Kudziwa Zomwe Zimayambitsa ndi Kusankha Dongosolo Latsopano la Mankhwala
Kulephera kwa kachilombo koyambitsa matenda a HIV kumachitika pamene mankhwala anu ochepetsa kachilombo ka HIV amalephera kukwaniritsa zolinga za mankhwalawa-kuteteza kachilombo ka HIV kapena kubwezeretsa chitetezo cha mthupi kuteteza matenda opatsirana . Kuperewera kwa mankhwala kungatchulidwe kuti virologic (yokhudzana ndi kachilombo), immunologic (zokhudzana ndi chitetezo cha m'thupi), kapena zonse.
Pamene vutoli likulephera, chinthu choyamba ndicho kuzindikira chinthu kapena zinthu zomwe zakhala zikuthandizira kulephera, zomwe zingaphatikizepo:
- Kugwiritsa ntchito mankhwala osokoneza bongo
- Kulimbana ndi mankhwala osokoneza bongo
- Kulephera kwa mankhwala kale (s)
- Kusamalidwa kosavomerezeka ku zoletsedwa za zakudya
- Kuchuluka kwa CD4 kuchuluka kwa mankhwala
- Matendawa (monga hepatitis C kapena chifuwa chachikulu)
- Kuyanjana kwa mankhwala osokoneza bongo
- Mavuto ndi kuyamwa mankhwala kapena kagayidwe kabakiteriya
- Zotsatira za mankhwala, zomwe zingakhudze kumamatira
- Kusokonezeka maganizo kapena kugwiritsa ntchito mankhwala osokoneza bongo, komwe kungathenso kugwiritsidwa ntchito
Kulephera kwa Virologic
Kulephera kwa virologic kumatanthawuza kuti sitingakwanitse kukwaniritsa kapena kuteteza kachilombo ka HIV kamodzi ka 200 / mL. Izi sizikutanthauza kuti munthu ayenera kusintha nthawi yomweyo mankhwalawa ngati mtengo wa tizilombo ukuponya pansi pa 200. Umangokhala ngati mlingo umene adokotala angapange chigamulo chodziwa zachipatala pokhapokha kulumikizidwa kwachilendo ndi machitidwe a dosing akutsimikiziridwa.
Mofananamo, kutanthauzira sikuyenera kusonyeza kuti ndizovomerezeka kukhala osapitirira momwe mungagwiritsire ntchito mankhwalawa. Ngakhale "zovuta zomwe sizikuoneka" (ma 50/99 ma copies / mL) ziyenera kukhala zodetsa nkhaŵa, ndipo kafukufuku waposachedwapa akusonyeza kuti ntchito yowonjezera, yomwe imakhala yochepa pa miyezi isanu ndi umodzi ingapangitse chiopsezo cha virologic kulephera m'chaka ndi 400%.
(Mosiyana ndi zimenezi, nthawi zina mavairasi "amawombera" nthawi zambiri saganiziranso zolephera za virological.)
Kusamalidwa bwino kwa mankhwala osokoneza bongo ndi kupeza mankhwala osokoneza bongo masiku ano ndizo zifukwa ziwiri zomwe zimayambitsa vuto la virologic, makamaka mu mankhwala oyamba. Malingana ndi kafukufuku, pafupifupi mmodzi mwa odwala anayi amatha kulephera chifukwa cha kusamalidwa bwino, pamene pakati pa 4% ndi 6% a odwala amalephera chifukwa cha kukanidwa kwa mankhwala.
Ngati kunyalanyaza kosavuta kuli pamtima wa kulephera, ndizofunika kuti dokotala ndi wodwalayo athe kuzindikira chifukwa china chilichonse. Nthawi zambiri, kuchepa kwa mankhwala (mwachitsanzo, kuchepetsa mapiritsi, kuchepa kwafupipafupi) kungathandize kuchepetseratu zolepheretsa kugwira ntchito. Nkhani zokhudzana ndi kugwiritsira ntchito mankhwala ozunguza bongo ziyenera kuthandizidwa, ndi kutumizidwa ku malo opatsirana kapena alangizi othandizira, ngati kuli kofunikira.
