Hepatitis C chirwere chinopararira chinokonzera chiropa, chinoparadzirwa nehutachiona hweHepatitis C (HCV) uye chimwe chezvikonzero zvinokonzerwa nekurapwa uye kufa pakati pevanhu vane HIV.
Sangano reAmerican Association for the Study of Liver Diseases (AASLD) rinotaura kuti chirwere chetachipatara-chinosanganisira hepatitis A, B , uye C-chiri nhasi chinokonzera rufu rwepasi rose, nekurasikirwa noupenyu kupfuura yeAIDS , TB uye malaria .
Parizvino hapana mushonga wehepatitis C.
HIV / HCV Kuchengetedza
Kupararira kwehutachiona hweHIV / HCV kunowanzosiyana nekudzidza, asi kutsvakurudza kwakanyatsoratidza kuti mukana weHCV hutachiona pakati pevanhu vane HIV ndewepamusoro ne30 muzana muUnited States neEurope. Munyika yose, mutoro weHIV / HCV unenge uri mamiriyoni 4 kusvika ku5, kana pakati pe10-15 muzana yehuwandu hweHIV.
Vashandisi vezvinodhaka zvisina kufanira (IDUs) vane ngozi yakanyanya kune HIV / HCV coinfection, ine kupararira kubva 82 kubva kune 93 kubva muzana. Kusiyana neizvi, kufungidzirwa kwekodhi nenzira yekutengesa zvepabonde kune inenge 9 muzana.
Kunyange zvazvo varume vanoita zvepabonde nevarume (MSM) havasi ivo vane huwandu hwehutachiona hweHCV, njodzi inogona kuwedzera kusvika kune 23 muzana muSMSM vane maitiro akaipisisa-sekuita zvepabonde akawanda, zvepabonde dzeboka, kana kunyange vakataurirana zvinodhaka zvakatorwa mushure kana kuti nepamusoro.
Vanhu vane mari yakawanda vane hutachiona hweHCV hwepamusoro kupfuura avo vanoita sono, vanoita kuti kukurumidza kuwedzere kune fibrosis , cirrhosis , uye hepatocellular carcinoma (iyo inowanzosiyana yekenza yeropa).
Uyezve, vanhu vane mari yakawanda vane hutatu hukuru hwehutachiona hwehutachiona hwehutachiona hwehutachiona hwehutachiona hwehutachiona hwakanyanya kupfuura avo vane HIV chete.
Aya mafananidzo anoratidza kudikanwa kwekuzivikanwa kukuru kweHCV pakati pevanhu vane HIV, pamwe chete nemishonga inobatsira kune inojekesa HCV chirwere kana, zvisinei, zvishoma nezvishoma chirwere chekuwedzera.
Nguva Yokutanga Kutapwa
Nguva yokutanga HCV inogona kunge iri nyaya yakaoma. Kazhinji kutaura, hutachiona hweHCV hunoratidzwa kune vanhu vane HCV-yakabatana nechiropa chisina kunaka. Dhipatimendi reUnited Health Health and Human Services (DHHS) ikozvino rinorayira kuti chirwere cheHCV chiitwe kune vanhu vanoita mari yakawanda vane fibrosis inokosha uye vari pangozi yakakura yekusimudzirwa kwechirrhosis.
Nemhaka yezvakakosha zvemigumisiro yemishonga-pamwe chete nekuti kurapwa hakubvumi zvachose kubvumirwa kweHCV-chisarudzo chekurapa chinonyanya kuenderana nekugadzirira kwevarwere, pamwe nekuongorora zviratidzo zvekufananidzira kwekubudirira kwekurapa (semuenzaniso, HCV genotype , HCV viral load ).
Zvisinei, zvakakosha kuziva kuti nguva dzose-kuvandudza HCV zvinodhaka zviri kukurumidza kuderedza zvipingamupinyi zvekurapa, pamwe nemigumisiro yerapi iri kure kupfuura mikana inogona kuitika.
DHHS inowedzera kukurudzira kushandiswa kwemishonga inorwisa antiretroviral therapy (ART) kune vanhu vose vakagadziriswa pasinei neCD4 count , iyo yakaratidzwa kuti inonoke kufambira mberi kwezvirwere zvakabatana neHCV. Uyezve:
- Kune vanhu vane ma CD4 akawandisa (pasi pemakumi maviri emasero / mL), hutachiona hweHCV hunofanira kunonoka kusvika panguva yakadaro iyo CD4 inowedzera. Kusarudzwa kwemishonga inorwisa mabhakitiriya inopesana zvachose pamusoro pemishonga yekushandisa zvinodhaka-zvinodhaka, pamwe chete nehuwandu hwezvinodhaka. (Chinonyanya kunetseka ndechokuti mamwe emishonga inoshandiswa muHCV kurapwa inogadziriswa mumigwagwa yakafanana nemamwe ma antiretroviral, kuderedza kushandiswa kwemishonga pamwe chete nekuwedzera kuitika kune ngozi.)
