Malangizo Okalamba Okalamba kwa Anthu Okhala ndi HIV
Pamene kuyesa ndi kuchiza koyambirira kwa kachirombo ka HIV kwawonjezera chiwerengero cha moyo kwa anthu ambiri, pakali pano akugwiritsidwa ntchito pa thanzi la anthu omwe ali ndi zaka 50 kapena kuposerapo, omwe nthawi zambiri amakhala ndi zofooka msanga ndi matenda chifukwa cha nthawi yayitali -matendawa.
Malinga ndi deta yochokera ku US Centers for Disease Control and Prevention (CDC), oposa 25 peresenti ya anthu okwana 1.2 miliyoni omwe ali ndi kachirombo ka HIV-kapena anthu okwana 313,000-amapita ku matendawa.
Zomwe zikuyesa zimasonyeza kuti, pakapita zaka zingapo, chiŵerengero chimenecho chikhoza kuwonjezeka kufika pa 50 peresenti.
Matenda Oyamba Kwambiri
Kutupa kosatha komwe kumayambitsidwa ndi HIV kwaphatikizidwa m'magulu apamwamba a matenda osagonana ndi HIV - monga matenda a mtima , khansa , matenda osokoneza bongo , ndi mtundu wa shuga 2 -omwe nthawi zambiri amawoneka zaka khumi ndi khumi zisanafike kuposa zomwe zingakhalepo chiyembekezeredwa kwa anthu ambiri omwe alibe kachilomboka. Ngakhale anthu omwe ali ndi kachilombo koyambitsa matenda a HIV, omwe amatha kusamalira zowonongeka kwa vutolo kwa zaka zambiri, pakakhalabe chiopsezo chachikulu cha zotsatira za ukalamba.
Ngakhale njira za chikhalidwe ichi-zotchedwa senescence msanga -sizikumveka bwino, zimavomerezedwa kuti kutupa kosatha kungachepetse chitetezo cha munthu mwa njira yomwe si yosiyana ndi ya akuluakulu, momwe thupi liri "zaka zambiri" nthawi yake. "
Ndipo zikuwoneka kuti zimakhudza ambiri, ngati sizinthu zonse zogwiritsira ntchito ziwalo. Ngakhale ma T-maselo a munthu , omwe ali pakati pa chitetezo cha mthupi, amakhala ochepa pozindikira ndi kupondereza anthu akunja pamene akuvutika ndi vutoli, lopweteka. Kulimbana ndi nkhani zowonjezereka, onse omwe ali ndi kachilombo ka HIV ndi mankhwala ena ochepetsa kachilombo ka HIV athandizidwa kuti awonjezere mafuta operekera m'mimba mwa anthu omwe ali ndi kachilombo ka HIV, zomwe zimangowonjezera phindu pobisa mapuloteni omwe amatha kutentha kwambiri.
Ndiye kodi munthu angachite chiyani kuti akhale ndi thanzi labwino ndi kachilombo ka HIV ndikupewa matenda ndi zinthu zomwe zimakhudzana ndi matenda a nthawi yaitali?
Pezani Mayesero Lero
Zingakhale zoonekeratu, koma pafupifupi 20 peresenti ya anthu a ku America omwe amakhala ndi kachilombo ka HIV sanayesedwe ndi kachirombo ka HIV ndipo, malinga ndi bungwe la World Health Organization (WHO), pafupifupi 50 peresenti ya anthu omwe ali ndi kachilombo koyambitsa matenda a Edzi alibe .
Utsogoleri wamakono kuchokera ku US Preventive Services Task Force umafuna kuti kuyesa kachilombo ka HIV kamodzi kokha kwa azimayi onse a ku America a zaka 15 mpaka 65 akhale gawo lachizoloŵezi chachidwi. Magulu ena akuluakulu oopsa, kuphatikizapo amuna ogonana omwe amagonana ndi amuna (MSM), amalimbikitsidwa kuyesa chaka chilichonse. Popanda kuyesedwa, palibe njira yogwiritsira ntchito chinthu chimodzi kuposa momwe zingakhalire ndi thanzi labwino la anthu omwe ali ndi kachilombo ka HIV, ndipo ndizo ...
