Kugonjetsedwa pakati pa amuna awiri pa mapiritsi opewa kutulutsa nkhawa
Pa February 25, 2016, anthu ambiri adanena kuti munthu amene ali ndi kachilombo koyambitsa kachilombo ka HIV, Truvada , adatenga kachilombo ka HIV ngakhale kuti akutsatira ndondomeko ya mankhwala osokoneza bongo. Nkhaniyi inachititsa kuti anthu ambiri azidandaula kuti njirayi, yomwe imatchedwa HIV pre-exposure prophylaxis ( PrEP ), makamaka ikuonetsetsa kuti anthu omwe alibe kachilombo ka HIV amakhalabe osatetezeka.
Mu lipoti lawo, ofufuza a Maple Leaf Medical Clinic (MLMC) ku Canada adatsimikizira kuti munthu wina wazaka 43 wamwamuna yemwe ali ndi chiwerewere anayezetsa kachilombo ka HIV panthawi ya PrEP, komanso kuti kafukufuku wa ma pharmacy ndi mayendedwe a mankhwala ochiritsa odwala ( kugwiritsidwa ntchito poyeza ndondomeko ya mankhwala mu magazi).
Kuyesedwa kwa mitundu ina kunatsimikizira kuti mwamunayo adapeza matenda omwe sakhala nawo "omwe sapezeka" omwe ali ndi kachilombo koyambitsa matenda a Edzi , omwe sanagwirizane ndi anthu awiri omwe amagwiritsa ntchito mankhwala omwe amapanga Truvada.
Kotero funso likutsalira: kodi nkhaniyi ndi "yosavuta" monga ena mwawailesi amavomerezera? Kapena kodi chochitikacho, chikusonyeza kuti zingatheke kuti zikhale zankhondo zowononga kachilombo ka HIV?
Zochitika Zenizeni za World PrEP
Mabungwe ambiri omwe ali ndi kachilombo ka HIV lero adzakukulangizani kuti PrEP, ngati itengedwa molondola ngati pulogalamu ya tsiku ndi tsiku ya Truvada, ikhoza kuchepetsa chiopsezo cha munthu kutenga HIV ndi 90 peresenti kapena kuposerapo.
Adzachenjezanso ogwiritsa ntchito, makamaka omwe ali pachiopsezo chachikulu , kuti mankhwalawa sayenera kugwiritsidwa ntchito padera koma monga mbali ya pulogalamu yowononga kachirombo ka HIV (kuphatikizapo makondomu, kuchepetsa chiwerengero cha anthu ogonana, etc.)
Koma uthengawu nthawi zambiri umasewera anthu posiyana kwambiri, ndi mafilimu ndi zofalitsa zamabuku kawirikawiri zowonongeka kapena kusokoneza umboni weniweniwo.
Masiku ano zimakhala zachilendo kumva kuti PrEP ndi "99 peresenti yogwira ntchito" popewera HIV, kapena pakufufuza kafukufuku kuti atchule kuti "Peresenti ya 100" yomwe imakhala yovuta kwambiri pakati pa amuna omwe ali pachiopsezo samagwiritsa ntchito makondomu .
Ndipo ngakhale ziri zoona kuti kafukufuku wina pakati pa amuna omwe ali pachiopsezo chotenga amuna omwe ali ndi chiopsezo chotere amadziwitsa kuti palibe odwala pakati pa anthu omwe amatsatira mankhwala, zotsatirazi sizikutanthawuza kwenikweni ku zochitika zenizeni zadziko, kumene kulimbikitsa ambiri kungachepetse mphamvu ya PrEP payekha.
Ndizo zambiri zomwe zimachititsa kuti nkhaniyi ichitike ku Canada.
Zomwe Zimakhudza Kukonzekera Kwambiri
Mu kafukufuku wawo, ofufuza a MLMC adanena kuti munthu wa ku Canada ali ndi kachilombo ka HIV yemwe ali ndi kachilombo ka HIV komwe kameneka sikanathe. Pambuyo poyezetsa magazi , kachilombo ka HIVyo kanakonzedwa kuti sagwirizana ndi tenofovir ndi emtricitabine (mankhwala opangidwa ndi mankhwala a Truvada), pochotseratu chitetezo cha PrEP.
Ngakhale kuti ena amatha kunena kuti mtundu uwu wa mankhwala osokoneza bongo ndi wosawerengeka-ndi kuchuluka kwa osakwana peresenti-kufufuza kwina kumajambula chithunzi china. Mwachitsanzo, tikudziŵa kuti kuteteza kwa tenofovir pakadali pano kumapitirira 20 peresenti (ku Ulaya) mpaka 57 peresenti (ku Africa) pakati pa odwala omwe akulephera kulandira chithandizo, malinga ndi lipoti la 2016 lochokera ku TenoRes Study Group.
Milandu ngati iyi, ngakhale kuti emtricitabine chikhalebe chotheka, mphamvu yake yothetsera matenda imakhalabe, mwabwino kwambiri, yosawerengeka. Izi ndi zokhazokha ngati zikhalidwe za matenda mu Canada zakhala "zosavuta," pofotokoza zovuta zomwe anthu ammudzi omwe amatha kuteteza nawo matenda a tenofovir amatha.
Pakalipano, zovuta zina zingathe kuchepetsa mphamvu ya PrEP. Mmodzi mwa iwo:
- Kulephera kukwaniritsa ndi kusunga mbali zokwanira za Truvada mu magazi. Ngakhale kuti vuto losavomerezeka nthawi zambiri limayambitsa zolephera izi, zimadziwikanso kuti odwala omwe amayamba PEPP ayenera kumwa mankhwala kwa masiku 20-30 asanayambe kumwa mankhwalawa. Ngati mankhwala akuchiritsika amatha, nthawi zina amalephera kuchepetsa vutoli, makamaka pakati pa amuna okhaokha.
