IHepatitis C Uhlobo lweGenotype: Imibuzo yakho iyaphendulwa

Umxholo

• Yintoni i-hepatitis C genotypes?
• IHepatitis C inee-genotypes ezahlukeneyo. Ithetha ntoni le nto?
• Nguwuphi umahluko phakathi kwe-hepatitis C genotypes?
• Luthini uphando lwangoku kwii-genotypes kunye nonyango kuhlobo ngalunye?
• Ngaba i-genotype iqikelela impendulo kunyango lwe-DAA njengoko yenzayo kunyango lwe-interferon?
• I-genotype ihlala ichonga uhlobo lonyango umntu alufumanayo. Ngaba zikho ezinye izinto ezichaphazela unyango?
• Ngaba i-genotype yam ichaphazela amathuba okuba ndiza kuphuhlisa i-cirrhosis okanye umhlaza wesibindi?
• Malunga nogqirha

Imifanekiso kaGetty

IHepatitis C sisifo esosulelayo esibangela ukudumba kwesibindi. Intsholongwane idluliselwa ngegazi kwaye kunqabile ngokudibana ngokwesondo.

Zininzi iintlobo zentsholongwane ye-hepatitis C. Kodwa zonke iintlobo ze-hepatitis C zabelana ngokufana okubalulekileyo.

Emva kokufumana ukuxilongwa kwe-hepatitis C, ugqirha wakho uya kusebenza ukuchonga uhlobo onalo ukuze ufumane unyango olungcono.

Fumanisa umahluko kwiindidi ze-hepatitis C. Iimpendulo zeengcali zinikezelwa nguGqr. Kenneth Hirsch, osebenza kakhulu eklinikhi esebenza nabantu abane-hepatitis C.

Yintoni i-hepatitis C genotypes?

Umahluko kwabo banentsholongwane ye-hepatitis C engapheliyo (HCV) yi "genotype," okanye uhlobo lwentsholongwane xa befumana usulelo. I-genotype ichongiwe kuvavanyo lwegazi.

Uhlobo lwe-genotype aludingi kudlala indima ekuqhubekeni kwentsholongwane, kodwa kunokuba ibe yinto ekukhetheni amayeza afanelekileyo okunyanga.

Ngokuka-, kuchongwe ubuncinci ii-genotypes ezisixhenxe ze-HCV, nangaphezulu kune, ezichongiweyo.

Iindidi ezahlukeneyo ze-HCV kunye nee-subtypes zinezabelo ezahlukeneyo kwihlabathi liphela.

IiGenotypes 1, 2, kunye ne-3 zifumaneka kwihlabathi liphela. IGenotype 4 yenzeka kuMbindi Mpuma, Jiphutha, nakuMbindi Afrika.

IGenotype 5 ikho phantse eMzantsi Afrika kuphela. IGenotype 6 ibonakala kuMazantsi mpuma eAsia. IGenotype 7 ixeliwe kwiDemocratic Republic of Congo.

IHepatitis C inee-genotypes ezahlukeneyo. Ithetha ntoni le nto?

I-HCV yintsholongwane ye-RNA eyodwa. Oko kuthetha ukuba ikhowudi yemfuza yentsholongwane nganye iqulethwe kwisiqwenga esinye se-nucleic acid RNA.

Yonke imicu ye-nucleic acid (i-RNA okanye iDNA) yenziwe ngetyathanga leebhloko zokwakha. Ukulandelelana kwezi bhloko kumisela iiproteni ezifunwa ngumzimba, nokuba yintsholongwane, isityalo, okanye isilwanyana.

Ngokungafaniyo ne-HCV, ikhowudi yemfuza yomntu ithathwa yi-DNA enemicu emibini. Ikhowudi yemfuzo yomntu ihamba ngokuvavanywa ngokungqongqo ngexesha lokuphindaphindeka kwe-DNA.

Utshintsho olungahleliwe (uguquko) kwikhowudi yemfuzo yomntu lwenzeka ngexabiso eliphantsi. Kungenxa yokuba iimpazamo ezininzi zokuphindaphindeka kweDNA ziyaqwalaselwa kwaye zilungiswe.

