Kuvhara muvarume vaviri pakudzivirira mapiritsi mukusimudzira kusava nehanya
Yaiva yakawanda yakaparidzwa musi waFebruary 25, 2016 kuti murume anotora chirwere chekudzivirira HIV, Truvada , akagamuchira chirwere ichi pasinei nekunyatsopindirana kune rimwe zuva zuva rega remishonga regimen. Nhau dzakakonzera kukanganisa kwakakura pakati pevamwe nezvekuti nzira yakakosha-inozivikanwa seHIV pre-exposure prophylaxis ( PrEP ) -chokwadi ndeyekuti vanhu vasina HIV havagari vasina hanya.
Mumushumo wavo, vatsvakurudzi veMaple Leaf Medical Clinic (MLMC) muCanada vakatsigira kuti murume ane makore 43 ane gayari akaedza kuva nehutachiwana hweHIV panguva yePrEP, uye kuti kuongororwa kwemabhuku maviri ezvemishonga uye zvirwere zverapa zvirwere ( yakashandiswa kuyera kuisirwa kwezvinodhaka muropa) yakabhadhara uchapupu kumunhu wepamusoro wekuteerera.
Kuwedzera kwekuenzanisa kwemafuro ekupedzisira kwakaratidza kuti murume uyu akawana "zvisingawanzo" kutapurirwa kweHIV , iyo yakanga isinganzwisisiki kune avo vaviri vanoshandisa zvinodhaka zvinosanganisira Truvada.
Saka mubvunzo unoramba uripo: ndechiitiko ichi se "zvisingawanzo" sevamwe mune zvemitereji vaudza here? Kana kuti chiitiko chacho, chaizvoizvo, chinoratidza kuti zvinogona kuitika here mune zvombo zvechirongwa ichi chekudzivirira HIV?
Chaicho-Kubudirira Kwepasi kwePPR
Mazhinji masangano eHIV nhasi achakukurudzira kuti PrEP, kana yakatorwa nenzira yakakodzera seTruvada tablet, inogona kuderedza ngozi yevanhu yekuwana HIV ne 90 muzana kana kupfuura.
Vachatarisawo vashandi, kunyanya avo vari pangozi yakanyanya , kuti mishonga haifaniri kushandiswa muga woga asi asi sechikamu chehurongwa hwekudzivirira hutachiona hweHIV (kusanganisira makondomu, kuvhara nhamba yevanhu vanoita zvepabonde, nezvimwewo)
Asi shoko iri rinowanzosvitsa vanhu kune nzira dzakasiyana zvakasiyana-siyana, nehuwandu hwemagariro evanhu uye zvinyorwa zvemashoko zvinowanzowedzera-hyping kana kutora uchapupu chaihwo.
Nhasi hazvishamisi kunzwa kuti PrEP i "99 muzana inoshanda" mukudzivirira HIV, kana kuti kuona tsvakurudzo inofungidzirwa kuitira kuti kuzivisa kuti PrEP "100% inoshanda" pakati pevanhu vane pangozi yevanhurume havashandise makondomu .
Uye kunyange zvazvo ichokwadi kuti vamwe vanoongorora pakati pevanhu vane hutachiona hwepamusoro-soro vakarovera vasina zvirwere pakati peavo vakanyatsoteerera kurapwa, mhando dzemigumisiro haisi kureva kushandura kumamiriro ezvinhu chaiwo enyika, apo vazhinji vanovhiringidza vanogona kuderedza zvakanyanya kushanda kwePPR munhu mumwechete.
Izvo zvizhinji zvezvivhiringidzi izvo zvinokonzera chiitiko cheCanada muchiedza.
