Ive nezera idzva remishonga rakashandura mitemo ine hutachiwana hweHIV here?
Kushandisa zvinodhaka kunoramba kuri chinhu chinokosha pakurapa nekugadzirisa utachiona hweHIV. Kusiyana nemishonga isingagumi inoshandiswa kurapa zvirwere zvakadai sechirwere chepfungwa kana chirwere cheshuga-icho chinoda kushoma se 70% kuomerera kuwana zvipatara zvinangwa- antiretroviral therapy (kana kuti ART) inoda kuswedera pedyo-kukwana kuchengetedza hutachiona nekudzivirira kusati kwatanga kukura kwechirwere kushorwa .
Asi tipei kuti isu iye zvino tava nehutsva, chizvarwa chakavandudzwa chemishonga inorwisa mabhakitiriya , ndiwo mitemo inofanana here?
Izvo zvikamu makumi mapfumbamwe nezviviri zvekutenda Mantra
Nhungamiro yehutachiona hweHIV inotaurira kuti varwere vanoda kuchengetedza kupfuura 95% kuomerera kuitira kuti varambe vachichengetedzwa nehutachiona hwehutachiona. Kune rimwe zuva-zuva remishonga regimen, iro rinoshandura rinenge kusvika mazuva gumi nemaviri kubva pane dzimwe nguva, kurasikirwa kwemaawa panguva yegore.
Zvisinei, vamwe vakatanga kutaurirana kuti "95% mantra" inobva pane data yakabatwa mumakore ekuma1990, apo mishonga yemishonga yaiva yakanyanya kuoma uye madhiragi aiva nehafu shoma-upenyu. Nepo kune vashomanana avo vanogona kutaurira 85% kana kunyange 90% se "itsva" yekuchengetedza mitemo, vazhinji vanodavira kuti kudikanwa kwekucheka kana kusayira varwere kuti vave vasingapfuuri vakakwana hakuna nzvimbo inotarisirwa sezvakaitwa makore gumi akapfuura.
Kunyange zvakadaro, pane vakawanda vanofunga kuti kuderedza kubata kwechikwata (kana kuti kunyange kuratidza kuchinja) iko kukanganisa, zvichibvumira kuti mazinga ekuderera achangowedzera kudarika nguva.
Pane uchapupu hunotsigira nharo iyi. Maererano nedhenda yakagadzirwa neUnited States for Disease Control and Prevention (CDC), vanenge 30% veAmerica paAIDS havagoni kupedza kuvharirwa kweropa. Vazhinji vanobvumirana kuti kusungirirwa kwepamusoro kunobata basa rinokosha mune izvi, asi dzimwe dzidzo dzinoratidza kuti kunyatsoteerera kunowanzopera mushure mekunge "mwedzi wekuzvarwa" wakatevera mushure mekutanga kweART.
Zvisinei, kune humwe uchapupu hwakakwana hunotsigira chizvarwa ichocho chitsva zvinowedzera "kukanganwira" pamwe nekusagadzikana, kunyanya "kukurudzira" zvinodhaka zvinokwanisa kuchengetedza huwandu hweplasma mishonga kwenguva refu.
Asi ihwohwo huchapupu hunokwana here kuti hudane kuti uwane rusununguko rwekuteerera maitiro? Kunyangwe nehuwandu, hutachiona hwehutachiona hwemishonga, isu tiri chaizvoizvo pachiitiko ichocho zvakadaro?
Kuyera Uhupupu
Protease inhibitors (PIs) ndiwo muenzaniso mukuru wekufambira mberi kwemazuva ano ART. Mazuva ano, mapurogiramu anowanikwa pasi rose "anokurudzirwa" -kureva kuti anobatanidzwa pamwe chete nemishonga yechipiri inogona kuwedzera serum hafu yeupenyu hwePI. Meta-kuongorora zvidzidzo zvikuru zvishanu zvinoratidza kuti chizvarwa chitsva chinowedzera PIs-sePrezista (darunavir) -kuda, chaizvoizvo, chinongoda 81% kuomerera kuitira kuti zvive nehutachiona hwekuderedza.
Kusiyana neizvi, kukura kwakanyanya kwePIs kwakafanana neKalatra (lopinavir + ritonavir) inoratidzika kusina kubudirira kana kuomerera kunodonha pasi pe95%, pamwe nekuongorora kumwe chete kunoratidza kuti 53% chete yevarwere vanogona kuwana miviri isingaoneki yehutachiona pasi pehutano hwekunamatira.
