Kodi mankhwala osokoneza bongo atsopano amatha kusintha malamulo okhudzana ndi kulandira HIV?
Kugwiritsa ntchito mankhwala osokoneza bongo kumakhala chinthu chofunikira kwambiri kuti athe kuchiza ndi kuthana ndi kachirombo ka HIV. Mosiyana ndi mankhwala osachiritsika omwe amagwiritsidwa ntchito pochiza matenda monga matenda a mtima kapena shuga-zomwe zimafuna kuti 70% azikwaniritsa zolinga zachipatala- antiretroviral therapy (kapena ART) imafuna kuti munthu asamalimbikitse kuti asamangokhala ndi matenda osokoneza bongo. kukana .
Koma popeza kuti tsopano tili ndi kachilombo ka HIV kamene kamakhalako bwino , kodi malamulowa ndi ofanana?
Zotsatira 95% za Mantra
Malangizo a chithandizo cha kachilombo ka HIV amachititsa kuti odwala azikhala oposa 95% kuti athetse vutoli. Kwa nthawi imodzi ya mankhwala osokoneza bongo, omwe amamasulira pafupifupi masiku 14 a nthawi zina, omwe amalephera kuyeza pa chaka.
Komabe, ena ayamba kunena kuti "95% ya mantra" imachokera ku deta yomwe inasonkhanitsidwa kumapeto kwa zaka za m'ma 1990, pamene mankhwala osokoneza bongo anali ovuta komanso mankhwala osokoneza bongo anali afupi kwambiri. Ngakhale pali ochepa amene angalengeze 85% kapena 90% kuti akhale "yatsopano," ambiri amakhulupirira kuti kufunika kodula kapena kusokoneza odwala chifukwa chokhala opanda ungwiro kulibe malo oyenera monga momwe zinaliri zaka khumi zapitazo.
Komabe, alipo ambiri amene amakhulupirira kuti kuchepetsa malo okhomerera (kapena kutanthauza kusintha) ndi kulakwitsa, kuti pakhale njira zowonjezera zomwe zingangowonjezera nthawi.
Pali umboni wotsimikizira mfundoyi. Malingana ndi deta yokonzedwanso ndi US Centers for Disease Control and Prevention (CDC), pafupifupi Amereka Achimereka 30 pa ART sangathe kulandira ma ARV. Ambiri amavomereza kuti kumamatira mwachidwi kumathandiza kwambiri pa izi, pamene maphunziro ena amasonyeza kuti kumatira kumakhala kochepa pambuyo pa mwezi woyamba wa "chisangalalo" pambuyo pa kukhazikitsidwa kwa ART.
Komabe, pali umboni wokwanira wothandizira kuti mbadwo watsopano wa mankhwalawa ndi "kukhululukirana" makamaka ngati kulimbana ndi vutoli, makamaka "mankhwala opititsa patsogolo" omwe amatha kukhala ndi vuto lalikulu la mankhwala a plasma kwa nthawi yaitali.
Koma kodi umboni uli wokwanira kuti ufunse kusangalala ndi zizoloŵezi zowamatira? Ngakhalenso ndi mankhwala abwino kwambiri othandizira tizilombo toyambitsa matenda, kodi tilidi panthawi imeneyi?
Kufufuza Umboni
Protease inhibitors (PIs) ndi chitsanzo chabwino cha kupita patsogolo kwa ART zamakono. Masiku ano, mapulogalamu apakati ali pafupifupi "akulimbikitsidwa" konse- akuyesa kuti amagwiritsidwa ntchito limodzi ndi mankhwala ena achiwiri omwe angathe kuwonjezera mphamvu ya seramu ya PI. Kafukufuku wamakono akulu asanu akusonyeza kuti mbadwo watsopano umalimbitsa PIs-monga Prezista (darunavir) -mangoyenera, motero, ndikutenga 81% kuti athandizidwe.
Mosiyana ndi zimenezi, okalamba owonjezereka monga Kaletra (lopinavir + ritonavir) amawonetsedwa kuti sagwira ntchito pokhapokha ngati mankhwalawa amachepera pansi pa 95%, ndipo kafukufuku wina amasonyeza kuti odwala 53 peresenti okha ndi omwe amatha kupeza zovuta zowoneka mosavuta pamtundu uwu wotsamira.