- Kusiyanitsa pakati pa prEP ndi amuna omwe ali ndi chiwerewere poyerekeza ndi akazi ogonana amuna kapena akazi okhaokha. Panopa palinso umboni wosonyeza kuti PrEP singakhale yothandiza kwa amayi ndipo ngakhale kuti amamatira mokwanira, osasokonezeka, chitetezo chingagwere pansi pamtundu wa 90 peresenti yomwe ikuwonedwa ndi amuna achiwerewere.
Mwachidziwikiratu, izi zikusonyeza zinthu ziwiri: kuti kupambana kwa PrEP m'madera ena kudzakhala kochepa kwambiri kuposa ena, komanso kuti kufunika kondomu ndi njira zina zothandizira zikhalebe zothandiza kale.
PEPEPA ndi Multiple Sex Partners
Pomwe zikunenedwa, mphamvu ya PrEP siziwoneka kuti yafooka ndi zifukwa zambiri zomwe zimayambitsa matenda. Ngakhale kugwiritsira ntchito makondomu osagwirizana ndi anthu ambiri ogonana nawo, mwachitsanzo, amadziwika kuti aziwonjezera kachilombo koyambitsa matenda a Edzi, sizikutanthauza kuchepetsa mphamvu ya PrEP omwe ali pachiopsezo chachikulu.
Ndipotu, pakati pa amuna okhwima omwe amadziwika kuti ndi omwe ali oopsa kwambiri, kugwiritsa ntchito PrEP kumagwirizananso ndi anthu okwana 86 peresenti oteteza opindulitsa omwe samagwiritsa ntchito PrEP. Zopindulitsa zimangowonjezereka kuwonjezeka kwa omwe amadwala nthawi zonse, omwe amagwiritsira ntchito makondomu nthawi zonse, ndi omwe amachepetsa chiwerengero chawo chogonana (makamaka omwe alibe chikhalidwe kapena chithandizo cha mankhwala).
Ndikunenedwa kuti, PrEP sitingathe kuonedwa kuti ndi "matsenga" omwe amalephera kupindula ndi njira zina zotetezera monga makondomu. Mu February 2017, munthu wachitatu anayesera zabwino pa PrEP. Komabe, pakadali pano, ochita kafukufuku amakhulupirira kuti kachilomboka kankachitika chifukwa cha "chiwerengero chokwanira" cha anthu ogonana nawo.
Mwamuna wazaka 50 wa Chidatchi anali wochita nawo phunziro la European PrEP ndipo anafotokoza anthu opitirira 90 ogonana ndi magawo opitirira 100 a kugonana kosakondomu pachilakolako cha masabata 12. Pamene anali pa PrEP, munthuyo adapezeka kawiri kachilombo kamodzi ndipo kamodzi ali ndi chlamydia.
Ngakhale kuti zochitika zowopsa kwambiri zakhala zikupangitsa kukhulupirira kuti ichi ndi chochitika chimodzi, ena sali otsimikiza. Poyesera kachilombo ka munthuyu, adapeza kuti panalibe kusintha kwa HIV kwa mtundu wina uliwonse ndipo kachilombo ka HIV kameneka kamatengedwa kuti amatchedwa "zakutchire."
Izi zikutanthawuza kuti, popeza adalandira mbiri yake yotsatila, mankhwalawa ayenera kukhala atapereka chitetezo kupatulapo zifukwa zina zimayambitsa matenda. Ngati ndi choncho, zinthu izi zomwe sizidziwike zikhoza kuika ena pangozi. Mpaka kafukufuku amadziwa zambiri, njira zoyenera zogonana ziyenera kutsatiridwa ngati kungopereka chitetezo chowonjezera.
Zotsatira:
> Hoornenborg, E. ndi de Bree, J. "Kutenga Kwambiri Ndi Mtundu Wachirombo wa HIV-1 mu PrEP Mtumiki ndi Mipamwamba ya TDF." Msonkhano wa Retroviruses ndi Matenda Opondereza; Seattle, Washington; February 13-16, 2017; Zosamveka 953.
> Molina, J ;; Wotsutsa, C .; Zoipa, B .; et al. "On-Demand Preexposure Prophylaxis mwa Amuna Amene Ali Pangozi Yaikulu Yopatsira HIV." New England Journal of Medicine. December 1, 2015; inalembedwa pa intaneti kusanayambe kusindikizidwa; DOI: 10.1056 / NEJMoa1506373.
> POZ Magazine. "PrEP Inalephera Kugonana ndi Amuna a Gay Akugwirizana ndi Tsiku Lachiwiri la Truvada, Amagwira Ntchito Yotsutsa Kachilombo ka HIV." February 25, 2016.
> Gulu Lophunzira la TenoRes. "Mliri wadziko lonse wa matenda osokoneza bongo pambuyo pa kulephera kwa WHO kunalimbikitsa zigawo zoyamba za anthu akuluakulu omwe ali ndi kachilombo ka HIV. Matenda Opatsirana a Lancet. January 28, 2016; losindikizidwa pa intaneti; DOI: 10.1016 / S1473-3099 (15) 00536-8.
> Komiti Yoyang'anira Boma la UK PROUD. "KUYAMBIRA kafukufuku wamakono akupeza kuti pre-exposure prophylaxis (PrEP) imateteza kwambiri ku HIV kwa amuna achiwerewere ndi amuna ena omwe amagonana ndi amuna ku UK." London, England; Pulogalamu yomasuliridwa yomwe inatulutsidwa pa October 16, 2014.