Hepatitis C ndi matenda opatsirana omwe amachititsa chiwindi, omwe amafalitsidwa ndi kachirombo ka hepatitis C (HCV) ndipo ndi chimodzi mwa zifukwa zomwe zimayambitsa matenda ndi imfa pakati pa anthu omwe ali ndi HIV.
Bungwe la American Association for the Study of Liver Illness (AASLD) linanena kuti tizilombo ta chiwindi-chomwe chimaphatikizapo chiwindi cha A, B , ndi C-chiri lero chomwe chimayambitsa imfa padziko lonse, ndi kutaya moyo woposa wa AIDS , chifuwa chachikulu, ndi malungo .
Pakalipano palibe katemera wa chiwindi cha C.
Kuchepetsa kachilombo ka HIV / HCV
Kuwerengera kwa kachilombo ka HIV / HCV kumakhala kosiyana ndi kufufuza, koma kafukufuku amasonyeza kuti kuchuluka kwa kachilombo ka HIV pakati pa anthu omwe ali ndi kachilombo ka HIV ndikoposa 30 peresenti ku US ndi Europe. Padziko lonse, mliri wa HIV / HCV uli pafupi ndi anthu 4-5 miliyoni, kapena pakati pa 10-15 peresenti ya anthu omwe ali ndi HIV.
Ogwiritsa ntchito mankhwala osokoneza bongo (IDUs) ali ndi chiopsezo chachikulu chotengera kachilombo ka HIV / HCV, pofalikira kuyambira 82 peresenti mpaka 93 peresenti. Mosiyanitsa, coinfection kudzera njira kugonana ndi pafupifupi 9 peresenti.
Ngakhale amuna omwe amagonana ndi amuna (MSM) sakhala ndi chiopsezo chowonjezereka chifukwa cha matenda a HCV, chiopsezo chikhoza kuwonjezeka mpaka 23 peresenti mu MSM omwe amakhala ndi khalidwe loopsa-monga ogonana nawo ambiri, kugonana pagulu, kapena ngakhale anagawana mankhwala osokoneza bongo omwe amachitidwa pamtunda kapena pamodzi.
Anthu omwe amagwiritsidwa ntchito ndi coinfected amakhala ndi mavitamini apamwamba a HCV kuposa omwe amagwirizana nawo, zomwe zimapangitsa kuti pang'onopang'ono mafupa a fibrosis , a cirrhosis , ndi a hepatocellular carcinoma (omwe ali ndi khansa ya chiwindi).
Kuwonjezera apo, anthu omwe ali ndi coinfected ali ndi mwayi waukulu kwambiri wa ma antiretroviral-omwe amagwirizana ndi hepatotoxicity (chiwindi cha chiwindi) kuposa omwe ali ndi HIV okha.
Ziwerengero izi zikuwonetsa kufunikira kozindikiritsa kwambiri HCV pakati pa anthu omwe ali ndi kachilombo ka HIV, komanso njira zowonjezera zothandizira kuti awonetsere matenda a HCV kapena, makamaka, kuchepetsa matenda.
Nthawi Yoyamba Kuchiza Chithandizo
Nthawi yoyamba HCV ingakhale nkhani yovuta. Kawirikawiri, mankhwala a HCV amasonyezedwa mwa anthu omwe ali ndi zizindikiro zowonongeka za HCV. Dipatimenti ya zaumoyo ku United States (DHHS) ikuyamikira kuti mankhwala a HCV ayambidwe mwa anthu omwe ali ndi ndalama zambiri omwe ali ndi fibrosis yambiri ndipo ali pachiopsezo chachikulu cha kukula kwa chiwindi.
Chifukwa cha zifukwa zowopsa zowononga mankhwala - kuphatikizapo kuti chithandizo sichinatsimikize kuti HCV chivomerezo-chisankho chochiza chimachitika makamaka chifukwa cha kulakalaka kwa odwala, komanso kuwonetsa zizindikiro zowonetsera kupambana kwa mankhwala (mwachitsanzo, HCV genotype , HCV chiwerengero cha tizilombo ).
Komabe, ndikofunika kuzindikira kuti mankhwala osokoneza bongo a HCV amachepetsa mofulumira zolepheretsa kuchipatala, ndi phindu la mankhwala opitirira kutalika kwa zotsatira zake.
