Izidakamizwa ezishaqisayo ze-Anti-Viral Izidakamizwa ezingaphezu kwamaphesenti angama-90 ama-Cure
Uma ucabanga ukuthi igciwane le-hepatitis C (i-HCV) laqala ukutholakala ngo-1989 nokuthi ikakhulukazi libhekwa lingelapheki kuze kube sekupheleni kwekhulu lama-20, ukuthuthukiswa kokwelapha akuzange kube okumangalisayo.
Kwaphela ngoDisemba 2013, empeleni, ukuthi lo mdlalo ushintshiwe ngokuphelele ngokukhululwa kweSovaldi , isifo sokulwa namagciwane ngokuqondile (DAA) esanikeza imiphumela emibi embalwa, isikhathi esifushane sokwelashwa, kanye nesilinganiso sokuphulukisa esiphezulu samaphesenti angu-99 kwezinye abantu.
Imithi iphumelele kakhulu ukuthi ukwelashwa namuhla sekuye kwadluliselwa kubantu bobabili abane-HCV ekhuthele futhi engapheli, kanye nalabo abanesifo esibindile sesibindi.
Ngokuqonda kangcono imigomo ye-hepatitis C yokwelashwa-kubandakanya ukuthi izidakamizwa zikhethiwe futhi zisetshenziswe kanjani-ungenza ukhetho oluthe xaxa mayelana nesenzo esilungele kakhulu kuwe.
Izinhloso ze-Hepatitis C Therapy
Njengomthetho wesithupha, ukuphathwa kwangaphambili kwe-hepatitis C kuhlobene nemiphumela engcono, hhayi kuphela ngokususa igciwane kodwa ngokuvimbela noma yimuphi umonakalo wesikhathi eside esibindi nesitho ezihlobene.
Izinhloso ze-hepatitis C therapy, ngakho-ke, ziphindwe kabili:
- Ukuthola impendulo egciniwe yegciwane lesandulela ngculazi (SVR) , echazwa ngokuthi ukungabi khona kwegciwane egazini lomuntu isikhathi esingamaviki angu-24 kulandela ukwelashwa
- Ukuvimbela ukuqhubekela phambili kwezifo zesibindi, kufaka phakathi ukuthuthukiswa kwe- cirrhosis nesifo somdlavuza wesibindi
Phakathi nesikhathi sokwelapha, izivivinyo zamalebhu zenziwa njalo ukuze zihlolwe izinga legciwane egazini lomuntu.
Eyaziwa nangokuthi umthamo wegciwane le- HCV , lezi zivivinyo zingasiza odokotela babikezele ukuthi kungenzeka yini imiphumela (noma ukubikezelwa) kokwelashwa.
Umthamo wegciwane elingenakulinganiswa ubhekwa njengempendulo enhle, futhi amaviki angu-24 e-SVR acatshangwa ngokucophelela ngokuthi "ukwelashwa."
I-pathologists ichaza indlela yokwelashwa ngendlela elandelayo:
| Ithemu | Okushoyo | Incazelo | Isibikezelo |
| RVR | Ukusabela okusheshayo kwegciwane | Umthamo wegciwane elingenakulinganiswa emva kwamasonto amane okwelashwa | Ngokuvamile amathuba okufinyelela i-SVR |
| I-eRVR | Ukuphendula okusheshayo kwe-viral | Umthamo wegciwane elingenakulinganiswa ngeviki 12, emva kwe-RVR yokuqala | Ngokuvamile amathuba okufinyelela i-SVR |
| EVR | Impendulo yokuqala yegciwane | Umthamo wegciwane elingenakulinganiswa noma ukunciphisa amaphesenti angu-99 ekutheni umthamo wesandulela ngculazi ngesonto 12 | Ukuhluleka ukufezekisa i-EVR ngeviki 12 ama-correlates angaphansi kwamaphesenti angu-4 ithuba lokufinyelela i-SVR |
| I-ETR | Ukuphela kokuphendula kokwelashwa | Umthamo wegciwane elingenakutholakali otholakala ekupheleni kwesonto 12 | Akusizi ekubikezeni imiphumela yokwelapha |
| Umphenduli oyingxenye | Iyakwazi ukufeza i-EVR kodwa ayikwazi ukugcina umthamo wegciwane elingenakutholakali ngemva kwamasonto angu-24 ngemuva kokuphelelwa ukwelashwa | Kucatshangwa ukwehluleka kokwelashwa | |
| Umphenduli ongenayo | Ayikwazi ukufeza i-EVR ngesonto 12 | Ukwelashwa kuvamise ukuphela uma i-EVR ingatholakali ngesonto 12 | |
| I-SVR | Impendulo yegciwane lesondlo | Iyakwazi ukusekela umthamo wegciwane elingenakulinganiswa amasonto angu-12 (i-SVR-12) namaviki angu-24 (i-SVR-24) ngemva kokuphela kwelashwa | I-SVR-24 ingabhekwa ngokuthi "ukwelapha," kuyilapho iziguli ezine-SVR-12 zivame ukufeza i-SVR-24 |
Namuhla, abangaphezu kuka-99 amaphesenti alabo abaphumelela i-SVR-24 bazohlala bengenalo igciwane okungenani iminyaka emihlanu. Kulabo, cishe isigamu sizokwazi ukuxazululwa kwe-cirrhosis engakapheli unyaka, kuyilapho iningi lizobona ukuguqulwa okuphawulekayo ekunqandeni kwesibindi ( fibrosis ).
