Pasinei Nokufambira Mberi, Chiitiko pakati pevakadzi neHIV Chinoramba Chisingashanduki
Vanhu vane HIV vane njodzi yakakwirira yekuwedzera dzimwe kanza, dzakawanda dzingarondedzerwa sehutano hweAIDS. Pakati pawo mune chirwere chemukombomu chinoparadza (ICC), danho rezvirwere izvo kenza inopararira mberi kwepamusoro pemukati mumiviri yakadzika yemukati uye zvimwe zvikamu zvemuviri.
Kunyange zvazvo ICC inogona kukura mumadzimai maviri ane HIV uye vasina HIV, chiitiko pakati pevakadzi vane HIV chinogona kuva chakakwirira kanomwe kanomwe.
Madzimai ane HIV, chirwere cheC ICC chinoonekwa chichiwedzera nekuderera muCD4 count , pamwe nekuwedzera kwemazana matanhatu kuvakadzi vakadzi vane CD4 nhamba pasi pe200 cells / mL kana vachienzanisa neavo vane CD4 dzinopfuura mazana masere / mL.
NezveCervical Cancer
Human papillomavirus (HPV) inofungidzirwa yakakosha pakugadzira chirwere chemuviri wechibereki, kuverenga kune zvese zviitiko zvakanyorwa. Sezvakaita mapillomaviruses ose, HPV inogadzira zvirwere mune mamwe masero eganda uye mucosal membrane, akawanda ayo haana ngozi.
Munenge makumi mana emhando dzeHIVV dzinozivikanwa kuti dzinotapurirwa zvepabonde uye dzinogona kukonzera zvirwere zvakakomberedza anus uye zvikadzi, dzimwe nguva zvichionekwa sehondo. Pakati idzi, 15 "huwandu hwehuwandu" hunogona kutungamirira mukukudziridza zvipembenene zvisinganzwisisiki. Kana ikasatenderwa, zvipembenene zvisinganzwisisiki dzimwe nguva zvinogona kufambira mberi kumucheche wechibereki. Zvirwere zvishoma nezvishoma zvinowanzopfupika, kutora makore zvisati zvaonekwa zviratidzo zvinooneka. Zvisinei, kune avo vane maitiro ekudzivirira zvirwere (CD4 pasi pe200 cells / ml), kufambira mberi kunogona kukurumidza zvikuru.
Kuonekwa kwepakutanga nenzira yeP Pap smear kuongorora kunoshamisa kwakaderedza chiitiko chekenza yemumuromo mumakore achangopfuura, apo kuendeswa kwezvirwere zveHIVV kwakatungamirira kuderedza kuderedza nekudzivirira huwandu hwehutano hunobatanidzwa ne75 muzana yekenza yekenza.
Kuongororwa kweHIV kuvakadzi vekuAmerica ndeye 26,8 muzana asi 3.4 muzana vane utachiona hweHIVV dzinokonzerwa nehuwandu hwemakore gumi nemaviri nemakumi mapfumbamwe nematanhatu, iyo inotarisa inenge 65% yekenza yemukondombera.
Cervical Cancer muvakadzi neHIV
Pasinei nokufambira mberi uku, kenza yemukomana inoramba ichitarirwa chechipiri inowanzosangana nekenza pakati pevakadzi munyika yose, inotarisa vanhu vanenge 225 000 gore negore. Nepo huwandu hwemhosva hunoonekwa munyika inosimudzira (nekuda kwehurombo hwekuongorora mapepa uye kupemha kweHIVV), chirwere chepachivha chechirwere ichi chiri kukonzera kufa kwevanhu vanenge 4 000 muUnited States gore negore.
Kunyanya pamusoro pezvo zvakadaro ndeyekuti chiitiko chekenza yemukomana mukati mevakadzi vane hutachiwana hweHIV chakaramba chisina kuchinjwa kubvira pakuunza antiretroviral therapy (ART) kuma1900. Izvi zvakasiyana zvikuru neKapisi's sarcoma uye isiri Hodgkin lymphoma, zvose zviri kujekesa AIDS izvo zvakaderera nepamusoro pe50 muzana panguva imwecheteyo.
Kunyange zvazvo zvikonzero izvi zvisinganzwisisi zvakakwana, zvidzidzo zviduku asi zvinoenderana neFox Chase Cancer Center muPhiladelphia zvinoratidza kuti vakadzi vane HIV havagoni kubatsirwa nemishonga yeVVV inowanzoshandiswa kudzivirira matambudziko maviri anonyanya kukonzerwa nehutachiona (marudzi 16 uye 18). Pakati pevakadzi vane HIV, makumi mapfumbamwe nemakumi mashanu nemana makumi mashanu nemana makumi mashanu nemana makumi mashanu nemana makumi mashanu nemashanu zvakanyanya kuonekwa, izvo zvese zvinonzi zvinowanikwa pangozi uye zvisingabviri kune zvingasarudzwa zvino.