DHHS imalimbikitsanso kugwiritsa ntchito mankhwala opatsirana pogonana (ART) mwa anthu onse omwe ali ndi ndalama zosawerengeka mosasamala kanthu kwa chiwerengero cha CD4 , chomwe chawonetsedwa kuti chichepetse kuwonjezeka kwa matenda okhudzidwa ndi HCV. Komanso:
- Kwa anthu omwe ali ndi ma CD4 otsika (pansi pa 200 maselo / mL), mankhwala a HCV ayenera kuchedwa mpaka nthawi yomwe CD4 ikuwonjezeka. Kusankhidwa kwa mankhwala opatsirana pogwiritsa ntchito mankhwala ozunguza bongo kumagwirizana ndi momwe mungagwiritsire ntchito mankhwala osokoneza bongo, komanso kuphwanya toxicities. (Chodetsa nkhaŵa chachikulu ndi chakuti mankhwala ena ogwiritsidwa ntchito mu mankhwala a HCV amawongolera njira zofanana ndi ma antiretroviral, kuchepetsa kupweteka kwa mankhwala onse awiri pamene akuwonjezera ngozi.)
- Kwa munthu yemwe ali kale pa ART, ayenera kuganiziranso kukonzanso mankhwala kuti achepetse zotsatira zowonongeka, ndi phindu lokhalanso kusokoneza nkhawa za kukula kwa mankhwala osokoneza bongo .
- Kwa anthu osatetezedwa omwe ali ndi CD4 oposa 500 maselo / mL, odwala akhoza kusankha kuchepetsa ART mpaka atatha mankhwala a HCV.
Zomwe mwasankha za mankhwala a HCV
Msana wa mankhwala a HCV wakhala ukuphatikizapo pegylated interferon alpha (kapena PEG-IFN) ndi ribavirin . PEG-IFN ndi kuphatikiza mankhwala atatu oletsa tizilombo toyambitsa matenda omwe amachititsa maselo kupanga mabakiteriya ambirimbiri omwe angathe kupha onse omwe ali ndi kachilombo ka HIV.
Ribavirin, wina wothandizira tizilombo toyambitsa matenda, amalepheretsa RNA kagayidwe kamene kamayenera kubwereza kachilombo ka HIV.
Mankhwala atsopano opatsirana mofulumira (DAAs) amatha kukhala ndi matenda osiyanasiyana a chiwindi a hepatitis C popanda kugwiritsa ntchito PEG-INF ndipo, nthawi zambiri, ribavirin. Pochita zimenezi, zotsatira zokhudzana ndi mankhwala a HCV zimachepetsedwa kwambiri, monga momwe nthawi yayambira.
Pakati pa ma DAA omwe amavomerezedwa masiku ano amagwiritsidwa ntchito pochiza matenda a chiwindi cha matenda a chiwindi (mwa lamulo la FDA)
| Mankhwala | Zavomerezedwa | Olemba | Kusankha | Nthawi |
| Epclusa (sofosbuvir + velpatasvir) | genotype 1, 2, 3, 4, 5, ndi 6 ndi opanda chiwalo cha cirrhosis | ribavirin panthawi ya chibwibwi chosokonezeka komanso popanda ribavirin m'mabuku ena onse | piritsi limodzi tsiku ndi tsiku kapena opanda chakudya | Masabata 12-16 |
| Zafiti (elbasvir + grazoprevir) | genotype 1 ndi 4 ali ndi kapena popanda chiwindi | ribavirin kapena opanda ribavirin, malingana ndi mbiri ya genotype ndi mbiri ya mankhwala | piritsi limodzi tsiku ndi tsiku kapena opanda chakudya | Masabata 12-16 |
| Daklinza (daclatasvir) | genotypes 3 popanda cirrhosis | Sovaldi (sofosbuvir) | piritsi limodzi tsiku ndi tsiku ndi chakudya | Masabata 12 |
| Technivie (ombitasvir + paritaprevir + ritonavir) | genotype 4 popanda chibwibwi | ribavirin | mapiritsi awiri tsiku ndi tsiku ndi chakudya | Masabata 12 |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, yogwirizanitsidwa ndi dasabuvir) | genotypes 1 ndi kapena popanda cirrhosis | ribavirin kapena kutengedwa paokha, kumene kumasonyezedwa | mapiritsi awiri a ombitasvir + paritaprevir + ritonavir amatengedwa kamodzi tsiku lililonse ndi chakudya, kuphatikizapo piritsi imodzi ya dasabuvir yomwe imatengedwa kawiri tsiku ndi tsiku ndi chakudya | Milungu 12-24 |