- Kune mumwe munhu atova pane ART, kufungidzirwa kunofanira kuitwa kugadzirisa kurapwa kuti kuderedze migumisiro yemigumisiro, pamwe nekubatsirwa kwekuchinja zvakare kuwedzeresa kunetseka pamusoro pekugadziridzwa kunokonzerwa nehutachiona hweHIV .
- Kune vanhu vasingateereri vane CD4 dzinosvika mazana mashanu masero / mL, vanachiremba vanogona kusarudza kunonoka ART kusvika pakupedzwa kweHCV kurapwa.
Kuratidzwa kweHCV Mishonga Options
Mutsara weHCV kurapwa kwenguva refu wakanga uri kusanganiswa kwe pegylated interferon alpha (kana PEG-IFN) uye ribavirin . PEG-IFN inosanganiswa nemishonga mitatu inobatsira masero kuti abudise huwandu hwakawanda hwemakemikari anokwanisa kuuraya zvose zvirwere uye masero anogamuchira vane utachiona.
Ribavirin, imwe nhengo yemagetsi, inopesana neRNA metabolism inofanirwa kupindurwa kwehutachiona.
Zvitsva zvinoshandiswa kurwisa mahara (DAAs) zvinowedzera kukwanisa kurapa zvirwere zvakasiyana-siyana zvehepatitis C pasina kushandisa PEG-INF uye, kakawanda, ribavirin. Nokuita kudaro, migumisiro yechirwere inobatanidza neHCV chirwere inoderedzwa zvikuru, sekuda kwenguva yekutonga.
Pakati peaDAA dzakagamuchirwa zvinodiwa mukurapa chirwere chisingaperi chekushaya hepatitis C (kuburikidza nekurairwa kweDAA kugamuchirwa):
| Zvinodhaka | Approved for | Yakanyorwa ne | Kusarudza | Nguva |
| Epclusa (sofosbuvir + velpatasvir) | genotypes 1, 2, 3, 4, 5, uye 6 pamwe nesu pasina cirrhosis | ribavirin mumatambudziko e-cirrhosis decompensed uye pasina ribavirin mune zvimwe zviitiko | imwe piritsi zuva rimwe nerimwe kana kuti isina zvokudya | 12-16 vhiki |
| Zepatier (elbasvir + grazoprevir) | genotypes 1 uye 4 ane kana pasina cirrhosis | ribavirin kana pasina ribavirin, zvichienderana nejenotype uye nenyaya yekurapa | imwe piritsi zuva rimwe nerimwe kana kuti isina zvokudya | 12-16 vhiki |
| Daklinza (daclatasvir) | genotypes 3 pasina cirrhosis | Sovaldi (sofosbuvir) | Rimwe piritsi zuva rimwe nerimwe nechingwa | Vhiki 12 |
| Technivie (ombitasvir + paritaprevir + ritonavir) | genotypes 4 pasina cirrhosis | ribavirin | mapiritsi maviri zuva nezuva nechingwa | Vhiki 12 |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, yakabatanidzwa ne dasabuvir) | genotypes 1 kana kana pasina cirrhosis | ribavirin kana kutorwa pachayo, uko kunoratidzwa | mahwendefa maviri e-ombitasvir + paritaprevir + ritonavir inotorwa kamwe chete zuva nezuva nezvokudya, pamwe chete nehwendefa rimwe redasabuvir rinotorwa kaviri zuva nezuva nezvokudya | 12-24 mavhiki |
| Harvoni (sofosbuvir + ledipasvir) | genotype 1 ine kana pasina cirrhosis | inotorwa pachayo | imwe piritsi zuva rimwe nerimwe kana kuti isina zvokudya | 12-24 mavhiki |
| Sovaldi (sofosbuvir) | maitiro e1, 2, 3 uye 4 ane cirrhosis, kusanganisira avo vane cirrhosis kana hepatocellular carcinoma (HCC) | peginterferon + ribavirin, ribavirin oga, kana Olysio (simeprevir) kana kuti kana pasina ribavirin, uko kwakaratidzwa | imwe piritsi zuva rimwe nerimwe kana kuti isina zvokudya | 12-24 mavhiki |
| Olysio (simeprevir) | genotype 1 ine kana pasina cirrhosis | peginterferon + ribavirin, kana Sovaldi (sofosbuvir), uko kunoratidzwa | rimwe capsule zuva nezuva rine zvokudya | 24-48 vhiki |
Nharaunda Dzakabatana
Chimwe chezvinhu zvinonyanya kukosha pamusoro pokurapa HIV / HCV coinfection ndiyo inogona kuipa migumisiro pane inogona kuitika sechikonzero cherapi. Kunyange zvazvo kuiswa kwezvizvarwa zvitsva zvinodhaka kwakashandura kurapwa kweHCV hutachiona, hapana kuisa pfungwa kune zvinetso izvo vamwe varwere vanosangana nazvo.
