Ingxelo malunga nenkqubela phambili ye-HIV: Ngaba sikufutshane kunyango?

Umxholo

• Ugonyo
• Uthintelo olusisiseko
• I-pre-exposure prophylaxis (PrEP)
• Ipost-exposure prophylaxis (PEP)
• Ukuxilongwa ngokufanelekileyo
• Amanyathelo onyango
• Ukungafumaneki kulingana nokungenakuthunyelwa
• Iimbalasane kuphando
• Inaliti yenyanga
• Ukujolisa kumachibi e-HIV
• Ukuqhekeza intsholongwane kagawulayo
• ‘Umsebenzi uphilisiwe’
• Apho sikhona ngoku

Ushwankathelo

INTSHOLONGWANE KAGAWULAYO ​​iwenza buthathaka amajoni omzimba kwaye ithintela amandla omzimba okulwa izifo. Ngaphandle konyango, i-HIV inokukhokelela kwinqanaba le-3 le-HIV, okanye i-AIDS.

Ubhubhane onguGawulayo waqala eMelika ngeminyaka yoo-1980. Uqikelelo olungaphezulu kwezigidi ezingama-35 zabantu abasweleke ngenxa yale meko.

Okwangoku alukho unyango lwe-HIV, kodwa izifundo ezininzi zeklinikhi zinikezelwe kuphando lwonyango. Unyango lwangoku lwe-antiretroviral luvumela abantu abaphila ne-HIV ukuba bathintele ukuqhubela phambili kwayo kwaye baphile ubomi obuqhelekileyo.

Amanyathelo amakhulu enziwe kuthintelo kunye nonyango lwe-HIV, ngenxa:

• izazinzulu
• amagosa ezempilo oluntu
• iiarhente zikarhulumente
• imibutho yasekuhlaleni
• Amatshantliziyo e-HIV
• iinkampani ezixuba amayeza

Ugonyo

Ukuphuhliswa kwesitofu sokuthintela i-HIV kungasindisa ubomi bezigidi. Nangona kunjalo, abaphandi abakafumani isitofu esisebenzayo se-HIV. Ngo-2009, uphando olwapapashwa kwiJenaliya yeVirology lwafumanisa ukuba iyeza lokulinga lithintela malunga neepesenti ezingama-31 zamatyala amatsha. Uphando olongezelelekileyo lwamiswa ngenxa yomngcipheko oyingozi. Ekuqaleni kuka-2013, i-National Institute of Allergy and Infectious Diseases yamisa uvavanyo lwezonyango olwaluvavanya inaliti yesitofu se-HVTN 505. Idatha esuka kulingo ibonise ukuba isitofu asithinteli ukuhanjiswa kwe-HIV okanye sinciphise inani le-HIV egazini. Uphando kwizitofu zokugonya luyaqhubeka kwihlabathi liphela. Rhoqo ngonyaka kukho izinto ezintsha ezifunyanisiweyo. Kwi-2019, babhengeze ukuba bayakuphuhlisa unyango oluthembisayo oluvumela ukuba:

1. injineli yeeseli ezithile zomzimba wokuzikhusela kwi-HIV kwiiseli eziqukethe i-HIV engasebenziyo, okanye efihlakeleyo
2. sebenzisa enye iseti yeeseli zomzimba zomzimba ukuba zihlasele kwaye zisuse iiseli ezine-HIV

Iziphumo zabo zingabonelela ngesiseko sokugonya i-HIV. Uvavanyo lwezonyango lusemsebenzini.

Uthintelo olusisiseko

Nangona ingekabikho isitofu sokugonya se-HIV okwangoku, zikho ezinye iindlela zokukhusela ekusasazeni usulelo. Intsholongwane kaGawulayo isasazeka ngokutshintshiselana ngeencindi zomzimba. Oku kunokwenzeka ngeendlela ezahlukeneyo, kubandakanya:

• Ukuqhagamshelana ngesondo. Ngexesha lokudibana ngokwesondo, i-HIV inokusasazeka ngokutshintshana kolwelo oluthile. Babandakanya igazi, amadlozi, okanye imfihlo kunye nelungu lobufazi. Ukuba nezinye izifo ezosulela ngokwabelana ngesondo kunokunyusa umngcipheko wokosulela nge-HIV ngexesha lokwabelana ngesondo.
• Iinaliti kunye neesirinji ekwabelwana ngazo. Iinaliti kunye neesirinji ezisetyenziswe ngumntu one-HIV zinokuba nale ntsholongwane, nokuba akukho gazi libonakalayo kuyo.
• Ukukhulelwa, ukuhanjiswa, kunye nokuncancisa. Oomama abane-HIV bangayidlulisela le ntsholongwane ebantwaneni babo ngaphambi nasemva kokuzalwa. Kwiimeko apho kusetyenziswa amayeza e-HIV, oku kunqabile kakhulu.

