Uhlolojikelele lwe-HIV Ukwelashwa
Akungabazeki ukuthi izidakamizwa ezisetshenziselwa ukwelashwa kwegciwane lesandulela ngculazi ziye zahamba phambili eminyakeni eyishumi eyedlule. Lokhu kuyiqiniso uma kuqhathaniswa nama-agent agesi asebekhulile ayenamazinga aphezulu obudakamizwa futhi ajwayele ukuthuthukiswa kokuqala kwezidakamizwa. Lokho abanye abangase bangaqapheli ukuthi isayensi isifikile kangakanani kusukela ngo-1996, lapho ukwelashwa kokuqala kwezidakamizwa ezintathu kushintshela inkambo yengozi.
Ngaphambi kuka-1996, ukulinganiselwa kokuphila komuntu osanda kutholakala owesilisa oneminyaka engu-20 ubudala e-US kwakuyiminyaka engu-17 kuphela. Namuhla, izindlela zokwelapha ezintsha zesikhulu ziyakwazi ukukhokhela izilinganiso zokuphila ezilingana neyabantu abaningi ngenkathi ziqhayisa ngemiphumela emibi kakhulu yezidakamizwa futhi zinikeza amashejuli wezinhlelo ezilula njengokulula kwephilisi elilodwa ngosuku.
Noma kunjalo, naphezu kwale ntuthuko, abangaphansi kwengxenye yabantu baseMelika abathola ukwelashwa bayakwazi ukufeza imigomo yokwelashwa, ngenxa yokubheka ukungalingani okungahambisani noma ukuphazamiseka kokwelashwa ngokuzithandela.
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Ingabe izidakamizwa ezisetshenziselwa ukutshala i-Frontier elandelayo nge-HIV Therapy?
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Amathiphu amane okwenza ukuthi izidakamizwa zakho ze-HIV zingabi nakakhulu
Ngokuphathelene nalokho okwamanje yilokho, kulaba baseMelika abayizigidi ezingu-1.2 abaphila negciwane lesandulela ngculazi namuhla, noma yikuphi phakathi kwamaphesenti angu-20 kuya kwangu-25 okwamanje akutholakali.
Ekugcineni, ukwelashwa kwe-HIV kungaphezu kwamaphilisi kuphela. Ngokuqondene nokuqonda ukuthi izidakamizwa zisebenza kanjani futhi zikhomba ukuthi yini okudingeka uyenze njengomuntu ukuze ufeze imiphumela emihle kakhulu, kungakhathaliseki ukuthi usanda kutholakala noma usubandakanyeka ngokunakekelwa.
Yiziphi Izidakamizwa Ze-Antiretroviral?
I-HIV ihlukaniswa njenge- retrovirus , okusho ukuthi ichaza ngokuphindaphindiwe ukuthi amanye amagciwane aphindaphinda kanjani. Esikhundleni sokuguqula ikhodi yezofuzo kusuka ku-DNA kuya ku-RNA njengezinto eziningi eziphilayo, i-HIV idlulisa ikhodi yayo kusuka ku-RNA kuya ku-DNA.
Ngokukhomba izindlela lapho i-HIV ibeka khona, ososayensi basebenzisa izidakamizwa ezikwazi ukuphazamisa izigaba ezithile emjikelezweni wokuphila kwegciwane. Lezi zidakamizwa, esizibhekisela njengezidambisigciwane , zisetshenziselwa izindlela zokwelapha ezihlanganyelwe ukuvimbela ukuphindaphinda kwamagciwane endaweni lapho kubhekwa khona kungabonakali.
Nakuba izidambisigciwane eziphumelela kakhulu, aziqedi igciwane kodwa zivimbela ikhono layo lokuphindaphinda. Ngokwenza kanjalo, amasosha omzimba ahlala ehlelekile futhi angakwazi ukulwa nezifo (ezaziwa ngokuthi izifo ezithathelanayo ) ezingase zivele uma izivikelo zomzimba zingasebenzi.
I-Antiretrovirals isebenza kanjani?
