Ukwelapha i-HIV kungaba nzima. Ukwelashwa okuphumelelayo kudinga inhlanganisela yemithi yokwelashwa kwama-antiretroviral. Lokhu kuyaziwa ngokuthi yi- CART (i-antiretroviral therapy), noma i- HAART (ukwelashwa kwama-antiretroviral kakhulu). Inhlanganisela ye-HIV yokwelapha ngokuvamile isebenzisa izidakamizwa kusukela okungenani amakilasi amabili okwelashwa ahlukene. Lokhu kusiza ukugcina igciwane lingakhulumi ukumelana nokwelapha.
Amakilasi okusetshenziswa kwezidakamizwa asetshenziselwa ukwelashwa kwe-HIV afaka:
- i-protease inhibitors (i-PIs) - evimbela i-enzyme edingekayo ukuhlanganisa i-HIV virions
- i-nucleoside / nucleotide reverse transcriptase inhibitors (i-NRTIs) - egcina igciwane lesandulela ngculazi lingabhalisi i- RNA ibe yi- DNA ukuze likopishwe ngamaseli
- ama-non-nucleoside reverse transcriptase inhibitors (i-NNRTIs) - enomsebenzi ofanayo njenge-NRTI, kodwa ebopha endaweni ehlukile
- integrase inhibitors - okugcina igciwane lesandulela ngculazi lihlanganisa i-genome yalo emangqamuzaneni
- Ukungena kwe-inhibitors - okuvimbela i-HIV ukungena emangqamuzaneni. Enye i-subset of entry inhibitors yilabo abaphikisana nabo be-ccR5. Lezi zivimbela amaprotheni okuthi i-HIV ibophe ekufakeni amaseli
Iklasi ngalinye lezidakamizwa linemiphumela emihle kanye nezinkinga. Isibonelo, odokotela abathile bakhetha ukusebenzisa imithi yokwelapha i -nuc-sparing ukuze bagweme imiphumela emibi, njengokuguga ngaphambi kwesikhathi , okuhambisana ne-NRTIs. Kodwa-ke, ochwepheshe be-HIV bayazi ukuthi ayikho irejimi elilodwa elifanele bonke abagulayo abane-HIV.
Lapho beka ukwelashwa, kufanele bacabangele izici eziningana. Lokhu kufaka hlangana nemiphumela emibi, ukumelana kwamagciwane, nokuthi kungenzeka ukuthi iziguli zithatha zonke izipilisi zabo ngesikhathi futhi njengoba ziqondisiwe.
Kungaba nzima ukuphatha isikhathi semigomo ethile yepART. Emiphakathini eminingi, amaphilisi kufanele athathwe ngezikhathi ezahlukene zosuku.
Abanye kufanele bathathwe, futhi abanye ngaphandle, ukudla. Ngakho-ke kuye kwaba nesithakazelo emibhalweni eyodwa-tablet yokuphathwa kwe-HIV. Lezi zinhlobo ziqukethe izidakamizwa ezivela emakilasini amaningi kuphilisi elilodwa. Ngokuyinhloko nge-HIV ngelinye ilanga nge-HIV, nakuba abanye bangase badinge ukuthathwa kabili ngosuku. Njengamanje, izinqubo eziningana ze-tablet eyodwa zivunyelwe yi-FDA:
- I-Atripla - equkethe i-tenofovir, emtricitabine, ne-efavirenz (Kuvunyelwe 7/2006)
- I-Complera - equkethe i-tenofovir, emtricitabine, ne-rilpivirine (Kuvunyelwe 8/2011)
- Stribild ("Quad") - equkethe i-tenofovir, emtricitabine, i-elvitegravir, ne-cobicistat (Kuvunyelwe 8/2012)
- I-Genvoya - equkethe i-elvitegravir, i-cobicistat, i-emtricitabine, ne-tenofovir alafenamide) (Kuvunyelwe 11/5/15)
Izilawuli zamaphilisi ezilodwa zibizwa nangokuthi inhlanganisela ye-dose fixed. Kodwa-ke, akuyona yonke inhlanganisela ye-dose fixed-fixed regimens. Ezinye zidinga ukusetshenziselwa ukuhlanganiswa nezinye izidakamizwa.
Ziyini izinzuzo zempilo yokwelapha kanye neyodwa ngosuku?
