Asayansi ndi Olemba Mapulani Amavomereza Kachilombo ka HIV Kachilombo ka Onse
Anthu akhala akukangana nthawi zambiri pakati pa omwe amapanga ndondomeko, ochita kafukufuku, ndi madokotala omwe ali ndi kachilombo koyambitsa matenda a HIV panthawi yomwe amadziwa kuti ali ndi kachilombo ka HIV angakhale ndi phindu kwa wodwalayo, potsata thanzi labwino komanso nthawi zonse Matenda okhudzana ndi HIV.
Phunziro lapadera lofalitsidwa ndi New England Journal of Medicine pa July 20, 2015 linapangitsa mpikisanowo kupuma pozindikira kuti mankhwalawa sichidzangowonjezera mwayi wodwala komanso kufa kwa 57 peresenti koma angatero mosasamala za msinkhu wa munthu, mtundu, kugonana, mavairasi , chigawo cha dziko, chikhalidwe chachuma kapena chidziwitso cha chitetezo cha mthupi (monga chiwerengero cha CD4 count).
Pambuyo pa phunziroli, mankhwala opatsirana pogwiritsa ntchito ma ARV (antiretroviral therapy) adalimbikitsidwa pamene chiwerengero cha CD4 cha munthu chinatsika pansi pa malo ena (makamaka pansi pa 500 cells / mL kapena, m'mayiko ena, pansi pa maselo 350 / mL).
Kafukufuku watsopano wotchedwa Strategic Timing of Antiretroviral Therapy (START) mayesero - anapangidwa kuti adziwe ngati mankhwala oposa ma CD4 angapereke zotsatira zabwino zaumoyo popanda kuwonjezera chiopsezo cha wodwala wa matenda a mtima, a impso kapena ena omwe alibe HIV.
Yambani Kuphunzira Phunziro ndi Zotsatira
Zotsatira zoyamba zokhudzana ndi mayankho a START, zomwe zafotokozedwa pa msonkhano wa International AIDS Conference ku Vancouver ndi Dr. Jens Lundgren wa Copenhagen HIV Programme, adali kuyembekezera kwambiri kuti adzalengezedwe mu May kuti phunziroli lidzathetsedwa posakhalitsa chifukwa cha umboni wodabwitsa. zothandiza.
Phunziroli, lomwe linayambika mu 2009, linalimbikitsa amuna ndi akazi 4,685 omwe ali ndi kachilombo ka HIV kuchokera ku malo 215 m'mayiko 35, onse omwe anali ndi CD4 chiwerengero cha maselo oposa 500 / ml. M'zaka zam'mbuyomu panali zaka 36, pamene azimayi 27% anali amayi.
Odwalawo anagawidwa m'magulu awiri: imodzi yomwe ART inayambika pomwepo ndi ina yomwe ART inalembedwera mpaka chiwerengero cha CD4 cha munthuyo chitadutsa pansi pa maselo 350 / mL kapena pali chitukuko chachikulu cha matenda odwala AIDS kapena imfa.
Panthawi yomwe phunziroli linathetsedwa, zochitika zazikulu zokhudzana ndi Edzi zinadziwika pakati pa mkono woponderezedwawo, pafupifupi nthawi zinayi kuposa odwala omwe anapatsidwa ART (14). Mofananamo, panali zochitika zazikulu zomwe sizinachitike ndi Edzi (29) zomwe zinkachitika mofulumira kuposa zomwe zinawonetsedwa mwapadera (ARM).
Chifuwa cha TB, lymphoma ndi Kaposi sarcoma (KS) ndizo zitatu zochitika zokhudzana ndi Edzi zomwe zimawonedwa ndi ophunzira, ndipo 62 peresenti ya izi zikuchitika mu Africa. Zochitika zazikulu zomwe sizinachitike ndi Edzi makamaka anali khansa , mtima wamtima (CVD) ndi imfa.
Mwa gulu, zochitika zambiri zovuta zinawoneka kwa okalamba achikulire, zomwe zingawoneke kuti ndi zogwira mtima zomwe zimapereka chiwopsezo cha khansa ndi CVD pakati pa anthu okalamba ambiri. Chodabwitsa n'chakuti kusuta sikuwoneka kuti kusintha zotsatirazo, kutanthauza kuti ART yomweyo inali yopindulitsa kwambiri kwa osuta fodya kusiyana ndi osuta fodya.
Mwinamwake kupeza kosazolowereka kwambiri, kunali kovuta kuti zochitika zoipa zisachitike pakati pa odwala okhala ndi CD4 count, monga momwe angayang'anire, koma mwa iwo omwe ali ndi ma CD4 apamwamba . Ngakhale kuti ofufuza sanathe kufotokozera bwino zotsatira zake, zomwe anapezazo zinagwirizana ndi maphunziro oyambirira omwe ankanena kuti ma CD4 okhawo sangapereke chithunzi chonse cha kufooka kwa chitetezo cha munthu.
Msonkhano wake, Dr. Lundgren adafuna kufufuza njira zatsopano zowononga chitetezo cha mthupi kuti amvetse bwino njira zowonongeka za Edzi komanso zosagwirizana ndi Edzi.
YAM'MBUYO YOTSATIRA TUMIZANI LINKI SINDIKIZANI
Chiyeso cha START choyamba chinapindula mu 2011 pamene maphunziro ena, HPTN 052, adasonyeza kuti kutenga kachilombo ka HIV kunachepetsera chiopsezo chotulutsa kachilombo kwa munthu amene ali ndi kachilombo ka HIV kupita kwa munthu yemwe alibe kachilombo koyambitsa matendawa-njira yomwe imadziwika kuti Treatment monga Prevention, kapena TASP .
Malingana ndi zotsatira ziwiri izi, atsogoleri a msonkhano wa 2015 wa IAS anapereka chikalata chotchedwa Vancouver Consensus, pofotokoza kuti "(onse) omwe ali ndi kachilombo ka HIV ayenera kupeza mankhwala opatsirana pogonana."
Ngakhale atsogoleriwa adavomereza kuti pali zolepheretsa kuti pakhale kukhazikitsidwa, osati zochepa zomwe zimaphatikizapo ndalama zokwana $ 8-10 biliyoni zomwe zimapereka ndalama kuchokera ku mabungwe apadziko lonse ndi mayiko opereka ndalama - iwo amaumirira njirayi kuti athe "kuthetsa" mliriwu monga momwe tikudziwira poyamba monga 2030.
Poyankha pa zotsatira za START, Kate Thomson wa Global Fund adalengeza kuti mlanduwu unafotokozera "nthawi yeniyeni" pa nkhondo yapadziko lonse yolimbana ndi kachilombo ka HIV, yomwe ikuwonabe anthu opitirira mamiliyoni awiri ndikufa ndi 1.2 million chaka chilichonse.
Zotsatira:
Gulu Lophunzira la INSIGHT START. "Kuyambitsidwa kwa mankhwala opatsirana pogonana ku Antiymmetomatic HIV Infection." New England Journal of Medicine. July 20, 2015; DOI: 10.1056 / NEJMoa1506816.