Dzidzo muAfrica neEurope dzinotora mhedziso dzakasiyana
Muna December 2014, vaviri vanodzidza kuongorora kuenzanisa kwehutachiwana hweHIV kumaodzanyemba kweAfrica neEurope, pamwe chete, vakatora zviviri zvakasiyana zvakagadziriswa.
Yokutanga, yakaitwa muBotswana neSouth Africa, yakaratidza kuti hutachiona 'hunoenderana nemhando dzakasiyana-siyana dzeGear-resistant genes-dzinonzi human leukocyte antigen B (HLA-B) -notadzisa hutachiona' kukwanisa kudzokorora, nokudaro zvirwere zvishoma nezvishoma zvinowedzera.
Chechipiri, iyo yakatevera boka revarwere veEurope kwemakore anoverengeka, yakarongedza zvakananga kuvhareji yemavhuthala uye CD4 count mushure mokunge chiitiko chechirwere chetachiona uye chakagumisa kuti, maererano nehutachiona hwekuwedzera ari oga, HIV yakave yakanyanya kuipa nekukurumidza kuwedzera kwezvirwere.
Zvinogoneka sei kuti zvidzidzo zviviri zvakaguma nekududzirwa kwakasiyana kwakasiyana-siyana? Icho chiri chikonzero chekusava nechokwadi chekugadzirisa kudzidza, kana zvinogona here kuti kuchinja kwehutachiona kubva kune kondinendi kuenda kune kondinendi- kana kunyange nyika kune imwe nyika-kwakatungamirira mapoka evasayendisiti mune zvakasiyana zvachose?
Kuyera HIV Kubudirira muBotswana nekuSouth Africa
Pakuongorora kwekutanga, masayendisiti kuOxford University, akatungamirirwa nemutungamiri wekutungamirira Rebecca Payne, akabvunzurudza kana kuvapo kwemamwe mazita eHLA-B-zvakanyanyobatanidzwa nehutachiona hwekuwedzera kwezvirwere uye huri nani hutachiona-hunogona kunge hwakaita kuti kuchinja kwehutachiwana hweHIV kuve kuchikanganisa "utano hwetachiona."
Pakutanga tsvakurudzo yakaratidza kuti vamwe vanhu vaiva nehuwandu hwehuwandu hwevanhu vane izvi zvisingawanzoitiki, kushanduka kweHIV, kubva pa75% muJapan kusvika 20% muSouth Africa. Mukucherechedza kusaparadzaniswa, vatsvakurudzi vakatanga kushamisika kana izvi zvichigona kupa, pane imwe chikamu, kune kusiyana kukuru kwechirwere pakati pepasi-pasi- kuwanda nyika yakafanana neJapan uye nzvimbo dzakapararira dzakadai seSouth Africa.
Sezvo hutachiona hweHIV huchiri huri pasi muJapan, vatsvakurudzi vakatsvaga tsvakurudzo yavo kune boka revarwere muBotswana, nyika umo chirwere cheHIV chakapfuura muna 2000, ndokuchienzanisa neboka rakafanana muSouth Africa, iro rakasvika chete iyo yakakwirira muna 2010.
Ongororo yekutanga yakaratidza kuti mavhareji ehutachiwana pakati pevarwere vasina kurapwa muBotswana, apo chirwere chacho "chakwegura," chakanga chakaderera zvikuru kupfuura cheSouth Africa, apo chirwere chacho makore gumi "vaduku" (makopi 15,350 / mL kusvika 29,350 makopi / mL, maererano). Uyezve, pasinei nokuva neCD4 count 50 masero / mL pasi peya South Africa, Botswanans vane HIV vakagara kurarama kwenguva yakareba, vachiratidza kuti zvishoma zvishoma zvinyorwa.
Nehuchapupu huri muruoko, vatsvakurudzi vakabva vatarisa maitiro ehutachiona hweHIV uye vakawana kuti nhamba yepamusoro yevaBotswanans yaive neHLA-B "kupukunyuka" mutation (zvinoreva kuti hutachiona hwainge hwakagadzirirwa kuvapo kweHLA molecule kuti arege kuonekwa). Mukuita kudaro, masayendisiti aifunga kuti "kufanana" kwehutachiona kungangoderedzwa, kuchidzikisa simba rekudzorera pamwe chete nekukwanisa kwaro kukanganisa zvirwere zvemuviri wezvirwere.
Zvose zvakataurwa, 46 muzana yeboka reBotswanan rakanga rine matanho makuru eHLA-B akaenzaniswa ne 38% chete vevanhu vokuSouth Africa.
Test tube assays yakaratidza kutsigira pfungwa, neHIV kubva mumuenzaniso weBotswanan kudzokorora 11% zvishoma kupfuura iyo kubva kuSouth Africa.
Kubva pane zvinyorwa zvinowanikwa kubva kumakiriniki ekuberekwa, Payne neboka rake vakaramba vachiratidza kuti hutachiona hweHIV hunogona kunge hwakatanga kuwedzera kuSouth Africa, uyewo, nehuwandu hwehutachiona hwevakadzi pakati pevakadzi vasina kutendeuka huri kubva kubva 13,550 muna 2002 kusvika ku57 kusvika muna 5 750 muna 2012- 2013.
Kuyera HIV Kubudirira muEuropean CASCADE Cohort
Kudzidza kweEurope kwakatora nzira yakajeka, yakakwana-yenyika, umo dambudziko remashoko kubva kune refu, pan-European CASCADE cohort rakaongororwa kubva muna 1979 kusvika muna 2002.
