Genetic, Clinical uye Kunyange Zvimwe Zvimwe Zvokuita Tamba Chikamu Pakusarudza Nokuchenjera
Nekuvhura mitsva inotanga kushandiswa kwechirwere, kusarudza chirongwa cheHIV pamwe chete chinowanzova nyore sekusarudza rimwe zuva zuva rimwe nerimwe, zvose-mu-rimwe piritsi rimwe nerimwe zuva rimwe nerimwe, yose-in-one tablet. Uye kune vakawanda vatsva vanorapwa, zvakajeka sezvo-zvinoda zvishoma kudarika kuongororwa kweropa uye kunyatsoongorora kwezvenhau yezvechiremba kuti uone kuti chirwere chechirwere chinoshanda zvakadini kwauri somunhu oga.
Zvisinei, kuita chisarudzo chakanaka hakusi nguva dzose pamusoro pekugadzirira. Nepo kuva nehumwe -mu-imwechete sarudzo yakadai seAtripla , Complera kana Genvoya inogona kuita kuti upenyu huve nyore kubva pakunamatira kwemaonero, mazita, zvipatara kana zvimwe zvinhu zvevanhu zvinowanzoreva nzira dzakasiyana dzokurapa.
Pakupedzisira chinangwa chekurapa kwakanyatsozivikanwa ndechokuti iwe pachako uwane kurapa kuitira kuti mishonga yako inoshanda kwemakore akawanda zvichiita neine madhara emigumisiro uye yakawandisa kuvhara ropa (sekuenzaniswa nehutachiona hweHIV ). Kuita izvi zvinoda kuongorora zvinotevera zvinorapwa:
Mhando yemishonga inosarudzwa muTein-Line Therapy
Mishonga yekurapa yakashanduka zvikuru mumakore gumi adarika, kuenda kune dzimwe mishonga (kana makirasi emishonga) inozivikanwa kuti inonyanya kuora kana kuti inowanzogadzirisa kuwedzera kushandiswa kwezvinodhaka .
Mune mirayiridzo yezvino yeUnited States , kusimbiswa kwakanyanya kwakaiswa pakushandiswa kwe integrase inhibitors (ISTIs) murapi yekutanga, uye ine ina yemitanhatu inoshandiswa kurapwa inosanganisira zvirongwa zveItI madhara darunavir (yakawanikwa muTurumeq neTivicay ), raltegravir (Isentress) kana elvitegravir (inowanikwa muVitekta , Stribild , uye Genvoya ).
Chikonzero chechigaro chinosarudzwa chinosanganisira kubvumira kutsungirira, zvishomanana maitiro ekurapa, uye zvishoma nezvishoma kupikisa mapurogiramu (zvinoreva kuti vanokwanisa kukunda chero ipi zvayo yakagara iripo zvinoshandiswa nemishonga yako HIV inogona kuva nayo). Zvose zvinoshandiswa kurapwa zvinotorwa pane kamwechete-zuva rimwe nerimwe, kubvuma kuti kushandiswa kwekushandiswa kwechinhu chinhu chinokosha pakuchengetedza zvakakwana kushandiswa kwemishonga .
Maziso eGenetic Your Virus
Hapana chimwe chinhu chakadai sorudzi rumwe rwe HIV. Mukati yehutachiona hweHIV, hutachiona hucharamba huchingopfurikidza, humwe hupi hunoita kuti hurumende isaramba. Sezvo ichi chinotapurirwa utachiona chakapfuura kubva kumunhu kusvika kumunhu, kupikisa kunopfuudzwa (chirwere chinonzi chinoparadzirwa kana chinogadziriswa).
Vose sevanhu vatanhatu vatsva vane hutachiwana muUnited States vachawana kushorwa kune rimwe boka remishonga yeHIV. Yakagadziriswa nehuwandu-class-drug resistance resistance inowanzonzi.
Kuti uone kuti mushonga wako wekutanga wakakwanisa kukunda zvipingamupinyi zvakadaro, maitiro ekuberekwa (zvinowanzozivikanwa sejenotyping) inoitwa kuti uone kuti kuchinja kupi kune hutachiwana hwako uye kuti kuchinja uku kunopesana. Kusarudzwa kwezvinodhaka kunobva pakuongorora kwakanyatsogadzirisa migumisiro ye genotypic.
Muzvigadziriswa-zvishoma zvisingakwanisi kugadziriswa, kusarudza zvinodhaka kunobva pakuongorora kwakadzidziswa kwe (a) maitiro anozivikanwa kana kuti anofungidzirwa asingagadziri mune imwe nzvimbo yenharaunda uye (b) mishonga inowanikwa inozivikanwa kuti inogona kukunda kusagadzikana kwakadaro.
Zvinyorwa zvePhysical and Psychological
Zviri pachena kuti hutano huripo hwevarwere hunotungamirira kuti kurapwa kunowanzotaurwa sei kuvanhu vane HIV.
Zvirwere zvemuviri zvemuviri wemurwere (sekuenzaniswa neCD4 count ) zvinogona kukurudzira kushandiswa kwemumwe mushonga pane imwe. Mamwe mararamiro anokwanisawo kusanganisa kushandiswa kwemamwe ma antiretroviral agents, zvichida nokuti mishonga inogona kuwedzera mamiriro ezvinhu akambovapo kana kuti kukonzera kupera-kwezviratidzo.
Pakati pemuenzaniso:
- Kushandiswa kwetenofovir kunopesana nevanhu vane chirwere chakakomba (renal) kusagadzikana sezvo kunogona kukonzera kukanganisa kwepvo mune vamwe varwere. Mamiriro ezvinhu akadaro angasabvisa kushandiswa kwemishonga inonzi tenofovir-ine Viread, Truvada, Stribild, Complera, uye Atripla.