Ukuthatha amanyathelo okhuseleko athile kunokukhusela umntu ekufumaneni i-HIV:

• Vavanyelwa i-HIV. Buza amaqabane ezesondo ngesimo sawo phambi kokuba wabelane ngesondo.
• Vavanywa kwaye unyangelwe ii-STIs. Cela abantu owabelana nabo ngesondo ukuba benze okufanayo.
• Xa usabelana ngesondo ngomlomo, kwilungu lobufazi, kunye nelwini, sebenzisa indlela yokuthintela iikhondom ngalo lonke ixesha (kwaye uyisebenzise ngokuchanekileyo).
• Ukuba utofa iziyobisi, qiniseka ukusebenzisa inaliti entsha, engenazintsholongwane engakhange isetyenziswe ngomnye umntu.

I-pre-exposure prophylaxis (PrEP)

I-Pre-exposure prophylaxis (PrEP) lunyango olusetyenziswa ngabantu abangenayo i-HIV ukwehlisa amathuba okuba bafumane i-HIV, ukuba bathe bavezwa. Iyasebenza kakhulu ekuthinteleni ukuhanjiswa kwe-HIV kwabo banemingcipheko eyaziwayo. Abantu abasengozini kubandakanya:

• amadoda abelana ngesondo kunye namadoda, ukuba baye babelana ngesondo ezimpundwini ngaphandle kokusebenzisa ikhondom okanye babene STI kwezi nyanga zintandathu zidlulileyo
• amadoda okanye abasetyhini abangasebenzisi ndlela isithintelo njengeikhondom rhoqo kwaye banamaqabane nomngcipheko owandayo we-HIV okanye imeko engaziwayo ye-HIV
• Nabani na owabelana ngeenaliti okanye osebenzise iziyobisi kwiinyanga ezintandathu ezidlulileyo
• abasetyhini abacinga ukukhulelwa nabalingane abane-HIV

Ngokwe-PrEP, ungawunciphisa umngcipheko wokosulelwa yi-HIV ngokwesondo malunga neepesenti ezingama-99 kubantu abanemingcipheko eyaziwayo ye-HIV. Ukuze i-PrEP isebenze, kufuneka ithathwe yonke imihla kwaye ngokungaguquguqukiyo. Wonke umntu osemngciphekweni wentsholongwane kaGawulayo kufuneka aqale irejimeni yePrEP, ngokwesindululo sakutsha nje esivela kwi-US Preventive Services Task Force.

Ipost-exposure prophylaxis (PEP)

I-post-exposure prophylaxis (PEP) yindibaniselwano yamachiza ee-antiretroviral kaxakeka. Isetyenziswa emva kokuba umntu esenokuvezwa yi-HIV. Ababoneleli ngezempilo banokucebisa i-PEP kwezi meko zilandelayo:

• Umntu ucinga ukuba babekhe babhencwa kwi-HIV ngexesha lokwabelana ngesondo (umzekelo, ikhondom yaphuka okanye khange kusetyenziswe khondom).
• Umntu uye wabelana ngeenaliti xa etofa iziyobisi.
• Umntu uye wahlaselwa ngokwesondo.

I-PEP kufuneka isetyenziswe kuphela njengendlela yothintelo olungxamisekileyo. Kufuneka iqalwe kwisithuba seeyure ezingama-72 zokuvezwa kwe-HIV. Ngokufanelekileyo, i-PEP iqalwa ngokusondeleyo kwixesha lokuvezwa kangangoko kunokwenzeka. I-PEP ihlala ibandakanya inyanga yokubambelela kunyango lwe-antiretroviral.

Ukuxilongwa ngokufanelekileyo

Ukuchonga i-HIV ne-AIDS linyathelo elibalulekileyo ekuthinteleni ukosuleleka yi-HIV. Ngokwe-UNAIDS, icandelo leZizwe eziManyeneyo (i-UN), malunga neepesenti ezingama-25 zabantu abane-HIV kwihlabathi jikelele abayazi imeko yabo ye-HIV. Kukho uvavanyo lwegazi olwahlukeneyo olunokuthi lubonelelwe ngababoneleli bokhathalelo lwe-HIV. Ukuzivavanya i-HIV kuvumela abantu ukuba bavavanye amathe abo okanye igazi kwindawo yabucala kwaye bafumane iziphumo ngaphakathi kwemizuzu engama-20 okanye ngaphantsi.

