Lipoti Pakukula kwa HIV: Kodi Tili Pafupi Kuchira?

Zamkati

• Katemera
• Kupewa koyambirira
• Pre-exposure prophylaxis (PrEP)
• Post-exposure prophylaxis (PEP)
• Matenda oyenera
• Njira zothandizira
• Chosawoneka chimakhala chosasunthika
• Zochitika mufukufuku
• Jakisoni wamwezi uliwonse
• Kuyang'ana malo osungira HIV
• Kuthetsa HIV
• 'Ogwira ntchito bwino'
• Komwe tili pano

Chidule

HIV imafooketsa chitetezo cha mthupi ndipo imalepheretsa thupi kulimbana ndi matenda. Popanda chithandizo, HIV imatha kubweretsa gawo lachitatu la HIV, kapena Edzi.

Mliri wa Edzi udayamba ku United States mzaka zam'ma 1980. Anthu oposa 35 miliyoni amwalira ndi vutoli.

Pakadali pano palibe mankhwala a HIV, koma maphunziro ambiri azachipatala amaperekedwa pakufufuza zamankhwala. Mankhwala omwe alipo pakadali pano amalola anthu omwe ali ndi kachilombo ka HIV kupewa kupitiriza kwawo ndikukhala ndi moyo wathanzi.

Zinthu zazikulu zachitika pokhudzana ndi kupewa komanso kuchiza kachilombo ka HIV, chifukwa cha:

• asayansi
• ogwira ntchito zaumoyo
• mabungwe aboma
• mabungwe omwe amakhala mdera
• Omenyera HIV
• makampani opanga mankhwala

Katemera

Kupanga katemera wa HIV kudzapulumutsa miyoyo mamiliyoni ambiri. Komabe, ofufuza sanapezebe katemera wogwira mtima wa HIV. Mu 2009, kafukufuku wofalitsidwa mu Journal of Virology adapeza kuti katemera woyeserera amateteza pafupifupi 31% ya matenda atsopano. Kafukufuku wowonjezera adayimitsidwa chifukwa chowopsa. Kumayambiriro kwa chaka cha 2013, National Institute of Allergy and Infectious Diseases idayesa kuyesa kwachipatala komwe kumayesa jakisoni wa katemera wa HVTN 505. Zambiri pazoyeserera zikuwonetsa kuti katemerayu sanateteze kufalikira kwa kachilombo ka HIV kapena kuchepetsa kuchuluka kwa kachilombo ka HIV m'magazi. Kafukufuku wokhudza katemera akupitilirabe padziko lonse lapansi. Chaka chilichonse pamakhala zatsopano. Mu 2019, adalengeza kuti apanga chithandizo chodalirika chowalola kuti:

1. pangani maselo ena amthupi kuti ayambitse kachilombo ka HIV m'maselo omwe ali ndi HIV yosagwira ntchito, kapena yobisika
2. gwiritsirani ntchito magulu ena amthupi a chitetezo kuti amenyane ndikuchotsa ma cell omwe ali ndi kachilombo ka HIV

Zotsatira zawo zitha kupereka maziko a katemera wa HIV. Mayesero azachipatala ali m'ntchito.

Kupewa koyambirira

Ngakhale kulibe katemera wa HIV panobe, pali njira zina zotetezera kufalitsa. HIV imafala chifukwa chosinthana madzi amthupi. Izi zitha kuchitika m'njira zosiyanasiyana, kuphatikiza:

• Kugonana. Pogonana, kachilombo ka HIV kangapatsiridwe mwa kusinthana madzi ena. Amaphatikizapo magazi, umuna, kapena kumatako ndi kumaliseche. Kukhala ndi matenda opatsirana pogonana kumatha kuonjezera chiopsezo chotenga kachilombo ka HIV panthawi yogonana.
• Kugawana masingano ndi ma syringe. Singano ndi ma syringe omwe agwiritsidwa ntchito ndi munthu yemwe ali ndi HIV atha kukhala ndi kachilomboka, ngakhale kulibe magazi owonekera.
• Mimba, kubereka, ndi kuyamwitsa. Amayi omwe ali ndi kachilombo ka HIV amatha kufalitsa kachilomboko kwa mwana wawo asanabadwe komanso atabadwa. Nthawi yomwe mankhwala a HIV amagwiritsidwa ntchito, izi ndizosowa kwambiri.

