Inguquko kunyango lwe-HIV

Umxholo

• Zisebenza njani iziyobisi ze-HIV
• Iindidi zamachiza ee-antiretroviral
• I-Nucleoside / i-nucleotide reverse transcriptase inhibitors (i-NRTIs)
• Hlanganisa ii-inhibitors zokudlulisa umtya (i-INSTIs)
• Iprotease inhibitors (ii-PIs)
• I-non-nucleoside reverse transcriptase inhibitors (ii-NNRTIs)
• Ukungena kwi-inhibitors
• Unyango nge-antiretroviral
• Unamathelo ngundoqo
  
• Iipilisi zokudibanisa
• Iziyobisi kufutshane

Ushwankathelo

Iminyaka engamashumi amathathu eyadlulayo, ababoneleli bezempilo babengenazo iindaba ezikhuthazayo zokuba banike abantu abafumene ukuxilongwa kwe-HIV. Namhlanje, yimeko yezempilo elawulekayo.

Akukabikho nyango lwe-HIV okanye lwe-AIDS okwangoku. Nangona kunjalo, inkqubela phambili ephawulekayo kunyango kunye nokuqonda kweklinikhi malunga nendlela i-HIV eqhubela phambili ngayo ivumela abantu abane-HIV ukuba baphile ixesha elide, ubomi obupheleleyo.

Makhe sijonge ukuba luphi unyango lwe-HIV namhlanje, iziphumo zonyango lutsha olunazo, kwaye nalapho unyango lunokukhokelela khona kwixa elizayo.

Zisebenza njani iziyobisi ze-HIV

Olona nyango luphambili lwe-HIV namhlanje ngamachiza ee-antiretroviral. La machiza akayinyangi i-HIV. Endaweni yoko bayayicinezela intsholongwane kwaye bacothise ukukhula kwayo emzimbeni. Nangona bengayiphelisi i-HIV emzimbeni, banokuyicinezela kwinqanaba elingafumanekiyo kwiimeko ezininzi.

Ukuba iyeza le-antiretroviral liphumelele, linokongeza iminyaka emininzi esempilweni, nenemveliso ebomini bomntu kwaye linciphise umngcipheko wokudluliselwa kwabanye.

Iindidi zamachiza ee-antiretroviral

Unyango oluqhele ukumiselwa kubantu abaqala unyango lwe-antiretroviral lungahlulwa lube ziindidi ezintlanu zamachiza:

• i-nucleoside / i-nucleotide reverse transcriptase inhibitors (i-NRTIs)
• ukudibanisa ii-inhibitors zokudlulisa umtya (i-INSTI)
• Iprotease inhibitors (PIs)
• i-non-nucleoside reverse transcriptase inhibitors (ii-NNRTIs)
• izithinteli zokungena

Amachiza adweliswe apha ngezantsi onke avunyiwe yi-Food and Drug Administration (FDA) ukunyanga i-HIV.

I-Nucleoside / i-nucleotide reverse transcriptase inhibitors (i-NRTIs)

Ii-NRTI zigcina iiseli ezosulelwe yi-HIV ekubeni zenze iikopi zazo ngokuphazamisa ukwakhiwa kwakhona kwetyathanga le-DNA yentsholongwane xa isebenzisa i-enzyme reverse transcriptase. Ii-NRTI zibandakanya:

• i-abacavir (ekhoyo njengechiza elizimeleyo iZiagen okanye njengenxalenye yamachiza amathathu ahlukeneyo okudibanisa)
• I-lamivudine (ekhoyo njengechiza elizimeleyo i-Epivir okanye njengenxalenye yeziyobisi ezisithoba zokudibanisa)
• i-emtricitabine (efumanekayo njengechiza elizimeleyo i-Emtriva okanye njengenxalenye yamachiza alithoba ahlanganisiweyo)
• i-zidovudine (efumaneka njengechiza elizimeleyo iRetrovir okanye njengenxalenye yamachiza amabini ahlukeneyo okudibanisa)
• i-tenofovir disoproxil fumarate (efumanekayo njengechiza elizimeleyo iViread okanye njengenxalenye yamachiza alithoba ahlanganisiweyo)
• i-tenofovir alafenamide fumarate (iyafumaneka njengechiza elizimeleyo iVemlidy okanye njengenxalenye yamayeza amahlanu ahlanganisiweyo)