Kafufuzidwe sichidziwika bwino za zotsatira zotsatila magulu ena a antiretroviral. Ngakhale kuti kafukufuku wina wasonyeza kuti mankhwala osagwirizana ndi nucleoside reverse transcriptase inhibitors (NNRTI) monga Sustiva (efavirenz) angafunike 80% mpaka 90% pokhapokha ngati agwiritsidwa ntchito palimodzi ndi PI yowonjezereka, ena amanena kuti kumakhala kofunika kwambiri chifukwa kuti mwina angathe kukana ndi kusamvana kwa mankhwala ena a NNRTI.
Mofananamo, Pulogalamu Yoyamba Phunziro la CPCRA inapeza kuti mankhwala osokoneza bongo a nucleoside reverse transcriptase inhibitor (NRTI) monga retrovir (AZT, zidovudine) akuwonjezereka mwachindunji ndi kuchepa kwa kumatira mankhwala.
Pakalipano pali zochepa zofufuza zomwe zimawoneka kuti ziwone mgwirizano pakati pa kugwirana ndi mankhwala atsopano monga Intelence (etravirine) kapena ngakhale analogue ya nucleotide, Viread (tenofovir). Mofananamo, a integrase inhibitors omwe amavomereza kugwiritsa ntchito, kuphunzira kokha kochepa kokha ka Isentress (raltegravir) kumasonyeza kuti kuwonjezeka kwa 90% kungakhale kovomerezeka.
Kodi Muyenera Kusamala Chinthu Chimodzi (Kapena Zambiri)?
Kupanda mlingo wamba kapena kulephera kutenga mlingo pa nthawi ndi chinthu chomwe chimachitika kwa onse omwe akudwala mankhwala osapitirira malire.
Kawirikawiri, izi siziyenera kudetsa nkhawa kwambiri. Komabe, kuchepa kwafupipafupi kapena mobwerezabwereza kumachitika, osachepera kwambiri mankhwalawa amakhalabe osatetezeka.
Kafukufuku wina wopangidwa ndi National Institute of Infectious Diseases ku Rome anasonyeza kuti mipata ya mankhwala masiku awiri okha m'kati mwa mwezi inachititsa kuti kuwonjezereka kwachisanu kuwonjezeka kwa zochitika zowononga tizilombo. Kuwongolera kafukufuku mu 2013 kwasonyeza kuti ngakhale atasungidwa, "zowonongeka" zokhudzana ndi mavairasi (pakati pa 50 ndi 199 makope / mL) zingabweretse chiopsezo chachikulu cha 400% cha kulephera kwa virologic.
Mofananamo, kufufuza kuchokera ku chipatala cha Cote de Nacre ku University of France kuwonetsa kuti mipata yambiri pa ART inachititsa kuti chithandizo cha mankhwala chisamayende bwino , ndi kutsekedwa kwa masiku khumi ndi zisanu ndi makumi asanu ndi limodzi (50%).
Mofananamo, Kuvomereza ndi Kuchita Zoyesera za Protease Inhibitor Therapy (AEPIT) zinaphunzira zotsatira za zolakwika za nthawi yachithandizo pa ntchito ya tizilombo. Malinga ndi kafukufuku, odwala omwe analola maola atatu mbali iliyonse ya nthawi yawo ya dosing nthawi anali ndi 300% zazikulu zedi ma ARV kuposa awo amene adatenga mankhwala awo pa nthawi.
Choncho Kodi Zimenezi Zikutanthauza Chiyani kwa Ine?
Palibe kukayikira kuti mbadwo watsopano wamagetsi ndi osavuta kugwiritsa ntchito ndi kulekerera, kupereka "chikhululukiro" chachikulu ngati wodwala akuphonya mlingo wosadziwika. Ndipo pamene tikuyenda mofulumira ku mankhwala osokoneza bongo omwe amafuna kuti tipeze kuchepetsa kawirikawiri, makhothi adakalipobe ngati izi zikuwonetseratu kusintha kwakukulu pamalangizo othandizira.
