Mosasamala kanthu, Kuwonjezeka kwa Akazi omwe ali ndi kachilombo ka HIV sanasinthe
Anthu omwe ali ndi kachilombo ka HIV ali ndi chiopsezo chachikulu chokhala ndi khansa zina, zomwe zingathe kuwerengedwa ngati zizindikiro za AIDS. Zina mwazo ndi khansa yapachiberekero yoopsa (ICC), siteji ya matenda yomwe khansayo imafalikira pamtunda wa chiberekero mpaka kumatenda akuluakulu a chiberekero ndi mbali zina za thupi.
Ngakhale kuti ICC ikhoza kukhala ndi kachirombo ka HIV ndi amayi omwe alibe kachilomboka, chiwerengero cha amayi omwe ali ndi kachirombo ka HIV kangakhale kakang'ono kwambiri kuposa kasanu ndi kawiri.
Kwa amayi omwe ali ndi kachilombo ka HIV, chiwopsezo cha ICC chimawonjezeka ndi kuchepa kwa chiwerengero cha CD4 , ndi kuwonjezeka kwa kasanu ndi kamodzi kwa amayi omwe ali ndi ma CD4 pansi pa 200 maselo / mL poyerekeza ndi omwe ali ndi CD4 chiwerengero cha ma cell 500 / mL.
Za Khansa ya Chiberekero
Mankhwala a papillomavirus (HPV) amaonedwa kuti ndi ofunikira kupanga khansara ya khola lachiberekero, kuwerengera pafupifupi zochitika zonse zolembedwa. Monga mapulogalamu onse a papillomaviruses, HPV imayambitsa matenda m'maselo ena a khungu komanso mu membranes, omwe ambiri amakhala opanda vuto.
Pafupifupi 40 mitundu ya HPV yomwe imadziwika kuti ikugwiritsidwa ntchito mogonana komanso imayambitsa matenda opatsirana pogonana ndi maonekedwe, nthawi zina amawoneka ngati ziphuphu. Mwa izi, mitundu 15 "yoopsa kwambiri" ingayambitse kukhala ndi zilonda zam'tsogolo. Ngati sanatengedwe, zilonda zam'mimba zimatha kupita ku khansara ya chiberekero. Matendawa amayamba kuchepa, kutenga zaka zisanachitike zizindikiro zooneka. Komabe, mwa omwe ali ndi ma chitetezo a chitetezo chamthupi (CD4 osachepera 200 maselo / ml), chiwerengerocho chikhoza kukhala mofulumira kwambiri.
Kuzindikira koyambirira mwa njira yozoloŵera kuwonetsetsa kwa mapepala kumapangitsa kuti matenda a khansa yapachibelekero ayambe kuchepa, pomwe chitukuko cha katemera wa HPV chawathandiza kuchepetsa kuchepa kwakuteteza mitundu yowopsa kwambiri yomwe imayanjanitsidwa ndi 75 peresenti ya khansa ya pachibelekero.
Kuwerengeka kwa HPV pakati pa amayi ku US ndi 26,8 peresenti pamene 3,4 peresenti ali ndi kachilombo ka HPV kazaka 16 ndi 18, zomwe zimawerengetsa 65% za khansa ya pachibelekero.
Khansara ya Chiberekero mwa Akazi omwe ali ndi HIV
Ngakhale izi zikupita patsogolo, khansara ya chiberekero imakali ngati khansa yachiwiri yomwe imafala kwambiri pakati pa akazi padziko lonse, yomwe imawerengera pafupifupi 225,000 chaka chilichonse. Ngakhale kuti ambiri amapezeka m'mayiko akutukuka (chifukwa cha kufooka kwa mapepala a katemera ndi katemera wa HPV), khansara ya chiberekero ikuwerengera anthu pafupifupi 4,000 ku US chaka chilichonse.
Zambiri zokhudzana ndi chiwerengero cha khansa ya chiberekero pakati pa amayi omwe ali ndi kachilombo ka HIV sanasinthe kuyambira poyambitsa antiretroviral (ART) kumapeto kwa zaka za m'ma 1990. Izi zikusiyana kwambiri ndi Kaposi's sarcoma ndi non-Hodgkin lymphoma, zomwe zimafotokozera za AIDS zomwe zatsika ndi 50 peresenti panthawi yomweyi.
Ngakhale zifukwa za izi sizikumveka bwino, kafukufuku wochepa koma wofunikira wa Fox Chase Cancer Center ku Philadelphia akusonyeza kuti amayi omwe ali ndi kachilombo ka HIV sangapindule ndi katemera wa HPV omwe amagwiritsidwa ntchito kuti asatengere mavitamini awiri (mitundu 16 ndi 18). Pakati pa amayi omwe ali ndi kachilombo ka HIV, mitundu 52 ndi 58 inkawoneka kawirikawiri, zomwe zonsezi zimawoneka kuti ndizowopsa kwambiri ndipo sizikutheka ndi zosankha zamakono.
Zizindikiro za khansa ya m'mimba
Nthawi zambiri zimakhala zizindikiro zochepa kwambiri m'mayambiriro a khansa ya chiberekero .
