukukhathala, ukuleleka, ukuhlukunyezwa, ukukhanda ikhanda, i-anemia
- I-Sovaldi + ribavirin: ukukhathala, ikhanda
- I-Olysio + PEG / INF + i-ribavirin: i-rash, isikhumba esinomuthi, isicanucanu, ubuhlungu besisu, ukuphefumula
Nakuba eminingi yemiphumela emibi iphela, ixazulula phakathi nesonto noma kokubili kokuqala, ezinye izimpawu zingase zinde futhi zibizwe (ikakhulukazi ezithombeni ezisekelwe ku-PEG / INF). Khuluma nodokotela wakho ngokushesha uma izimpawu ziphathelene nokuthi / noma ziphikelela.
Ngaphambi kokuqala ukwelashwa kwe-HCV
Ukuqonda nokulindela imiphumela emibi yilezi zihluthulelo zokwelashwa okuzimele futhi ufeze imigomo efanele yokwelapha. Imithwalo yepilisi, ama-schedule schedule, kanye nezinguquko zokudla (okungukuthi, ukunyuka kwamafutha okudla kulabo abadla ukudla okunamafutha aphansi) yizinye zezimpikiswano okudingeka ziqondiswe ukuze kuqinisekiswe kangcono ukulungiswa kwesiguli.
Futhi nakuba ukukhethwa kwezidakamizwa kungabhekwa njengesihluthulelo empumelelweni yokwelashwa, ngakho-ke, ukunamathela kwezidakamizwa . Akuhlobene kuphela nemiphumela engcono kodwa ezimweni eziningi kunciphisa izigameko nokuqina kwemiphumela emibi. Ukunamathela ngokulinganayo, empeleni, kuyisici esiningi sokuthi ukwehluleka ukwelashwa kungenzeka njengemicimbi yokwelapha embi.
Ukuguquka kwesibindi
I-cirrhosis ngenxa yokutheleleka okungapheli kwe-HCV yikhombisi ehamba phambili yokufakelwa kwesibindi e-US, eYurophu naseJapane, nakuba igciwane liyaziwa ukuthi liphindaphinda cishe ngamaphesenti angu-70 abamukeli bokufakelwa ngaphakathi eminyakeni emithathu. Ukwengeza, ukutheleleka kwe-graft ngokwayo kungaholela phakathi kwamaphesenti angu-10-30 weziguli ezikhula nge-cirrhosis phakathi neminyaka emihlanu.
Kubantu abadinga ukufakelwa kwesibindi, ukuqaliswa kwe-HCV kathathu ukwelashwa kunganciphisa kakhulu ingozi yokulahlekelwa kwe-graft nge-30%.
Naphezu kwezingozi zokuhlanganyela, kubalulekile ukuqaphela ukuthi izinga lokusinda ngesiguli lifana nazo zonke ezinye izibonakaliso zokufakelwa kwesibindi-nezinga lokusinda ngemuva kokuphakathi kuka-68% no-84% phakathi neminyaka emihlanu yokuqala.
Imithi ye-HCV yesizukulwane esisha ingase iqhubekele phambili le miphumela, ngenkathi igxilisa izinga eliphezulu lemiphumela emibi yezidakamizwa ezihlobene nokwelashwa.
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