Ngakhale kuti zochepa, maphunziro amati chiopsezo sichikhoza kuthetsedwa kwathunthu
Kafukufuku wa chipatala wasonyeza kuti mankhwala ochepetsa kachilombo ka HIV (ARV) angathe kuchepetsa kwambiri chiopsezo chotenga kachilombo ka HIV m'mabanja osiyana-siyana (omwe ali ndi HIV) omwe ali ndi kachirombo ka HIV ndipo wina alibe kachilombo ka HIV.
Njira zomwe zimaphatikizapo kuchepetsa kupatsirana kwa kachilombo ka HIV pogwiritsira ntchito mphamvu yowonjezera yosatetezeka (yomwe imatchulidwa monga mankhwala monga kupewa, kapena TasP ), komanso kugwiritsa ntchito tsiku ndi tsiku mapiritsi ochepetsa kachilombo ka HIV pofuna kuchepetsa chiopsezo cha HIV kwa wokondedwa (wotchedwa pre-exposure prophylaxis, kapena PrEP ).
Zomwe zimagwiritsidwanso kuti zikuluzikulu ndizitsulo zopewera za ART, monga makondomu komanso mdulidwe wa amuna omwe amadzipereka mwachangu (omwe amadziwika kuti amachepetsa chiopsezo cha HIV kwa amuna omwe alibe kachilomboka). Ngakhale kufufuza koyambirira kwawonetsa kuti ubwino wa ART ukhoza kukhala wabwino pakati pa maukwati osiyana-siyana ndi TasP kuchepetsa chiopsezo cha HIV mpaka 96 peresenti ndipo PrEP kuchepetsa chiopsezo ndi pafupifupi 75 peresenti-ena afunsanso ngati ziwerengerozi zidzakwera malo enieni a dziko.
Kugonana kosakondweretsa komanso kachilombo ka HIV
Pamsonkhano wa 2014 pa ma retroviruses ndi Matenda Opatsirana (CROI) ku Boston, ofufuza omwe amaphunzira nawo PARTNER anasonyeza kuti pakati pa anthu 767 osiyana-siyana omwe amagwiritsidwa ntchito pogwiritsa ntchito TasP okha, palibe matenda amodzi omwe anachitika ngakhale kuti anthu oposa 44,000 amachita chiwerewere. Phunziroli linaphatikizapo maanja omwe ali amuna kapena akazi okhaokha omwe ali amuna kapena akazi okhaokha omwe amafotokoza kuti pafupifupi 37 mpaka 43 amagonana mosakwatirana pachaka.
Komabe, ngakhale ovomerezedwa omwe ofufuza, ziwerengero ndi zovuta kwambiri. Kuchokera pa zinthu zingapo zosiyana-kuphatikizapo mitundu ya zochitika zogonana komanso ngati kutuluka kwadongosolo kapena ayi-nthawi yolingalira (yomwe inkayesa kutsimikizika kwa zowonjezera) inali pa 96 peresenti.
Izi zikutanthauza kuti pafupifupi 4 peresenti ya chiopsezo cha matenda-ndipo osati 0 peresenti yomwe ena angaganizire. Kwa omwe amagonana ndi abambo, chiwopsezochi chikawonjezeka kufika pa 10 peresenti. Kafukufuku wopitilirapo athandiziranso kwambiri momwe zipangizo zothandizirazi zingachepetsere chiopsezo cha chiopsezo kwa nthawi yaitali.
Kusiyanasiyana pakati pa Ogonana ndi Amuna Kapena Akazi Okhaokha
Pa kafukufuku wopangidwa ndi US Centers for Disease Control and Prevention (CDC) , asayansi anafufuza deta yamakono ponena za mphamvu ya TasP, PrEP, ndi makondomu m'mabanja osagonana ndi amuna ndi akazi okhaokha. Cholinga cha phunziroli sichiyenera kufotokozeratu chiwopsezo chenicheni chotenga kachilomboka ku malo enieni a dziko lapansi, koma kusonyeza kuti chiopsezo chimakhalapo pakapita nthawi, kutatha zaka chimodzi ndi khumi.
Malingana ndi chiwerengero cha zinthu zomwe zingakhumudwitse, mwayi wokhala ndi kachilombo pakati pa anthu osiyana-siyana omwe amagwiritsa ntchito ART umakhala ngati magawo awiri peresenti chifukwa cha amuna kapena akazi okhaokha komanso 25 peresenti yokhazikika m'mabanja achiwerewere. Zomwe anapezazo zinachokera pamaganizidwe angapo, monga:
- 80 peresenti ya kuchepetsa chiopsezo chogwiritsa ntchito kondomu
- 96 peresenti yochepetsera chiopsezo pamene odwala kachilombo ka HIV ali pa ART / TasP
- Maperesenti okwana 73 peresenti amachepetsa chiopsezo cha abwenzi omwe sagwidwa ndi abwenzi omwe sagwirizana nawo pa PrEP
- 44 peresenti yochepetsera chiopsezo cha atsikana omwe sagonana nawo pa PrEP
- 54 peresenti ya kuchepetsa chiopsezo cha mwamuna kapena mkazi yemwe sagwidwa omwe amadulidwa
- Amayi okwana 73 peresenti amachepetsa chiopsezo kwa amuna omwe sagwidwa, odulidwa omwe ali okha ("pamwamba") pa nthawi yogonana
- Pafupifupi asanu ndi limodzi omwe amachita zochitika zogonana pamwezi
Ndikofunika kuzindikira kuti kusiyana pakati pa kugonana pakati pa amuna kapena akazi okhaokha ndi amuna okhaokha sikutanganidwa ndi chiopsezo chachikulu cha matenda opatsirana pogonana , koma pa kafukufuku wamakono omwe amasonyeza kuti peresenti ya PREP imakhala yochepa pakati pa mabanja omwe ali ndi zibwenzi. Ofufuzawo amavomereza kuti kuwonjezeka kwa PrEP ndi / kapena kukwanira kokwanira kukwanira deta akhoza kusintha izi kuyerekezera.