Ngokwahlukileyo, ikhowudi yemfuza ye-HCV ayivavanywanga xa iphindaphindwa. Ukutshintsha okungahleliwe kwenzeka kwaye kuhlala kwikhowudi.

I-HCV ivelisa ngokukhawuleza kakhulu - ukuya kuthi ga kwi-1 yezigidi zezigidi zekopi ngosuku. Ke, iinxalenye ezithile zekhowudi yemfuza ye-HCV ziyohluka kakhulu kwaye zitshintsha rhoqo, nangaphakathi komntu omnye onesifo.

IiGenotypes zisetyenziselwa ukuchonga iintlobo ezithile zeHCV. Zisekelwe kwiyantlukwano kwimimandla ethile ye-genome yentsholongwane. Kukho amacandelwana amatsha esebe ngaphakathi kohlobo lwe-genotype. Ziquka ii-subtype kunye ne-quasispecies.

Nguwuphi umahluko phakathi kwe-hepatitis C genotypes?

Njengoko sele kukhankanyiwe, ii-HCV genotypes ezahlukeneyo kunye nee-subtypes zinezabelo ezahlukeneyo kwihlabathi liphela.

IGenotype 1 yeyona ixhaphakileyo yeHCV genotype eMelika. Ifunyanwa phantse kwiipesenti ezingama-75 zalo lonke usulelo lwe-HCV kweli lizwe.

Uninzi lwabantu abaseleyo e-United States abane-HCV usulelo baphatha ii-genotypes 2 okanye 3.

I-HCV genotype ayihambelani ngokupheleleyo nenqanaba lokonakala kwesibindi, okanye amathuba okuba ekugqibeleni kuphuhle i-cirrhosis. Nangona kunjalo, inokukunceda ukuqikelela isiphumo sonyango.

I-genotype inokukunceda ukuqikelela isiphumo sonyango lwe-anti-HCV kunye neerejimeni zonyango olusekwe kwi-interferon. IGenotype ikwancede ekufumaniseni unyango.

Kwezinye iindlela zokwenziwa, iidosi ezinconywayo ze-ribavirin kunye ne-pegylated interferon (i-PEG) yeyabantu abanee-genotypes ezithile ze-HCV.

Luthini uphando lwangoku kwii-genotypes kunye nonyango kuhlobo ngalunye?

Olona nyango lusetyenziswa kakhulu lwe-HCV, i-PEG / ribavirin, ayijolisisi intsholongwane uqobo. Le rejimeni yonyango ichaphazela ikakhulu amajoni omzimba omntu. Injongo yalo kukuhlanganisa amajoni omzimba ukuze aqaphele kwaye aphelise iiseli ezosulelwe yi-HCV.

Nangona kunjalo, iiyantlukwano ze-HCV kumntu omnye aziyi "kujonga ngokufanayo" kumajoni omzimba. Esi sesinye sezizathu zokuba usulelo lwe-HCV luqhubeke kwaye lube zizifo ezingapheliyo.

Ngaphandle kokwahluka kwemfuza, abaphandi bafumanise iiproteni ezifunekayo ekuveliseni i-HCV emzimbeni. Ezi proteni zikhona ikakhulu kuzo zonke izinto ezahlukeneyo zeHCV.

Unyango olutsha lwe-HCV lujolise kwezi proteni. Oko kuthetha ukuba bajolise kwintsholongwane. Unyango olusebenza ngokuthe ngqo lwe-antiviral (DAA) lusebenzisa iimolekyuli ezincinci ezenzelwe ukuthintela ngokukodwa ezi proteni zentsholongwane.

Amachiza amaninzi eDAA ebephantsi kophuhliso kule minyaka ilishumi idlulileyo. Ichiza ngalinye lijolise kwelinye lamaproteni abalulekileyo e-HCV.

Amachiza amabini okuqala eDAA, i-boceprevir kunye ne-telaprevir, afumana imvume yokusetyenziswa e-United States ngo-2011. Zombini zijolise kuhlobo oluthile lwe-enzyme ye-HCV eyaziwa ngokuba yi-protease. La machiza asetyenziswa ngokudibeneyo ne-PEG / ribavirin.

Omabini la mayeza amatsha asebenza kakhulu kwi-HCV genotype 1. Zisebenza ngokulinganayo kwi-genotype 2, kwaye ayisebenzi kwi-genotype 3.