Yambani Chithandizo cha HIV lero
Mu Julayi 2015, kafukufuku woperekedwa ku msonkhano wa 8 wa International AIDS Society ku Vancouver adafuna kuti pakhale kuyambitsidwa kwa mankhwala opatsirana pogonana (ART) kwa anthu onse omwe ali ndi kachilombo ka HIV, mosasamala kanthu za nthendayi kapena CD4 count . Phunziroli, lomwe limadziwika kuti Strategic Timing of Antiretroviral Therapy (START), linatsimikizira kuti kutulukira kachilombo ka HIV kumachepetsera mwayi wa matenda ndi imfa ndi makumi asanu ndi atatu (53 peresenti), poika chiopsezo cha mikhalidwe yosagwirizana ndi HIV, monga matenda a mtima (CVD) ) ndi khansa zina, pafupifupi magawo awiri pa atatu.
Mosiyana ndi zimenezo, ngakhale anthu omwe sali osowa amatha kusunga zowonongeka za tizilombo toyambitsa matenda popanda anthu omwe ali ndi ART omwe amadziwika kuti "olamulira apamwamba" -kuwirikiza katatu kuchipatala, katatu kuti athe kuchipatala ku CVD, ndipo nthawi zina amavomereza katatu chifukwa cha matenda opatsirana pogonana poyerekezera ndi olamulira omwe sali opambana pa ART. Ngati pali "choyenera" kukhala ndi moyo wautali ndi wabwino ndi HIV, izi ndizo. Ndi malo amodzi okha omwe angayambe.
Lekani Kusuta
Uku sikutchulidwa kwina chabe kwa anthu. Choonadi chodabwitsa lero ndi chakuti anthu omwe ali ndi kachilombo ka HIV amakhala ndi mwayi wosuta fodya ngati anthu omwe sali ndi kachilombo (42 peresenti ndi 21 peresenti), zomwe zimapangitsa kuti munthu akhale ndi kachilombo kawiri kawiri kawiri kawiri kawiri. , ndipo kuwonjezeka kwa maulendo 14 kuopsa kwa khansa ya m'mapapo.
Ndipotu, kafukufuku wambiri akuganiza kuti kusuta fodya ndi chinthu choopsa kwambiri chomwe chimachititsa kuti anthu azikhala ndi kachilombo ka HIV komanso kuchepetsa kufala kwa anthu omwe ali ndi kachilombo ka HIV.
Ngakhale kusuta mapulogalamu sikumakhala kosavuta nthawi zonse-kumafuna kuyesera katatu kuti asayese-kulandira chithandizo chakhala chophweka kwambiri pansi pa Care Affordable Care Act , ndi mayesero awiri omwe amapita pachaka omwe amaloledwa ndi mankhwala ndi mapulogalamu osiyanasiyana omwe amaperekedwa kudzera mu Medicaid mu onse 50 akunena.
Pezani Mapu Anu
Ndizodabwitsa chiwerengero cha anthu omwe ali ndi kachilombo ka HIV omwe amapewa, samanyalanyaza, kapena sakudziwa za mtundu wa zipolopolo kapena katemera omwe amatha kuwathandiza . Izi zimaphatikizapo zochitika monga katemera wa matenda a chiwindi B, papillomavirus ya munthu (HPV) , chibayo cha pneumococcal, ndi (inde) chaka chilichonse cha quadrivalent chimfine .
Zomwe zimatetezedwa zimakhala ndi tanthauzo latsopano pamene, mwachitsanzo, chiopsezo cha khansa ya khansa (yogwirizana kwambiri ndi matenda a HPV) amadziwika kuti ndi ochulukitsa kawiri pa anthu omwe ali ndi kachirombo ka HIV, pamene khansara ya chiberekero ikuwonjezeka kasanu ndi kamodzi. Katemera wa HPV wosavuta, womwe uli ndi atatu, ungathe kutengapo katemera wa khansa pafupifupi 56 peresenti.
Musanayambe zochitika zonse za katemera, onetsetsani kuti mukukumana ndi dokotala kuti mukambirane zosankha ndi zoopsa. Ngakhale kuti ambiri amachepetsa kwambiri chiopsezo chotenga HIV, ena akhoza kukupwetekani , makamaka ngati chitetezo chanu cha mthupi chimasokonezeka kwambiri.
Kambiranani Malemba ndi Dokotala Wanu
Malingana ndi kafukufuku wochokera ku Johns Hopkins University School of Medicine, kugwiritsa ntchito kolesitolomu-kuchepetsa mankhwala a statin, kuphatikizapo ART, kungachepetse chiopsezo cha imfa mwa anthu omwe ali ndi kachilombo ka 67 peresenti. Ofufuzawo anafotokoza kuti, kuphatikizapo kuchepetsa makilogalamu oopsa a kolesterolini, ma statins amawoneka kuti amachepetsa kwambiri kutupa kosatha.