Ukwelashwa kwe-antiretroviral kusebenza ngokuvimbela i-HIV ukuthi ingabe isichazwa ngezigaba eziyinhloko emjikelezweni wayo wokuphila , echazwe kabanzi ngokuthi:
- Okunamathiselwe-isiteji lapho i-HIV ifaka khona kumakhalekhukhwini
- I-Fusion-isiteji lapho i-HIV ifinyelela khona kumlenze weselula futhi ibeka izinto zayo zofuzo emangqamuzaneni
- Phinda ubhale phansi-isiteji lapho i-RNA yegciwane ebhalwa khona ku-DNA
- Ukuhlanganiswa-isiteji lapho i-DNA ye-HIV ihlanganiswa khona ku-nucleus yeseli yesitokisi (kusetshenziswa i-integrase enzyme), ngokuphanga imishini
- Ukubhalisa-isiteji lapho i-HIV isebenzisa leyo mishini ukudala amabhlokhi wokwakha ama-virus amasha
- Umhlangano-isiteji lapho igciwane elikhulile lihlangene futhi lihanjiswe ebusweni bamangqamuzana
- Ukugaya nokuvuthwa-isiteji lapho igciwane lithemba khona ngokoqobo esitokisini esasisindayo besebenzisa i-protease enzyme ukudala igciwane egcwele ukuvuthwa
Ngokusebenzisa inhlanganisela yezidakamizwa (ezivimbela izigaba ezimbili noma ngaphezulu zomjikelezo wokuphila), ikhono le-HIV lokuphindaphinda liye laphela, kanti kuphela ama-virus aguquguqukayo akwazi ukuphunyuka futhi ajikeleze ngokukhululekile ekusakazeni kwegazi.
Amakilasi wezidakamizwa ze-Antiretroviral Drugs
Kukhona okwamanje amakilasi amahlanu omuthi we-antiretroviral, ngamunye ohlukaniswe ngesigaba somjikelezo wokuphila abavimbela:
- Ama-inhibitors e-Fusion
- I-nucleoside reverse transcriptase inhibitors
- Ama-non-nucleoside reverse transcriptase inhibitors
- Integrase inhibitors
- Ama-protease inhibitors
Kulezi zigaba ezinhlanu, kunezidakamizwa ezingu- 39 ezihlukene zokulwa nezidambisigciwane ezivunyiwe yi-US Food and Drug Administration, kuhlanganise nezinhlanganisela eziyi-12 ezihleliwe (FDC) eziqukethe izidakamizwa ezimbili noma ngaphezulu.
Kungani Ukwelashwa Kokuhlanganiswa Kusebenza
I-HIV ivame ukudidiyelwa uhlobo oluthile lwegciwane lesandulela ngculazi (olubizwa ngokuthi "uhlobo oluthile lwegciwane") kanye ne-plethora yezinguquko ezibangelwa yi- viral , ngayinye enezibonakaliso eziyingqayizivele zezakhi zofuzo kanye nokuvumelana. Ukwelashwa kokuhlanganiswa kusetshenziselwa ukuvimbela eziningi zalezi zihlukahluka ngangokunokwenzeka kuze kube iphuzu lapho umthamo wegciwane lomuntu ubhekwa njengokungabonakali .
Uma isetshenziselwa inhlanganisela, izidakamizwa ze-antiretroviral zisebenza njengento ethi "ithimba lethegi". Uma umuthi A, isibonelo, awukwazi ukucindezela okuhlukile ngokucindezela isiteji emjikelezweni wokuphila, khona-ke izidakamizwa B no C zingakwazi ukuqeda umsebenzi ngokuhlasela isigaba esithile.
Ukuhlola ukuphikiswa kwezidakamizwa kusetshenziswa odokotela ukusiza ukuhlonza izinhlobo nezinhlobo zokuguquguquka okukhona ngaphakathi kwenzalo yakho yegciwane. Ngokusekelwe emiphumeleni yokuhlola, ukwelashwa kungahle kwenziwe ukuthi izidakamizwa ezinqunyiwe zingathinteki kuphela ukulawula okuphelele kwegciwane kodwa ziphinde zanqobe noma yikuphi ukushintshashintsha kwezidakamizwa ezingaba khona phakathi kwabantu abanegciwane.
Nini Ukuqala Ukwelashwa Kwe-Antiretroviral
NgoMeyi 2014, uMnyango WezeMpilo WezeMpilo waseMelika (DHHS) uhlaziye umhlahlandlela wezokwelapha we-HIV, ukhuthaza ukuqaliswa kokwelashwa kuwo wonke umuntu omdala one-HIV, kungakhathaliseki ukuthi yi- CD4 count or stage of disease .