Ndipotu, panthawi yomwe magazi amagazi ndi / kapena kukhudzana ndi magazi amapezeka-zizindikiro ziwiri zomwe zimadziwikiratu kawirikawiri-chiwonongeko chimatha kale. Nthawi zina, pangakhale pathupi, kumaliseche, kupweteka kwa m'mimba, kupweteka kwa m'mimba, ndi ululu panthawi yogonana.
Kulimbana ndi matenda, kuthamanga kwa magazi kumimba, kupweteka kwa thupi, kupweteka kwa mtima, kutopa, kusowa kwa kudya, ndi kupuma kwa mafupa ndizo zizindikiro zomwe zimatchulidwa kawirikawiri.
Kuzindikira kwa Khansa ya Chiberekero
Ngakhale kuti mayeso a Pap smear akulimbikitsidwa kuti awonetseredwe, malingaliro olakwika angakhale oposa 50%. Chitsimikizo cha khansara ya chiberekero kapena chiberekero cha dysplasia (chitukuko chosadziwika cha maselo chikhomo cha khola lachiberekero) chimafuna chidziwitso cha kafukufuku ndi wochizira matenda.
Ngati chiberekero cha dervous dysplasia chikutsimikiziridwa, chimagawidwa motsatira kukula kwake . Mapuloteni a Pap angapangidwe kuchokera ku ASCUS (maselo osadziwika bwino omwe sadziwika kwenikweni) kwa LSIL (kutsika kochepa kwambiri m'mimba mwachisawawa ) ku HSIL ( kuthamanga kwapamwamba kwambiri kwa intraepithelial lesion). Maselo amtundu kapena minofu amafanana nawo ngati ofatsa, oyenera kapena ovuta.
Ngati pali chitsimikizo chodziwika bwino, chigawidwa ndi nthendayi ya matenda pogwiritsa ntchito kafukufuku wodwala wodwalayo, kuyambira pa Gawo 0 mpaka Gawo IV motere:
- Gawo 0: Katemera mu situ (chiwonongeko chomwe sichinafalikire)
- Gawo Woyamba: Khansara ya chiberekero yomwe yakula mu chiberekero, koma siifala kupitirira
- Gawo lachiwiri: Khansara ya chiberekero yomwe yafalikira, koma osati kupyola m'makoma a pelvis kapena m'mimba mwace
- Gawo lachitatu: Khansara ya chiberekero yomwe yafalikira kupyola pamapanda a m'mimba kapena kuchepa kwa mkazi, kapena imachititsa kuti hydronephrosis (kuphatikiza mkodzo mu impso chifukwa cholepheretsa ureter) kapena kusagwira ntchito kwa impso
- Gawo lachinayi: Khansara ya chiberekero yomwe imafalikira kupyola m'mimba mwapafupi ndi ziwalo zakutali kapena kutali, kapena ikuphatikizapo minofu ya chikhodzodzo kapena chikhodzodzo
Kuchiza kwa Khansa ya Chiberekero
Chithandizo cha khansa yoyamba kapena khansa ya chiberekero imatsimikiziridwa kwambiri ndi kuika kapena kuyika kwa matendawa. Amayi ambiri omwe ali ndi dysplasia wochepa (otsika kwambiri) adzasinthidwa modzidzimutsa wodwalayo popanda kuchipatala, kumafuna kufufuza nthawi zonse.
Kwa omwe dysplasia ikupita, chithandizo chingayesedwe. Izi zikhoza kutenga maonekedwe a maselo a electrocautery, laser, kapena cryotherapy (kuzizira kwa maselo); kapena pogwiritsa ntchito resection (kuchotsa) maselo kupyolera muzitsulo zamagetsi (zomwe zimatchedwanso kuti kuyendetsa magetsi nthawi yaitali, kapena LEEP ) kapena kugwiritsira ntchito (conical biopsy of tishu).
Chithandizo cha khansara ya khola lachilombo chikhoza kusiyana ngakhale kuti chigogomezero chachikulu chikugwiritsidwa ntchito pa kubereka-kuteteza mankhwala. Chithandizo chingatenge mawonekedwe a chimodzi kapena zingapo zotsatirazi, chifukwa cha kuopsa kwa matendawa:
- chemotherapy
- chithandizo cha ma radiation
- Njira zothandizira opaleshoni, kuphatikizapo LEEP, conization, hysterectomy (kuchotsa chiberekero), kapena trachelectomy (kuchotsedwa kwa chiberekero pamene kusunga chiberekero ndi mazira.
Kawirikawiri, 35% ya amayi omwe ali ndi khansara ya khola la chiberekero adzabwezeretsanso pambuyo pa chithandizo.
Ponena za kufa, chiwerengero cha kupulumuka chimayambira pa siteji ya matenda panthawi yomwe akudziŵa. Kawirikawiri, akazi omwe amapezeka kuti ali pa Gawo 0 ali ndi mwayi wopulumuka, koma amayi omwe ali pa Gawo la IV ali ndi zaka 16 peresenti.
