Ngati kachilombo ka HIV kanatsimikiziridwa, mayesero amachitidwa kawirikawiri kuti adziwe momwe chitetezo cha mthupi cha munthu chimakhalira komanso momwe chiwerengero cha mavairasi alili m'thupi. Izi zikufotokozedwa mu zomwe zimadziwika kuti CD4 count ndi chiwerengero cha mavairasi .
Kodi CD4 Amawerengera Chiyani?
Kuyezetsa kwa CD4 ndi chimodzi mwa mayeso omwe amadziwika bwino ndi anthu omwe ali ndi HIV. Chiyeso chimayeza mlingo wa maselo a T-CD mumatenda a magazi omwe sali ofunikira kuti chitetezo cha thupi chitetezeke koma ndizofunika kwambiri pa kachirombo ka HIV.
Pamene kachilombo ka HIV kamadutsa maselowa, thupi silingathe kudziletsa palokha pazowonjezereka za matenda opatsirana.
Chiyesochi chikuchitidwa mwa kutenga zitsanzo za magazi, zotsatira zomwe zimayeza chiwerengero cha CD4 maselo mu microliter (μL) ya magazi. Kuwerengera koyambirira kumatsimikizira momwe thupi lanu limakhalira, pamene kuyesedwa kutsatila kumatidziwitsa zambiri
- siteji ya matenda ndi kukula kwa matenda
- chitsimikizo chakuti matenda ena adzakula ngati maselo a CD4 atha
- Momwe mukuyankhira mankhwalawa mwa kukhalabe kapena kubwezeretsa thupi lanu
Ziwerengero za CD4 zosawerengeka zili pakati pa 500-1,500 maselo / μL. Mosiyana ndi zimenezi, CD4 chiwerengero cha maselo 200 / μL kapena zocheperapo ndizomwe zimaikidwa ngati AIDS . Kafukufuku wasonyeza kuti kuyambitsa mankhwala pafupipafupi kapena pamunsiyi kumagwirizanitsa ndi zotsatira zosauka zachipatala komanso kuchepetsa chiyembekezo cha moyo kwa zaka 15.
Ndondomeko zamankhwala zam'mbuyomu zinalimbikitsa kuti mankhwala opatsirana pogwiritsa ntchito ma ARV (antiretroviral therapy) ayambe kuwerengedwa kwa odwala omwe ali ndi CD4 pansi pa 500 cells / μL kapena pamaso pa matenda opatsirana pogonana . Mu 2016, ndondomeko zowonjezera zinapereka ART kwa onse odwala kachilombo ka HIV, mosasamala za CD4 count, malo, ndalama, kapena siteji ya matenda.
Masiku ano, kachiwerengero ka CD4 kakagwiritsidwa ntchito kufotokozera zotsatira za matenda monga momwe mungayesere mphamvu ya thupi ya munthu. Mwachitsanzo, CD4 nadir (malo otsika kwambiri omwe CD4 count yagonjetsa) ikuwonetseratu kuwonongeka kwa nthawi yayitali, ndi mfundo zochepa zomwe zikuwonetsa chiopsezo chowonjezereka cha matenda okhudzana ndi kachirombo ka HIV ndi omwe alibe HIV, komanso kuchepetsa chitetezo cha m'thupi.
Kodi Vuto la Vuto Ndi Chiyani?
Ngakhale kuti CD4 chiwerengero cha chidziwitso cha chitetezo cha mthupi ndi chithandizo cha mankhwala, chiwerengero cha mavairasi ndi chofunika kwambiri pamene mankhwala opatsirana pogonana amayamba.
Mliri wa tizilombo umayambitsa mavairasi m'magazi, omwe amadziwikanso kuti ndi "vuto lanu la tizilombo." Mapulogalamuwa adzagwiritsa ntchito njira zamakono zowonetsera mafupa-makamaka, polymerase chain reaction (PCR) kapena bDNA (nthambi ya DNA) -kuti chiwerengero cha tizilombo toyambitsa matenda tizilombo toyambitsa matenda. Matenda a kachilombo ka HIV amatha kuchoka ku zosaoneka (m'munsi mwazidziwitso zoyesayesa zatsopano) kwa makumi khumi.
Zotsatira zosaoneka sizikutanthauza kuti mulibe kachilombo m'magazi anu kapena "mwayeretsedwa" pa matenda. (Ndipotu, osachepera 5% a kachilombo ka HIV mumthupi amapezeka m'magazi.) Zomwe sitingathe kuziwona zimangotanthauza kuti anthu omwe ali ndi kachilombo ka HIV adagwa pansi pa kuyesa magazi m'magazi koma akhoza kuwoneka kwinakwake, monga mmimba.