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Yeka ukuthi Izimpembelelo Zezansi Zingaba kanjani I-Frontier Elandelayo Ekuvimbeleni I-HIV
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I-Daklinza (daclatasvir) I-Hepatitis C Ulwazi Lwezidakamizwa
Esikhathini esidlule, ukwelashwa kwanconywa kuphela uma inani le-CD4 yomuntu liwela ngaphansi kwesibalo samaseli angu-500 / mL.
Isinqumo se-DHHS sasixhaswa ubufakazi bokuthi ukwelashwa kokuqala kuhlotshaniswa nemiphumela eminingi emihle, okungukuthi:
- Ukunciphisa ingozi yezifo ezihlobene nokutheleleka nge-HIV
- Ukunciphisa ingozi yokudluliselwa kusuka kumama kuya kwengane
- Ukunciphisa ingozi yokudlulisela i-HIV
Izincomo zamuva zixhaswa ngokufakazela ukuthi ukwelashwa ngezidambisigciwane kunganciphisa kakhulu ukutheleleka komuntu ophila negciwane lesandulela ngculazi, isu elibizwa ngokuthi iTraction as Prevention (noma TasP) . Kuye kwaboniswa ukuthi abantu abahlinzekwa nge-HIV yokwelashwa kokuqala bangamaphesenti angama-53 amathuba okuthuthukisa isifo esibi , kokubili i-HIV-kanye ne-HIV engekho.
Ngokuphambene, ukuhoxisa ukwelashwa kuze kube yilapho inani le-CD4 yomuntu liwela ngaphansi kuka-200 (isigaba sesifo esibizwa ngokuthi i- AIDS ) singanciphisa isikhathi somuntu wokuphila ngokulinganiselwa kweminyaka eyi-15.
Yiziphi Izidakamizwa Okufanele Ngiziqale Ngazo?
Ngenkathi iziqondiso zokwelashwa zizoguquka njalo futhi ziguquke ngokukhululwa kwezidakamizwa ezintsha noma ulwazi lwesayensi, umzimba wamanje wesayensi ukhuthaza ukusetshenziswa kwezizukulwane ezintsha ezintsha zokufaka integrase inhibitors kanye nama-nucleoside analogues ekwelapheni kokuqala.
Inhloso yokwelashwa kokuqala komgqa ukuhlinzeka ngezidakamizwa ezizohlinzekela isimiso esilula kunazo zonke, imiphumela embalwa kakhulu emibi, kanye nengozi ephansi kakhulu ekuthuthukiseni ukumelana nezidakamizwa. Namuhla, inhlanganisela eminingi yezidakamizwa itholakale kuphilisi eyodwa, kanye nokwakhiwa kwansuku zonke, okungenza ngcono ikhono lomuntu lokugcina amazinga okunamathela okubalulekile ekuphumeleleni kwezokwelapha.
Lokhu kubaluleke kakhulu njengoba umzimba wamanje wezokucwaninga ukhombisa ukuthi abantu ekwelapheni kudingeka balondoloze ukunamathela kwamaphesenti angama-90 ukuze bafeze imigomo efanele yokwelashwa.
Funda kabanzi mayelana nezincomo zamanje zokwelashwa ezikhishwe uMnyango WezeMpilo WezeMpilo wase-US kubantu abadala abaphila negciwane lesandulela ngculazi.
Kwenzekani Uma Ukwelashwa Kuhluleka?
Uma kuthathwa njengokushiwo, imithi yakho ye-antiretroviral kufanele ihlale isebenza ngokuphelele iminyaka emihlanu, engu-10, noma engu-15. Lokhu kungahluka kusuka kumuntu kuya komuntu, yebo, kuye ngezinhlobo zegciwane elilodwa elibhekene nalo. Kodwa ukukhuluma ngokuvamile, isikhathi sokusebenza kahle kwezokwelapha kuhambisana ngokuqondile nesilinganiso sokunamathela umuntu okwazi ukufeza.
Ukwehluleka ukugcina ukulawulwa kwegciwane kuvumela igciwane ukuba liphindaphindile ngokukhululekile, ukunikeza ukuguquguquka kwezidakamizwa ukukwazi ukukhula futhi kube yinto ehlukile kakhulu . Uma lokhu kwenzeka, ukwelashwa kuzoba ngempumelelo kancane futhi ekugcineni uyeke ukusebenza ngokuphelele. Lokhu kwaziwa ngokuthi ukuhluleka kokwelashwa .