- Varwere vane kliniki yekuora mwoyo, kuzvidya mwoyo, schizophrenia, bipolar disorder, kana chero ipi zvayo yakakura yepfungwa / yepfungwa mamiriro ezvinhu inogona kunyeverwa nekushandiswa kwe efavirenz, chirwere chinozivikanwa kuti chinokanganisa zvakanyanya chirwere cheshuga (zvichiita zviratidzo zvakajeka, zvinetso zvekutarisa uye kushungurudzika kwehope) . Chimwe chezviitiko izvi chinogona kusabvisa kushandiswa kweSusvava uye efavirenz ine-drug Atripla.
- Vanhu vane hutachiona hwechiropa hunozivikanwa kana hunoonekwa (kusanganisira avo vane hepatitis) vanofanira kudzivisa chero mishonga inogona kuwedzera mamiriro acho ezvinhu. Izvi zvinokonzerwa nekugadzirwa kwemishonga kwemishonga iyi muropa, izvo zvinogona kutungamirira pakuvaka-up kwemishonga inotyisa (chirwere chinonzi hepatotoxicity). Kushandiswa kweAptivus (tipranavir) kunopesana mumamiriro ezvinhu akadaro, sekune dzimwe nhamba dzevamwe antiretroviral agents mune zviratidzo zvakakomba zvechiropa chisingaiti.
Zvinodhaka-Zvinodhaka Zvinodhaka
Kushandiswa kwezvinodhaka-zvinodhaka zviitiko zvinowanzoonekwa mumurwere ane HIV, uye humwe hutano hunoda kuchinja munharaunda uye vamwe hunoda kupedzisa hutachiona hweHIV kana kuti zvinodhaka.
Chimwe chekubatana kwakanyanya kunosanganisira zvinodhaka zvinoshandiswa kurapa chirwere chetachiona (TB), isina mishonga inodarika 13 antiretroviral mishonga inopesana kuti ishandiswe nemishonga inonzi TB rifampin uye rifapentine.
Saizvozvowo, gumi nembiri mishonga yeHIV haigoni kushandiswa pamwe chete nedzimwe mishonga yeHepatitis C , kushandiswa kwavo pamwe chete kuderedza kushanda uye zvibereko zveimwe kana mishonga yose. Izvo zvinoshandawo kune kunyorera-kuderedza zvinodhaka Mevacor (lovastatin) uye Zocor (simvastatin), iyo isingafaniri kutorwa nevakawanda veHIV protease inhibitor class drug s .
Zvinoshamisa zvinoshamisa, zvichida, mhando yepamusoro yemishonga yemishonga St. John's Wort inopesana kuti ishandiswe nemishonga yose yeHIV sezvo ichizivikanwa kuti inonyanya kuderedza kushungurudzwa kwezvinodhaka muropa.
Zvakakosha kugara uchiudza chiremba wako nezvemhando ipi zvayo yemishonga, zvose zvakatemerwa uye zvisingarevi, izvo uri kutora kana nguva dzose kana kwete.
Lifestyle Factors uye Zvimwe Zvimwe
Kuzivikanwa kwehutano hweHIV kunofunga nezvehupenyu hwomunhu uye kuti kurapwa kungave kwakakanganisa sei mararamiro iwayo. Uye kazhinji hazvisi nyore kuchema. Kunyange mumatambudziko anoita se "akareruka" -kuti, somuenzaniso, kushandiswa kwemaitiro kusina kushanda kungaita kuti maitiro eurovirogical efavirenz arege kushungurudzika-kunyanya kutarisirwa kunofanira kutorwa kuti uone kuti kurapwa kunofanirwa zvakanyanya kune pfungwa yemurwere wehupenyu hwakanaka zvinokonzerwa nekliniki.
Vakadzi vane makore ekuberekwa nevana, somuenzaniso, vanofanira kupiwa mazano pamusoro pengozi ye efavirenz pakukura kwekuberekwa uye nekuraira imwe nzira yekurapa inofanira kuvepo inogona kuva nepamuviri.
Muvatana vakwegura, vanoita sehuwandu hwevanhu vane hutano hwakawanda hwehupfungwa, tenofovir inogona kuchinjwa kuitira kuti isadzivirire kukwanisa kukanganisa kudarika.
Varwere pamethadone therapy (inoshandiswa kurapa uropiyard) zvinogonawo kurayirwa kuti urege efavirenz, pamwe neViramune (nevirapine) uye Kaletra (lopinavir / ritonavir) , sezvavanogona kuderedza kushanda kwemishonga yose. Mukufema kwakafanana, kufungidzirwa kunofanira kuitwa sekushandiswa kwezvigadziriswa zvinoshandiswa pakurapa muhuwandu umo kusunga kuwirirana kunowanzoomera.
Sources:
Dhipatimendi reHutano neHuman Services (DHHS). "Mirayiridzo yeKushandiswa kweAntiretroviral Agents muHIV-1-Vakabatwa Vakuru Nevana Vari Kuyaruka." Rockville, Maryland; yakasvika musi waFebruary 15, 2016.
Li, J ;; Kim, D.; Linley, L .; et al. "Kuchengetedza kunzwisisika kunoratidza kupararira kunopararira kwekutapurirwa kweHIV mune zvinodhaka." 2014 Musangano weRevroviruses uye Mikana Yakasangana (CROI); Boston, Massachusetts. March 3-7, 2014; abstract 87.