Kuziva Zvinokonzera uye Kusarudza Mitsva DzeMishonga Inodhaka
Utachiona hweHIV huripo hunoitika kana zvakatemwa kuti mishonga yako ye antiretroviral isingakwanise kuzadzisa zvinangwa zverapa-kureva kubviswa kwechirwere chetachiona hweHIV kana kudzorerwa kwezvirwere zvekudzivirirwa kwezvirwere kudzivirira zvirwere zvisingabatsiri . Kukanganisa kurapwa kunogona kuiswa se virologic (ine chokuita nehutachiwana), immunologic (inosangana nezvirwere zvemuviri), kana zvose zviri zviviri.
Kana kukanganisa kurapwa kuchiitika, danho rokutanga nderokuona chikonzero kana zvikonzero zvingangodaro zvakakonzera kukanganisa, izvo zvingasanganisira:
- Kuwedzerwa kwechirwere chekushandisa zvinodhaka
- Acquired drug resistance
- Kwakaitika kuporesa kukanganisa (s)
- Urombo husina kukodzera kumiganhu yezvokudya
- A low pre-treatment CD4 count
- Co-zvirwere (zvakadai sehepatitis C kana tuberculosis)
- Kubatana kwezvinodhaka nezvinodhaka
- Zvinetso nekunwa kwemishonga kana metabolism
- Zvinodhaka zvinokonzerwa nemishonga, izvo zvingakanganisa kuterera
- Kutadza kuora mwoyo kana kushandiswa kwemishonga, izvo zvinogona kukanganisa kuterera
Kukundikana kwechirologic
Kukundikana kwechirogiki kunorondedzerwa sekusakwanisa kuwana kana kuchengetedza utachiona hutachiwana hweHIV huri pasi pemakopi 200 / mL. Izvi hazvirevi kuti munhu anofanirwa kuchinja shanduko kana chirwere chetachiona chichiderera pasi pe200. Chinongoshanda sechiyero icho chiremba angakwanisa kuita chirongwa chechipatara chine ruzivo kana kushivirira kwechiremba uye dosing maitiro anovimbiswa.
Saizvozvowo, tsanangudzo haifaniri kureva kuti zvinogamuchirwa kuchengetedza zvishoma pane zvakakwana zvekuderedza ropa. Kunyange "zvisingatariswi" mitoro yemavhu (kureva kuti, 50 -99 makopi / mL) inofanira kuva nehanya, uye zvidzidzo zvenguva pfupi zvichiratidza kuti basa rinoramba riripo, rekuvhara mavharasi pasi pemwedzi mitanhatu rinogona kuwedzera dambudziko rekukundikana kwe virologic mukati megore inenge 400%.
(Kusiyana neizvi, dzimwe nguva utachiona hwe "blips" kazhinji hausi kutarisa kusakundikana kwechirological.)
Kusagadzikana kwekushandisa zvinodhaka uye kuwanika kwezvinodhaka nhasi kunofungidzirwa kuti zvikonzero zviviri zvinoita kuti virologic isakundikana, kunyanya murapi yekutanga. Maererano nekutsvakurudza, avhareji yemunhu mumwechete muvarwere achaona kukundikana sechikonzero chekushaya zvakasimba, asi pakati pe4% uye 6% yevarwere vachakundikana nekuda kwekuwana mishonga yekurwisa.
Kana kusanyisa kunamatira kuri pamwoyo wekukundikana, zvakakosha kune vose chiremba uye murwere kuziva chero chinokonzera chikonzero. Muzviitiko zvakawanda, kushandiswa kwechirwere (semuenzaniso, kuderedza pill weight, dosing frequency) kunogona kubatsira kuderedza zvipingamupinyi zvinoshanda zvekuteerera. Nyaya dzepfungwa kana kushandisa zvinodhaka dzinofanira kutaridzirwa, nekutumira kunoitwa kuchipatara kana vatsigiri vatsigiri, kana zvichidiwa.
Kunyange kana kukanganisa kwe virologic kunonzwisiswa nenzira yekuongorora maitiro ekudzivirira , zvakakosha kugadzirisa chero hutano husati hwaita mberi usati uenderere mberi nehutano hutsva. Kunze kwekutevedza kwakataurirwa sechimwe chikamu chekugadzirisa kwehutachiona hweHIV, mukana wekudzokorora unopera uchava wakakwirira.