Kupewa Khansara ya Chiberekero
Zochitika zachiwerewere zotetezeka, kugonana kwa pap smear, ndi katemera wa HPV amadziwika kuti njira zitatu zoyenera zothandizira khansa yapachilombo. Kuwonjezera pamenepo, kuyambitsidwa kwa ART nthawi yayitali ndikofunika kwambiri kuti kuchepetsa chiopsezo cha ICC kwa amayi omwe ali ndi HIV.
Maofesi a US Prestective Services (USPSTF) akuyamikira mapulogalamu a Pap apatha zaka zitatu kwa amayi a zaka zapakati pa 21 ndi 65, kapena zaka zisanu zilizonse kwa amayi a zaka zapakati pa makumi atatu ndi zisanu ndi zisanu ndi zisanu ndi zisanu ndi zisanu ndi zisanu ndi zitatu (65) kuphatikizapo kuyesedwa kwa HPV .
Pakali pano, katemera wa HPV pakalipano akulimbikitsidwa kwa mtsikana aliyense kapena mtsikana yemwe wagonana naye. Komiti Yopereka Malangizo Odziteteza Kudzitemera (ACIP) imapereka chithandizo chamatenda kwa atsikana a zaka 11 mpaka 12, komanso amayi omwe ali ndi zaka makumi awiri ndi zisanu ndi ziwiri (26) omwe sanakhalepo kapena kutsiriza katemera.
Katemera awiri amavomerezedwa kuti agwiritsidwe ntchito: katemera wotchedwa quadrivalent umene ungalepheretse mitundu 6, 11, 16 ndi 18 (Gardasil) ndi katemera wa bivalent omwe angateteze ku mitundu 16 ndi 18 (Cervarix). Aliyense amafunika mndandanda wa ma shoti atatu operekedwa kwa miyezi isanu ndi umodzi.
Ngakhale kuti katemera sungakhoze kuteteza mitundu yonse ya HPV, ofufuza a Fox Chase Cancer Center amatsimikizira kuti amayi omwe ali ndi kachilombo ka HIV pa ART sakuwoneka kuti ali ndi kachilombo koopsa kwambiri ka HPV 52 ndi 58 kusiyana ndi anzawo omwe sanamvere. Izi zimatsitsimutsa mfundo yakuti ART yoyambirira ndi yofunika kwambiri popewera khansa yokhudzana ndi HIV ndi anthu omwe alibe kachirombo ka HIV mwa anthu omwe ali ndi HIV.
Zochitika zamtsogolo zamtsogolo ndi njira
Ponena za njira zopangira njira, kafukufuku waposachedwapa wanena kuti mankhwala omwe amatchulidwa kawirikawiri omwe amatchedwa antiretroviral mankhwala, lopinavir (omwe amapezeka mu mankhwala osokoneza bongo a Kaletra), amatha kuteteza kapena kutembenuzira ngakhale mankhwala apamwamba a dervous dysplasia. Zotsatira zoyambirira zinasonyeza kuchuluka kwa mphamvu zowonjezereka pamene ataperekedwa mwamsanga pafupipafupi kawiri-tsiku tsiku lililonse kwa miyezi itatu.
Ngati zotsatira zikhoza kutsimikiziridwa, amayi akhoza tsiku limodzi kuti athe kuchiza khansa yapachilombo kunyumba, pomwe iwo omwe ali ndi kachirombo ka HIV amatha kuteteza kachilombo ka HIV kukhala gawo la ART.
Zotsatira:
Abraham, A .; D'Souza, G ;; Jing, Y ;; et al. "Chiopsezo cha khansa yapachibelekero chotheka pakati pa amayi omwe ali ndi HIV: mgwirizano wa North America multicohort." Journal of Deficiency Immune Deficiency Syndromes. April 1, 2013; 62 (4): 405-413.
Adler, D. "Mmene HIV imakhudzira matenda a chiberekero." Kafukufuku wamakono wa HIV. October 8, 2010; 8 (7): 493-7.
Amayi, D .; Blackman, E .; Butler, R .; et al. "Matenda Oopsa a Kervical Human Papillomavirus pakati pa Azimayi Oyenera Kukhala ndi Mavitamini a Anthu ku Bahamas." PLoS | Mmodzi. January 23, 2014; 9 (1): e85429. lembani: 10.1371.
Gulu la Ntchito Yothandizira ku United States (USPSTF). "Zokambirana Zogwira Ntchito Zogwira Ntchito ku United States Zotsatira Zatsopano za Khansa ya Chiberekero: Umboni umasonyeza kuti kuyeretsa khansa ndi kotheka." Rockville, Maryland; inatulutsidwa pa March 15, 2013.
Maofesi a Kuletsa ndi Kuteteza Matenda (CDC). "Katemera wotchedwa Quadrivalent Human Papillomavirus Vaccine: Malangizo a Advisory Council on Practices Practices (ACIP)." Kukonzekera Kwachisawawa ndi Kufa Sabata Lamlungu (MMWR). March 23, 2007; 56 (RR02) .1-24.