Kafukufuku ku Africa ndi ku Ulaya akupeza zosiyana
Mu December 2014, akufufuza kafukufuku wokhudzana ndi kachilombo ka HIV kummwera kwa Africa ndi Europe, anapeza mfundo ziwiri zosiyana.
Yoyamba, yomwe inachitidwa ku Botswana ndi South Africa, inanena kuti kachilombo ka HIV kameneka kamene kamatchedwa kuti leukocyte antigen (HLA-B) kamene kamapangitsa kuti kachilombo ka HIV kasinthe, motero kupititsa patsogolo matenda.
Wachiwiri, womwe unatsatira gulu la odwala ku Ulaya kwazaka zingapo, unayang'ana makamaka pa chiwerengero cha mavairasi ndi CD4 chiwerengero chokhalira ndi kachilombo koyambitsa matenda ndipo pamapeto pake, ponena za kupititsa patsogolo kwa matenda okha, kachilombo ka HIV kakula mofulumira kwambiri kupita patsogolo kwa matenda.
Kodi zingatheke bwanji kuti maphunziro awiriwa adatha ndi kutanthauzira kosiyana kwambiri? Kodi ndizochidziwitso chokhazikitsidwa, kapena kodi zingatheke kuti kusiyana kwa kachilombo kochokera ku kontinenti mpaka ku continent -ngakhale ngakhale dziko ndi dziko-kwatsogolera magulu a asayansi kumbali yotsutsana?
Kuyeza Kugonana kwa HIV ku Botswana ndi South Africa
Phunziro loyamba, asayansi ku yunivesite ya Oxford, yomwe inatsogoleredwa ndi wofufuza wamkulu, Rebecca Payne, adafunsa ngati kukhalapo kwa majeremusi ena a HLA-B-kumagwirizanitsa ndi matenda ochepa kwambiri komanso kupatsirana kwa tizilombo toyambitsa matenda-kungachititse kuti kusintha kwa HIV kufooketse "kukhala ndi thupi labwino."
Kafukufuku wakale wasonyeza kuti anthu ena anali ndi chiwerengero chachikulu cha anthu omwe ali ndi vutoli, osasintha kachilombo ka HIV, kuyambira 75% ku Japan kufika 20% ku South Africa. Poyang'ana chisokonezo, ofufuzawo adayamba kudabwa ngati izi zingapangitse, mwa zina, kusiyana kwakukulu kwa mliri pakati pa mayiko ocheperapo monga Japan ndi madera omwe ali ndi maiko ambiri omwe ali pansi pa Sahara Africa.
Popeza kuti kachilombo ka HIV kamakhala kochepa kwambiri ku Japan, ochita kafukufukuwo adayang'ana kafukufuku pa gulu la odwala ku Botswana, dziko limene mlili wa HIV unayambira pachimake mu 2000, ndipo anawuyerekeza ndi gulu lina lomwe linagwirizanitsidwa ku South Africa, lomwe linafikira chiwerengero chake mu 2010.
Kafukufuku woyamba adawonetsa kuti kuchuluka kwa ma ARV pakati pa odwala osatetezedwa ku Botswana, kumene matendawa ndi "okalamba," anali otsika kwambiri kuposa a South Africa, kumene matendawa ndi "zaka" khumi (makope 15,350 / mL oposa makope 29,350 / mL, motsatira). Komanso, ngakhale kuti ali ndi CD4 count 50 maselo / mL ochepa kuposa a South Africa, anthu a ku Botswanani omwe ali ndi kachilombo ka HIV amakhala ndi moyo wautali, kutanthauza kuti pang'ono ndizochepa.
Pogwiritsa ntchito umboni umenewu, ofufuzawo anayang'ana maonekedwe a kachilombo ka HIV ndipo adapeza kuti anthu ambiri a ku Botswanans anali ndi vuto lothawa "HLA-B" (kutanthauza kuti kachilomboka kanasinthidwa kukhalapo kwa molecule wa HLA kuti asatuluke). Pochita zimenezi, asayansi amakhulupirira kuti "thanzi" la kachilomboka likhoza kufooketsa, kuchepetsanso mphamvu zake zobwerezabwereza komanso kuwononga mphamvu ya chitetezo cha wodwalayo.
Zonse zanenedwa, 46% a gulu la Botswanan anali ndi kusintha kwakukulu kwa HLA-B poyerekeza ndi 38% a ku South Africa okha.
Zizindikiro zapayipi zoyesera zinkawoneka kuti zimathandizira lingaliro, ndi HIV kuchokera ku sampuli ya Botswanan kufotokozera 11% pang'onopang'ono kuposa kuchokera ku South Africa.
Malinga ndi chiwerengero cha ziwerengero kuchokera kuchipatala cha amayi odwala, Payne ndi gulu lake adanenanso kuti chiwopsezo cha HIV chikhoza kuyamba ku South Africa, komanso kuti chiwerengero cha amayi osatetezedwa chikhoza kuchepa kuyambira 13,550 mu 2002-2005 kufika 5,750 mu 2012- 2013.
Kuyeza Kachilombo ka HIV mu European CASCADE Cohort
Kuphunzira ku Ulaya kunayendetsa bwino kwambiri, momwe dziko lapansili likudziwira, zomwe dokotala wachikulire, pan-European CASCADE cohort anayesedwa kuyambira 1979 mpaka 2002.
