Matenda Okhudzidwa ndi Kuopsa Kwambiri kwa Imfa, Kuwonongeka kwa Ubongo
HIV ingawononge chitetezo chanu cha mthupi; izi zikuwonekera bwino. Pamene kachilombo ka HIV kamakhala kowonjezereka ndikupanga makopi ambiri, kuwonongeka kungakhale koopsa kwambiri, zomwe zingabweretse chiopsezo chachikulu cha chitukuko cha matenda opatsirana .
Chimodzi mwazoopsa kwambiri ndi matenda omwe amatchedwa progressive multifocal leukoencephalopathy (PML) . Mkhalidwewu umatchulidwa ndi dzina lomwelo: "leuko" kutanthauza woyera, "encephalo" kutanthauza ubongo, ndi "njira" yomwe imatanthauza matenda.
Kotero PML ndi kuwonongeka koyamba kwa nkhani yoyera ya ubongo m'malo osiyanasiyana (multifocal).
Matendawa amayamba chifukwa chochotsa mitsempha ya myelin pang'onopang'ono yomwe imatha kumapeto kwa mitsempha, makamaka nkhani yoyera ya ubongo. Monga matenda opatsirana, PML imasonyeza zambiri mofanana ndi multiple sclerosis (MS) , ngakhale mofulumira.
Vuto lomwe limayambitsa PML ndilo limene anthu ambiri amawatcha kuti JC virus (kapena John Cunningham). Ngakhale kuti anthu 70 mpaka 90% a padziko lapansi ali ndi kachilombo ka HIV, zimangowonjezera matenda ngati munthu ali ndi vuto lalikulu lakumana ndi matenda monga momwe zimachitikira ndi Edzi.
Pulogalamu ya PML imakhala ndi chiwerengero chachikulu cha anthu omwe amwalira, ndipo anthu 30-50% amafa m'miyezi yoyamba ya matenda. Anthu amene amapulumuka amakhala ndi ubongo wosiyanasiyana-ena amatha, ena amawopsa.
PML imapezeka kwambiri pamene munthu amene ali ndi kachilombo ka HIV ali ndi CD4 chiwerengero cha 100% / mL.
Mwachidule, matenda a Edzi apangidwa pamene CD4 imagwa pansi pa maselo 200 / mL
Zizindikiro ndi Zizindikiro za PML
Zizindikiro za PML zingafanane ndi zina zambiri, makamaka m'mayambiriro ake. Kawirikawiri, chizindikiro chokha cha vuto chingakhalepo:
- Kufooka kwachinsinsi mmanja kapena miyendo
- Kuvuta kuganiza kapena kuganizira
- Kusagwirizana kwambiri
- Mutu
Kawirikawiri, anthu amalakwitsa zizindikiro za kutopa, zoopsa za mankhwala, kapena kupwetekedwa kwapang'onopang'ono kapenanso kusachedwa kwaschemic . Pamene PML ikupita, zizindikiro zowonjezereka zingapangidwe, kuphatikizapo kuyankhula ndi kuwonongeka kwa masomphenya, komanso kusintha kwa umunthu ndi kusintha kwa umunthu.
Nthawi zina, odwala angathenso kukhala ndi matenda omwe amachititsa kuti munthu asamadziwe yekha kapena kuti athe kuugwira.
Kuzindikira kwa PML
PML amatha kupezeka mwa njira imodzi.
- Pofufuza mthendayi yamtsempha kuti mavitamini a JC athandizidwe mothandizidwa ndi MRI (magnetic resonance Imaging) kuti azindikire zitsulo mu nkhani yoyera ya ubongo.
- Mosiyana, ubongo wa ubongo ungagwiritsidwe ntchito, kuphatikizapo njira zothandizira kukhalapo kwa JC kachilombo.
Kodi Pali Chithandizo cha PML?
Asanafike poyambitsa matenda opatsirana pogonana (ART) , PML nthawi zonse inkafa m'mayezi angapo kapena miyezi ingapo yapadera. Ngakhale pakalipano palibe mankhwala omwe angathe kuteteza kapena kuchiritsa PML, kuyambitsidwa kwa ART kungachepetse zizindikiro zambiri pobwezeretsa zina mwa thupi lake.
Zasonyezedwa kuti ART ikhoza kupititsa patsogolo moyo wa munthu ndi PML kwa zaka zingapo.
Pazifukwa zazing'ono, chiopsezo cha PML chikhoza kutetezedwa kwambiri poonetsetsa kuti kuyambitsidwa kwa ART kuli koyambirira, panthawi yomwe akudziŵa komanso asanawonongeke.
Mankhwala amachiritso angapo ayambanso kufufuza, ngakhale kuti zotsatira zimasakanizidwa kapena zinyama zabwino. Zimaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo a malaria ndi mankhwala ndi interleukin-2 (mapuloteni omwe amayang'anira maselo oyera a magazi).
Mpaka pano, pangokhala anthu ochepa okha omwe amawoneka kuti adachiritsidwa ndi PML pogwiritsira ntchito mefloquine, pamene odwala awiri adawoneka kuti ayambiranso kugwiritsa ntchito mapuloteni oteteza mthupi, interleukin-2.
Mwamwayi, pambali zonse ziwirizi, zapamwamba za poizoni zogwiritsidwa ntchito ndi mankhwala osokoneza bongo zothandizira anthu omwe ali ndi PML.
Zotsatira :
National Institutes of Health (NIH). "Progressive Multifocal Leukoencephalopathy Information Page" Washington, DC; zasinthidwa pa February 14, 2014; inapezeka pa February 24, 2016.
Shackelton, L .; Rambaut, A .; Pybus, G ;; et al. "JC Virus kusintha ndi kusonkhana ndi anthu". Journal of Virology . 2006; 80 (20): 9928-9933.
Gofton, T .; Al-Khotani, A .; O'Farrell, B ;; et al. "Mefloquine pakuthandizidwa ndi multifocal leukoencephalopath". Journal of Neurology, Neurosurgery ndi Psychiatry. June 2010; 82 (4): 452-455.
Buckanovich R. Liu, G ;; Wovuta, C; et al. "Kupanga maselo osagwiritsidwa ntchito mosagwiritsa ntchito mankhwala a allogeneic stem cell transplantation kwa Hodgkin's lymphoma yowonongeka yovuta kwambiri chifukwa cha interleukin-2 yomwe imayendera matenda ambiri a leukoencephalopathy." Chaka chilichonse cha Hematology. July 2002: 81 (7): 410-413.