Kutsvakurudza hakusi pachena zvakajeka pamusoro pemagumisiro ekuteerera kune mamwe makirasi emishonga inorwisa mahara. Kunyange zvazvo zvimwe zvidzidzo zvaratidza kuti kwete nucleoside reverse transcriptase inhibitors (NNRTI) zvinodhaka seSusvava (efavirenz) inogona kungoda 80% kusvika 90% kuomerera kana yakashandiswa pamwe chete nePI yakasimudzirwa, vamwe vanopikisa kuti mazinga akawanda ekuteerera achiri kudiwa kune zvingangodaro zvekudzivirira nekupikisana-siyana kune dzimwe NNRTI zvinodhaka.
Saizvozvowo, CPCRA FIRST Yokudzidza yakawana kuti maitiro ekurwisana pakati pe nucleoside reverse transcriptase inhibitor (NRTI) zvinodhaka zvakadai seRetrovir (AZT, zidovudine) kuwedzera mukuwirirana zvakananga nekuderera kwekuchengetwa kwemishonga.
Ikozvino pane zvishoma zvidzidzo zvinowanika kuongorora hukama huri pakati pekuteerera uye mutsva wechizvarwa chemishonga seIndelence (etravirine) kana kunyange inonzi nucleotide analog, Viread (tenofovir). Saizvozvowo, ye integrase inhibitors inobvumirwa kushandiswa, chidzidzo chimwe chete chiduku cheIsentress (raltegravir) chinoratidza kuti kuomerera kwema 90% kunogona kugamuchirwa.
Icho Chinofanira Kushaya Rimwe (kana Rakawanda) Disi Inondirangarira?
Kushaya chirwere chechiitiko kana kukundikana kutora chirwere panguva inenge chiri chinhu chinoitika kumunhu wese ane mishonga isingaperi.
Nezvikamu zvizhinji, izvi hazvifaniri kukonzera kunetseka zvisina kukodzera. Zvisinei, nguva yakanyanya kana kuti inowanzopera inopera, zvisingakwanisi kuti mishonga iyi ichengetedze kusingaoneki kwehutachiona kubviswa.
Chimwe chidzidzo chakatungamirirwa neNational Institute of Infectious Diseases muRome chakaratidza kuti zvipembenene mukurapa kwemazuva maviri chete mukati memwedzi zvakaguma nekuwedzera kwemazuva mashanu mune zvinoitika zvehutachiona hwekuita. Kubatsiridza tsvakurudzo muna 2013 kwakaratidza kuti kunyange yakasimudzirwa, "zvinotaridzika" zvinokonzerwa nemavhuvira (pakati pe50 ne 199 makopi / mL) zvingaguma nehuwandu hwe 400% hwekushayikwa kwe virologic.
Saizvozvowo, kutsvakurudza kubva kuCôte de Nacre University Hospital muFrance kwakaratidza kuti mazamu mazhinji kwenguva refu muART yakagadzirisa mikana yekurapa kukanganisa , nekupererwa kwemazuva gumi nemashanu zvichiita kuti 50% inokonzerwa nehutachiona hwekuwedzera.
Saizvozvowo, Kubvuma uye Efficacy yeProtease Inhibitor Therapy (AEPIT) miedzo yakadzidza kukanganiswa kwezvikanganiso zvekuita nguva panguva yehutachiona. Maererano nekutsvakurudza, varwere vakabvumidza kusvika maawa matatu ewayway kumativi ose ewavo vanowanzosangana nenguva yakaita 300% yakawanda yehutachiona kune avo vakanga vatora mishonga yavo nenguva.
Saka Izvi Zvinorevei Kwandiri?
Pane kusava nechokwadi zvishoma kuti chizvarwa chitsva chiri nyore kushandisa uye kubvumira, kupa "mukuru" kukanganwirwa "inofanirwa kuti murwere arege kurasikirwa nechirwere chisina kunaka. Uye apo isu tiri kunyatsoenderera kune zvinodhaka-nguva zvinoshandisa zvinoda kuderedzwa kashoma, juri rinenge risiri kunze kwekuti izvi zvinomiririra shanduko chaiyo mukunyorera mazano.