| Harvoni (sofosbuvir + ledipasvir) | genotype 1 ndi kapena popanda cirrhosis | atengedwa yekha | piritsi limodzi tsiku ndi tsiku kapena opanda chakudya | Milungu 12-24 |
| Sovaldi (sofosbuvir) | genotype 1, 2, 3 ndi 4 ali ndi matenda a chiwindi, kuphatikizapo odwala matenda a cirrhosis kapena hepatocellular carcinoma (HCC) | peginterferon + ribavirin, ribavirin yekha, kapena Olysio (simeprevir) kapena wopanda ribavirin, kumene amasonyezedwa | piritsi limodzi tsiku ndi tsiku kapena opanda chakudya | Milungu 12-24 |
| Olysio (simeprevir) | genotype 1 ndi kapena popanda cirrhosis | peginterferon + ribavirin, kapena Sovaldi (sofosbuvir), kumene kumasonyezedwa | kapsule imodzi tsiku ndi tsiku ndi chakudya | Masabata 24-48 |
Zotsatira Zogwirizana
Chimodzi mwazofunikira kwambiri pa nkhani ya kuchiza matenda a HIV / HCV ndi zotsatira zowopsa kusiyana ndi zomwe zimachitika chifukwa cha mankhwala. Ngakhale kuyambitsidwa kwa mankhwala osokoneza bongo atsopano kwasintha chithandizo cha matenda a HCV, palibe vuto lililonse limene odwala ena amakumana nawo.
Kwa anthu oyamba mankhwalawa, nthawi zambiri zotsatira za HCV mankhwala (zomwe zimachitika pazifukwa zisanu) ndi awa:
- Epclusa: kutopa, kupweteka mutu
- Zepatier : kutopa, kupweteka mutu, kunyoza
- Daklinza : kutopa, kupweteka mutu, kupweteka, kutsegula m'mimba
- Technivie : kufooka kwa thupi, kutopa, kunyowa, kusowa tulo
- Viekira Pak : kutopa, khungu, khungu lopweteka, khungu la maso, kusowa tulo, kufooka, kutopa
- Harvoni : kutopa, mutu
- Sovaldi + PEG / INF + ribavirin: kutopa, kusowa tulo, kunyowa, kupweteka mutu, kuchepa magazi m'thupi
- Sovaldi + ribavirin: kutopa, kupweteka mutu
- Olysio + PEG / INF + ribavirin: kuthamanga, khungu lopweteka, kunyoza, kupweteka kwa minofu, kupuma pang'ono
Ngakhale kuti zotsatira zake zambiri zimatha nthawi yayitali, kuthetsa patangotha sabata imodzi kapena ziwiri, zizindikiro zina zingakhale zowonjezereka ndipo zimatchulidwa (makamaka pa mankhwala a PEG / INF). Lankhulani ndi dokotala mwamsanga ngati zizindikiro zokhudzana ndi / kapena zotsalira.
Musanayambe Kachilombo ka HCV
Kumvetsetsa ndi kuyembekezera zotsatira zowonongeka ndizofunikira kwambiri kuti munthu adzipange mankhwala komanso kuti akwaniritse zolinga zabwino. Mankhwala a mapiritsi, ndondomeko yolemba, komanso kusintha kwa zakudya (mwachitsanzo, kuwonjezeka kwa mafuta omwe amadya mafuta ochepa) ndizo zina mwazofunikira kuti zithetsedwe kuti zitsimikizidwe bwino.
Ndipo ngakhale kuti kusankha mankhwala osokoneza bongo kungaoneke ngati kofunika kwambiri pa chithandizo chamankhwala, momwemonso, kumatira mankhwala . Zimakhudzana osati ndi zotsatira zabwino koma nthawi zambiri zimachepetsa kuopsa kwa zotsatira zake. Kukhazikika kwamtunduwu, makamaka, ndikochititsa kuti chithandizo cha mankhwala chitheke monga zochitika zovuta.
Chiwopsezo cha chiwindi
Matenda a cirrhosis chifukwa cha matenda akuluakulu a HCV ndi chiwonetsero cha chiwindi cha chiwindi ku US, Europe, ndi Japan, ngakhale kuti kachirombo ka HIV kamadziwika kuti kamapezeka pafupifupi 70 peresenti ya obwereza mkati mwa zaka zitatu. Kuwonjezera apo, matenda a graft omwewo amatha kukhala pakati pa 10-30 peresenti ya odwala omwe akudwala matenda a chiwindi m'kati mwa zaka zisanu.