Ngakhale kusagwirizana kwa virologic kumatsimikiziridwa ndi momwe kuyesera kukana kusamalidwa , ndikofunika kukonza zinthu zilizonse zotsatizana musanapite patsogolo ndi mankhwala atsopano. Pokhapokha ngati kutchulidwa ngati gawo lotsogolera la kasamalidwe ka kachilombo ka HIV, mwayi wokhala wobwerezabwereza udzatha.
Kusintha Kwambiri Pambuyo pa Kulephera kwa Virologic
Kulephera kwa virologic kumatanthauza kuti chiwerengero cha kachilombo ka HIV m'kati mwa "phukusi" la wodwalayo sichimagwira ntchito imodzi kapena mankhwala ena osokoneza bongo.
Ngati ataloledwa kukula, kachilombo koyambitsa matenda kamene kamakhala kakulimbana ndi kukana mpaka mankhwala osokoneza bongo amapezeka.
Ngati mukuganiza kuti mankhwala osokoneza bongo ndi osakanikirana komanso kuti chiwerengero cha tizilombo ta wodwalayo chili pamwamba pa makope 500 / mL, kuyezetsa magazi kumatetezedwa . Kuyezetsa kumachitika ngakhale pamene wodwalayo akungotenga regimen yolephera kapena mkati mwa masabata anai asanathe. Izi, kuphatikizapo ndondomeko ya mbiri ya chithandizo cha wodwalayo, zidzakuthandizira kutsogolera kusankha kwa mankhwala opita patsogolo.
Mukamatsutsa mankhwala, ndizofunika kusinthira mwamsanga mwamsanga kuti muteteze kusintha kwina kosokoneza bongo kuchokera pakukula.
Momwemonso, regimen yatsopanoyi idzakhala ndi ziwiri, koma makamaka katatu, mankhwala atsopano ogwira ntchito. Kuonjezera mankhwala osagwira ntchito limodzi sikungakonzedwe chifukwa kungangowonjezera chitukuko cha mankhwala osokoneza bongo.
Kugwiritsa ntchito mankhwala osokoneza bongo kuyenera kukhazikitsidwa pa kafukufuku wapadera kuti aone momwe angagwiritsire ntchito mankhwala osokoneza bongo, kapena kudziwa ngati mankhwala ena angapitirizebe ntchito ngakhale kuti amatsutsa pang'ono .
Kafukufuku wasonyeza kuti odwala amawoneka bwino kuposa mankhwala ochiritsidwa. Izi zikhoza kukhala chifukwa chakuti odwala amakhala ndi kachilombo koyambitsa CD4 / kachilombo kochepa pamene akuyambitsa mankhwala atsopano, kapena mankhwala obadwa atsopano ndi abwino kwambiri kuchiza odwala kwambiri kukana. Zofukufuku zawonetsanso kuti odwala omwe alephera kupatsirana chifukwa cha kusamalidwa bwino kumapangitsa kuti anthu azitsatira pafupipafupi.
Komabe, ndikofunika kuzindikira kuti kuthetsa kwa tizilombo totere sikungatheke kwa odwala onse, makamaka omwe akhala akuchiritsidwa kangapo pazaka zambiri. Zikatero, mankhwala ayenera kupitilizidwa ndi cholinga choonetsetsa kuti mankhwala osokoneza bongo ndi ochepa komanso kusunga CD4 ya wodwalayo.
Odwala omwe ali ndi kachilombo ka CD4 amawerengera osachepera 100 maselo / mL ndi njira zochepetsera chithandizo, kuwonjezera kwa wothandizira ena kungathandize kuchepetsa chiopsezo cha matenda.
Kulephera kwa Immunologic
Tsatanetsatane ya kulephera kwaumunthu kumakhala kovuta kwambiri, ndipo ena amafotokoza izo monga
- Kulephera kuwonjezera chiwerengero cha CD4 wodwalayo pamtunda wina (mwachitsanzo, kuposa 350 kapena 500 maselo / mL) ngakhale kuponderezedwa kwa ma ARV, kapena;
- Kulephera kuwonjezera CD4 ya wodwala ndi ndalama zina pamasana a chithandizo chamankhwala asanayambe kulandira mankhwala.