Kuchita zinthu mosamala kumateteza munthu kuti asatenge HIV:

• Kayezetseni HIV. Funsani anthu ogonana nawo za mikhalidwe yawo musanagonane.
• Kayezetseni ndikuchiritsidwa matenda opatsirana pogonana. Funsani ogonana nawo kuti achite chimodzimodzi.
• Mukamagonana m'kamwa, kumaliseche, ndi kumatako, gwiritsani ntchito njira yotchinga ngati makondomu nthawi zonse (ndipo mugwiritse ntchito moyenera).
• Ngati mukubaya mankhwala osokoneza bongo, onetsetsani kuti mukugwiritsa ntchito singano yatsopano, yosawilitsidwa yomwe sanagwiritsepo ntchito ndi wina aliyense.

Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) ndi mankhwala omwe amagwiritsidwa ntchito tsiku ndi tsiku ndi anthu omwe alibe HIV kuti achepetse mwayi wawo wotenga kachilombo ka HIV, ngati awululidwa. Ndizothandiza kwambiri popewa kufalitsa kachilombo ka HIV mwa iwo omwe ali ndi zoopsa zodziwika. Anthu omwe ali pachiwopsezo ndi awa:

• abambo omwe amagonana ndi abambo, ngati adagonana ndi abambo popanda kugwiritsa ntchito kondomu kapena adadwala matenda opatsirana pogonana m'miyezi isanu ndi umodzi yapitayo
• abambo kapena amayi omwe sagwiritsa ntchito njira yotchinga ngati makondomu pafupipafupi ndipo amakhala ndi zibwenzi zomwe zili ndi chiopsezo chowonjezeka chotenga kachirombo ka HIV kapena kukhala ndi kachirombo kosadziwika ka HIV
• aliyense amene agawana singano kapena kugwiritsa ntchito mankhwala obayidwa m'miyezi isanu ndi umodzi yapitayo
• Amayi omwe akuganiza zokhala ndi pakati pa omwe ali ndi kachilombo ka HIV

Malinga ndi a PrEP atha kuchepetsa chiopsezo chotenga kachilombo ka HIV pogonana ndi 99% mwa anthu omwe ali ndi ziwopsezo zotenga kachilombo ka HIV. Kuti PrEP igwire bwino ntchito, imayenera kumwedwa tsiku ndi tsiku komanso mosasinthasintha. Aliyense amene ali pachiwopsezo cha kachilombo ka HIV ayenera kuyamba mtundu wa PrEP, malinga ndi upangiri waposachedwa kuchokera ku US Preventive Services Task Force.

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) ndi kuphatikiza kwa mankhwala ochepetsa mphamvu ya kachilombo ka HIV. Amagwiritsidwa ntchito wina atakhala kuti ali ndi kachilombo ka HIV. Othandizira azaumoyo atha kulangiza PEP m'malo otsatirawa:

• Munthu amaganiza kuti mwina adapezeka ndi kachilombo ka HIV panthawi yogonana (mwachitsanzo, kondomu idathyoledwa kapena palibe kondomu yomwe idagwiritsidwa ntchito).
• Munthu amagawana singano pobayira mankhwala osokoneza bongo.
• Munthu wagwiriridwa.

PEP iyenera kugwiritsidwa ntchito ngati njira yodzitetezera mwadzidzidzi. Iyenera kuyambitsidwa mkati mwa maola 72 kuchokera pomwe mungakhale ndi kachilombo ka HIV. Momwemo, PEP imayambika pafupi kwambiri ndi nthawi yowonekera momwe zingathere. PEP nthawi zambiri imakhudza mwezi umodzi kutsatira mankhwala ochepetsa mphamvu ya kachilombo ka HIV.

Matenda oyenera

Kuzindikira kachilombo ka HIV ndi Edzi ndi gawo lofunikira popewa kufalikira kwa HIV. Malinga ndi UNAIDS, gulu la United Nations (UN), pafupifupi 25% ya anthu omwe ali ndi kachirombo ka HIV padziko lonse lapansi sadziwa ngati ali ndi kachirombo ka HIV. Pali mayesero osiyanasiyana amwazi omwe othandizira azaumoyo angagwiritse ntchito kuti aone ngati ali ndi HIV. Kudziyesa nokha kwa kachilombo ka HIV kumalola anthu kuyesa malovu awo kapena magazi awo patokha ndikulandila zotsatira mkati mwa mphindi 20 kapena zochepa.

