Mankhwala Osokoneza Bongo Osati Kokha Mlandu wa Kusintha kwa Mafuta
Lipodystrophy , nthawi zina kubwezeretsa kwa thupi kwa mafuta a thupi, kwa nthawi yaitali kunayamba kuonedwa kuti ndi mbali yowonjezera yogwirizanitsidwa ndi mankhwala owonjezera antiretroviral , makamaka akale omwe ali ngati Zerit (stavudine) ndi Retrovir (AZT), omwe ali m'gulu la mankhwala otchedwa nucleoside reverse transcriptase inhibitors .
Zaka zaposachedwapa, ena azinthu akhala akuwonjezeka ku mndandanda wa anthu omwe angakayikire, kuphatikizapo Sustiva (efavirenz), Isentress (raltegravir), ndi kalasi ya mankhwala omwe amatchedwa kachilombo ka HIV omwe amatchedwa protease inhibitors .
Pomwe zikunenedwa, chifukwa chenicheni cha lipodystrophy -chimachititsa kuti mafuta asungunuke (lipohypertrophy) kapena kutayika kwa mafuta (lipoatrophy) -kusazindikira kwenikweni. Umboni wochulukirapo wanena kuti kachirombo ka HIV, komanso kutupa kosalekeza komwe kumakhudzana ndi matenda , kungakhale othandizira kwambiri, ngakhale kuti posachedwapa pakhala pali deta yochepa yotsimikizira izi.
Phunziro la 2015 lomwe linaperekedwa pa Msonkhano wa Retroviruses ndi Matenda Oponderezedwa ku Seattle anathandiza ena kumvetsetsa nkhaniyo. Malingana ndi kafukufuku, anthu omwe ali ndi mavairasi akuluakulu kumayambiriro kwa mankhwala (makope oposa 100,000 / mL) amawoneka kuti ali ndi chidziwitso chochulukirapo cha lipodystrophy kusiyana ndi omwe ali ndi tizilombo toyambitsa matenda.
Mapangidwe Ophunzirira ndi Zotsatira
Phunziro la masabata 96, lochitidwa ndi ofufuza ku University of Case Western Reserve ku Ohio, adalandira 328 odwala kachilombo ka HIV omwe alibe chithandizo chamankhwala. M'badwo wapakati unali zaka 36; 90% anali amuna.
Aliyense wa iwo adayikidwa chimodzi mwa mitundu itatu ya mankhwala osokoneza bongo, yomwe inali ndi nsana ya Truvada (tenofovir + emtricitabine).
- Reyataz (atazanavir) + Norvir (ritonavir),
- Prezista (darunavir) + Norvir (ritonavir), kapena
- Isentress (raltegravir).
Pakati pa phunzirolo, odwala anapatsidwa CAT ndi DEXA (mphamvu zamadzimadzi X-ray absorptiometry) amayesa kuyeza kusintha kwa thupi.
Ngakhale adakayikira kuti mankhwala ochepetsa kachilombo ka HIV amatha kusintha zotsatira zosiyanasiyana kwa odwala, asayansi anadabwa kuona kuti mafuta owonjezeka a thupi anali ofanana ndi magulu onse. Pang'ono ndi pang'ono, thupi lawonjezeka ndi 3% mpaka 3.5%, pamene mafuta amphamvu akuwonjezeka ndi 11% mpaka 20% ndipo mafuta amimba amakula ndi 16% mpaka 29%.
Kusiyana kokha koyezera komwe iwo angapeze kunali muzitsulo za odwala. Kwa iwo omwe ali ndi mavairasi akuluakulu, mafuta operekera (mwachitsanzo, m'mimba mwa m'mimba) anawonjezeka ndi pafupifupi 35% mosasamala za mankhwala osokoneza bongo kapena mankhwala. Mosiyana ndi zimenezi, odwala omwe ali ndi mavitamini oposa 100,000 / mL anali ndi 14 peresenti yokha ndi Isentress ndipo osachepera 10% ndi protease inhibitors.
Kuwonjezera apo, imatuluka mu Interleukin-6 (IL-6), chizindikiro cha kutsegulira mthupi, kunkaphatikizidwa ndi kuwonjezeka kwa mafuta am'thupi (mwachitsanzo, mafuta nthawi yomweyo pansi pa khungu). Izi zikusonyeza kuti kutupa kwa kugonana kwa HIV kumakhudza mwachindunji kupindula kwamtengo wapatali, kaya ndi mgwirizano wodziteteza kapena wodzisamalira.
Mosasamala kanthu zomwe zimayambitsa kapena zowonjezera, mafuta operekera a 30% pa zaka ziwiri ndi ovuta, atanyamula ndi chiopsezo chachikulu cha matenda a mtima , matenda a shuga , ndi matenda odwala matenda a dyslipidemia .
Zomwe anapezazi zingapereke umboni wochuluka wokhudzana ndi chithandizo cha kuchipatala , musanayambe kuchuluka kwa tizilombo kapena ma CD4 atha.
Zotsatira:
McComsey, G ;; Moser, C ;; Ribaudo, H ;; et al. "Kusintha kwa Thupi Pambuyo Kuyambitsa Raltegravir kapena Protease Inhibitors." Msonkhano wa Retroviruses ndi Matenda Opondereza (CROI); Seattle, Washington; February 23-26, 2015; chosamveka 140.
Virolet, C .: Delhumeau-Cartier, C ;; Sartori, M .; et al. "Lipodystrophy pakati pa odwala kachilombo ka HIV: kufufuza magawo osiyanasiyana pa zomwe zimakhudza moyo ndi matenda a maganizo." AIDS Research and Therapy. 2015; 12-21: DOI 10.1186 / s12981-051-0061-z.