Iwe unofunga kuti zvaizova chinhu chakanaka kuti uite: ita gelisiki kana gorosi iwe waungashandisa musati waroorana pabonde kuti uuraye hutachiwana hweHIV pahutano. Pashure pezvose, kana chimwe chinhu chakadai se-nonoxynol-9 chinogona kuderedza ngozi yekubata nekuuraya mwana, zvinove zvakaoma sei kukura chimwe chinhu cheHIV, chakanaka?
Ichokwadi ndechokuti kukura kwe microbicidal agents kwave kwakazara nematambudziko uye matambudziko kubva pakutanga kwaikurudzirwa makore anopfuura 25 apfuura.
Mune zvimwe zviitiko, kukwanisa kwemugadziri kubvisa hutachiwana hweHIV kwakatungamirira kukuvhiringidzika kwemukatial maviri emudzimai kana kukonzera-kufambisa pane kudzivirira kutapurirwa kweHIV.
Mune zvimwe zviitiko, vashandi vacho vakanga vasingabatsiri mukudzivirira hutachiona hweHIV kana kuti kwakaguma nemagumisiro asina kuvhiringidza kune avo vari kurapwa.
Kusvika iye zvino, hakuna HIV microbicide inowanikwa kana inokurudzirwa kuti ishandiswe. Zvisinei, nhamba inokosha yevatsvaga vari kunyatsotsvakurudzwa, kusanganisira gel tenofovir-based, zvigaro zvema intravaginal rings, uye rectal microbicides.
Nei Microbicides Inoonekwa Seinokosha?
Microbicides hazvifungidziri kutora makondomu kana kutora zvepabonde zvakachengeteka zvepabonde , asi pane kupa chimwe chidziviriro chekudzivirirwa munguva yepabonde-kunyanya mukurara-kugamuchira kana kumudzimai-kugamuchira zvepabonde apo ngozi yekutengesa yakawanda.
Zvisinei, kubva pane imwe mifananidzo yakawanda, microbicides inoonekwa senzira dzinogona kuderedza kupararira kweHIV pakati pevanhu vari pangozi.
Izvi zvinosanganisira vakadzi vanotambura nechisimba chekuita zvepabonde kana kushungurudzwa, kana kuti avo vanoita zvepabonde hakusi kwechokwadi (zvichida nekuda kwekuda kubereka vana, kana kuti mitemo yezvigadziro inopedza kudzivirira kwavo uye simba).
Zvinofungidzirwa kuti microbicides inogona kugona kupa vakadzi-pangozi nzira dzinobatsira dzekuzvidzivirirwa pavanenge vachipa vashandisi kuchengetedzwa kwakawedzerwa kana kondomu inoputika kana kuparara panguva yenyaya dzepabonde.
Matambudziko Ekutanga muCrosbicidal Research
Zvakawanda zvekutanga kutsvaga microbicidal zvakaratidza kushandiswa kwezvinonzi detergents kana vashandi vanogona kugadzirisa vaginal pH kuuraya (kana kusashanda) HIV.
Pakati pevadzidzi vepakutanga kwaiva nonoxynol-9 inonzi ichitaura, munhu anogadzirisa zvinokonzerwa nehutachiona anoshandisa zvose zviri zviviri se spermicide uye muzviso zvekunze / zvemitambo. Alarmingly, meta-analysis yakagadzirwa muna 2002 yakagumisa kuti kushandiswa kwe nonoxynol-9 kwakanyanya kuwedzera njodzi yeHIV mumadzimai nemamwe makumi mashanu, uye ine mikana yakawanda yezvipembenene zvechikadzi zvinokonzera njodzi.
Zvimwe zvinoshandiswa kuchengetedza zvakakwirira, kudzivirirwa kwechikadzi vagid (kusanganisira yakawanda-yakatsvakurudzwa BufferGel ) yakaratidzwa kuti yakanyatsorambidzwa kune vakadzi, asi pakupedzisira yakaratidza kuti hapana kuderedzwa kwekutapurirwa kweHIV.
Nzira dzekusimudzira
Kune nzira dzakawanda dzinogona kuitika pakuvandudzika kwehutachiona hweHIV microbicide, iyo inogona kuputsika kusvika kune zvikamu zviviri zvakasiyana.
Ikutanga inogona kuiswa seasina antiretroviral microbicides , iyo vashandi vanogona kuita sevryoy receptors kune HIV (kudzivirira kubatanidzwa kwehutachiona kutarisa masero emukadzi) kana kushandisa macromolecules anonzi dendrimers anoshanda zvakasimba kuHIV kudzivirira utachiona.
Kunyange zvazvo maitiro ekutanga aonekwa kuti haana kubudirira ( PRO 2000 , Carraguard , cellulose sulphate), nhamba yevashandi vatsva vari kuongororwa-kusanganisira dendrimer microbicide VivaGel , uye kushandiswa kwevashandi vevarindi vemvura uye CCR5 kupinda muhibhiyi Selzentry (maraviroc) yakashandiswa pamwe chete antiretroviral therapy (ART) .
Chechipiri, uye zvinonzwisisika zvinoremekedzwa, chikamu chiri antiretroviral microbicides . Kuvandudzwa kwemasangano aya kunobva pakutsvakurudza kunoshandiswa kweTenofovir nedzimwe mishonga inorwisa mabhakitiriya mune zvinyorwa zvemajeri, zvindori, mafuta, uye dzimwe nzira dzokuendesa.
IC CAPRISA 004 Kudzidza muna 2010 ndiyo yakatanga kuratidza kubudirira kwekutaura, kushandisa kushandisa 1% yejeri yeTenofovir mushure mekuita zvepabonde pabonde muna 889 vakadzi vasina HIV.