Zvinokonzera Kuita Kubudirira Kwepurogiramu
Mukutsvakurudza kwavo, vatsvakurudzi veMLMC vakaratidza kuti murume weCanada akabatwa nehutachiwana hweHIV uyo ane antiretroviral therapy yake yakanga isingakwanisi. Mushure mokunge maitiro ekudzivirira kushandiswa kwemajini , chirwere chemudiwa wacho chakaratidzirwa kuti chinopesana nezvose tenofovir uye emtricitabine (iyo inoshandiswa nemishonga yeTruvada), zvichibudirira kubvisa kubatsirwa kwePPR.
Nepo dzimwe dzimba dzakatsigira kuti rudzi urwu rwemishonga yakawanda-mishonga haigoni-nehuwandu hwehuwandu hwepfumbamwe kubva kune imwechete-imwe tsvakurudzo inoratidzira zvishoma mufananidzo wakasiyana. Tinoziva, semuenzaniso, kuti kudzivirira kweTenofovir ikozvino kunomira kupi zvako kubva kune 20 muzana (muEurope) kusvika 57 muzana (muAfrica) pakati pevarwere vanoshaya kurapa, maererano neshoko ra2016 kubva kuTenoRes Study Group.
Mumamiriro ezvinhu akadai, kunyange kana emtricitabine chikamu chakaramba ichigoneka, kukwanisa kwayo kudzivirira utachiona huripo, panguva yakanakisisa, yakaderera kuregererwa. Iyi iga mibvunzo kana mamiriro ekutapukira muCanada nyaya yaive "zvisingawanzoitiki," achitaura nezvezvinetso zvinotarisana nenharaunda umo tenofovir kudzivirira mazinga inotsika.
Panguva iyi, zvimwe zvinopesana zvinogona kukanganisa kushanda kwePPR. Mukuru pakati pavo:
- Kukundikana kuzadzikisa nekuchengetedza mazinga akakwana eTruvada muropa. Kunyange zvazvo kusawirirana kwematare kunowanzokonzera kukanganisa uku, zvinowanzonziwo kuti varwere vanotanga PREP vanofanira kuve kurapwa kwemazuva anenge makumi matatu nemaviri vasati vasvika mishonga inogona kuonekwa seyakashanda. Kana kambani yekurapa zvinodhaka zvinowanikwa, dzimwe nguva kushaya maitiro kunowedzera kuderera-kunyanya mumadzimai ehurume.
- Kuparadzana mukubudirira kwePREP mune varume vanoita zvepabonde nevakadzi vanoita zvepabonde. Ikozvino panewo humwe uchapupu hunoratidza kuti PrEP inogona kunge isingabatsiri kuvakadzi uye kuti kunyange nekuzadza kwakakwana, kusinganzwisisiki, rubatsiro rwekudzivirira runogona kuwira zvakanaka pasi pe 90 percent threshold inowanikwa mune varume vanoita zvepabonde.
Mukuzara kwavo, izvi zvinoratidza zvinhu zviviri: kuti kubudirira kwePrEP mune dzimwe nzvimbo kuchave kwakadzika kudarika kune vamwe, uye kuti kudiwa kwemakondomu nezvimwe zvirongwa zvekudzivirira zvinoramba zvakakosha sezvazvakaitika kare.
PrEP uye Multiple Sex Partners
Nezvo zvichitaurirwa, kushanda kwePPR hakuratidzi kunyanzvi kuderedzwa nevakawanda vezviitiko zvepabonde zvinokonzerwa nehutachiona. Kunyange zvazvo kushandiswa kwekondomu kusinganzwisisiki uye vazhinji vanoita zvepabonde, semuenzaniso, vanozivikanwa kuwedzera mikana yeHIV, hazvirevi kutadzisa kubudirira kwePPR pane vanhu vane ngozi.
Zvechokwadi, pakati pevarume vevamwe varume vanoona kuti vari pakati pepamusoro-soro rematambudziko, kushandiswa kwePrEP kuchiri kusanganiswa nekufungidzirwa 86% kudzivirirwa kunobatsira pamusoro pevamwe vasingashandisi PrEP. Kubatsirwa kunowanikwa kuwedzera kune avo vanorwara nguva dzose, vanoshandisa kondomu nguva dzose, uye vanogadzirisa nhamba yavo yevanhu vanoita zvepabonde (kunyanya avo vane chimiro chisingazivikanwi kana kuti chirwere chekurapa).
