Onse omwe ali ndi kachilombo ka HIV ndi omwe ali ndi kachirombo ka HIV akuwonetsedwa kuti awonjezere ngozi
Mtundu wa shuga wamtunduwu nthawi zambiri umagwirizanitsidwa ndi matenda a kachilombo ka HIV , omwe amachititsa kuti agwiritse ntchito mankhwala ena opatsirana pogonana ( anti - antiretroviral antibiotics) monga mankhwala akuluakulu monga Crixivan (indinavir) ndi mphamvu zonse Norvir (ritonavir) .
Ngakhale sizikudziwika bwinobwino kuti ndalama zomwe ARV zimapereka, timadziwa kuti chiopsezo cha shuga kwa munthu yemwe ali ndi kachilombo ka HIV kawirikawiri chimachokera ku zinthu zingapo zomwe zimapereka, kuphatikizapo:
- Ukalamba (kawirikawiri 40 ndipitirira)
- Mbiri ya banja
- Kunenepa kwambiri
- Chiwindi cha hepatitis B (HBV) ndi coinfection ya hepatitis C (HCV)
- Kuthamanga kwa magazi
- Cholesterol Chokwera
- Mimba yamakono
- Mitundu (Asia, African-American, Hispanic)
Komabe, m'zaka zaposachedwapa, kufufuza kwatanthawuza kuti kutupa kosatha komwe kumayambitsidwa ndi matenda a nthawi yayitali komanso mankhwala achilendo omwe amachitira kuti athetse vuto la kachirombo ka HIV angadwale kwambiri matenda a shuga.
Matenda a shuga ndi HIV-Associated Chronic Inflammation
Ngakhalenso pamene kachilombo ka HIV katha kapena kuthetsedwa kwathunthu kudzera mwa mankhwala opatsirana pogonana (ART) , kukhalapo kwa kachilombo koyambako kumayambitsa kuchitapo kanthu kotha kupweteka pamene chitetezo cha mthupi chimasiyidwa mwatcheru.
Pakati pa kutupa kwachilombo ka HIV, zizindikiro zina zotupa zotchedwa C-reactive protein (CRP) ndi interleukin-6 (IL-6). Kafukufuku waposachedwapa amasonyeza kuti kuwonjezeka kwa zizindikirozi kumapangitsa kuti chiwopsezo cha shuga chifike patsogolo kwa anthu omwe ali pa ART.
Asayansi ndi gulu la INSIGHT SMART ndi ESPIRIT anafufuza kafukufuku wa shuga pakati pa anthu 3,695 omwe ali ndi HIV pa ART pafupifupi zaka 4.6. Chiwerengero cha CD4 pakati pa ophunzirawo chidaonedwa kukhala chapamwamba pa 523 cell / mL.
Malingana ndi deta, odwala omwe ali ndi CRP ndi IL-6 ambiri amakhala ndi matenda a shuga a mtundu wa 2, ndi kawiri kawiri ndi CRP ndi IL-6 kuchokera pachiyambi chomwe chimachititsa kuti pakhale ngozi yaikulu 20% ndi 33%.
Zonsezi, anthu 137 anadwala matenda a shuga panthawi ya mulanduyo pa chiwerengero cha 8.18 pa 1,000-wodwala zaka.
Ngakhale kuti chikhalidwe chachikhalidwe chinkawoneka kuti chimalimbikitsa chitukuko cha shuga pakati pa ophunzira - kuphatikizapo thupi lachimake (BMI), ukalamba, chiwindi cha hepatitis ndi mankhwala a statin -kuti ngakhale kutupa kwapafupi kungapangidwe kukhala kofunikira , kupereka maziko omwe angawone bwino anthu omwe ali pachiopsezo chachikulu cha mtundu wa shuga wa mtundu wa 2 ndikuonetsetsa kuti pali njira zoyenera zothandizira ART asanayambe.
Kodi Matenda a Shuga Amagwiritsidwa Ntchito Pogwiritsa Ntchito Mankhwala Osokoneza Bongo?