Mukutsvakurudza kwavo, vatsvakurudzi veCASCADE vakataura nezvezvinhu zviviri zvinokosha:
- muvhareji CD4 count mushure meSeroconversion (iyo inosarudza kuti kupararira kweHIV kwakanyanyisa sei muviri wemunhu), uye;
- iyo inowanikwa nehutachiona "set point" (apo utachiona hunogadziriswa huri shure kwehutachiona hwehutachiona, uye hutachiona hwepamusoro hutsika hunowirirana huri kukurumidza kufambira mberi kwezvirwere).
Mukuongorora kwavo, vatsvakurudzi vakawana kuti mavhareji eCD4 akawira kubva pa770 masero / mL muna 1979 kusvika ku570 masero / mL muna 2002, asi mavhareji ega ega akaisa katatu kubva ku11 200 muna 1979 kusvika ku 31 000 muna 2002.
Kunyanya pamusoro pekukurumidza kwechirwere ichi chakaita sechichienderera mberi, gore negore, kune vanhu vane HIV. Maererano nekutsvakurudza, muvhareji nguva yakatora kuti CD4 yevarwere iite pasi pe 350-danho iro chirwere chinorwisa antiretroviral chinoridzirwa-chakarehwa kubva mumakore manomwe muna 1979 kusvika kune makore 3.4 muna 2002.
Kusiyana Kunokosha muUtsvaga
Zvikamu zviviri zvekutsvakurudza pakupedzisira zvine zvikwereti zvavo, nekudzidza zvigadziro izvo zvingangoita kuti mhirizhonga pakati pevasayendisiti nevatongi vese. Pakati pemakakatanwa makuru:
- Kunyange zvazvo kuongorora kweAfrica kuchidzokorora nhamba yezvinyorwa kubva kune vanopfuura 2 000 muBotswana neSouth Africa, nhamba chaiye yevarwere inowanikwa muhupiti yekuzvidzivirira yakange isiri duku (16 kubva kuSouth Africa uye 63 kubva kuBotswana) asi yakatorwa panguva imwe chete munguva . Kusiyana neizvi, varwere vanoda kusvika 16 000 vakabatanidzwa muCASCADE cohort, vose avo vakaongororwa kwenguva refu yakareba.
- Apo Payne neboka rake vakatarisa pamagumisiro ekuchinja kweHLA-kushandiswa kwemuviri mune mutachiona hwehutachiona hwehutachiona, havakwanise kuratidza kuti kuvepo kwekuchinja uku kwakave nemagumisiro ekuderera kweCD4. Kusiyana neizvi, vatsvakurudzi veCASCADE vaifunga kuti CD4 / virusi simba rinoshandiswa pakuita hutachiona hweHIV. Vakatadzawo kuisa kune avo chete varwere avo vakanga vaongororwa mukati memwedzi mitatu yehutachiona, vachipa chikonzero chekutanga chekutanga chekuyera kuwedzera kwezvirwere / CD4 kuparara.
- Zvakakosha kuziva, zvisinei, kuti CASCADE team yakangobatsira kuongorora tsanangudzo pamusoro pevarume, varume vanoita zvepabonde (kuti vawedzere kujekesa kuwanana munhoroondo yehutano nehutachiona hwemashure). Kunyange zvazvo kuongororwa kwakaratidza kuti kuwedzera kunogona kunge kuri kuwedzera muEurope yose-nehutachiona hwehutachiona huchibva kubva ku 31,000 muna 2002 kusvika 25 500 muna 2008-izvo chete hazvigone kutaurwa nevarume vanoita zvepabonde. Sezvo zvichizivikanwa kuti kupararira nokukurumidza kweHIV kuburikidza nehutachiona hwevanhukadzi (pamwe chete nehupamhi hwehutachiona hwekurapa) hwakaguma mune hutano hwakasiyana-siyana uye hutachiwana huripo, zvinoita kuti utachiona hwehutachiona hunoita boka iri huve, chaizvoizvo, huve humwe chinotyisa.
- Kusiyana neizvi, kuongorora kweAfrica kwakaitwa kune dzimwe nyika umo hutano hwepabonde hwakanga husiri hurumende chete yekuendesa mberi asi apo, kusvika munguva pfupi yapfuura, vashoma vashoma vakaonekwa nehutano hweHIV . Somugumisiro, hutachiona hwehutachiwana hweHIV mukati me Southern Africa hunofungidzirwa kuti hwakanyanya kudarika, pamwe nekutsvakurudza kunoratidza kuti kuchinja kwemuganhu wehutachiona kunogona kubvumira kusiyana kukuru kwehutachiona hweHIV.
Muchidimbu, pasinei nokukanganisa mukudzidza kweAfrica nekukwanisa kwekutsvakurudza kweCASCADE, zvose zvingarudzo zvingave zvakanaka chaizvo. Kuwedzera kuongororwa kunotarisirwa kubva kumakwi maviri acho.
Sources:
Payne, R .; Muenchhoff, M .; Mann, J .; et al. "Zvinokonzerwa nehutano hweHIV huchiendeswa kune hutachiona hwehutachiona hwehutachiona hweHIV." PNAS. December 16, 2014; 111 (50): E5393-5400.
Pantazis, N .; Porter, K .; Costagliola, D .; et al. "Maitiro emamiriro ekufananidzira kwevhirwere hweHIV-1 kuvhiringidza uye kutenderera: chiitiko chekucherechedza boka." The L ancet HIV. December 2014; 1 (3): e119-126.