Thanzi Labwino, Kutsika Kwambiri Kwambiri Pakati Phindu
Pa September 30, 2015, bungwe la World Health Organization (WHO) linakonza ndondomeko yake yothandizira anthu omwe ali ndi kachilombo koyambitsa matenda a Edzi poyambitsa kulandira mankhwala opatsirana pogonana.
Mpaka posachedwa, pakhala pali mkangano pakati pa opanga ndondomeko ndi ofufuza za momwe ART iyenera kuyambitsidwira mwamsanga kapena kuchedwa kufikira nthawi yomwe chitetezo cha wodwala chikugwera pansi pa chiwerengero china cha chiwerengero (ngati chiwerengero cha CD4 ).
Othandizira omwe ali ndi kachilombo ka HIV adalongosola deta yomwe inasonyeza kuti kuchepetsa nthawi yayitali kunachepetsanso kuwonongeka kwa nthawi yaitali. HIV ikhoza kuyambitsa chitetezo cha mthupi cha munthu-kuwonongeka komwe kungawononge kowopsa kwa matenda a nthawi yaitali. Otsutsa anachenjeza kuti panalibe umboni wosonyeza ngati kachilombo ka ART koyambirira kamene kanakonzedweratu (CD4 chiwerengero cha pansi pa maselo 500 / ml) chinali ndi phindu lenileni pa matenda kapena nthawi ya wodwalayo.
Kusintha kwa ndondomeko ya WHO kudzawonjezereka chiwerengero cha anthu omwe akufuna ART, kuyambira 15 miliyoni kupita kudziko lonse la anthu 37 miliyoni.
KUYAMBIRA Phunziro Kusintha Dziko Lonse la HIV
Pa May 27, 2015, asayansi ku National Institute of Allergies and Infectious Disease (NIAID) potsirizira pake anaika mpikisano wautali kuti apumitse mwa kuthetsa Makhalidwe Othandiza Odwala Matenda a Kachilombo ka HIV (START). umboni wakuti mankhwala ochiza matenda, mosasamala za CD4 count, adathandiza kwambiri odwala omwe ali ndi HIV.
Kuphunzira, komwe kunalembetsa amuna ndi akazi okwana 4,685 omwe ali ndi kachilombo ka HIV kwa zaka 18 kapena kupitirira, kunayenera kuthetsa kumapeto kwa 2016 koma kunatha nthawi isanakwane pamene zotsatira zapakatipakati zikuwonetsa kuchepa kwa 53% pa chiwerengero cha matenda aakulu pakati pawo omwe anachitidwa mofulumira kutsutsana ndi awo omwe ali ndi nthawi yochedwa ART.
Zopeza zinali zosagwirizana popyolera zida zophunzira, kaya odwala anali ochokera kumayiko apamwamba, apansi kapena apakati.
Poyankha, asayansi ndi omwe amapanga ndondomeko ya malamulo adatulutsa chigamulo cha boma pa July 19, 2015, adatchedwa Vancouver Consensus, yomwe idapempha kuti athandize anthu onse omwe ali ndi kachilombo ka ART. Pogwiritsa ntchito mawuwa, gululi linalongosola zifukwa zomwe ART imagwiritsira ntchito matenda opatsirana pogwiritsa ntchito kachilombo ka HIV.
Kuchedwa Kwambiri Kumachepetsa Mphamvu ya Kutupa Kwa Nthawi Zakale
Pambuyo pa kuyesedwa kwa START, ochita kafukufuku ambiri anali osamala pochiza kachilombo ka HIV kuti adziwe ngati chiwerengero cha kufa kwa odwala omwe anayambitsa ART pamwamba pa CD4 za maselo 350 / mL anali ndi moyo womwewo monga anthu ambiri. Chifukwa, adatsutsa kuti, kodi tiyenera kuika pangozi zovuta zosayembekezereka pamene tiyambira pa ma CD4 apamwamba sitingapindulepo phindu lazowonjezera moyo?
Pachifukwa cha imfa zokha, izo zingawoneke ngati zifukwa zabwino. Malingana ndi matenda enieni, komabe zoona zimayankhula mosiyana.