Amanyathelo onyango

Ndiyabulela kwinkqubela phambili kwisayensi, i-HIV ithathwa njengesifo esingapheliyo esilawulwayo. Unyango lwe-antiretroviral luvumela abantu abaphila ne-HIV ukuba bagcine impilo yabo. Ikwanciphisa nomngcipheko wokuhambisa le ntsholongwane kwabanye. Phantse iipesenti ezingama-59 zabo bonke abantu abane-HIV bafumana uhlobo oluthile lonyango, ngokwe-UNAIDS. Amayeza asetyenziselwa ukunyanga i-HIV enza izinto ezimbini:

• Ukunciphisa umthamo wentsholongwane. Umthamo wentsholongwane ngumlinganiselo wenani le-HIV RNA egazini. Injongo yonyango lwe-HIV ye-antiretroviral ukunciphisa intsholongwane iye kwinqanaba elingabonakaliyo.
• Vumela umzimba ukuba ubuyisele ubalo lwamajoni ayo e-CD4 kwesiqhelo. Iiseli ze-CD4 zinoxanduva lokukhusela umzimba kwizifo ezinokubangela i-HIV.

Zininzi iintlobo zamachiza e-HIV:

• I-non-nucleoside reverse transcriptase inhibitors (ii-NNRTIs) khubaza iprotein esetyenziswa yi-HIV ukwenza iikopi zemfuzo yazo kwiiseli.
• I-Nucleoside reverse transcriptase inhibitors (i-NRTIs) nika i-HIV iibhloko zokwakha ezingalunganga ukuze ingabinakho ukwenza iikopi zezinto zayo zofuzo kwiiseli.
• Iprotease inhibitors khubaza i-enzyme efuna ukuba i-HIV yenze iikopi zayo.
• Ukungena okanye i-fusion inhibitors thintela i-HIV ekungeneni kwiiseli ze-CD4.
• Ukudibanisa inhibitors thintela imisebenzi yokudibanisa. Ngaphandle kwale enzyme, i-HIV ayinakuzifaka kwi-CD4 yeseli ye-CD4.

Iziyobisi ze-HIV zihlala zithathwa ngokudityaniswa okuthile ukuthintela ukukhula kokuchasana neziyobisi. Amachiza e-HIV kufuneka athathwe ngokungaguquguqukiyo ukuze asebenze. Umntu one-HIV kufuneka athethe nomboneleli wezempilo phambi kokuba acinge ngokutshintsha amayeza ukunciphisa iziphumo ebezingalindelekanga okanye ngenxa yokusilela kunyango.

Ukungafumaneki kulingana nokungenakuthunyelwa

Uphando lubonakalisile ukuba ukufezekisa kunye nokugcina umthamo wentsholongwane ongafumanekiyo ngonyango lwe-antiretroviral kususa umngcipheko wokudlulisela i-HIV kwiqabane elabelana ngesondo. Izifundo ezikhulu azifumananga zimo zosasazo lwe-HIV zisuka kwi-virally suppressed (engabonakaliyo yomthamo wentsholongwane egazini) iqabane eline-HIV ukuya kwiqabane elingenayo i-HIV. Ezi zifundo zilandele amawaka abantu abatshatileyo abakwiminyaka eliqela. Kwakukho amawaka eziganeko zesini ngaphandle kweekhondom. Ngokwazi ukuba U = U ("ayibonakali = ayidluliswanga") iza kugxininisa ngakumbi "kunyango njengothintelo (TasP)." I-UNAIDS ine “90-90-90” ngenjongo yokuphelisa ubhubhane onguGawulayo. Ngo-2020, esi sicwangciso sijolise:

• Iipesenti ezingama-90 zabo bonke abantu abaphila nentsholongwane kaGawulayo bayasazi isimo sabo
• Iipesenti ezingama-90 zabo bonke abantu abafunyaniswe ukuba banentsholongwane kaGawulayo bakumachiza ee-antiretroviral
• Iipesenti ezingama-90 zabo bonke abantu abafumana unyango lwe-antiretroviral ukuba bacinezelwe

Iimbalasane kuphando

Abaphandi basebenza nzima bekhangela amachiza amatsha kunye nonyango lwe-HIV. Bazimisele ukufumana unyango olwandisa kunye nokuphucula umgangatho wobomi kubantu abanale meko. Ukongeza, banethemba lokuvelisa isitofu sokugonya kwaye bafumane unyango lwe-HIV. Nanku ukujonga ngokufutshane kwiindlela ezininzi zophando.

Inaliti yenyanga

Inaliti ye-HIV yenyanga icwangciselwe ukuba ifumaneke ekuqaleni kuka-2020. Idibanisa amachiza amabini: i-integrase inhibitor cabotegravir kunye ne-NNRTI rilpivirine (Edurant). Izifundo zonyango zaye zafumanisa ukuba inaliti yenyanga yayisebenza ekucinezeleni i-HIV njengerejimeni yonyango lwemihla ngemihla.