Njira zothandizira

Chifukwa cha kupita patsogolo kwa sayansi, kachilombo ka HIV kamawerengedwa kuti ndi matenda osachiritsika. Mankhwala ochepetsa mphamvu ya kachilombo ka HIV amalola anthu omwe ali ndi kachilombo ka HIV kuti akhale ndi thanzi labwino. Zimachepetsanso chiopsezo chotenga kachilomboka kwa ena. Pafupifupi 59 peresenti ya anthu onse omwe ali ndi kachilombo ka HIV amalandira mankhwala, malinga ndi UNAIDS. Mankhwala omwe amachiza kachilombo ka HIV amachita zinthu ziwiri:

• Kuchepetsa kuchuluka kwa ma virus. Kuchuluka kwa vutoli ndiyeso la kuchuluka kwa HIV RNA m'mwazi. Cholinga cha mankhwala ochepetsa mphamvu ya kachilombo ka HIV ndikuchepetsa kachilomboko mpaka kufika posaoneka.
• Lolani kuti thupi libwezeretse kuchuluka kwake kwama CD4 kukhala abwinobwino. Maselo a CD4 ali ndi udindo woteteza thupi kumatenda omwe angayambitse HIV.

Pali mitundu ingapo ya mankhwala a HIV:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) kulepheretsa puloteni yomwe kachilombo ka HIV kamagwiritsira ntchito popanga majini ake m'maselo.
• Nucleoside reverse transcriptase inhibitors (NRTIs) perekani zotchinga za HIV zolakwika kotero kuti sizingathe kupanga zamoyo zake m'maselo.
• Protease zoletsa thandizani enzyme yomwe HIV imafunika kuti izipanga yokha.
• Kulowera kapena kusakaniza zoletsa pewani kachilombo ka HIV kulowa m'ma CD4.
• Kuphatikiza zoletsa pewani zochitika za integrase. Popanda enzyme iyi, HIV sitha kudzilowetsa mu DNA ya CD4.

Mankhwala a kachilombo ka HIV nthawi zambiri amatengedwa mosakanikirana kuti athetse kukana kwa mankhwala. Mankhwala a HIV ayenera kumwa nthawi zonse kuti akhale othandiza. Munthu yemwe ali ndi kachilombo ka HIV ayenera kukambirana ndi omwe amamukonda asanayambe kusintha mankhwala kuti achepetse zovuta kapena chifukwa cha kulephera kwa mankhwala.

Chosawoneka chimakhala chosasunthika

Kafukufuku wasonyeza kuti kukwaniritsa ndikusunga kuchuluka kwa kachilombo kosazindikirika pogwiritsa ntchito mankhwala ochepetsa mphamvu ya kachilombo kumachotsa chiopsezo chotenga kachirombo ka HIV kwa munthu amene mukugonana naye. Kafukufuku wamkulu sanapezepo njira zofalitsira kachilomboka kuchokera kwa munthu yemwe ali ndi kachilombo ka HIV mosalekeza. Maphunzirowa adatsata zikwizikwi za mabanja osakanikirana pazaka zingapo. Panali zochitika zambiri zogonana popanda makondomu. Pozindikira kuti U = U ("osawoneka = osasunthika") amatsindika kwambiri za "chithandizo monga kupewa (TasP)." UNAIDS ili ndi cholinga cha "90-90-90" kuti athetse mliri wa Edzi. Pofika 2020, ndondomekoyi ikufuna:

• 90% ya anthu onse omwe ali ndi kachilombo ka HIV amadziwa momwe alili
• 90% ya anthu onse omwe amapezeka ndi kachilombo ka HIV ali ndi mankhwala ochepetsa mphamvu ya kachilombo ka HIV
• 90% ya anthu onse omwe amalandira mankhwala ochepetsa mphamvu ya kachilombo ka HIV kuti athe kuponderezedwa

Zochitika mufukufuku

Ochita kafukufuku akugwira ntchito mwakhama kufunafuna mankhwala atsopano ndi mankhwala a HIV. Akufuna kupeza njira zochiritsira zomwe zimawonjezera ndikusintha moyo wa anthu omwe ali ndi vutoli. Kuphatikiza apo, akuyembekeza kupanga katemera ndikupeza mankhwala a HIV. Taonani mwachidule njira zingapo zofunika pakufufuza.