I-Zidovudine ikwabizwa ngokuba yi-azidothymidine okanye i-AZT, kwaye yayilichiza lokuqala elamkelweyo yi-Food and Drug Administration (FDA) ukunyanga i-HIV. Kule mihla, kunokwenzeka kakhulu ukuba isetyenziswe njenge-post-exposure prophylaxis (PEP) yabantwana abasandul 'ukuzalwa abanomama abane-HIV kunonyango lwabantu abadala abane-HIV.

I-Tenofovir alafenamide fumarate isetyenziswa kwiipilisi zokudibanisa ezininzi ze-HIV. Njengechiza elizimeleyo, lifunyenwe kuphela imvume yokunyanga i-HIV. Iyeza elizimeleyo liye lavunywa yi-FDA ukunyanga usulelo olungapheliyo lwe-hepatitis B. Ezinye ii-NRTIs (emtricitabine, lamivudine, kunye ne-tenofovir disoproxil fumarate) zinokusetyenziselwa ukunyanga usulelo lwe-hepatitis B.

Ukudityaniswa kwee-NRTIs kubandakanya:

• abacavir, lamivudine, kunye ne-zidovudine (Trizivir)
• i-abacavir kunye ne-lamivudine (Epzicom)
• I-lamivudine kunye ne-zidovudine (Combivir)
• I-lamivudine kunye ne-tenofovir disoproxil fumarate (Cimduo, Temixys)
• Emtricitabine kunye ne-tenofovir disoproxil fumarate (Truvada)
• Emtricitabine kunye ne-tenofovir alafenamide fumarate (Descovy)

Ukongeza ekubeni isetyenziselwa ukunyanga i-HIV, i-Descovy kunye ne-Truvada inokusetyenziswa njengenxalenye yerejimeni yangaphambi kokuvezwa kweprophylaxis (PrEP).

Ukusukela ngo-2019, i-US Preventive Services Task Force icebisa irejimeni ye-PrEP yabo bonke abantu abangenayo i-HIV abasengozini yokosulelwa yi-HIV.

Hlanganisa ii-inhibitors zokudlulisa umtya (i-INSTIs)

Ii-INSTIs zikhubaza ukudityaniswa, i-enzyme esetyenziswa yi-HIV ukubeka i-HIV ye-HIV kwi-DNA yomntu ngaphakathi kweeseli ze-CD4 T. Ii-INSTI zezodidi lweziyobisi ezaziwa njenge-integrase inhibitors.

Ii-INSTI ngamachiza amiselweyo. Ezinye iindidi ze-integrase inhibitors, ezinje nge-integrase binding inhibitors (INBIs), zithathwa njengeziyobisi zovavanyo. Ii-INBI azifumananga kuvunywa yi-FDA.

Ii-INSTI zibandakanya:

• i-raltegravir (i-Isentress, i-Isentress HD)
• i-dolutegravir (ekhoyo njengechiza elizimeleyo iTivicay okanye njengenxalenye yamachiza amathathu ahlukeneyo okudibanisa)
• i-bictegravir (idityaniswe ne-emtricitabine kunye ne-tenofovir alafenamide fumarate kwichiza iBiktarvy)
• elvitegravir (idityaniswe necobicistat, emtricitabine, kunye ne-tenofovir alafenamide fumarate kwichiza iGenvoya, okanye ngecobicistat, emtricitabine, kunye ne-tenofovir disoproxil fumarate kwi-Stribild yeziyobisi)