Zviratidzo zveCervical Cancer
Kune dzimwe nguva zviratidzo zvishomanana zvakanyanya muzvikamu zvekutanga zvekenza yemumuromo .
Kutaura zvazviri, panguva yekubuda ropa uye / kana kusangana nekubuda ropa kunoitika-zviviri zvezviratidzo zvinowanzozivikanwa-kuipa kunogona kunge kwave kwakagadzirwa. Pane dzimwe nguva, pangave nemadzimai akawanda, pamwe nekubuda kwemudzimai, kurwadziwa kwepachevic, kurwadziwa kwepamuviri, uye kurwadziwa munguva yepabonde.
Muchikamu chepamusoro chechirwere, kuwedzerwa kwekubuda ropa, kuora kurasikirwa, kurwadziwa kwepelvic, kusuwa, kurasikirwa kwechido, uye kuputika kwefupa ndiyo inowanzoonekwa zviratidzo.
Kuongororwa kweCervical Cancer
Kunyange zvazvo kuongorora kwepap smear kunorudzirwa kuti zviongorore, zvinokanganisa zvisiri izvo zvinogona kuva zvakakwirira se50%. Kutsigira kwechirwere chemuviri wechibereki kana cervical dysplasia (kusagadzikana kwemasero emadziro emudzimai) kunoda biopsy yekuongororwa nehutachiona.
Kana kervical dysplasia ichinyatsosimbiswa, inotsanangurwa zvichienderana nehuwandu hwekuoma . Pap smear zvinyorwa zvinogona kubva kuAscus (atypical squamous cells dzisinganyatsozivikanwa) kuLSIL (yakaderera-grade grade squamous intraepithelial lesion) kuHSIL (high-grade squamous intraepithelial lesion). Masero anonyanya kushandiswa kana tisiki akafananidzwa zvakafanana sezvinove zvinyoro, zvishoma kana zvakaoma.
Kana pane chiratidzo chisina kumira, chinosarudzwa nechigarire chechirwere chinotarisana nekliniki yekuongororwa kwemurwere, kubva paGanho 0 kusvika kuGedhi IV sezvinotevera:
- Nhanho 0: Carcinoma in situ (tsvina yakawanikwa iyo isina kupararira)
- Nhanho I: Mushonga wekenza wechikwata wakakura mumuviri wemukati, asi haana kupararira kupfuura iyo
- Chikamu II: Mukenza wechibereki wakapararira, asi kwete kunze kwemasvingo emapanga kana kuti chetatu chechikadzi
- Nhanho yechitatu: Mukenza wemukomana wechiropa wakapararira kunze kwemapuranga emadziro kana kuti yechitatu yevakadzi, kana kuti yakakonzera hydronephrosis (kuunganidza urinyi muinso nekuda kwekudziviswa kwechiremba) kana kusagadzikana kwemakumbo
- Nhanho IV: Mushonga wekenza wechikwata wakapararira mberi kwemapapiro kune zvikamu zvakatarisana kana kuti kure, kana kuti wakabatanidzwa mucosal tissue ye bladder kana rectum
Kurapa kweCervical Cancer
Kurapwa kwekenza isati yasvika kana kenza yemukomana kunotsanangurwa muchikamu chakakura nekugadzira kana kuiswa kwechirwere ichi. Vazhinji vakadzi vane runyoro (pasi-grade-grade) dysplasia vacharamba vachidzorera mamiriro ezvinhu pasina kurapwa, vachida kungoongorora nguva dzose.
Kune avo vane dysplasia iri kufambira mberi, kurapa kunogona kudiwa. Izvi zvinogona kutora mufananidzo wekubvisa (kuparadzwa) kwemasero ne electrocautery, laser, kana cryotherapy (kupisa kwemasero); kana nechisimba (kubviswa) kwemasero kuburikidza nekushongedzwa kwema electrosurgical (inozivikanwawo seyenguva refu yemagetsi kushandiswa, kana LEEP ) kana kuti conization (iyo conical biopsy yezviviri).
Kurapa kwekenza yemukomana kunogona kusiyanisa kunyange kunyanya kusimbiswa kuri kuiswa kune kubereka-kurega kurapwa. Kurapa kunogona kutora chimiro cheimwe kana zvimwe zvezvikamu zvinotevera, zvichienderana nekuoma kwechirwere ichi:
- chemotherapy
- radiation therapy
- chirongwa chokuvhiya, kusanganisira LEEP, conization, hysterectomy (kubviswa kwechibereko), kana kuti trachelectomy (kubviswa kwechibereko chechibereko panguva yekuchengetedza chibereko uye mavhai).
