Ukuhlukunyezwa kanye nokuPhenotyping Kungabona, Futhi Kubikezela, Ukuphikiswa Kwemithi Ye-HIV
Ngisho nabantu abanamathela ngokutheleleka kwezokwelapha, izinga elithile lezinga le-HIV lokumelana nezidakamizwa kulindeleke ukuba lithuthuke ngokuhamba kwesikhathi ngenxa yokushintshashintsha kwemvelo kwegciwane. Kwezinye izimo, ukuphikiswa kungathuthuka ngokushesha lapho ukunamathela okunamandla kuvumela ukuthi abantu abaphikisana negciwane lesandulela ngculazi baqhubekele phambili, okuholela ekugcineni ekuhlulekeni kokwelapha.
Uma ukwehluleka kokwelashwa kwenzeka, ukuhlanganiswa okunye kwezidakamizwa kufanele kukhethwe ukuze kuqede leli qembu elisha legciwane eliphikisanayo.
Ukuhlola ukuphikiswa kwe-genetic kusiza ukusiza lokhu ngokukhomba izinhlobo zokuguquguquka okunomthelela "echibini le-viral" lomuntu, ngenkathi uthola ukuthi lezo zingculazi zingakwazi kanjani ukulwa nama-antiretroviral agents .
Amathuluzi amabili ayisisekelo asetshenziselwa ukuhlola ukuvikelwa kwe-genetic ku-HIV: isilingo se- HIV genotypic kanye nesilingo se- HIV phenotypic .
Yini i-Genotype ne-Phenotype?
Ngencazelo, i-genotype imane nje isakhiweni sezinto eziphilayo, kuyilapho i-phenotype yizici ezibonakalayo noma izici zezinto eziphilayo.
Ukuhlolwa kwe-genotypic (noma i-genotyping) ukusebenza ngokukhomba iziyalezo ezizuzwe njengefa ngaphakathi kwe-genetic coding, noma i-DNA. Izivivinyo ze-Phenotypic (noma i-phenotyping) ziqinisekisa ukushiwo kwaleyo miyalo ngaphansi kwethembandlela yezimo ezahlukene zemvelo.
Ngenkathi ubudlelwane phakathi kwe-genotype ne-phenotype akuyona into ephelele, i-genotyping ingase ibe ukubikezela kwe-phenotype, ikakhulukazi lapho izinguquko ku-ikhodi yezofuzo zinikeza izinguquko ezilindelekile ezicikisweni noma izici-njengokungathi ukuthuthukisa ukumelana nezidakamizwa.
Ukucabangela, ngakolunye uhlangothi, kuqinisekisa "lapha-futhi-manje." Ihlose ukuhlola ukusabela komzimba ekushintsheni okwehlukile ekucindezelweni kwemvelo-njengokuthi uma i-HIV ivuleleke emithini ehlukene nemithi noma izidakamizwa.
Ukuchaza i-HIV Genotyping
I-HIV ngokohlobo lwe-HIV ngokuvamile i-teknoloji evame ukusetshenziswa kakhulu ekuhloleni ukuphikiswa.
Umgomo wesilingo ukuthola ukushintshashintsha kwezakhi zofuzo esifundeni se- gag-pol of ' genome ' (noma i-genetic code). Lesi yisifunda lapho i-reverse transcriptase, i-protease ne-integrase enzymes-okuhloswe ngayo imishanguzo eminingi yezidambisigciwane- ifakwe ikhodi ku-chain DNA.
Ngokuqala ukukhulisa i-genome ye-HIV isebenzisa ubuchwepheshe be- polymerase chain reaction (PCR) , ochwepheshe belebhu bangalinganisa (noma "imephu") izakhi zofuzo ngokusebenzisa ubuchwepheshe obuhlukahlukene bokuthola ukuguqulwa.
Izinguquko ezithintekayo (noma ukuqoqwa kwezinguquko) zihunyushwa ngabachwepheshe abahlaziya ubuhlobo phakathi kwezinguquko ezithintekile kanye nokutholakala kwegciwane 'okulindeleke ukuthi kube nemithi elwa nezidambisigciwane ezihlukene. Ama-yolwazi e-inthanethi angasiza ngokuqhathanisa ukulandelana kokuhlolwa kwesimo se- " prototype -type" virus (okungukuthi, i-HIV engequkethe ukuguquguquka okungenakuphikiswa).
Ukuchazwa kwalezi zivivinyo kusetshenziselwa ukunquma ukutholakala kwezidakamizwa, nenani elikhulu lokuguqulwa okubalulekile okwenza amazinga aphezulu okuphikisa izidakamizwa .