Pakati pa matenda alionse, thupi lidzayankhidwa ndi kutupa pamaso pa munthu wothandizira ngati HIV. Ngati simunalandidwe, kupitirizabe, kutupa kosalekeza kungayambitse kuwonongeka kwa maselo ndi matupi a thupi.
Chifukwa chakuti matenda a HIV ndi matenda aakulu, ngakhale kutupa kosalekeza, komwe kumakhala kochepa kwambiri kungayambitse maselo, omwe amadziwika kuti senescence msanga kapena "kutupa" -ndipo nkhani zapamwamba za matenda a mtima ndi khansa kwa anthu omwe ali ndi kachilombo ka HIV, Zaka 15 m'mbuyo mwake kusiyana ndi anthu omwe sali odwala.
Ngakhale anthu omwe ali ndi kachilombo koyambitsa matenda a HIV omwe amadziwika kuti "olamulira akuluakulu" -kutheka kwa kutupa kosatha kumabweretsa zotsatira zosauka kwambiri komanso kuchuluka kwa matenda poyerekeza ndi anthu omwe ali ndi kachilombo ka HIV omwe ali ndi kachilombo ka HIV .
Mwachidule, mwaika munthu pa ART pamayambiriro a matenda , mumamupulumutsa munthu wosafunika chifukwa cha kutupa komwe kumakhudzana ndi matenda osatulutsidwa.
Kutaya kokha kumalola kutupa kupitiriza, kusasunthika, kulikonse pakati pa zaka 5-10.
Mankhwala atsopano Amapereka Chithandizo Chochepa Kwambiri, Kukanizidwa Kwambiri
Zambiri mwazinthu zomwe zimakhudzana ndi mankhwala osokoneza bongo nthawi yayitali zinakhazikitsidwa pa zochitika zomwe zinayambitsidwa ndi ma antiretroviral am'mbuyomu, kumene kufalikira kwa ntchito nthawi zambiri kunachititsa kuti wodwalayo asokonezedwe mosayembekezereka.
Mankhwala monga stavudine, amawonedwa kuti amachititsa kuti anthu ambiri azitha kumwa mankhwala osokoneza bongo kwa odwala, kuchokera ku lipodystophy (kubwezeretsa kwabwino kwa mafuta a thupi) ku matenda a ubongo (kuwonongeka kwa maselo a mitsempha) kwa lactic acidosis (yomwe ingakhale yopseza moyo kumanga lactic asidi).
Mofananamo, ambiri mwa ma antiretroviral oyambirira anali ndi mauthenga osagwirizana ndi mankhwala osokoneza bongo. Kugwiritsa ntchito nevirapine mu monotherapy, mwachitsanzo-kachitidwe kanthaŵi kochepa mu 2002 kuti athetse kutengako kwa amayi kupita kwa mwana-omwe amatha kuthamanga kwa nevirapine, nthawi zina pambuyo pa mlingo umodzi.
Izi zikudetsa nkhawa kwambiri ndi mankhwala osokoneza bongo atsopano, omwe samangopereka mauthenga ochepa omwe amakhala pambali pang'onopang'ono koma zochepa zowonjezera mapiritsi ndi "chikhululuko" chachikulu (mwachitsanzo, kuthekera kwa kusunga mankhwala osokoneza bongo ngakhale ngati mankhwala akusowa).
Kuwonjezera pamenepo, mantha okhudzana ndi mankhwala osokoneza bongo -kupitirira kwa munthu mmodzi kupita kutsogolo-akhala akuchotsedwa, ndipo deta yamakono kuchokera ku World Health Organization ikuwongolera kuchuluka kwa chiwerengero cha anthu oposa 7% m'mayiko otsika mpaka ochepa ( pafupifupi theka limene linawonetsedwa ku US ndi Europe).
M'mayiko omwe amapeza ndalama zambiri, kusagwiritsidwa ntchito kwa mankhwala osokoneza bongo nthawi zambiri kumagwirizana ndi mankhwala obadwa kale omwe amapezeka kwa anthu 10-15 m'mbuyomu kuposa m'mayiko ambiri omwe akutukuka.