Ekuqaleni, zazivunyiwe kuphela ukuba zisetyenziswe kubantu abane-genotype 1 HCV ngokudibeneyo ne-PEG / ribavirin.

Amachiza eDAA ongezelelweyo avunyiwe ukuba asetyenziswe kunye ne-PEG / ribavirin. La machiza amatsha ajolise kwiiproteni ezininzi zeHCV. Elinye lala machiza yi-sofosbuvir.

Ngonyango lwe-PEG / ribavirin kuphela, i-genotype 1 HCV isetyenziselwa ukufuna elona xesha lide lonyango ngaphandle kwamathuba okuphumelela. Nge-sofosbuvir, i-genotype 1 ngoku iyanyangeka ngaphezulu kwama-95 epesenti yabantu abanyangwe iiveki ezili-12 kuphela.

I-Sofosbuvir inamandla aphezulu kakhulu okucinezela ukuphindaphindeka kwentsholongwane, ngaphandle kohlobo lwe-genotype (phakathi kwabafundileyo). Ngenxa yokuphumelela kwesiyobisi, iYurophu kutshanje itshintshe izikhokelo zayo zonyango.

Ngoku icebisa ikhosi yeeveki ezili-12 yonyango kubo bonke abantu abane-HCV engenabunzima abangazange banyangwe ngaphambili.

Nge-sofosbuvir, i-FDA [Ukutya noLawulo lweeDrug] ikwamkele unyango lwendibaniselwano yasimahla ye-interferon (sofosbuvir kunye ne-ribavirin). Olu unyango lusetyenziselwa iiveki ezili-12 kubantu abane-genotype 2, okanye iiveki ezingama-24 kubantu abane-genotype 3.

Ngaba i-genotype iqikelela impendulo kunyango lwe-DAA njengoko yenzayo kunyango lwe-interferon?

Mhlawumbi… mhlawumbi hayi.

Iiproteni nganye ze-HCV ezibalulekileyo zisebenza ngokufanayo, ngaphandle kohlobo lwe-genotype. Ezi proteni zibalulekileyo zinokwahluka ngokwendlela eyahlukileyo ngenxa yotshintsho oluncinci.

Ngenxa yokuba zibalulekile kumjikelo wobomi we-HCV, ubume beendawo zabo ezisebenzayo kunqabile ukuba butshintshe ngenxa yotshintsho olungahleliwe.

Ngenxa yokuba indawo esebenzayo yeprotini iyahambelana phakathi kweentlobo ezahlukeneyo zohlobo, indlela esebenza ngayo iarhente yeDAA ichaphazeleka apho ibophelela khona kwiprotein ekujoliswe kuyo.

Ukusebenza kwezo arhente zibopha ngokuthe ngqo kwindawo esebenzayo yeprotein kuncinci kunokuchaphazeleka yintsholongwane.

Onke amayeza eDAA acinezela ukuphindaphindeka kwe-HCV, kodwa ayikhuphi intsholongwane kwiseli yayo yokubamba. Kananjalo abazisusi iiseli ezosulelekileyo. Lo msebenzi ushiywe kwinkqubo yomzimba yokuzikhusela.

Ukusebenza okungafaniyo kwonyango lwe-interferon kubonisa ukuba amajoni omzimba akwazi ukucoca iiseli ezosuleleke kwezinye ii-genotypes ngcono kunalezo zisulelwe ngabanye.

I-genotype ihlala ichonga uhlobo lonyango umntu alufumanayo. Ngaba zikho ezinye izinto ezichaphazela unyango?

Ngaphandle kohlobo lwe-genotype, zininzi izinto ezinokuchaphazela ukubakho kwempumelelo yonyango. Ezinye zezona zibalulekileyo zibandakanya:

• ubungakanani bentsholongwane ye-HCV egazini lakho
• ubuzaza bomonakalo wesibindi ngaphambi konyango
• imeko yenkqubo yomzimba wakho yokuzikhusela (ukosulelwa yimali yentsholongwane kaGawulayo, unyango nge-corticosteroids, okanye ukufakelwa komzimba kunako konke ukuthoba umzimba wakho)
• ubudala
• ubuhlanga
• ukusetyenziswa gwenxa kotywala gwenxa
• impendulo kunyango lwangaphambili

Ezinye izakhi zofuzo zabantu zinokuxela kwangaphambili ukuba unyango lungasebenza njani. Imfuza yomntu eyaziwa njenge IL28B sesinye seziqalo ezomeleleyo zokuphendula kunyango lwe-PEG / ribavirin kubantu abane-HCV genotype 1.