Ngakhale kuti deta imakhalabe yosiyana kwambiri, kafukufuku wina wasonyeza kuti chiwerengero cha odwala omwe ali ndi kachilombo kochepa kwambiri ka CD4 kamakhalapo ngakhale kuti kupatsirana kwa kachilombo ka HIV kungakhale kotsika kwambiri kuposa 30%.
Vuto la kuchepetsa matenda a immunologic ndiloti nthawi zambiri limagwirizanitsidwa ndi chiwerengero cha CD4 chochepa chithandizo kapena chiwerengero cha "CD" cha "nadir" (mwachitsanzo, chochepa kwambiri, chiwerengero cha CD4 chakale). Mwachidule, chitetezo cha mthupi cha wodwala chimasokonezedwa asanayambe kuchipatala, zimakhala zovuta kwambiri kubwezeretsa chitetezo cha mthupi.
Ndi chifukwa chake machitidwe omwe ali ndi kachilombo ka HIV akuthandizira kuti ayambe kulandira chithandizo pamene chitetezo cha mthupi sichitha.
Kumbali ina, kuchepa kwa immunologicalic kungatheke ngakhale ndi mankhwala apamwamba a CD4 chiwerengero. Izi zikhoza kukhala chifukwa cha matenda omwe apita kale kapena ogwira ntchito, ukalamba, kapena ngakhale zotsatira za kutupa kosalekeza komwe kumayambitsa HIV. Nthawi zina, palibe chifukwa chomveka chomwe chimachitikira.
Zovuta kwambiri ndizokuti palibe mgwirizano weniweni wa momwe angaperekere kulephera kwa thupi. Odwala ena amasonyeza kusintha kwa mankhwala kapena kuwonjezera wothandizira wodwala kachilombo ka HIV, ngakhale kuti palibe umboni wakuti izi zimakhudza kwenikweni.
Komabe, ngati vuto la immunologic likulephera, odwala ayenera kufufuza bwinobwino ngati alipo
- mankhwala amodzi omwe angathe kuchepetsa kupanga maselo oyera (makamaka CD4 + T ), kulowetsa kapena kusiya mankhwalawa nthawi iliyonse, kapena;
- Matenda omwe sagwidwa ndi mankhwala kapena matenda aakulu omwe angakhale akuthandiza kuchepetsa kuteteza thupi.
Matenda angapo opangidwa ndi chitetezo cha mthupi akufufuzidwa, ngakhale palibe pano omwe akulimbikitsidwa kunja kwa nkhani ya mayesero a zachipatala.
> Zotsatira:
> Dipatimenti ya US Health and Human Services (DHHS). "Kulamulira kwa Chithandizo-Odwala Odziŵa: Virologic ndi Immunologic Imalephera." Rockville, Maryland; yafika pa February 21, 2014.
> Paredes, R .; Lalama, C .; Ribaudo, J ;; et al. "Kusiyana kwa mankhwala omwe ali ndi kachilombo koyambitsa matendawa, koyambirira, komanso chiopsezo cha mankhwala osokoneza bongo." Journal of Infectious Diseases . March 2010; 201 (5): 662-671.
> 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.
> Hammer, S .; Vaida, F .; Bennett, K ;; et al. "Kulimbana ndi kachilombo ka HIV kamodzi kokha kamodzi kokha kamene kachilombo ka HIV katayika: kuyesedwa kosavuta." Journal of the American Medical Association (JAMA) . July 10, 2002; 288 (2): 169-180.
> Gazzola, L .; Tincati, C ;; Bellistri, G ;; et al. "Kupezeka kwa CD4 + T selo kumapulumutsidwa ngakhale atalandira kachilombo koyambitsa antiretroviral (virologically suppressive) yogwira ntchito: chiopsezo chachipatala, mipata ya immunological, ndi njira zothandizira." Matenda opatsirana pogonana. February 2009; 48 (3): 328-337.