Mu kafukufuku wawo, ofufuza a CASCADE anatsindika mfundo ziwiri zofunika:
- chiwerengero cha CD4 pambuyo pa seroconversion (chomwe chimatsimikizira momwe kachilombo ka HIV kakufooketsa chitetezo cha munthu), ndi;
- Vuto loteteza "tizilombo" (komwe chiwerengero cha mavairasi chimatha pambuyo pa chiwopsezo chachikulu cha matenda, ndi mavitamini apamwamba omwe amagwirizana kwambiri ndi kukula kwa matenda).
Pa kafukufuku wawo wobwereza, ofufuza apeza kuti kuchuluka kwa CD4 kuchuluka kunagwa kuchokera pa 770 maselo / mL mu 1979 kufika 570 maselo / mL mu 2002, pamene mavoti ambiri a mavairasi pafupifupi khumi ndi awiri kuchokera mu 11,200 mu 1979 kufika pa 31,000 mu 2002.
Zambiri zokhuza matendawa ndizowopsa kwambiri zomwe zimawoneka kuti zikupita patsogolo, chaka ndi chaka, mwa anthu omwe ali ndi HIV. Malinga ndi kafukufukuyo, nthawi yochuluka yafunika kuti CD4 ya wodwalayo ikhale pansi pa 350-siteji yomwe thandizo la mankhwala opatsirana pogonana limalangizidwa - linawonjezeka kuchokera zaka zisanu ndi ziwiri mu 1979 kufika pa zaka 3.4 pofika chaka cha 2002.
Kusiyana Kwambiri pa Research
Maphunziro onsewa ali ndi zolephera zawo, ndi mapangidwe ophunzirira omwe angayambitse mkangano pakati pa asayansi ndi opanga mapulani chimodzimodzi. Zina mwa kusiyana kwakukulu:
- Ngakhale kuti maphunziro a ku Africa adakumbukira deta ya odwala oposa 2,000 ku Botswana ndi South Africa, chiwerengero chenicheni cha odwala omwe anaphatikizidwa mu sampulatifomu sizinali zazing'ono (16 ochokera ku South Africa ndi 63 ochokera ku Botswana) koma atatenga nthawi imodzi . Mosiyana ndi zimenezi, odwala pafupifupi 16,000 anaphatikizidwa ku CASCADE cohort, onse omwe anafufuzidwa pa nthawi yaitali.
- Ngakhale Payne ndi timu yake adayang'ana pa zotsatira za kusintha kwa HLA komwe kunayambitsa matenda a wodwalayo, sakanakhoza kusonyeza kuti kusintha kwa kusintha kumeneku kunakhudza vuto la CD4. Mosiyana ndi zimenezi, ochita kafukufuku wa CASCADE ankaganiza kuti CD4 / mphamvu ya ma ARV imakhala yovuta kwambiri kukhazikitsa chiopsezo cha HIV. Iwo amalephera kuphatikizidwa kwa odwala omwewo omwe anapezeka kuti ali mkati mwa miyezi itatu ya matenda, kupereka chiyambi choyambirira chomwe angayesere kuchuluka kwa matenda / CD4 kutaya.
- Ndikofunika kuzindikira kuti gulu la CASCADE limangoganizira zokhudzana ndi zoyera, amuna okhaokha (kuti atsimikizire kuti zimachitika pa mbiri yakale ndi kachilombo ka HIV). Ngakhale kufufuzaku kunapangitsa kuti chiwerengero cha mliri chikhale chokwanira ku Ulaya lonse - ndi chiwerengero cha tizilombo toyambitsa matenda chimachokera pa 31,000 mu 2002 kufika 25,500 mu 2008-zomwezo sizingatchulidwe kwa amuna amasiye. Popeza zimadziwika kuti kufalikira kwa kachilombo ka HIV kudzera mwa amuna omwe ali ndi chiwerewere (pamodzi ndi maulendo apamwamba a chithandizo cha mankhwala) kwachititsa kuti mitundu yosiyanasiyana ya ma genetiki ikhale yowonjezereka komanso yowonjezera, zingatheke kuti kachilombo ka HIV kamene kamakhudza gululi, zovuta.
- Mosiyana ndi zimenezi, kufufuza kwa Africa kunkachitika m'mayiko omwe kugonana amuna kapena akazi okhaokha sikuti ndi njira yokhayo yofalitsira koma kumene, posachedwapa, anthu ochepa sapezeka ndi HIV . Chotsatira chake, kusiyana kwa mitundu yosiyanasiyana ya kachilombo ka HIV m'madera a kumwera kwa Africa akuwoneka kuti ndi kochepa kwambiri, ndipo kafukufuku wina akusonyeza kuti kusiyana kwa chigawo cha HIV kungathandize kusiyana kwakukulu kwa HIV.
Mwachidule, ngakhale zolephera mu kufufuza kwa African ndi zolephera za kafukufuku wa CASCADE, zonsezi zikhoza kukhala zolondola. Kufufuzanso kwina kumayembekezeredwa ku magulu onse awiri.
Zotsatira:
Perekani, R .; Muenchhoff, M .; Mann, J ;; et al. "Zotsatira za kusintha kwa HIV ndi HIV kumayambitsa chiwawa cha anthu omwe ali ndi HIV." PNAS. December 16, 2014; 111 (50): E5393-5400.
Pantazis, N .; Porter, K .; Costagliola, D .; et al. "Zochitika zamakono mu zizindikiro zolosera za kachilombo ka HIV-1 ndi kupititsa patsogolo: phunziro lopenya la gulu." L ancet HIV. December 2014; 1 (3): e119-126.