Ngakhale izi sizikutanthauza kuti mankhwala osokoneza bongo amasonyeza kuti anthu onse omwe ali ndi kachilombo ka HIV amapindulitsa kwambiri kuti aziwonekeranso bwino ndi zizindikiro zina za matenda a mtima - makamaka okalamba kapena ena omwe ali ndi chiopsezo. mbiri, kusuta fodya, etc.).
Taganizirani Vitamini D & Calcium Supplementation
Mankhwala ochepa kwambiri a mafupa (BMD) amapezeka nthawi zonse kwa anthu omwe ali ndi kachilombo koyambitsa matenda a Edzi. Kutaya kwa BMD pakati pa magawo awiri ndi asanu ndi limodzi mwa magawo asanu ndi limodzi omwe amapezeka kawirikawiri mkati mwa zaka ziwiri zoyambirira za ART, mlingo wofanana ndi wa amayi m'zaka ziwiri zoyamba za kusamba.
Chifukwa cha izi ndi ziwerengero zina, pakalipano akulimbikitsidwa kuti amayi onse omwe ali ndi kachilombo ka HIV athandizidwe DEXA (scan-ray-ray-ray-absorptiometry) kuti athe kuwonetsa kutheka kwa mafupa, komanso amuna onse omwe ali ndi kachilombo ka HIV ali ndi zaka 50.
Ponena za kusamalira, kafukufuku wambiri wanena kuti co-administration ya vitamini B tsiku ndi supplement calcium zingathandize kuchepetsa ngozi ya mafupa. Ngakhale kuti kafukufukuyo sali wovomerezeka, malangizo a US tsopano amalimbikitsa pakati pa 800 ndi 1000 mg ya vitamini D pamlomo tsiku ndi 1000 mpaka 2000 mg ya calcium yamlomo patsiku. Odwala osteoporosis angapindule ndi mankhwala oyamba monga alendronate (Fosomax) ndi zoledronic acid (Zometa) zomwe zingathandize kupewa zofooka za osteoporotic.
Kudya ndi Kuchita Zochita
Mwina ngakhale kuposa kusuta fodya, mawu oti "zakudya" ndi "zochita masewera olimbitsa thupi" amachititsa kuti odwala asamangokhalira kugula (ngakhale kuti nthawi zina amachotsa maso) kwa odwala, ngati kuti mwakachetechete amapezeka kunyumba osati malingaliro achipatala omwe ali.
Koma taganizirani izi-anthu omwe ali ndi kachilombo ka HIV amayamba kuwonjezeka kwambiri-mafuta ochulukirapo chifukwa cha ma ARV okha osati mankhwala okhaokha komanso mankhwala omwe amagwiritsidwa ntchito pochiza matendawa. Ndipo ngakhale kwa iwo omwe ali ndi ART yowononga kwambiri, ndi zachilendo kuona 40 peresenti ikukula mafuta ammimba ndipo 35 peresenti imapeza mafuta amkati, ndi kuwonjezereka kwa ma CVD onse ndi mtundu wa matenda a shuga 2.
Kuwonjezera pa makonzedwe a mankhwala a statin, kasamalidwe ka tsiku ndi tsiku ka HIV kamaphatikizapo kudya zakudya zolimbitsa thupi, zochepetsera mafuta komanso kuphunzitsidwa kwa aerobic ndi kukaniza maphunziro , mosasamala za msinkhu, CD4 count, kapena matenda. Musanayambe ART, ma lipids ndi magulu a m'magazi amagazi ayenera kuyesedwa ndi kufufuza nthawi zonse kuti awone zotsatira za chitukuko cha CVD ndi / kapena shuga.
Mfundo yofunika kwambiri: musadalire mapiritsi kapena zakudya zokha kuti muchepetse vutoli kapena mutenge njira yothetsera vutoli. Gwiritsani ntchito ndi dokotala wanu ndikupempha kuti mutumizidwe kwa akatswiri odziwa zakudya zamagetsi komanso akatswiri olimbitsa thupi m'madera mwanu, makamaka ngati mukulemera kwambiri, mukudwala, muli ndi maganizo a mtima kapena matenda a shuga, kapena mukusowa chitsogozo.