Ukujolisa kumachibi e-HIV

Inxalenye yento eyenza ukufumanisa ukuba unyango lwe-HIV kunzima kukuba amajoni omzimba anengxaki yokujolisa kwizisele ezinesifo se-HIV. Amajoni omzimba awanakho ukuziqonda iiseli ezine-HIV okanye aziphelise iiseli ezivelisa intsholongwane. Unyango nge-antiretroviral aluyiphelisi indawo yokugcina i-HIV. baphonononga iindlela ezimbini ezahlukeneyo zokunyanga i-HIV, zombini ezinokuthi zitshabalalise iindawo zokugcina i-HIV:

• Unyango olusebenzayo. Olu hlobo lonyango luya kulawula ukuphindaphinda kwe-HIV xa kungekho nonyango lwe-antiretroviral.
• Unyango lokubulala iintsholongwane. Olu hlobo lonyango luya kuyiphelisa ngokupheleleyo intsholongwane ekwaziyo ukuyiphindaphinda.

Ukuqhekeza intsholongwane kagawulayo

Abaphandi kwiYunivesithi yase-Illinois e-Urbana-Champaign basebenzise ukulinganisa kweekhompyuter ukufundisisa i-HIV capsid. I-capsid sisiqulatho semathiriyeli yemfuza yentsholongwane. Ikhusela intsholongwane ekutshatyalalisweni ngamajoni omzimba. Ukuqonda ukwenziwa kwe-capsid kunye nendlela enxibelelana ngayo nokusingqongileyo kunokunceda abaphandi bafumane indlela yokuyivula. Ukophula i-capsid kunokukhupha izinto zemvelo ze-HIV emzimbeni apho zinokutshatyalaliswa ngamajoni omzimba. Ngumda othembisayo kunyango lwe-HIV kunye nonyango.

‘Umsebenzi uphilisiwe’

UTimothy Ray Brown, waseMelika owayehlala eBerlin, wafumana uxilongo lwe-HIV ngo-1995 kunye noxilongo lwe-leukemia ngo-2006. Ngomnye wabantu ababini ekuthiwa "sisigulana saseBerlin." Ngo-2007, uBrown wafumana ukufakelwa kweseli ye-stem ukunyanga i-leukemia-kwaye wayeka unyango lwe-antiretroviral. Intsholongwane kaGawulayo kuye ukusukela oko kwenziwa. Uphononongo lwamalungu amaninzi omzimba wakhe kwiYunivesithi yaseCalifornia, eSan Francisco luye lwabonisa ukuba akanasifo sikagawulayo. Uthathelwa ingqalelo "ngokunyanga ngokufanelekileyo," ngokophando olupapashwe kwi-PLOS Pathogens. Ungumntu wokuqala ukunyangwa i-HIV. Ngo-Matshi 2019, kwenziwa uphando esidlangalaleni ngamanye amadoda amabini awayefumene isifo esine-HIV kunye nomhlaza. NjengoBrown, omabini la madoda afumene ukufakelwa kweeseli zokunyanga umhlaza. Omabini la madoda ayekile unyango lwe-antiretroviral emva kokufumana ukufakelwa kwawo. Ngeli xesha uphando lwalunikezelwa, "isigulana saseLondon" sikwazile ukuhlala kuxolelo lwe-HIV iinyanga ezili-18 kunye nokubala. "Isigulana saseDusseldorf" sikwazile ukuhlala kuxolelo lwe-HIV iinyanga ezintathu ezinesiqingatha kunye nokubala.

Apho sikhona ngoku

Abaphandi babengayiqondi kakuhle i-HIV kwiminyaka engama-30 eyadlulayo, singasathethi ke ngendlela yokuyinyanga okanye ukuyinyanga. Kule minyaka ingamashumi, inkqubela phambili kwezobuchwephesha kunye namandla kwezonyango kuzise unyango lwe-HIV oluphambili. Unyango lwe-antiretroviral oluyimpumelelo ngoku lunokumisa ukuqhubela phambili kwe-HIV kunye nokunciphisa umthamo wentsholongwane yomntu kumanqanaba angabonakaliyo. Ukuba nomthamo wentsholongwane ongabonakaliyo awuphuculi kuphela impilo yomntu one-HIV, kodwa kuphelisa umngcipheko wokuhambisa i-HIV kwiqabane elabelana ngesondo nalo. Ukunyanga okujolise kwiziyobisi kunokuthintela abantu abakhulelweyo abane-HIV ekubeni bayidlulisele intsholongwane ebantwaneni babo. Unyaka ngamnye, iimvavanyo ezininzi zeklinikhi zijolise ekufumaneni unyango olungcono lwe-HIV ngethemba lokuba ngenye imini luya kufumana unyango. Ngolu nyango lutsha kuza iindlela ezingcono zokuthintela ukosulelwa yi-HIV. Funda eli nqaku ngeSpanish.