Kune vanhu vanotanga kurapwa kwekutanga, zvinowanzova nemigumisiro yeHCV therapy (inowanikwa mune zvinenge 5% zvezviitiko) ndeiyi:
- Epclusa: kuneta, kuora musoro
- Zepatier : kuneta, kuora musoro, nekunyunyuta
- Daklinza : kuneta, kuora musoro, kusuruvara, chirwere
- Technivie : kushaya muviri, kuneta, kushushikana, kusuruvara
- Viekira Pak : kuneta, kushungurudza, ruvara rweganda, ganda rekuita, kusuruvara, kushaya simba, kuneta
- Harvoni : kuneta, musoro
- Sovaldi + PEG / INF + ribavirin: kuneta, kusuruvara, nausea, musoro, anemia
- Sovaldi + ribavirin: kuneta, musoro
- Olysio + PEG / INF + ribavirin: chikafu, chivara chinoputika, chifukidziro, kurwadziwa kwemisonda, kupererwa kwemhepo
Kunyange zvazvo yakawanda yemigumisiro inopedza nguva, kugadzirisa mukati memavhiki kana maviri ekutanga, dzimwe zviratidzo zvingawedzerwa uye zvinotaurwa (kunyanya mu PEG / INF-based therapies). Taura nechiremba wako pakarepo kana zviratidzo zvichitaura uye / kana kuramba.
Usati Watanga HCV Therapy
Kunzwisisa uye kutarisira migumisiro inokonzerwa nemigumisiro ndiyo chinhu chinokosha pakushandura utachiona uye kuwana zvinangwa zvekurapa zvakakwana. Pill mutoro, kuenzanisa zvirongwa, uye kuchinja kwezvokudya (kureva, kuwedzera mafuta kunodya kune avo vari kudya zvakaderera-mafuta) ndezvimwe zvezvinhu zvinoda kutarirwa kuti zvive nechokwadi chekugadzirira varwere.
Uye kunyange zvazvo kusarudzwa kwezvinodhaka kunogona kuonekwa sechinhu chakakosha pakubudirira kwekurapa, saka, zvakare, kushandiswa kwemishonga . Iyo inoratidzira kwete kungova nemigumisiro iri nani asi mumatambudziko mazhinji inoderedza kusangana uye kuoma kwemigumisiro. Kuwedzera kwekuteerera, ikoizvo, sechimwe chinhu chinoita kuti mukana wekurapa kusakanganiswa sezviitiko zvinotambudza zviitiko.
Chiropa Transplants
Chirwere chetachirwere chinokonzerwa nekusingaperi kweHCV hutachiona chiratidzo chinotungamirira chiropa chinoputika muU.S., Europe, neJapane, kunyange zvazvo hutachiona hunozivikanwa kuti hudzoke inenge makumi manomwe kubva muzana yevakagadziriswa mukati mumakore matatu. Uyezve, hutachiona hwekubatanidzwa pachahwo hunogona kuita kuti pakati pe10-30 muzana yevarwere vari kuwedzera chirwere chepirhosis mukati memakore mashanu.
Muvanhu vanoda chiropa chekuputika, kutanga kweHCV katatu kurapa kunogona kuderedza zvikuru njodzi yekurasikirwa kwemafuro inenge 30%.
Pasinei nezvengozi dzekubatana, zvakakosha kuona kuti chirwere chekuchengetedza chirwere chinofananidzwa nezvimwe zvose zvinoratidza chiropa chinoputika-nehupenyu hwekuchengetedzwa kwemashure pakati pe 68% ne 84% mukati memakore mashanu ekutanga.
Zvitsva zvizvarwa zveHCV mishonga zvingangodaro zvichifambisa izvi, asi zvichisimudzira huwandu hwemigumisiro yemishonga ine chokuita nemishonga.
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