Iro Utano Hutatu Hwakachinja Chirwere cheHIV Kwose
HART ndeyokuti "kunyanya kushandiswa kwemishonga inorwisa mabhakitiriya," izwi rakagadzirwa kunopera kwema1990 kurondedzera kubudirira kwemishonga inoshandiswa pakushandisa mishonga yekurapa HIV.
Hondo yeHART isati yashandiswa, kushandiswa kwemishonga imwe chete kana maviri inorwisa mabhakitiriya kazhinji kwakaguma kubudirira kuburikidza nevarwere vane HIV, izvo zvinokonzera kukanganisa kurapwa nekukurumidza pamwe nekushaya kukwanisa kubvisa zvachose mabasa ehutachiona.
Izvo zvaiva nekutumirwa kweprotease inhibitors muna 1996 kuti vanachiremba vakakwanisa kubatanidza vatatu kana kupfuura vanodhaka vanoshandisa mishonga nenzira iyo yakagadzirisa kuvhara utachiwana hwekutapukira pane dzimwe nzvimbo muhupenyu hwayo. Nekuuya kweHART, vanachiremba uye masayendisiti vakakwanisa kupupurira kudonha kwema50% muhuwandu hwehupenyu hweAIDS huri muUnited States neEurope mumazuva matatu emakore (1995-1999).
Mukuwedzera kune HAART, nzira yakasiyana-siyana yemishonga yakange ichizivikanwawo se "chirwere chetatu" kana "katatu yezvokudya zvinodhaka."
Nhasi, izwi iri rakanyanya kuendeswa kune vamwe vatengesi, kusanganisira chirwere (kusanganisa antiretroviral therapy) kana, kunyange zvakanyanya, ART (antiretroviral therapy).
Sei HAART Inoshanda?
Sezvinopesana nemusikana-mishonga kana maviri-mushonga wemishonga, kusanganiswa kwemashure matatu kana kupfuura anoretroviral kunogona kushanda seboka retipa, nekudzivisa zvakakwana zvakasiyana-siyana zveHIV zvinogona kuvapo mukati mehutachiona hwemumwe chete.
Kana rimwe chirwere chisina kukwanisa kudzvinyirira rumwe rudzi rwehutachiona, rimwe kana kuti mamwe maviri ejenti ingangove yakanyanya kuita.
Nekudaro, nekuchengetedza hutachiona hwehutachiona husingaonekwi ( husingaonekeki ), kune vashomanana vanopararira mavirusi muropa uye madiki mashoma kuti hutachiona hutsve mumatambudziko ekudzivirira.
Ndokusaka pre-HAART kurapwa kwaitadza kukundikana nokukurumidza zvakadai: vanhu vashoma mutant vaibvumirwa kuramba vachiwedzera uye kuwedzerwa kuwanda kuti vave dambudziko guru rekutachiona. Kana izvi zvichiitika, madhiragi haasisiri kukwanisa kuvhara utachiwana hweHIV kuti urege kudzokorora, mamiriro ezvinhu atinotsanangura se "mushonga unopesana."
Zvinodhaka Zvinoshandiswa muHART
Kune ikozvino makirasi mashanu emishonga inorwisa mabhakitiriya , imwe neimwe inodzivisa imwe nzvimbo muhupenyu hweHIV:
- kupinda kana fusion inhibitors (iyo inosanganisira CCR5 receptor antagonists)
- nucleoside uye nucleotide reverse transcriptase inhibitors (NRTI / NtRTI)
- kwete nucleoside reverse transcriptase inhibitors (NNRTI)
- integrase inhibitors
- protease inhibitors
Zvimwe makirasi e-antiretrovirals ari kuongororwa, apo mitsva inotanga-madzinza inotarisira kuvandudza kushivirira, kuderedza migumisiro yakaipa uye kurerutsa kudhesa kune avo vari kurapa.
Nguva Yemberi yeHART
Mukuwedzera pakupa kudzvinyirirwa kwenguva refu kweHIV mune vanhu vane utachiona, HAART ikozvino inoshandiswa senzira yekuderedza kutapurirwa kwehutachiwana mune vakawanda vane ngozi yakawanda.Sarudzo, inozivikanwa sekudzorera sekudzivirira (TasP) , yakaratidzwa kuderedza "hutachiona hwehutachiwana" mukati mehuwandu hwevanhu, zvichiita kuti zvive zvakaoma zvikuru kupfuudza hutachiona kubva kune munhu ane hutachiwana kune munhu asina HIV.
Uyezve, HAART yakaratidzwa kuderedza njodzi yezvirwere zvose zveHIV- uye zvisina zveHIV (kusanganisira zvirwere uye chirwere chemwoyo) neanosvika 58% kana yakatanga panguva yekuongororwa. Somugumisiro, ikozvino yakakurudzirwa kuti HAART iitwe kune vanhu vose vane HIV , pasinei nemuviri wemuviri, mari, nzvimbo, rudzi, kana HIV inotakura zvirwere.
Izwi reHART rinogonawo kuchinja nekukurudzirwa kwemazuva ano anogara kwenguva refu kana majekiseni emagetsi (izvo zvinogona kubvumira mishonga yepamwedzi kana yechina) uye zvinotevera zvizvarwa zvinodhaka zvinotarisira kuderedza mbatya dzechirwere chechitatu zvinodhaka kune mashoma semishonga mbiri.
Miviri mikuru yeGlasi III, inonzi SWORD-1 ne SWORD-2, yakaratidza kuti kushandiswa kweTivicay (dolutegravir) uye Edurant (rilpivirine) kwakaguma nekuchengetedzwa kwemhepo kwemasvondo makumi mana nemine madhara. Chimwe chiedzo chiduku, chinonzi LAMIDOL chidzidzo, chakaratidza kuti Tivicay yakashandiswa ne lamivudine (chizvarwa chakare chemishonga) yakakwanisa kuwana mhinduro imwechete kune vakambopora varwere.
Sources:
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> Cohen, M .; Chen, Y ;; McCauley, M .; et al. "Kuchengetedzwa kweHIV-1 utachiona nehutano hwekare hwehutachiona hweHIV." New England Journal of Medicine. August 11, 2011; 365 (6): 493-505.
> INSIGHT START Chidzidzo Chekudzidza. "Kutanga kweAntiretroviral Therapy muAt Early Asymptomatic HIV Infection." New England Journal of Medicine. July 20, 2015; DOI: 10.1056 / NEJMoa1506816.
> Llibre, J .; Hung, C .; Brinson, C .; et al. "Phase III SWORD 1 & 2: kushandura kuDTG + RPV inotsigira virologic kuderedza kuburikidza nema 48 wks." 2017 Musangano weRevroviruses uye Mikana Yakasangana (CROI); February 13-16, 2017; Seattle; abstract 44LB
> Joly, V .; Burdet, C .; Landman, R .; et al. "Kupikira migumisiro ye > dolutegravir > + lamivudine kuchengetedzwa mu ANRS 167 > LAMIDOL > kutongwa." 2017 Musangano weRevroviruses uye Mikana Yakasangana (CROI); February 13-16, 2017; Seattle; abstract 458.