Nini Ukuqala Ukwelashwa
Ubufakazi busekela ngokuqinile ukwelashwa kwabo bonke abantu abane-hepatitis C, abaneminyaka engama-18 noma ngaphezulu. Okuwukuphela kokukodwa yilabo abanokuphila esikhathini esingaphansi kwezinyanga ezingu-12 ngenxa yezizathu ezingezona isibindi.
Kodwa-ke, njengoba ukwelashwa kungatholakali kubo bonke abagulayo (ngenxa yezindleko noma ukulinganiselwa komshuwalense), okudingeka kuqala kunikezwe labo abanesidingo esiphuthumayo kakhulu. Lezi zibandakanya abantu abane-fibrosis ephakeme, i-cirrhosis ekhokhelwa, ukufakelwa kwesibindi, noma izinkinga ezihlobene nokungahlosi kwesibindi zokutheleleka kwe-HCV.
Ngokucatshangelwayo futhi kunikezwa abantu abasengozini enkulu yokuhlukunyezwa kwe-hepatitis C, okubalwa nalabo abane-fibrosis elinganisiwe, ukutheleleka nge-HIV , ukutheleleka kwesifo sofuba, uhlobo lwesifo sikashukela, kanye nezinye izifo zesibindi ezenzeka ngokuhlanganyela.
Nokho, kufanele kuqaphele ukuthi abantu abanokuthola ukwelashwa okusheshayo bangazuza kakhulu, hhayi ngokunciphisa ukulimala kwesibindi kodwa ngokwandisa ubude be-SVR.
Ucwaningo luye lwabonisa ukuthi abantu abaphathwa ngezindlela zokuqala ze-fibrosis (njengoba kulinganiswa ngamaphuzu we- METAVIR ) banethuba elingamaphesenti angu-92 lokuhlala lingenalo igciwane okungenani iminyaka engu-15.
Ngaphambi kokuqala noma iyiphi indlela yokwelashwa, kubalulekile ukuthi uhlole kokubili ukuzimisela kwakho kanye nokukwazi ukunamathela ekwelapheni. Uma ubona kuqala izinkinga-kuhlanganise nomsebenzi noma izinkinga zomuntu siqu, ukusetshenziswa kotshwala / izidakamizwa, noma ukwesaba mayelana nemithi ngokwabo-qiniseka ukuthi uxoxe nabo nodokotela wakho ngaphambi kokuqala ukwelashwa. Izinsizakalo zesekelo zingatholakala ukuthola usizo olungcono ukunqoba lezi zinkinga.
Imithi Evunyelwe I-Hepatitis C
I-hepatitis C yokwelapha inamanye ama-agent ezidakamizwa, ajwayele ukuthi abekwe esikoleni sezinyanga ezingu-12.
Kwezinye izimo, isikhathi sokwelashwa singadlulela ku-24 noma ngisho namaviki angu-48, ngokuvamile kaningi kubantu abane-cirrhosis noma labo abaye baphelelwa ukwelapha ngaphambilini.
Ngaphandle kwe-DAA enqunyiwe, ezinye izidakamizwa ezimbili zingasetshenziswa njengengxenye yokwelashwa okuhlanganisiwe:
- i-peginterferon , inguqulo eyenziwe ngumuntu we-interferon, eyenza ngokufaka uphawu emzimbeni ekubeni khona kwama-agent abangela izifo njenge-HCV
- i-ribavirin , imithi yomlomo eyaziwa ukuphazamisa ukuphindaphinda kwamagciwane
I-Peginterferon, enikezwe umjovo, ngokuvamile ibhalwe nge-ribavirin. I-Ribavirin, ngokuphambene, ivame ukusetshenziswa yodwa ngokuhambisana nomuthi we-DAA oyinhloko.