Zolinga za Kugonjetsa kwachilombo
Cholinga cha mankhwala ochepetsa kachilombo ka HIV ndikuteteza kwambiri mavairasi kuti asatuluke, zomwe zimagwirizanitsidwa ndi
- chithandizo chamankhwala chachikulu
- chiwopsezo chachikulu chokhazikitsa kachilombo koyambitsa matenda
- Zotsatira zabwino zachipatala zogwirizana ndi kukula kwa moyo,
- kuchepetsa chiopsezo chotenga kachilombo ka HIV kwa munthu amene sagonana naye. (njira yomwe imatchedwa kuti mankhwala monga kupewa (TasP) .
Komabe, kuwonjezeka kwa chiwerengero cha tizilombo kawirikawiri kumakhala chisonyezero cha kuchepa kwa mankhwala , kusamalidwa bwino kwa mankhwala, kapena zonse ziwiri.
Ndikofunika kuzindikira kuti mankhwala osokoneza bongo ndi oposa 95% amafunika kuonetsetsa kuti mankhwalawa akuwoneka bwino.
Kulumikizana kosagwirizana kumachepetsa kuchepetsa mphamvu za munthu kukwaniritsa izi, kumapangitsa kuti chithandizo cholephera kuchipatala chikhale chotheka mwa kulola kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo. Ubwenzi umenewu ndi chifukwa chake kutsata kuyenera kuyang'aniridwa asanamangidwe.
Izi zinati, kusintha kwapadera kwa chiwerengero cha mavitamini (kapena "blips") kungachitike ngakhale pakati pa omwe ali ndi 100% kumatira. Izi nthawi zambiri zimakhala zochepa ndipo siziyenera kukhala chifukwa cha alamu.
Kuwunika kawirikawiri kwa CD4 chiwerengero ndi mphamvu ya tizilombo kumalimbikitsa, kawirikawiri miyezi itatu kapena sikisi iliyonse yomwe CD4 ikhoza kuyesedwa miyezi 6 kapena 12 iliyonse ngati pakati pa 350 ndi 500 maselo / μL. Odwala angathe kusunga ma CD4 oposa 500 / μL akhoza kuyesedwa nthawi zina monga momwe amachitira ndi kuchiza dokotala.
Ubwino wa Control Viral
Malingana ndi kafukufuku wochokera ku UK UK Study Cohort (UK CHIC), anthu omwe ali ndi mavairasi osadziwika omwe anapeza CD4 ya maselo 350 / μL kapena zambiri mkati mwa chaka choyambitsa mankhwala amatha kukhala ndi moyo wabwino.
Pazifukwa zowonjezereka, kulepheretsa kukwaniritsa kachilombo ka HIV kumachepetsa moyo wautali ndi zaka 11-zofanana ndi kusuta fodya 40 patsiku.
Kafukufuku wobwereza womwe unachitika mu 2013 ndi University of Montreal ananenanso kuti anthu omwe anali ndi "mavitamini osadziwika" kwa miyezi isanu ndi umodzi (mwachitsanzo, pakati pa 50 ndi 199 makope / mL) anali ndi chiopsezo choposa 400% cha vuto la virologic mkati mwa chaka kusiyana ndi omwe angakwanitse kukwaniritsa ma ARV.
Phunziroli, limene linayang'anira amuna okwana 1,357 omwe ali ndi kachilombo ka HIV kuyambira 1999 mpaka 2011, linasonyezanso kuti anthu 60% omwe ali ndi kachilombo koyambitsa matendawa amakhalapo pakati pa 500 ndi 999 / ml.
Zotsatira:
Dipatimenti ya Zaumoyo ya Umoyo ku United States (DHHS). "Malangizo othandizira ogwiritsira ntchito ma antiretroviral omwe ali ndi kachirombo ka HIV ndi achinyamata." Kusintha kwa AIDS. Rockland, MD; February 12, 2013: C9-C21.
Mayi, M .; Gompels, M .; ndi Sabin. C. "Chiyembekezo cha moyo wa anthu omwe ali ndi kachilombo ka HIV-1 kowoneka bwino pambali poyankha njira zothandizira HIV / AIDS: Phunziro la Ogwirizanitsa HIV la UK." Journal of International AIDS Society. November 11, 2012; 15 (4): 18078.
Baligh, Y ;; Fleishman, J .; Metlay, J ;; et al. "Kugonjetsedwa kwa Virusi Ogonjetsedwa ndi Odwala Kachilombo ka HIV Opeza Matenda Opatsirana pogonana." The Journal of the American Medical Association. July 25, 2012; 308 (4): 339-342.
Laprise, C .; de Pokomandy, A .; Baril, J ;; et al. "Kulephera kwa virologic potsatira chidziwitso chochepa cha viremia mu gulu la odwala kachilombo ka HIV: zotsatira za zaka 12 zoziwona." Matenda opatsirana pogonana. November 2013; 57 (10): 1489-96.
Gulu Lophunzira LOWANI LOWANI. "Kuyambitsa Kachilombo ka Antiretroviral Pachiyambi Chakumayambitsa HIV." New England Journal of Medicine. July 20, 2015; DOI: 10.1056 / NEJMoa1506816.