Iprotease inhibitors (ii-PIs)

Ii-PIs zikhubaza iprotease, i-enzyme efunwa yi-HIV njengenxalenye yomjikelo wobomi bayo. Ii-PIs zibandakanya:

• i-atazanavir (iyafumaneka njengesiyobisi esizimeleyo iReyataz okanye idityaniswe necobicistat kwichiza iEvotaz)
• I-darunavir (ifumaneka njengesiyobisi esizimeleyo i-Prezista okanye njengenxalenye yamachiza amabini ahlukeneyo okudibanisa)
• ifosamprenavir (iLexiva)
• indinavir (iCrixivan)
• I-lopinavir (ifumaneka kuphela xa idityaniswe ne-ritonavir kwichiza le-Kaletra)
• nelfinavir (Intsholongwane)
• i-ritonavir (iyafumaneka njengechiza elizimeleyo iNorvir okanye idityaniswe ne-lopinavir kwichiza laseKalera)
• i-saquinavir (i-Invirase)
• I-tipranavir (iAptivus)

I-Ritonavir (iNorvir) ihlala isetyenziswa njengechiza lokunyanga amanye amayeza ee-antiretroviral.

Ngenxa yeziphumo ebezingalindelekanga, i-indinavir, i-nelfinavir, kunye ne-saquinavir kunqabile ukuba zisetyenziswe.

I-non-nucleoside reverse transcriptase inhibitors (ii-NNRTIs)

I-non-nucleoside reverse transcriptase inhibitors (NNRTIs) ithintela i-HIV ekubeni izenzele iikopi zayo ngokuzibophelela nokumisa i-enzyme reverse transcriptase. Ii-NNRTIs zibandakanya:

• i-efavirenz (ekhoyo njengechiza elizimeleyo iSustiva okanye njengenxalenye yamachiza amathathu ahlukeneyo okudibanisa)
• i-rilpivirine (ekhoyo njengechiza elizimeleyo i-Edurant okanye njengenxalenye yamachiza amathathu ahlukeneyo)
• I-etravirine (ukungabikho komzimba)
• I-doravirine (iyafumaneka njengechiza elizimeleyo iPifeltro okanye idityaniswe ne-lamivudine kunye ne-tenofovir disoproxil fumarate kwichiza iDelstrigo)
• nevirapine (Viramune, Viramune XR)

Ukungena kwi-inhibitors

Amangenelo okungenelela ludidi lwamachiza athintela i-HIV ekungeneni kwiiseli ze-CD4 T. Ezi zithintelo zibandakanya:

• I-enfuvirtide (Fuzeon), eyeklasi yeziyobisi eyaziwa ngokuba yi-fusion inhibitors
• i-maraviroc (i-Selzentry), yeklasi yeziyobisi eyaziwa njenge-chemokine coreceptor antagonists (CCR5 antagonists)
• ibalizumab-uiyk (Trogarzo), eyeyeklasi yeziyobisi eyaziwa njenge-post-attachment inhibitors

Ukungena kwi-inhibitors kunqabile ukuba kusetyenziswe njengonyango lodidi lokuqala.

Unyango nge-antiretroviral

INTSHOLONGWANE KAGAWULAYO ​​inokutshintsha kwaye inganyangeki kwelinye iyeza. Ke ngoko, uninzi lwabanikezeli bezempilo namhlanje bamisela amayeza aliqela e-HIV kunye.

Indibaniselwano yamachiza ee-antiretroviral amabini okanye nangaphezulu ibizwa ngokuba lonyango lwe-antiretroviral. Lunyango lokuqala olumiselweyo namhlanje kubantu abane-HIV.

Olu nyango lunamandla lwaziswa okokuqala ngo-1995. Ngenxa yonyango lwe-antiretroviral, ukusweleka okunxulumene noGawulayo e-United States kwehliswa ngama-47 eepesenti phakathi ko-1996 no-1997.