Ukukhethwa kwezidakamizwa kusekelwe kuhlobo lomzimba (i-genotype) yegciwane lomuntu onesifo, kanye nokuhlolwa kwesimo sempilo yomuntu nomlando wangaphambilini wezokwelapha.
Kukhona izidakamizwa ezingu-8 ze-DAA ezivunyiwe yi-US Food and Drug Administration:
| Isidakamizwa | Kuvunyelwe | Okushiwo | Ukuzikhohlisa | Isikhathi |
| I-Epclusa (sofosbuvir + valpatasvir) | i-genotypes 1, 2, 3, 4, 5, no-6 noma ngaphandle kwe-cirrhosis | ngaphandle kwethu ngaphandle kwe-ribavirin, kuye ngomlando we-genotype kanye nomlando wezokwelapha | i-tablet eyodwa nsuku zonke ngaphandle kokudla | 12-16 amasonto |
| I-Zepatier (elbasvir + grazoprevir) | i-genotypes 1 neyine noma ngaphandle kwe-cirrhosis | ngaphandle kwethu ngaphandle kwe-ribavirin, kuye ngomlando we-genotype kanye nomlando wezokwelapha | i-tablet eyodwa nsuku zonke ngaphandle kokudla | 12-16 amasonto |
| I-Daklinza (daclatasvir) | i-genotype 3 ngaphandle kwe-cirrhosis | noSovaldi | i-tablet eyodwa nsuku zonke nokudla | Amaviki angu-12 |
| I-Technivie (i-ombitasvir + paritaprevir + ritonavir) | i-genotypes 4 ngaphandle kwe-cirrhosis | ne-ribavirin | amaphilisi amabili nsuku zonke nokudla | Amaviki angu-12 |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, ehlanganiswe ne-dasabuvir) | i-genotype 1 ene-cirrhosis noma ngaphandle | nge noma ngaphandle kwe-ribavirin, njengoba kubonisiwe | Amathebulethi amabili e-ombitasavir + paritaprevir + ritonavir athathwa kanye nosuku ngokudla, kanye nebhebhulethi eyodwa ye-dasavuvir ethathwe kabili nsuku zonke ngokudla | Amaviki angu-12-24 |
| I-Harvoni (i-sofosbuvir + ledispasvir) | i-genotype 1 ene-cirrhosis noma ngaphandle | eyedwa | i-tablet eyodwa nsuku zonke noma ngaphandle kokudla | Amaviki angu-12-24 |
| I-Sovaldi (sofosbuvir) | i-genotypes 1, 2, 3, no-4 noma ngaphandle kwe-cirrhosis | kuhlanganiswe ne-ribavirin, i-Olysio, i-peginterferon + i-ribavirin, noma i- Olysio + ribavirin, njengoba kubonisiwe | i-tablet eyodwa nsuku zonke noma ngaphandle kokudla | Amaviki angu-12-24 |
| I-Olysio (simeprevir) | i-genotype 1 ene-cirrhosis noma ngaphandle | kuhlangene noSovaldi noma peginterferon + ribavirin, njengoba kubonisiwe | i-capsule eyodwa nsuku zonke nokudla | Amaviki angu-24-48 |
Ukubonisana okhethekile kufanele kudingeke ukuba umuntu abuyele esibhedlela se-C emva kokuhluleka kokwelashwa kwangaphambilini. Izinqumo zokutakula kufanele zisekelwe ekuhlolweni kwezinhlobo kanye nokuhlanganiswa kwezidakamizwa ezisetshenziswe ngaphambili, kanye nokuhlolwa kwesibindi somuntu.
Kwezinye izimo, ukuhlola ukuphikiswa kofuzo, okungaqapha ukuthuthukiswa kwe-HCV ukumelana nezidakamizwa, kungasiza ekukhetheni izidakamizwa, ikakhulukazi kubantu abane-genotype 1 ukutheleleka okuye kwavezwa ngaphambilini kuma-DAA.
> Umthombo:
> I-American Association ye-Study of Liver Illness (AASLD) kanye ne-Infectious Diseases Society of America (IDSA). "Isiqondiso se-HCV: Izincomo zokuhlola, ukuphatha nokuphatha isifo sofuba esibhedlela" Kubuyekezwe ngo-Julayi 6, 2016.