Pezani Nthaŵi Zowonongeka za Pap ndi Mammograms
Kuganizira zapadera kwa amayi omwe ali ndi kachilombo ka HIV, osati kokha kuti ateteze khansara ya chiberekero ndi zina zotere, koma kuthetsa nkhani zokhudza mimba , kachilombo ka HIV (mwachitsanzo, pamene wina ali ndi kachilombo ka HIV ndipo winayo ali ndi HIV -kugwiritsira ntchito), komanso kupewa kuteteza kachirombo ka HIV kuchokera kwa mayi kupita kwa mwana .
Akazi ayenera kukambirana zolinga kapena zolinga zilizonse zomwe angakhale nazo pokhudzana ndi mimba panthawi yoyambilira, pamene akuonetsetsa kuti kuyang'ana kwa amayi nthawi zonse kumawonetsedwa (chaka ndi chaka kwa akazi oposa 50 ndipo aliyense payekha kwa amayi a pakati pa zaka 40 ndi 49). Akazi omwe ali ndi kachilombo ka HIV ayenera kupatsidwa kachilombo ka Pervic, komanso pa kuyesedwa kwa chisamaliro, ndi kuyesedwa mobwerezabwereza miyezi isanu ndi umodzi yotsatira.
Musatengenso kachilombo ka HIV
Imodzi mwa malingaliro olakwika okhudza kachilombo ka HIV ndikuti ali ndi chiwerengero choyesedwa cha ma laboratory (CD4 count, viral load) ndi kuwonetsa nthawi zonse (matenda opatsirana pogonana, hepatitis) komanso kuphatikizapo kawirikawiri maulendo a HIV. Ndipo izo ndi zabwino kwambiri izo.
Pofuna kuika maganizo awo pa nthawi yayitali, ambiri ayamba kuitanitsa chiwerengero cha HIV, kuchiyesa ngati gawo la chisamaliro chapadera m'malo mokhala ngati apadera. Izi zikutanthauza kusintha momwe timayang'anirana ndi HIV lero, onse odwala komanso madokotala. Zimatanthawuza kumvetsetsa kuti kachilombo ka HIV sichikhoza kuchitidwa modzipatula, koma ngati gawo limodzi lokhazikika la chithandizo chamankhwala chamtsogolo.
Choncho, ndikofunika kuti nthawi zonse mulangize dokotala wanu wa HIV zachipatala chilichonse chomwe mungakhale mukuchilandira, kuphatikizapo zipatala kapena maulendo apakati. Ndipo musaganize kuti chinachake chiri "chosagwirizana" ndi HIV, makamaka chifukwa chakuti matendawa amatha kuwonetsa ndi zovuta zambiri zokhudzana ndi matendawa, kuchokera ku vuto la maso mpaka kumlomo / matenda a mano kumatenda a ubongo.
Ngati dokotala wanu wamkulu ndi wosiyana ndi dokotala wanu wa HIV, onetsetsani kuti nthawi zonse amagawana zotsatira, kuphatikizapo mayeso a ma labwino ndi mauthenga ena ofunikira kuti mukhale osamala.
> Zotsatira:
> Zomwe Zingathetsere Kudwala ndi Kuteteza Matenda (CDC). "HIV pakati pa anthu okalamba 50 ndi okalamba." Atlanta, Georgia; August 3, 2015.
> KUYAMBA KUYAMBIRA Gulu Lophunzira. "Kuyambitsidwa kwa mankhwala opatsirana pogonana ku Antiymmetomatic HIV Infection." New England Journal of Medicine. July 20, 2015; DOI: 10.1056 / NEJMoa1506816.
> Mdodo, R .; Frazier, E .; Mattson, C .; et al. "Kusuta fodya pakati pa anthu akuluakulu a HIV / akuluakulu akusamalira: Ntchito Yowunika Zamankhwala, US, 2009." Msonkhano wa 20 pa za Retroviruses ndi Matenda Opondereza (CROI 2013). Atlanta, Georgia; March 3-6, 2013: Zosintha 775.
> Dipatimenti ya US Health and Human Services (DHHS). "Analimbikitsa Katemera Wachilombo ka HIV Wokwanira." Washington, DC; August 3, 2015.
> Cannon, J. "Kukhalabe Oyenera ndi HIV - Malangizo a ACSM Pangani Zochita Zotheka kwa Odwala." Dokotala wa masiku ano. October 2011; 13 (10): 86.