Pakupedzisira, ART yakavakirwa pamusangano weva antiretroviral agents, mumwe nomumwe ane hafu yeupenyu-uye pharmacokinetics. Zvimwe zvemashure ane zviduku zvishoma zvezvikanganiso; vamwe vakuru. Kubva pane maonero anobatsira, zvingave zvisingabatsiri kushandura chinangwa chekunamatira pamwe nehurongwa hwehutano hwose.
Pane kudaro, nyaya dzekuteerera dzinofanirwa kusangana nekurerukirwa kukuru kubva kune vanobata uye kusazvidya mwoyo kubva kuvarwere vanotya kubvuma kukanganisa kwavo. Kana pane chimwe chinhu, inoda kukurudzirana-mutauri wekugadzirisa, nechinangwa chakanaka uye zvigadziro zvekuita kuti hutano hwakakwana, hunodikanwa-hupenyu huripo. Izvi zvinofanira kusanganisira:
- Kugadziriswa kwehutano hwekutevedzera zvipingamupinyi musati watanga kuiswa kweART (semuenzaniso, purogiramu yebasa, vana, kuzarura, kusurukirwa, nezvimwewo)
- Kuenderera mberi kuongororwa uye kubatanidzwa kutarisana nehupi matambudziko matsva kana aripo (kusanganisira kurapwa kwemigumisiro, matambudziko emhuri, nyaya dzepfungwa, nezvimwewo)
- Kunyoreswa kwehurongwa hwekurapa, uko kunoratidzwa
- Kutaura nezvekuchinja kwezvinhu zvinosanganiswa nekusagadzikana kwekutevedzera (semuenzaniso, kushandisa zvinodhaka, kuora mwoyo, kusava nemusha, nezvimwewo)
- Kushandiswa kwekuchengetedza majekiseni (semuenzaniso, vashandisi vemishonga, zviyeuchidzo zvishandiso) kana maitiro ekutsigira maitiro.
Muchidimbu, zvinowedzera kubudirira kugadzirisa kutambira kwete zvakanyanya maererano ne " Zvinore zvakadini ?," asi panzvimbo senzira yekuziva zvishandiso kuti ivimbise kuti ART inoshanda, chikamu chisina matambudziko chikamu chezuva nezuva .
Kana izvi zvingagoneka, saka mubvunzo wekuti "yakawanda" ungawira sei zvachose.
Sources:
Kobin, A. uye Sheth, N. "Nhamba dzekutenderera dzinodikanwa kuregererwa kwemhirizhonga pakati peNewer Antiretroviral Mishonga." The Annals of Pharmacology. 2011; 45 (3): 372-379.
Martin, M .; Del Cacho, E ;; Codina, C .; et al. "Kuwirirana Pakati Pokugadzikana Kwakawanda, Rudzi rweAntiretroviral Regimen, uye Plasma HIV Rudzi 1 RNA Viral Moroja: Chiitiko Chekufungidzira Cohort." AIDS Kuongorora Vanhu Retroviruses. Gunyana 2008; 24 (10): 1263-1268.
Mena, A .; Blanco, F .; Cordoba, M; et al. "Chidzidzo chePilotro Kuongorora Raltegravir QD NeBID muHIV Vashandi Vanowanikwa Mukuedzwa Kwakaitwa." Yakapiwa pa 49th Interscience Conference pamusoro peAntimicrobial Agents uye Chemotherapy (ICAAC). San Francisco, California; Svondo 12-15, 2009.
Laprise, C .; de Pokomandy, A .; Baril, J .; et al. "Kukundikana kweVirologic Kutevera Kuramba Kunoita Pasi-Viremia Muboka revarwere veHIV-Varwere Vakanaka: Zvibereko Kubva Mumakore 12 Okucherechedza." Clinical Infectious Diseases. November 2013; 57 (10): 1489-96.
Ammassari, A .; Trotta, M .; Zaccarelli, M .; et al. "Nzira dzeMhando dzakasiyana dzekugadzirisa zvinyorwa uye zveCART Zviratidzo zvePlasma HIV-1 RNA Kuongorora Pasi Pamugumo Wechechi yeChianti paIndangariro Yenguva Yenguva." Yakapiwa mu 12 Europe AIDS Conference Conference. Cologne, Germany; November 11-14, 2009.