Ezona ndlela zixhaphakileyo namhlanje ziqulethe ii-NRTI ezimbini kunye ne-INSTI, i-NNRTI, okanye i-PI eyonyuswe nge-cobicistat (iTybost). Kukho idatha entsha exhasa ukusetyenziswa kwamachiza amabini kuphela, njenge-INSTI kunye ne-NRTI okanye i-INSTI kunye ne-NNRTI.

Inkqubela phambili kunyango yenza ukuba ukubambelela kwiziyobisi kube lula kakhulu. Le nkqubela phambili ilinciphisile inani leepilisi umntu amele azithathe. Bazinciphisile iziphumo ebezingalindelekanga kubantu abaninzi abasebenzisa amayeza ee-antiretroviral. Okokugqibela, inkqubela phambili ibandakanye ukuphucula iiprofayili zokunxibelelana neziyobisi.

Unamathelo ngundoqo

1. Ukunamathela kuthetha ukunamathela kwisicwangciso sonyango. Unamathelo lubalulekile kunyango lwe-HIV. Ukuba umntu oneNTSHOLONGWANE KAGAWULAYO ​​akawathathi amayeza abo njengoko kumiselwe, amayeza anokuyeka ukuwasebenzela kwaye intsholongwane ingaqala ukusasazeka emzimbeni wabo kwakhona. Ukunamathela kufuna ukuthatha yonke idosi, yonke imihla, njengoko kufanele ukwenziwa (umzekelo, kunye okanye ngaphandle kokutya, okanye ngokwahlukileyo kwamanye amayeza).

Iipilisi zokudibanisa

Inkqubela phambili ephambili eyenza ukubambelela kubelula kubantu abaphantsi konyango lwe-antiretroviral kukuphuhliswa kweepilisi zokudibanisa. La mayeza ngoku ngawona mayeza aqhelekileyo amiselweyo kubantu abane-HIV abangazange banyangwe ngaphambili.

Iipilisi zokudibanisa ziqulethe iziyobisi ezininzi ngaphakathi kwipilisi enye. Okwangoku, kukho iipilisi ezili-11 zokudibanisa eziqulethe amayeza amabini ee-antiretroviral. Zili-12 iipilisi zokudibanisa eziqulethe amachiza ee-antiretroviral amathathu okanye nangaphezulu:

• Atripla (efavirenz, emtricitabine, kunye ne-tenofovir disoproxil fumarate)
• Biktarvy (bictegravir, emtricitabine, kunye ne-tenofovir alafenamide fumarate)
• I-Cimduo (lamivudine kunye ne-tenofovir disoproxil fumarate)
• I-Combivir (lamivudine kunye ne-zidovudine)
• IComplera (emtricitabine, rilpivirine, kunye ne-tenofovir disoproxil fumarate)
• Delstrigo (doravirine, lamivudine, kunye ne-tenofovir disoproxil fumarate)
• Descovy (emtricitabine kunye ne-tenofovir alafenamide fumarate)
• I-Dovato (i-dolutegravir kunye ne-lamivudine)
• I-Epzicom (abacavir kunye ne-lamivudine)
• Evotaz (atazanavir kunye necobicistat)
• UGenvoya (elvitegravir, cobicistat, emtricitabine, kunye ne-tenofovir alafenamide fumarate)
• UJuluca (dolutegravir kunye ne-rilpivirine)
• I-Kaletra (lopinavir kunye ne-ritonavir)
• Odefsey (emtricitabine, rilpivirine, kunye ne-tenofovir alafenamide fumarate)
• Prezcobix (darunavir kunye necobicistat)
• Uluhlu (elvitegravir, cobicistat, emtricitabine, kunye ne-tenofovir disoproxil fumarate)
• Symfi (efavirenz, lamivudine, kunye ne-tenofovir disoproxil fumarate)
• Symfi Lo (efavirenz, lamivudine, kunye ne-tenofovir disoproxil fumarate)
• ISymtuza (darunavir, cobicistat, emtricitabine, kunye ne-tenofovir alafenamide fumarate)
• I-Temixys (lamivudine kunye ne-tenofovir disoproxil fumarate)
• Triumeq (abacavir, dolutegravir, kunye ne lamivudine)
• I-Trizivir (abacavir, lamivudine, kunye ne-zidovudine)
• Truvada (emtricitabine kunye ne-tenofovir disoproxil fumarate)