Kuchinja Kurapa Pashure pekukundikana kweVirologic
Kukundikana kwe virologic kunoreva kuti huwandu hwehutachiona mukati memurwere "hutachiwana hwekudzivirira" hunopesana nemumwe kana mishonga yemishonga yakawanda.
Kana zvichibvumirwa kukura, hutachiwana hunopesana huchavaka kusagadzikana pazvicharamba kusvikira zvinodhaka zvinodhaka zvinowanikwa.
Kana kusagadzirwa kwezvinodhaka kuchifungidzirwa uye mutachiona hwehutachiona huri pamusoro pemaminitsi 500 / mL, kuongorora maitiro ekudzivirira kunorudzirwa . Kuedzwa kunoitwa kana murwere achiri kutora regimen inokundikana kana mukati memavhiki mana ekuregererwa kwerapi. Izvi, pamwe nekudzokororwa kwemashoko ekurapa kwemurwere, zvichabatsira kutungamirira kusarudzwa kwerapi inofambira mberi.
Kana mushure mokunge mishonga isinganzwisisiki, zvakakosha kuchinja kurapwa nokukurumidza sezvinobvira kuitira kudzivirira zvimwe zvinodhaka zvinogadzirisa zvirwere kubva pakukura.
Zvakanaka, iyo regimen itsva ichange ine zvinyorwa zviviri, asi zvichida zvitatu, zvitsva zvinoshandiswa zvinodhaka. Kuwedzera mishonga imwe chete inoshandiswa haisi kukurudzirwa sezvo inogona kungowedzera kukura kwekusagadzikana kwezvinodhaka.
Kusarudzwa kwezvinodhaka kunofanira kunge kwakabva kune unyanzvi hwekuongorora huripo kuitira kuti uongorore kugona kushandiswa kwemishonga, kana kuziva kuti zvimwe mishonga inogona kunge yakaramba ichishanda pasinei nekusagadzikana .
Kutsvakurudza kwakaratidza kuti varwere vanowanzoita zviri nani kune zvinotevera kurapwa. Izvi zvingave zvichiitika nekuda kwekuti varwere vanowanzova neCD4 yakakura / huwandu hwehutachiona hwepamusoro pavanotanga kurapa mutsva, kana kuti chizvarwa chechizvarwa chitsva chiri nani pakurapa varwere vane kushorwa. Dzidzo dzakaratidza zvakare kuti varwere vakakundikana chirwere nekuda kwekushaya zvakasimba kumeso kunowedzera kugadzirisa maitiro ekurapa kwechipiri-line.
Zvisinei, zvakakosha kuziva kuti kupera kwerachiona kwakakwana hakugoni kuitika kune varwere vose, kunyanya avo vakambova nemishonga yakawanda pamusoro pemakore. Mumamiriro ezvinhu akadaro, kurapwa kunofanira kuramba kuchienderera mberi nechinangwa chokugadzirisa kudhakwa kwezvinodhaka uye kuchengetedzwa kweCD4 murwere.
Mune varwere vane ruzivo vane CD4 vanoverenga zvishoma pane 100 masero / mL uye zvisarudzo zvishomanana zvokurapa, kuwedzerwa kweimwe sarudzo kunogona kuderedza dambudziko rekukurumidza zvirwere zvishoma.
Immunologic Kukundikana
Tsanangudzo yekusagadzikana kwema immunologic yakawanda kwazvo, uye vamwe vanotsanangura iyo se
- kushaya kukwanisa kuwedzera CD4 yevarwere pane imwe nzvimbo (semuenzaniso, kupfuura 350 kana 500 masero / mL) pasinei nekuderedza hutachiwana, kana;
- kushaya kukwanisa kuwedzera CD4 murwere nechimwe chimwe pamusoro pehutachiona husati hwavapo pasinei nekuderedza utachiona.