Abantu banolungelelwaniso lwesithathu esinokwenzeka IL28B:

• CC
• CT
• TT

Abantu abanokuqwalaselwa kweCC baphendula kakuhle kunyango nge-PEG / ribavirin. Ngapha koko, zinamathuba amabini okanye amathathu kunabantu abanolunye uhlengahlengiso ukuze baphendule ngokupheleleyo kunyango.

Ukuchonga IL28B Ukucwangciswa kubalulekile kwisigqibo sokunyanga nge-PEG / ribavirin. Nangona kunjalo, abantu abane-genotypes 2 kunye ne-3 banokuhlala bephathwa nge-PEG / ribavirin nokuba abanalo uqwalaselo lweCC.

Kungenxa yokuba ngokubanzi, i-PEG / ribavirin isebenza kakuhle ngokuchasene nezi genotypes. Ke, IL28B Ukucwangciswa akutshintshi amathuba okuba unyango lusebenze.

Ngaba i-genotype yam ichaphazela amathuba okuba ndiza kuphuhlisa i-cirrhosis okanye umhlaza wesibindi?

Kusenokwenzeka. Abanye bacebisa ukuba abantu abanesifo se-HCV genotype 1 (ngakumbi abo bane-subtype 1b) baneziganeko ezinkulu zokuqina kwesibindi kunabo banosulelo kwezinye i-genotypes.

Nokuba lo mbono uyinyani na, isicwangciso solawulo esicetyiswayo asitshintshi kakhulu.

Ukuqhubela phambili komonakalo wesibindi kuyacotha. Oku kuhlala kwenzeka kumashumi eminyaka. Ke, nabani na osandula ukufumanisa ukuba une-HCV kufuneka avavanywe ukonakala kwesibindi. Umonakalo wesibindi luphawu kunyango.

Umngcipheko wokuba nomhlaza wesibindi awubonakali unxulumene ne-HCV genotype. Usulelo olungapheliyo lwe-HCV, i-hepatocellular carcinoma (umhlaza wesibindi) ikhula kuphela xa i-cirrhosis isekiwe.

Ukuba umntu onesifo se-HCV uphathwa kakuhle ngaphambi kokuba ahlakulele i-cirrhosis, ngoko i-genotype echaphazelayo ayiyiyo into.

Nangona kunjalo, kubantu esele benze isifo se-cirrhosis, kukho uluvo lokuba i-genotypes 1b okanye 3 inokunyusa umngcipheko womhlaza.

Ukuvavanywa komhlaza wesibindi kuyacetyiswa kuye wonke umntu one-HCV ene-cirrhosis. Abanye oogqirha bancomela ukuhlolwa rhoqo kwabo banesifo se-genotypes 1 kunye ne-3.

Malunga nogqirha

UGqr. Kenneth Hirsch ufumene ugqirha wamayeza kwiYunivesithi yaseWashington eSt. Louis, eMissouri. Wenza uqeqesho lokuthweswa isidanga kunyango lwangaphakathi kunye ne-hepatology kwiYunivesithi yaseCalifornia, eSan Francisco (UCSF). Wenza uqeqesho olongezelelweyo kwi-National Institutes of Health kwi-allergies kunye ne-immunology. UGqirha Hirsch wayekwangumphathi we-hepatology eWashington, D.C., VA Medical Center. UGqirha Hirsch ubambe ukuqeshwa kwabafundi kwizikolo zonyango zeGeorgetown kunye neeDyunivesithi zaseGeorge Washington.

UGqr. Hirsch unenkqubo ebanzi yeklinikhi yokunceda abaguli abanentsholongwane ye-hepatitis C. Uneminyaka emininzi yamava kuphando lwamayeza. Usebenze kwiibhodi zeengcebiso kumzi mveliso, imibutho yezonyango yesizwe, nakwimibutho yolawulo.