Kakawanda, hutachiwana hwehutachiwana hwakaderedzwa ne39 muzana muboka risina nzvimbo yepo, apo vatori vechikamu vane marefu ekuteerera (makuru kupfuura 80 muzana) aiva ne 54% kuderedza.
Kusiyana neizvi, VOICE Trial yakaonekwa sechinhu chekudzoka. Kutevera pazvitsitsinho zveCAPRISA, Voice Trial yakadzidza maitiro maviri akasiyana ekudzivirira HIV-kushandiswa kwezuva nezuva kwemishonga inorwisa mabhakitiriya (iyo inonzi Viread kana Truvada ) kana kushandiswa zuva rimwe nerimwe geri re tenofovir-muvakadzi 5 052. Mhosva yacho yakagumiswa apo hapana yedzimwe nzira yawanikwa ichishanda.
Izvozvo zvinotevera kuongorora zvakaratidza kuti kukanganisa kwaisakonzerwa nekurapa, asi kushayikwa kwekuteerera kwevatori vechikamu (zvikurukuru pakati pevechidiki, vakadzi vasina kuroorwa). Kuwedzera kutsvakurudza kuchabatsira zviri nani kujekesa maitiro ekuita.
Nzira Yekutungamira
Kutevera kutendeuka kwekutongwa kwe VOICE, kushungurudzwa kwechisimba kwakagadzirwa kutsvaga nzira dzakasiyana dzekuvandudzwa kwe microbicidal agents. Migumisiro yakave yakavhenganiswa. Pakati peZvipiri II uye III mutsva ichangobva kupera:
- I FACT 001 Chiitiko, icho chakatora vakadzi 2 900 muSouth Africa, chakapa vatori vechikamu regimen imwechete iyo yakashandisa CAPRISA 004 (1% geri tenofovir mushure mekuita zvepabonde). Maererano nemigumisiro yekutsvaga kwemashure, pakanga pasina kuderedzwa kwehuwandu hwehutachiona hweHIV pakati pevashandisi.
- IA ASPIRE (MTN-020) yakaratidza kushanda kwemhemberero yekati yepravaginal ine dapivrine (ine simba kwazvo, kuongororwa kwemishonga inorwisa mabhakitiriya) painoshandiswa kwemwedzi mumwe chete muvakadzi 3,476 muAfrica. Migumisiro muna 2015 yakaratidza huwandu hwehuwandu hwehuwandu hwehutachiwana hweHIV pakati pevakadzi vari kushandisa dalivirine ring, kunyanya kuvakadzi vane makore anopfuura makumi maviri. Zvishoma kana pasina kudzivirirwa kwakaratidzwa kuvakadzi vasati vava nemakore makumi maviri nematanhatu, zvichida nekuda kwekushandisa kusinganzwisisiki kwechigadzirwa .
- Saizvozvowo, RING (IPM 027) Yokudzidza inotsvaga dhipivirine ringinowanikwa mumadzimai 1 650 muUganda nekuSouth Africa mune imwe nguva, Tested III. Vakapinda vachashandisa zvindori zvavo kwemakore maviri. Zvigumisiro zvaive zvishoma zvishoma pane izvo zvinowanikwa mukudzidza kweAIDS, pamwe nekuderedza kudarika kwe 37%. Zvakare, zvibereko zvaive nani pakati pevakadzi vane makore makumi maviri nemaviri uye kupfuura. Hapana zvikomborero zvakaonekwa kuvakadzi vane makore 18-21.
- Zvichakadaro, mutambo weMTN 017 uchatsvaga kushandiswa kwetelfovir-based rectal gel pamwe chete nekushandiswa kwezuva nezuva kweTruvada mune boka revarume 186 vanoita zvepabonde nevarume (MSM) uye vakadzi vanodarika . Chidzidzo chePekutanga II chakaitwa kwemavhiki masere, uye chikwata chekubvuma uye kuchengetedza regimen yakasiyana-siyana.Zvino zvidzidzo zvingangotarisa kubudirira uye kushandiswa kwejeri rectal nzira yekudzivirira mushure mekuita zvepabonde.
- Pakupedzisira, muna March 2014, chidzidzo chezvipfuwo chakaitwa neCenters for Disease Control and Prevention (CDC) chakaratidza kuti gel inoshandiswa kushandisa antiretroviral Isentress (ratelgravir) inogona kuvhara utachiona hweHIV kuvakadzi mushure mekuita zvepabonde. Hapana shoko asi zvakadaro kana chidzidzo chichizowedzerwa kunze kwechapupu huripo hwechiratidzo.
Zvimwe zviitiko zvekutsvakurudza zviri kuongorora kufambiswa kwemapepa-mashoma, anokurumidza-kuparadza makadzi mafirimu, uyewo maitiro akasiyana-siyana ekuravira majekiseni (kana co-formulations) yetipikiti gel kana zvindori.
Sources:
Abdool Karim, Q .; Abdool Karim, S ;; Frohlich, J .; et al. "Kubudirira uye kuchengeteka Tenofovir Gel, Antiretroviral Microbicide, nokuda kwekudzivirira hutachiona hweHIV muvakadzi." Sayenzi. Svondo 3, 2010; 329 (5996): 1168-1174.
Microbicide Trials Network (MTN). "Pamusoro pe Microbicides Fact Sheet: Microbicide Trials Network." Pittsburgh, Pennsylvania. Chokwadi chinyorwa chakabudiswa musi waMarch 25, 2014.
Dobard, C .; Sharma, S ;; Parikh, U .; et al. "Postexposure Protection of Macaques kubva kuVaginal SHIV Infection ne Topical Integrase Inhibitors." Sayenzi Inoshandura Mishonga . March 12, 2014. 6 (227): 227ra35.