Chimodzi mwa machitidwe oletsa matenda a shuga kwa anthu omwe ali ndi kachilombo ka HIV ndi zotsatira za mankhwala osokoneza bongo. Mankhwalawa, omwe amagwiritsidwa ntchito popanga mankhwala apamwamba kwambiri (makamaka a LDL cholesterol), amaonedwa kuti ndi ofunika kwambiri popewera matenda a mtima m'magulu omwe amatha kupwetekedwa mtima ndi pafupifupi anthu awiri.
Komabe, kafukufuku watsopano kuchokera ku HIV Outpatient Study (HOPS) wasonyeza kuti kugwiritsa ntchito mankhwala osokoneza bongo kwa anthu omwe ali ndi kachirombo ka HIV kungawonjezere chiopsezo cha shuga ndi 10% pachaka.
Kusanthula kwa zaka khumi, komwe kunatsatira odwala 4,962 omwe ali ndi kachilombo ka HIV kuyambira 2002 mpaka 2011, adawona momwe matenda a shuga a mtundu wa 2 amapezedwera pakati pa anthu omwe anapatsidwa mankhwala osokoneza bongo (590) poyerekeza ndi omwe sanali (4,372).
Kusintha chitsanzo cha msinkhu, kugonana, mtundu, kugwiritsa ntchito ma ARV ndi BMI, ofufuzawo adatha kuona kuti chiwopsezo cha shuga chimawonjezeka kwambiri.
Komabe, iwo adafulumira kuona kuti kuwonjezekaku kunalumikizidwanso mwachindunji ku ukalamba ndi apamwamba a BMI, komanso mtundu wa mtundu / mtundu (ndi 50% yapamwamba pakati pa anthu akuda ndi oposa awiri pakati pa a Hispania). Zosadabwitsa, ndizochepa zomwe zinalembedwa pakati pa odwala achichepere, pomwe mphamvu ya protease inhibitors inkawoneka kuti ndi yopanda phindu.
Malingaliro a uphungu, ofufuza a HOPS adalangiza kwambiri kuti statin "isapewe ngati mankhwala akuwonetsedwa" chifukwa cha "anawonetsa phindu la kupewa matenda a mtima."
Choncho ngakhale mankhwala osokoneza bongo amakhalabe ofunika monga njira yochepetsera lipid kwa anthu omwe ali ndi HIV, sayenera kugwiritsidwa ntchito paokha. Kuchepetsa kuchepetsa chiopsezo kumafuna njira yowonjezereka, kuphatikizapo kuchepetsa kudya zakudya , kuchepetsa kuchita masewera olimbitsa thupi , kusuta fodya , komanso kuyambitsidwa kwa ART nthawi yeniyeni kuti athetse vutoli kuti athe kuchepetsa kupweteka kwa matenda osatetezedwa.
Zotsatira:
Béténé A Dooko, C .; De Wit, S .; Neuhaus, J ;; et al. "Interleukin-6, High Sensitivity C-Reactive Protein, ndi Kukula kwa mtundu wa shuga 2 pakati pa odwala kachilombo ka HIV odwala matenda opatsirana pogonana." Journal of Deficiency Immune Deficiency Syndromes. December 15, 2014; 67 (5): 538-546.
Lichtenstein K.; Debes, R .; Wood, K. et al. "Kugwiritsira ntchito statin kumagwirizanitsa ndi matenda a shuga pakati pa odwala omwe ali ndi HIV Ophunzira Phunziro." Msonkhano wa 20 pa ma Retroviruses ndi Matenda Opondereza (CROI). March 3-6, 2013; Atlanta, Georgia; zomveka 767.
Freiberg, M ;; Chang, C .; Kuller, L .; et al. "Kutenga kachilombo ka HIV ndi chiopsezo chachikulu cha matenda a myocardial infarction." Journal of the American Medical Association (JAMA) Mankhwala Opatsirana. April 22, 2013; 173 (8): 614-622.