Ukuchaza ukuthembeka kwe-HIV
Ukuhlukunyezwa kwegciwane lesandulela ngculazi kuhlola ukukhula kwe-HIV komuntu phambi komuthi, bese kuqhathanisa nokuthi ukukhula kokulawula, igciwane lesandulela emzimbeni ofanayo.
Njengokuhlolwa kwe-genotypic, ukuhlolwa kwe-phenotypic kwandisa isifunda se-gag-pol se-genome ye-HIV.
Lesi sigaba sekhodi yezakhi zofuzo "sihlanganiswa" kwi-clone ye-wild-type usebenzisa i- recombinant technology ye-DNA . I-virus evuselelayo i-recombinant isetshenziselwa ukutheleleka amangqamuzana amamalia e-vitro (ebhodini).
Isampula yesandulela ngculaza isuke ibonakale ekukhuleni okukhulayo kwezidambisigciwane ezihlukene kuze kufike ku-50% no-90% ukucindezelwa kwegciwane. I-concentrations ke iqhathaniswa nemiphumela evela ekulawuleni, isampula-hlobo lwesimo sasendle.
Izinguquko ezihlobene "zempuphu" zinikeza ububanzi bokubaluleka ukuthi yikuphi ukutholakala kwezidakamizwa okunqunywa. Ushintsho olunezinyanga ezine luvele lisho ukuthi izikhathi ezine isidakamizwa sidingeka ukuze kutholakale ukucindezelwa kwamagciwane uma kuqhathaniswa nelohlobo olusendle.
I-value enkulu ye-fold, engaphansi kwegciwane isifo somuthi othile.
Lezi zindinganiso zibekwe ngaphansi kwemigqa ephansi emitholampilo nasemitholampilo, ngezindinganiso ezingaphezulu ezinikezela kumazinga aphezulu okuphikisa izidakamizwa. (Bona umbiko wesampula .)
Isivivinyo Sokuphikisana Nezakhi Zokuzalwa Senziwa Nini?
E-US, ukuhlolwa kokulwisana kwama-genetic kwenziwa ngokwejwayelekile kwiziguli ze-naïve zokwelapha ukuze kunqume ukuthi ngabe kukhona "ukutholakala" kwezidakamizwa. Ucwaningo lwase-US lubonisa ukuthi phakathi kuka-6% no-16% wegciwane lesandulela ngculazi kuzomelana nomuthi owodwa we-antiretroviral, kuyilapho cishe u-5% uzophikiswa emkhakheni owodwa wezidakamizwa.
Ukuhlola ukuphikiswa kwamagciwane kusetshenziselwa futhi uma ukuphikiswa kwezidakamizwa kusolakala kubantu abathintekayo. Ukuhlola kwenziwa ngenkathi isiguli sithatha umgomo ongaphumeleli noma phakathi kwamasonto amane ukuyeka ukwelashwa uma umthamo wegciwane ingaphezu kwamakhophi angu-500 / mL. Ukuhlolwa kwe-Genotypic kuvame ukukhetha kulezi zimo njengoba bebiza kancane, banesimo sokushintsha ngokushesha, futhi banikezwe ukuzwela okukhulu kokuthola izingxube zegciwane lesimo sasendle kanye nesimangalo.
Inhlanganisela yokuhlolwa kwe-phenotypic kanye ne-genotypic ngokuvamile ikhethwa ngabantu abanokumelana nezimo eziyinkimbinkimbi, eziningi-ikakhulukazi kulabo abatholwa yi- protease inhibitors .
Imithombo:
I-World Health Organization (WHO). "I-HIV Yezidakamizwa Zokuphikisana Nezidakamizwa ze-HIV." I-Geneva, eSwitzerland; Ngo-Ephreli 11, 2011.
Kim, D .; U-Ziebell, uR .; Saduvala, N .; et al. "Ukuthambekela kokudluliselwa kwe-HIV-1 kwe-ARV imishanguzo ehambisana nokulwa nezidakamizwa: izindawo ezingu-10 zokubhekwa kwe-HIV, i-US, 2007-2010." Ingqungquthela ye-20 yama-Retrovirus kanye nezifo ezivame ukubhekana nazo. I-Atlanta, Georgia; Mashi 6, 2013; I-Oral abstract 149.
Izikhungo Zempilo Zikazwelonke (NIH). "Imihlahlandlela Yokusetshenziswa kwama-Antiretroviral Agents ku-HIV-1-Adult Adultscents." I-Bethesda, e-Maryland; Ngo-Okthoba 11, 2013.