Kuonjezera apo, kafukufuku wochuluka wamakono atsindika kuti kugwiritsa ntchito kwapakati pa PrEP mu MSM kungakhale ndi phindu lomwe likuteteza monga kugwiritsa ntchito tsiku ndi tsiku. Ngati zotsatira zotere zingatsimikizidwe, monga ambiri akuyembekeza, zotsatira za prEP zothandizira maanja a MSM zidzakulitsidwa kwambiri.
Zinthu Zowopsa Kwanthawi yayitali ndi Zakale
Ofufuzawo anawonetsanso kuti maanja ogwiritsira ntchito njira imodzi yokhayo yopezera chitetezo anali ndi chiopsezo chachikulu kwambiri cha matenda, panthawi yochepa komanso yayitali. Zomwe mwapeza:
- Mabanja okwatirana omwe anangodalira kondomu okha anali ndi 13 peresenti ya kachilombo ka HIV m'chaka chimodzi ndipo 76 peresenti yowopsya kwa zaka 10, malinga ndi deta yogwiritsiridwa ntchito mofanana. Mosiyana ndi izi, amuna amodzi akugonana amuna amodzi akuwonetsedwa kuti ali ndi 1 peresenti ndipo 11 peresenti ali pangozi, motero.
- Mabanja okwatirana omwe anangodalira kokha ku TasP anali ndi chiwopsezo chachitatu peresenti chaka chimodzi ndipo 25 peresenti pangozi ya zaka 10. Poyerekezera, mabanja okwatirana okhaokha anali ndi chiwerengero cha 0.2 peresenti ndi 2 peresenti pangozi.
- Amuna ogonana omwe adagwiritsa ntchito TasP, PrEP, ndi mdulidwe, amagwiritsira ntchito kondomu nthawi zonse, osagonana ndi abwenzi omwe sagwidwa, kachilombo ka HIV kanasinthika kufika pa 0.1 peresenti kuposa chaka chimodzi ndi 1 peresenti kuposa zaka khumi.
- Mofananamo, madontho anawoneka m'mabanja ogonana omwe adagwirizana ndi TasP, PrEP, mdulidwe, komanso kugwiritsa ntchito kondomu nthawi zonse . Kwa amuna, chiopsezo chapitirira chaka chimodzi chinali 0.1 peresenti ndipo 1 peresenti yoposa zaka 10. Vuto pakati pa akazi linali locheperapo pa 0.05 peresenti ndi 0,5 peresenti.
Zotsatira izi zinkathandizidwa, mwa zina, ndi kufufuza kwa 2014 ndi Sorbonne Université ku Paris, yomwe idasanthula deta kuchokera ku maphunziro asanu ndi limodzi omwe amagwiritsidwa ntchito pogwiritsa ntchito TasP pakati pa anthu osakwatirana. Amuna omwe amaphatikizidwa pa phunziroli adagonana pakati pa katatu ndi 12 pamwezi, ndipo 80 peresenti amagwiritsidwa ntchito kondomu.
Ofufuzawo anapeza kuti deta yomwe ilipo sichikugwirizana ndi lingaliro lakuti ART ikhoza kuchepetsa chiopsezo cha HIV mpaka zero. M'malo mwake, kafukufuku wawo amatsimikizira kuti, pamene chiopsezo chotenga kachilombo ka HIV ndi chotsika kwambiri m'zaka ziwiri zoyambirira, chiopsezochi chikhoza kuwonjezeka kufika 1 peresenti pambuyo pa miyezi 18. Phunziroli silinayang'ane kuti nthawi yayitali chithandizo cha ART chikhale chonchi m'mabanja omwe amachititsa anthu kugonana.
> Zotsatira:
> Baeten, J .; Donnell, D .; Ndase, P .; et al. "Antiretroviral Prophylaxis ya Kupewa HIV mu Amuna ndi Akazi Ogonana." New England Journal of Medicine. August 2, 2012; 367 (5): 399-410.
> Rodger, A: Bruun, T .; Cambiano, V .; et al. "Kutenga kachilombo koyambitsa kachilombo ka HIV kudzera mwa kugonana kosakondomu ngati HIV + yothandizana naye pa ART yogonjetsa: PARTNER yophunzira." Msonkhano wa 21 pa Retroviruses ndi Matenda Opondereza (CROI); Boston, Massachusetts; March 3-6, 2014; zolemba 153LB.
> Lasry, A; Dipo, S .; Wolitski, R .; et al. "Kugonana kwa chiopsezo chotenga kachilombo ka HIV pakati pa anthu omwe ali ndi HIV / AIDS: kuyesa zotsatira za kugwirizanitsa njira zothandizira." AIDS . June 14, 2014; 28 (10): 1521-1529.
> Supervie, V .; Viard, J; Costagliola, D .; et al. "Kuopsa kwa chiopsezo chotenga kachilombo ka HIV pogonana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito ma ARV: ndondomeko yowonongeka ndi machitidwe achi Bayesi." Matenda opatsirana pogonana. April 19, 2014; 223 [Epub patsogolo pa kusindikiza].
> Molina, J; Fonsart, C .; Choipa, B; et al. "Pemphani PrEP Ndimamwa TDF-FTC mu MSM: Zotsatira za mayankho a ANRS Ipergay." Msonkhano wa 2015 pa Retroviruses ndi Matenda Opondereza (CROI); July 24, 2015; Seattle, Washington; zolemba 23LB