Kafukufuku wofananawo wasonyeza kuti chiwopsezo cha kachilombo ka HIV m'mayiko osauka , komwe amadziwika kuti akuchitika, ndi otsika kwambiri, makamaka chifukwa chakuti anthu ochepa sanaperekedwe kuchipatala poyerekezera ndi US ndi Europe.
Kuchiza pa Kuzindikira Kukhoza Kuchepetsa Kufalikira kwa HIV
Kuchiza monga Kuteteza (TasP) ndi njira yothandizira kuchepetsa zomwe zimatchedwa "chiwerengero cha tizilombo" poyika gulu la anthu pa ART. Pochita zimenezi, mwayi wopatsirana kachilombo ka HIV umachepetsedwa kwambiri pamene anthu ambiri angathe kuthetsa ntchito yowonjezera .
Njirayi ikugwiridwa ndi umboni wochokera ku San Francisco, mzinda womwe unapeza kuponyera kwa 30-33% mwa matenda opatsirana pogonana kuyambira 2006-2008 chifukwa cha kufalikira kwa ma antiretroviral. Malingana ndi zotsatirazi, akuluakulu a mumzindawu adayambitsa ndondomeko ya ART yomwe idaperekedwa kumayambiriro kwa chaka cha 2010.
Mofananamo, phunziro la 2015 kuchokera ku chigawo cha Henan ku China linawonetsa kuti chiopsezo chotenga kachilombo ka HIV m'modzi (mwachitsanzo, yemwe ali ndi HIV ndi wina yemwe alibe kachilombo ka HIV) chinachepetsedwa ndi 67% kuyambira 2006-2009 pomwe pafupifupi 80% Omwe ali ndi kachilombo ka HIV adayikidwa pa ART.
Potsata ndondomeko yapadziko lonse ya ART yomwe ikudziwika, akuluakulu a zaumoyo amakhulupirira kuti phindu lofananalo lingapangidwe ngakhale m'madera ambiri monga South Africa, kumene matenda atsopano amapitirira kukula ngakhale kuti akuwonjezeka kuwonjezera pa ART.
Kaya maboma apadziko lonse angakwanitse kukwaniritsa zolinga zomwe amapatsidwa ndalama zowonjezera kuchokera ku mayiko olemera a G8 ndi nkhani ina yonse. Ndili ndi anthu oposa 35 miliyoni omwe ali ndi kachilombo ka HIV lero-komanso pafupi 13 miliyoni pa ART - vuto lalikulu likhoza kukulitsa chithandizo m'maiko kumene zipatala nthawi zambiri sizikudziwika bwino.
Zotsatira:
National Institutes of Health (NIH). "Kuyambitsa Matenda a Antiretroviral Kumayambiriro Kumayambitsa Zotsatira za Anthu Okhudzidwa ndi HIV." Bethesda, Maryland; inatulutsidwa pa May 27, 2015.
Hasse, B ,; Ledergerber, B ;; Egger, M., ndi al. "Kukalamba ndi (Osagwirizana ndi kachilombo ka HIV) Kugwirizanitsa anthu omwe ali ndi kachilombo ka HIV: Phunziro la a Swiss Cohort (SHCS)." Msonkhano wa 18 pa ma retroviruses ndi matenda opatsirana (CROI). Boston, Massachusetts; February 27-March 2, 2011; 792.
Pantazis, N .; Porter, K .; Costagliola, D .; et al. "Zochitika Zakale Zowonetsera Prognostic za HIV-1 Chiwopsezo ndi Kutumiza: Phunziro la Ophunzira Padziko Lonse." Lancet HIV. December 2015; 1 (3): e119-126.
Smith, K .; Westreich, D .; Liu, H ;; et al. "Kuchiza Kuchepetsa Kutsekula kwa HIV M'banja la Serodiscordant ku Henan, China, 2006 mpaka 2012." Matenda opatsirana pogonana. March 13, 2015; pii: civ200. [Epub patsogolo pa kusindikiza].
Human Sciences Resource Council (HSRC). "Kuchuluka kwa HIV / AIDS , Kuchuluka kwa Anthu ndi Kuchita Kanthu, 2012." Pretoria, South Africa; adatulutsidwa pa December 1, 2012.