Kwa anthu omwe amafunika chiwindikiro cha chiwindi, kuyambitsidwa kwa mankhwala a HCV katatu kungachepetse kwambiri chiopsezo cha kutaya kwazitsulo ndi 30%.
Ngakhale kuti zowonjezereka zimakhala zoopsa, ndizofunikira kuzindikira kuti mliri wopulumuka ndi wofanana ndi zizindikiro zonse za chiwindi cha chiwindi-ndi kupuma kwapakati pa 68% ndi 84% mkati mwa zaka zisanu zoyambirira.
Mankhwala atsopano a HCV amatha kukhala patsogolo pa zotsatirazi, pomwe akuchepetsa zotsatira za mankhwala omwe akugwiritsidwa ntchito ndi mankhwala.
> Zotsatira:
> Association of American for the Study of Chilwere Matenda (AASLD). "Kuyang'ana Mliri Woopsa Wadziko Lonse Ndiponso Wachigawo." Washington, DC Nkhani yofalitsa ya November 3, 2013.
> Rotman, Y. ndi Liang, T. "Coinfection ndi Hepatitis C Virus ndi Human Immunodeficiency Virus: Virological, Immunological, ndi Clinic Outcomes." Journal of Virology. August 2009; 83 (15): 7366-7374.
> Danta >, M .; Brown, D .; Bhagani, S .; et al. "Mliri wamakono wa kachilombo koyambitsa matenda a hepatitis C mwa amuna omwe ali ndi kachilombo ka HIV omwe amagonana ndi amuna ogwirizana ndi chiopsezo chachikulu chotengera kugonana > makhalidwe abwino ." AIDS. May 11, 2007; 21 (8): 983-991.
> Sulkowski, M. ndi Benhamou, Y. "Matenda okhudzana ndi odwala kachilombo ka HIV / HCV." Journal of Viral Hepatitis. June 1, 2007; 14 (6): 371-388.
> Ghany, M .; Molakwika, D .; Thomas, D; ndi Seeff, L. "Kuzindikira, Kutenga, ndi Chithandizo cha Hepatitis C: Chotsitsimutsa." Hepatology. 2009; 49 (4): 1335-1374.
> US Department of Health and Human Services. "Malangizo othandizira kugwiritsa ntchito antiretroviral Agents ku HIV-1 Akuluakulu Okhudzidwa ndi Achinyamata." Washington, DC; March 27, 2012.
> Alcorn, K. "Mankhwala opatsirana pogwiritsa ntchito mankhwala a HCV amadza ndi chiopsezo chachikulu cha zovuta kwambiri kwa anthu omwe ali ndi matendawa." NAM / AIDSMAP. April 30, 2013.
> US Food and Drug Administration (FDA). "FDA imavomereza Technivie > kuti ikhale ndi matenda a chiwindi cha matenda a hepatitis C aakulu 4." Silver Spring, Maryland; > press > kutulutsidwa pa July 24, 2015.
> US Food and Drug Administration (FDA). "FDA imavomereza Viekira Pak kuti ikhale ndi matenda a hepatitis C." Silver Spring, Maryland; > press > kutulutsidwa pa December 19, 2014.
> US Food and Drug Administration (FDA). "FDA imavomereza > yatsopano > chithandizo cha kachilombo ka hepatitis C." Silver Springs, Maryland; > press > kutulutsidwa pa November 22, 2013.
> US Food and Drug Administration (FDA). "FDA imavomereza mankhwala osokoneza bongo oyambirira kuti athe kuchiza matenda a hepatitis C." Silver Spring, Maryland; > press > kutuluka pa October 10, 2014.
> US Food and Drug Administration (FDA). "Olysio (simeprevir) pochiza matenda a HCV osakaniza mankhwala." Silver Springs, Maryland. Nkhani yomasulidwa yotuluka pa November 22, 2013.
> Manns, M. ndi Cornberg, M. "Sofosbuvir: msomali womaliza mu bokosi la chiwindi cha chiwindi C?" Lancet. March 15, 2013; 13 (5): 378-379.
> Tsoulfas, G ;; Goulis, I; Papanikolaou, V .; et al. "HIV ndi Kuika Chiwindi." Hippokratia. October-December 2009; 13 (4): 211-215.
> Sulkowski, M .; > Naggie >, S .; Lalezari, J .; et al. "Sovaldi ndi > Ribivirin > chifukwa cha Hepatitis C kwa Odwala ndi Hepatitis C Coinfection."