I-Atripla, eyamkelwa yi-FDA ngo-2006, yayiyipilisi yokuqala yokudibanisa esebenzayo ukubandakanya amayeza amathathu ee-antiretroviral. Nangona kunjalo, isetyenziswa ngokufuthi ngoku ngenxa yeziphumo ebezingalindelekanga njengokuphazamiseka kokulala kunye nokutshintsha kwemood.

Iipilisi zokudibanisa ezisekwe kwi-INSTI ziirejimeni ezicetyiswayo ngoku kubantu abaninzi abane-HIV. Kungenxa yokuba ziyasebenza kwaye zibangela iziphumo ebezingalindelekanga ezimbalwa kunezinye iirejimeni. Imizekelo ibandakanya iBiktarvy, Triumeq, kunye neGenvoya.

Isicwangciso sonyango esibandakanya indibaniselwano yethebhulethi eyenziwe ngamachiza amathathu ee-antiretroviral angabhekiswa njengerejimeni yethebhulethi enye (STR).

I-STR ngokwesiko ibhekisa kunyango ngamachiza amathathu ee-antiretroviral. Nangona kunjalo, ezinye indibaniselwano zamachiza amabini (ezinje ngeJuluca kunye neDovato) zibandakanya iziyobisi ezivela kwiiklasi ezimbini ezahlukeneyo kwaye ziye zamkelwa njenge-FDA njengeerejimeni ezipheleleyo ze-HIV. Ngenxa yoko, bakwaqwalaselwa njenge-STRs.

Nangona iipilisi zokudibanisa ziyinkqubela phambili ethembisayo, azinakuba zilungele wonke umntu one-HIV. Xoxa ngezi ndlela kunye nomboneleli wezempilo.

Iziyobisi kufutshane

Unyaka ngamnye, unyango olutsha lufumana indawo engakumbi kunyango kunye nokunyanga i-HIV kunye noGawulayo.

Umzekelo, abaphandi baphanda unyango kunye nothintelo lwe-HIV. La mayeza aya kuthathwa rhoqo kwiiveki ezi-4 ukuya kwezi-8. Banokuphucula ukubambelela kunyango ngokunciphisa inani leepilisi abantu ekufuneka bezithathile.

I-Leronlimab, inaliti ngeveki yabantu abangafumaniyo unyango lwe-HIV, ibone impumelelo kuvavanyo lweklinikhi. Ikwafunyanwa kwi-FDA, eya kuthi ikhawulezise inkqubo yophuhliso lweziyobisi.

Inaliti yenyanga nganye edibanisa i-rilpivirine ne-INSTI, cabotegravir, icwangciselwe ukuba ifumaneke kunyango losulelo lwe-HIV-1 ekuqaleni kuka-2020. I-HIV-1 lolona hlobo luqhelekileyo lwentsholongwane kaGawulayo.

Kukwakho nomsebenzi oqhubekayo wokuthintela i-HIV.

Ukufumana ngakumbi ngamachiza e-HIV akhoyo ngoku (kunye nalawo anokuza kwixesha elizayo), thetha nomboneleli wezempilo okanye usokhemesti.

Uvavanyo lweklinikhi, olusetyenziselwa ukuvavanya iziyobisi kuphuhliso, lunokuba lunomdla. Khangela apha kuvavanyo lweklinikhi lwasekhaya olunokulunga.