Kulesi sigaba, odokotela bazodinga ukwenza ukuhlolwa okungavumelekile kwezakhi zofuzo ukuze baqaphele ukuthi ukuphikiswa kwezidakamizwa kubanzi kangakanani. Kwezinye izimo, ukumelana kungathinta izidakamizwa eyodwa noma ezimbili kuphela; kwezinye, amakilasi aphelele angenziwa angasebenzi. Ukwelashwa kuyodingeka kubuyekezwe ukuze kunqobe kangcono lezi zinkinga ngenkathi kubhekisana nezithiyo zokunamathela okungenzeka zenze ukuhluleka kokwelapha kuqala.
Funda kabanzi mayelana namathiphu namasu okulondoloza ukunamathela okuphelele kwe-HIV yokwelapha.
Kungani Ukungakwazi Amagciwane E-Antitrovirals Ukwelapha i-HIV?
Nakuba izidambisigciwane ziyakwazi ukuvimbela ukuphindaphinda kwamagciwane, ngokuyinhloko zenza kanjalo negciwane lijikeleza ngokukhululekile emzimbeni wamanzi.
Ngaphakathi kwe-viral population, i-subset yegciwane, ebizwa ngokuthi i- provirus , iyakwazi ukuzingena emasethini nasezicukweni zomzimba owaziwa ngokuthi iziqongo ezingavamile . Esikhundleni sokuphindaphinda nokuphuma kwamangqamuzana anegciwane, i-proviral i-HIV ihlukanisa iphinde iphindaphindiwe kanye nesitokisi esiphezulu, ingatholakali ngesistimu yomzimba. Ingahlala kulesi simiso iminyaka eminingi ngisho nangamashumi eminyaka, kuphela ukuphinde ivele lapho ukwelashwa kumiswa noma kungabonakali.
Kuze kube yilapho ososayensi bekwazi "ukukhahlela" igciwane kulezi zindawo ezifihlekile, ikhono lanoma iyiphi i-ejenti yokuqeda ngokuphelele i-HIV cishe akunakwenzeka, uma kungenakwenzeka.
Imithombo:
UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi (DHHS). " Imihlahlandlela yokusetshenziswa kwama-Antiretroviral Agents ku-HIV-1-Adult Adultscents." I-Rockville, Maryland; ibuyekezwe ngo-July 14, 2016.
I-Hogg, R .; I-Althoff, K .; I-Samji, H .; et al. "Ukuvala i-Gap: Ukwandisa esikhathini sokuphila phakathi kwabantu abathintekayo abane-HIV e-United States naseCanada, 2000-2007." I-7th International AIDS Society (IAS) Ingqungquthela yePathogenesis, Treatment and Prevention. I-Kuala Lumpur, e-Malaysia. Juni 30-Julayi 3, 2013; Abstract TUPE260.
I-Skarbinski, J .; I-Furlow-Parmley, i-C .; kanye ne-Frazie, E. "Izibalo Zomphakathi Zenani le-HIV + Abadala abaye bathola ukunakekelwa kwezokwelashwa, ama-ART aqoshiwe, kanye nePhrojekthi Yokuqapha I-Viral - 2009 kuya ku-2010-US." Ingqungquthela ye-19 yama-Retroviruses kanye nezifo ezivame ukuqhutshwa (CROI); Seattle, Washington; Mashi 8, 2013; isicaciso somlomo # 138.
Kitahata, M .; Gange, S .; U-Abraham, A., et al. "Umthelela we-antiretroviral we-antiretroviral we-antiretroviral ophikisana nayo ekuqaleni kokusinda." I-New England Journal of Medicine. Ngo-Ephreli 30, 2009; I-360 (18): 1815-1826.
I-Sax, i-P .; Meyers, J .; Mugavero, M., et al. "Ukunamathela kwi-Antiretroviral Treatment and Correlation neHholo Lokungenisa Izibhedlela Phakathi Neziguli Zama-HIV Eziphephile E-United States." I-International Congress Congress yezokwelashwa kwezidakamizwa ku-HIV Infection. NgoNovemba 8, 2010; I-Glasgow; I-Oral Presentation # 0113.