Kunezinzuzo eziningana ezikhona ezibhekene ne-single-tablet imithi yokwelashwa kwe-HIV. Inzuzo enkulu kunazo zonke, kokubili iziguli kanye nabahlinzeki, kulula kangakanani lezi zilawuli okufanele zithathe. Iphilisi elilodwa, kanye ngosuku, kulula kakhulu iziguli eziningi ukugcina ithrekhi ngaphezu kwamaphilisi amaningi.
Lokhu kuyiqiniso ngisho noma konke kungathathwa ngesikhathi esifanayo. Lokhu kusho ukuthi iziguli ezinegciwane lesandulela ngculaza cishe zithatha amaphilisi abo njalo. Ngokufanayo, lezo zidakamizwa zizosebenza kakhulu.
Enye inzuzo ehlobene nalokho ukuthi iziguli zikwazi ukuthatha imithi yazo ngendlela efanele nge-single piligen regimen. Iziguli ezithatha amaphilisi amaningi zingase zingakhathazeki kakhulu uma ziphuma eminye yemiyalelo yazo, noma uma zingenakukwazi ukugcwalisa enye. Bangase bacabange ukuthi "bahlanganisiwe" uma nje besathathe okuthile. Noma kunjalo, imiraro yesigodi inqunywe njengenhlanganisela ngesizathu.
Ukuthatha lezi zinhlawulo ngokungalungile kwandisa ingozi yokuhluleka kokwelapha nokumelana negciwane.
Ngokuphambene nalokho, ukungalungi okukhulu kwemigomo yamaphilisi eyodwa kuyinombolo elinganiselwe yezinketho. Njengamanje kukhona izidakamizwa ezimbalwa kuphela ezitholakalayo emakethe, futhi ngayinye isekelwe ekuhlanganisweni kwe-tenofovir ne-emtricitabine evame ukuthengiswa njenge-Truvada. Ngakho iziguli ezinenkinga yokubekezelela noma iyiphi yalezi zidakamizwa ngeke zikwazi ukushintshela ekwelapheni elilodwa-tablet. Ayikho indlela odokotela abazoyenza ngayo ukulungisa izidakamizwa zezidakamizwa ngabanye ngaphakathi kohlelo. Lawa maphilisi ayaziwa njengenhlanganisela ye-fixed-dose ngesizathu. Nakuba zingase zisebenze kahle iziguli eziningi, odokotela abathile bangase bathole ukuntuleka kokuguquguquka. Lokhu kungase kube yiqiniso ikakhulu odokotela abazama ukulawula ubuthi neminye imiphumela emibi.
Ingabe Kufanele Ngikhulume Nodokotela Wami Ngomhlahlandlela Wodwa Wethebulethi?
Uma unesandulela ngculazi futhi unenkinga ngokuvumelana nomgomo wakho wokwelapha wamanje, yebo u-yebo. Kufanele nakanjani ucabangele ukukhuluma nodokotela wakho ukuthi ngabe iphilisi le-once-a-day, elingahleliwe lingase libe yindlela enhle kuwe. Noma yini eyenza kube lula kuwe ukuthi uthathe imithi yakho ingase ithuthukise ukusebenza kwayo.
Noma kunjalo, le mithi ayifanele wonke umuntu. Kungabangela imiphumela emibi engase ibe yinkinga kwezinye iziguli. Futhi ziyabiza: njengamanje, izinketho zamagama kuphela ezikhona, futhi izinguqulo ezijwayelekile ngeke zihlasele imakethe iminyaka eminingana. Ngaphezu kwalokho, abantu abanomlando wokwelashwa ngokweqile, noma abaphikisana nemithi yokwelapha, akunakwenzeka ukuba bafanelekele imiraro yemigodi eyodwa.
Kubantu abathokozela ukwelashwa kwabo nge-HIV okwamanje, baqine. Lezi zidakamizwa akwanele ukuthuthuka kwezinye izilawuli okufanele uzizwe udinga ukunqamula umkhumbi. Uma irejista yakho yamanje isebenza kahle, inobuthi obuphansi, futhi ukhululekile ukuyithatha, kuhle. Akukaze kube umqondo omubi ukukhuluma nodokotela wakho mayelana nokuthi uhlala yini ekwelapheni ngenxa ye-inertia noma ngoba kuyindlela engcono kakhulu. Nokho, ukuxoxa akusho ukuthi kufanele ushintshe.