Kunyange zvazvo dhiyabhorosi iri kuramba yakasiyana-siyana, dzimwe dzidzo dzakaratidza kuti chiyero chevarwere vane chirwere chisingaverengeki cheCD4 chichiverengwa pasinei nekuderedzwa kwehutachiona kunogona kunge yakakura se30%.
Dambudziko rekugadzirisa kukanganisa kwema immunologic nderokuti rinowanzobatanidzwa nechepasi rekare remutachiona CD4 count kana pasi "nadir" CD4 count (kureva, iyo yakaderera, yakawanda CD4 count pachiremba). Zvichinyatsojeka, kunyanya urwere hwemurwere hwesirwere hwakave hwakanyengedzwa musati hwarapa, zvakanyanya kuoma kudzorera iyo maitiro ezvirwere.
Ndicho chikonzero maitiro ehutachiona ehutachiona anokurudzira kutanga kutanga kwerapi apo maitiro epachiviriro achiri kushanda.
Kune rumwe rutivi, kusagadzikana kwema immunologic kunogona kuitika kunyange nepamusoro pokurapa ma CD4 maverengero. Izvi zvinogona kuva mugumisiro wekare kana hushanda hutachiona-hutachiona, kukwegura, kana kunyange zvakakonzerwa nekuputika kunoramba kuchikonzerwa neHIV pachako. Pane dzimwe nguva, hapana chikonzero chakajeka nei izvi zvichiitika.
Kunyanya kunetseka ndechokuti hapana kubvumirana kwechokwadi pamusoro pekurapa kusakwanisa kwekudzivirira muviri. Vamwe vashandi vanoratidzira kugadzirisa utachiona kana kuwedzera imwezve antiretroviral agent, kunyange pasina humwe uchapupu hwokuti izvi zvine maitiro chaiwo.
Zvisinei, kana kukanganiswa kwe immunologic kunozivikanwa, varwere vanofanira kuongororwa zvakazara maererano kana pane
- chero ipi zvayo inogadzirisa mishonga inogona kuderedza kuchena kwemasero eropa (kunyanya CD4 + T cells ), kuisa kana kuregedza madhiragi chero nguva zvichibvira, kana;
- chero hutachiona husina kutenderwa kana hutano hwakakomba hunogona kuve huchiita kuti pave nehutachiona hwehutachiona.
Mune mishonga yakawanda yekuchengetedzwa kwezvirwere iri kuongororwa, zvisinei kuti iye zvino haasi kuratidzirwa kunze kwemamiriro ekuongorora kwechiremba.
> Sources:
> Dhipatimendi reUnited Health of Health and Human Services (DHHS). "Kutungamira Kwechirwere-Mwoyo Murefu Ane Mwoyo Murefu: Virologic uye Immunologic Inokundikana." Rockville, Maryland; yakasvika musi waFebruary 21, 2014.
> Paredes, R .; Lalama, C .; Ribaudo, J .; et al. "Zvichiripo zviripo zvishomanana zvisingabatsiri zvinodhaka zvinokonzerwa neHIV-1, kuomerera, uye ngozi ye antiretroviral kurasika kukanganisa." Journal of Infectious Diseases . March 2010; 201 (5): 662-671.
> Laprise, C .; de Pokomandy, A .; Baril, J .; et al. "Kukundikana kwechirogiki mushure mekuramba kuripo pasi-viremia muboka revarwere vane HIV / HIV: migumisiro kubva pamakore gumi nemaviri ekucherechedza." Clinical Infectious Diseases. November 2013; 57 (10): 1489-96.
> Hammer, S .; Vaida, F .; Bennett, K ;; et al. "Dual vs single protease inhibitor therapy inotevera kushandiswa kwemishonga inorwisa maitiro ekurapa: chirongwa chisinganzwisisiki." Journal of the American Medical Association (JAMA) . July 10, 2002; 288 (2): 169-180.
> Gazzola, L .; Tincati, C .; Bellistri, G ;; et al. "Kushaikwa kweCD4 + T cell count recovery kupona pasinei nekuwana virologically suppressive zvikuru yakashandura antiretroviral therapy: keminiki yengozi, zvirwere zvekudzivirira muviri, uye nzira dzokurapa." Clinical Infectious Diseases. February 2009; 48 (3): 328-337.