Pamapeto pake, ART imayambira pamagulu a antiretroviral, omwe ali ndi miyoyo yambiri ndi pharmacokinetics. Zina mwa ma regimens ali ndi mitsinje yaying'ono ya zolakwika; ena akuluakulu. Kuchokera pamwambo weniweni, zingakhale zopanda phindu kusintha chikhomo chotsatira ndi mankhwala onse.
M'malo mwake, nkhani zogwirizanitsa ziyenera kukumana ndi kulekerera kwakukulu kuchokera kwa ochiza ndi zosowa zochepa kuchokera kwa odwala omwe akuwvomera kuvomereza zofooka zawo. Ngati chili chonse, chimafuna kuyankhulana ndi oleza mtima kwambiri, ndi zolinga zenizeni ndi njira zowonjezera kuti zitsimikizidwe bwino, zenizeni pamoyo. Izi ziphatikizapo:
- Kuwonetsetsa mwatsatanetsatane zolepheretsa kumatira kutsogolo kwa ART (mwachitsanzo, nthawi ya ntchito, ana, kufotokoza, kudzipatula, ndi zina zotero)
- Kupita patsogolo ndikuyang'anizana kuti athetse mavuto aliwonse atsopano kapena omwe alipo (kuphatikizapo zotsatira za mankhwala, mavuto a m'banja, nkhani zamaganizo, ndi zina zotero)
- Kuphweka kwa dongosolo la mankhwala, kumene kumasonyezedwa
- Kutchula zinthu zosinthika zokhudzana ndi kusamalidwa bwino (mwachitsanzo, kumwa mowa mopitirira muyeso, kupanikizika, kusowa pokhala, ndi zina zotero)
- Kugwiritsa ntchito zipangizo zamakono (mwachitsanzo, opanga mankhwala, zida zamakono) kapena zothandizira zothandizira.
Mwachidule, zimapindulitsa kwambiri kuti musamalumikize mochuluka kwambiri ponena kuti " Ndikwanira bwanji ?," koma monga njira yodziwiritsira ntchito zida zothandizira kuti ART ikhale yogwira ntchito, gawo lopanda masautso tsiku ndi tsiku. .
Ngati izi zingatheke, ndiye kuti funso la "kuchuluka" lingagwe bwanji kwathunthu.
Zotsatira:
Kobin, A. ndi Sheth, N. "Miyezo ya Kuyenera Kuyenera Kuthetsa Kugonana kwachiwawa pakati pa mankhwala atsopano ochepetsa ma ARV." The Annals of Pharmacology. 2011; 45 (3): 372-379.
Martin, M .; Del Cacho, E .; Codina, C .; et al. "Kugwirizana Pakati pa Kugwirizana Kwambiri, Mtundu wa Antiretroviral Regimen, ndi Plasma HIV Type 1 RNA Viral Load: A Prospective Cohort Phunziro." AIDS Research Retroviruses Anthu. October 2008; 24 (10): 1263-1268.
Mena, A .; Blanco, F .; Cordoba, M; et al. "Phunziro Loyendetsa Bwino Kuyeza Raltegravir QD Potsutsana ndi BID mu HIV Odwala Akuphatikizidwa mu Mayeso Osavuta." Yofotokozedwa pa 49th Interscience Conference on Antitimicrobial Agents ndi Chemotherapy (ICAAC). San Francisco, California; September 12-15, 2009.
Laprise, C .; de Pokomandy, A .; Baril, J ;; et al. "Kulephera kwa Virologic Kulimbana ndi Viremia Yopitirira Momwe Alili M'gulu la Odwala Kachilombo ka HIV: Zotsatira Zaka Zaka 12 Zomwe Akuziwona." Matenda opatsirana pogonana. November 2013; 57 (10): 1489-96.
Ammassari, A .; Trotta, M ;; Zaccarelli, M .; et al. "Mmene Zimakhudzira Mitundu Yambiri Yogwirizana ndi KODI Zizindikiro za Plasma HIV-1 RNA Chidziwitso Pansi pa Malire Ochepa Othandizira pa Zowona Zenizeni." Yofotokozedwa ku Msonkhano wa 12 wa Edzi wa Edzi. Cologne, Germany; November 11-14, 2009.