Nezvo zvichitaura, PrEP haikwanise kuonekwa se "magic bullet" iyo neimwe nzira inokanganisa kubatsirwa kweimwe nzira dzokudzivirira, dzakadai semakondomu. MunaFebruary 2017, murume wechitatu akaedzwa zvakanaka panguva yePrEP. Muchiitiko ichi, zvisinei, vatsvakurudzi vanodavira kuti kutapurika kwakaitika munzvimbo huru nekuda kwe "nhamba yakakurumbira" yevakomana vaaibata naye.
Murume ane makore 50 wechiDutch aive mubatanidzwa mukuongorora kweEuropéan PrEP uye akaudza vanhu vanopfuura 90 zvepabonde uye vanopfuura 100 maitiro ekurara kwekondomu mushure mekutongwa kwevhiki 12. Paakanga ari paPrEP, murume wacho akaonekwa kaviri ane rectal gonorrhea uye kamwe ane rectal chlamydia.
Kunyange zvazvo kunyanya kwechiitiko chacho kwakange kwaita kuti vatende kuti ichi chiitiko chimwe chete, vamwe havana chokwadi zvakadaro. Mukuedza kuongorora hutachiona hwemunhu uyu, vakawana kuti pakanga pasina hutachiona hwehutachiona hwehupi hwemhando ipi zvayo uye izvi hutachiona hunofungidzirwa seinoti "mhuka dzomusango."
Zvinorevei izvi, izvo zvakapiwa zvinyorwa zvake zvekuteerera, zvinodhaka zvinofanira kunge zvakadaro zvakapiwa kuchengetedza kunze kwekuti zvimwe zvikonzero zvichitungamirira utachiona. Kana zvakadaro, izvozvi-zvisingazivikanwi zvinogona kuisa vamwe pangozi. Kusvikira vatsvakurudzi vanoziva zvakawanda, maitiro ehutano akachengeteka anofanira kuchengetwa kana chete kupa humwe hutete hwekudzivirirwa.
Sources:
> Hoornenborg, E. uye de Bree, J. "Kurwara kwakanyanya Nechirwere Chetachiona cheHIV-1 muPrEP User NeHigh TDF Levels." Musangano weRevroviruses uye Zvirwere Zvichida; Seattle, Washington; February 13-16, 2017; abstract 953.
> Molina, J .; Capitant, C ;; Spire, B ;; et al. "On-Demand Preexposure Prophylaxis muVarume Vari Pangozi yeHIV-1 Infection." New England Journal of Medicine. December 1, 2015; rakabudiswa paIndaneti mberi kwekudhindwa; DOI: 10.1056 / NEJMoa1506373.
> POZ Magazine. "PrEP Inokundikana muGay Man Kuenderana Nezuva nezuva Truvada, Anobata Dhirairi-Kurwisa HIV." February 25, 2016.
> TenoRes Study Group. "Global epidemiology yekushungurudzwa kwezvinodhaka mushure mekukundikana kweWIV kwakaronga mitambo yekutanga yehutachiona hweHIV-1: unyanzvi hwekudzivirira hutachiwana hwekudzidzisa." Lancet Infectious Diseases. Musi waJanuary 28, 2016; yakabudiswa paIndaneti; DOI: 10.1016 / S1473-3099 (15) 00536-8.
> UK PROUD Trial Steering Committee. "KUCHENYANYA kuongorora kwenguva refu kunowanzoona kuti pre-exposure prophylaxis (PrEP) inodzivirirwa zvikuru neHIV kune varume vanoita zvepabonde nevamwe varume vanoita zvepabonde nevarume muUK." London, England; gwaro rehurukuro rakabudiswa musi waOctober 16, 2014.