Kazhinji, 35 muzana yevakadzi vane chirwere chepachivha chechirwere vacharamba vachidzokorora mushure mekurapa.
Mukutaura kwekufa, hupenyu hwehupenyu hunobva pachirwere chezvirwere nenguva yekuongororwa. Kazhinji, vakadzi vanoongororwa paStage 0 vane 93 muzana mukana wekupona, asi vakadzi paChikamu IV vane 16 muzana yekupona.
Kudzivirirwa kweCervical Cancer
Nzira dzekuchengetedza tsika dzepabonde dzakachengeteka , Pap smear kuongorora, uye kupemha kweHIVV inoonekwa sevatatu nzira inotungamirira yekudzivirira chirwere chekenza chekudzivirira. Uyezve, kuumbwa kwenguva yakakodzera kweART kunofanirwa kuve kwakakosha kuderedza dambudziko reCIC kune vakadzi vane HIV.
Sangano reUnited States Preventive Services Task Forces (USPSTF) ikozvino rinokurudzira kupima Pap pamakore matatu oga oga nokuda kwevakadzi vari pakati pemakore 21 ne65, kana mamwe makore mashanu ega vakadzi vane makore 30 kusvika ku65 pamwe chete neHIVV kuedzwa .
Zvichakadai, kurwisa kweHIVV ikozvino kwakakurudzirwa kune chero musikana kana musikana wechidiki uyo akawana zvepabonde. Dare Rinokurudzira Rokudzivirira Kuzvidzivirira (ACIP) rinoratidzira zvirwere zvemazuva gumi nemakore gumi nemasere, pamwe chete nevakadzi kusvika kune makumi maviri nemaviri vasina kumbove kana kupedza chirongwa chekupora.
Zvirwere zviviri zvinobvumirwa kushandiswa: chirwere chinonzi quadrivalent chinogona kudzivirira marudzi 6, 11, 16 uye 18 (Gardasil) uye zvirwere zvebivalent zvinogona kudzivirira kumarudzi 16 ne18 (Cervarix). Rimwe nerimwe rinoda rutsva rwemashoko matatu anopiwa pamusoro pemwedzi mitanhatu.
Kunyange zvazvo zvirwere izvi zvisingakwanisi kuzvidzivirira pamarudzi ose eVVV, vatsvakurudzi veFox Chase Cancer Centre vanosimbisa kuti vakadzi vane HIV vane hutachiona hweHIV vane mikana yakawanda yekuti vane HPV mhando 52 uye 58 kupfuura avo vasingatendi. Izvi zvinosimbisa nharo yokuti pakutanga ART ndeyekukosha kwekudzivirira hutachiona hweHIV hune hutachiona hweHIV mune vanhu vane HIV.
Remangwana Mishonga uye Mazano
Mukutaura kwekuvandudza mazano, zvidzidzo zvenguva pfupi zvakaratidza kuti mishonga inowanzozivikanwa yakashandurwa nemishonga inonzi antiretroviral, lopinavir (inowanikwa mumvura inogadziriswa inosanganiswa nemishonga Kaletra), inogona kukwanisa kana kudzikamisa kana yepamusoro-grade cervical dysplasia. Mhinduro yepakutanga yakaratidza huwandu hwakawanda hwekubudirira paunenge watengeswa mukati mekuda-kaviri-kwemazuva ose pamwedzi mitatu.
Kana zviitiko zvingagoneswa, vakadzi vanga rimwe zuva vanogona kubata chirwere chepervical pre-cancer kumba, neavo vane HIV vanogona kurapa hutachiona hweVHV sechikamu cheVHIV.
Sources:
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Adler, D. "Chiitiko cheHART pane chirwere chepervical cervical." Nhasi kutsvakurudza kweHIV. Gumiguru 8, 2010; 8 (7): 493-7.
Dames, D .; Blackman, E ;; Butler, R .; et al. "High-Risk Cervical Human Papillomavirus Zvirwere pakati peHuman Immunodeficiency Virus-Positive Women in the Bahamas." PLoS | Poshi. January 23, 2014; 9 (1): e85429. doi: 10.1371.
US Preventive Services Task Force (USPSTF). "US Preventive Services Task Force Matambudziko Mutsva WeCervical Cancer Screening Recommendations: Uchapupu hunoratidza kuti kenza kuongorora kunobudirira." Rockville, Maryland; yakabudiswa March 15, 2013.
Nzvimbo dzeDaase Control and Prevention (CDC). "Quadrivalent Human Papillomavirus Vaccine: Zvirongwa zveBhuku reAdvisory pamusoro pekudzivirira maitiro (ACIP)." Kuipa uye Kufa Kwevhiki Yekare Ongororo (MMWR). March 23, 2007; 56 (RR02) .1-24.