Jakisoni wamwezi uliwonse

Jekeseni ya HIV pamwezi imayenera kupezeka koyambirira kwa 2020. Imaphatikiza mankhwala awiri: integrase inhibitor cabotegravir ndi NNRTI rilpivirine (Edurant). Kafukufuku wamankhwala apeza kuti jakisoni wapamwezi anali wokhoza kupondereza HIV monga momwe amachitira tsiku lililonse mankhwala atatu akumwa.

Kuyang'ana malo osungira HIV

Chimodzi mwazomwe zimapangitsa kuti kupeza kachilombo ka HIV kukhale kovuta ndikuti chitetezo chamthupi chimakhala ndi vuto lolunjika m'malo osungira maselo omwe ali ndi HIV. Chitetezo cha mthupi nthawi zambiri sichitha kuzindikira maselo omwe ali ndi kachilombo ka HIV kapena kuthetsa maselo omwe akutulutsa kachilomboka. Mankhwala ochepetsa mphamvu ya kachilombo ka HIV samachotsa malo osungira kachilombo ka HIV. akufufuza mitundu iwiri ya machiritso a HIV, onse omwe atha kuwononga nkhokwe za HIV:

• Chithandizo chogwira ntchito. Chithandizo chamtunduwu chimatha kuwongolera kubwereza kwa HIV pakalibe mankhwala ochepetsa mphamvu ya kachilombo ka HIV.
• Chithandizo chosawilitsa. Kuchiritsa kwamtunduwu kumathetseratu kachilombo kamene kangathe kubwereza.

Kuthetsa HIV

Ofufuza ku University of Illinois ku Urbana-Champaign akhala akugwiritsa ntchito zoyeserera zamakompyuta kuti aphunzire za kachilombo ka HIV. Kapisozi ndi chidebe cha majeremusi a kachilomboka. Zimateteza kachilomboka kuti zisawonongeke ndi chitetezo cha mthupi. Kuzindikira kapangidwe ka kapsididi ndi momwe imagwirira ntchito ndi malo ake kungathandize ofufuza kupeza njira yoti atsegulire. Kuswa capsid kumatha kutulutsa zinthu za majini a HIV m'thupi momwe zitha kuwonongeredwa ndi chitetezo chamthupi. Ndi malire olonjeza pamachiritso ndi machiritso a HIV.

'Ogwira ntchito bwino'

A Timothy Ray Brown, aku America omwe amakhala ku Berlin, adadziwika kuti ali ndi HIV mu 1995 ndipo adapezeka ndi leukemia mu 2006. Ndi m'modzi mwa anthu awiri omwe nthawi zina amatchedwa "wodwala waku Berlin." Mu 2007, a Brown adalandiridwa ndi tsinde kuti athetse khansa ya m'magazi - ndipo adasiya mankhwala ochepetsa mphamvu ya kachilombo ka HIV. HIV mwa iye kuyambira pomwe njirayi idachitika. Kafukufuku wa ziwalo zingapo za thupi lake ku Yunivesite ya California, San Francisco adamuwonetsa kuti alibe HIV. Amamuwona ngati "wochiritsidwa bwino," malinga ndi kafukufuku wofalitsidwa mu PLOS Pathogens. Ndiye munthu woyamba kuchiritsidwa ku HIV. Mu Marichi 2019, kafukufuku adadziwika pagulu la amuna ena awiri omwe adapezeka ndi kachilombo ka HIV komanso khansa. Monga Brown, amuna onsewa adalandiridwa ndi ma cell am'munsi kuti athetse khansa yawo. Amuna onsewa adasiyanso mankhwala ochepetsa mphamvu ya kachilombo ka HIV atalandira ziwalo zawo. Pomwe kafukufukuyu adawonetsedwa, "wodwala waku London" adatha kukhalabe mu chikhululukiro cha HIV kwa miyezi 18 ndikuwerengera. "Wodwala wa Dusseldorf" adatha kukhalabe mu chikhululukiro cha HIV kwa miyezi itatu ndi theka ndikuwerengera.

Komwe tili pano

Ofufuza sanamvetse za HIV zaka 30 zapitazo, samathanso momwe angachiritse. Kwa zaka makumi angapo, kupita patsogolo kwaukadaulo komanso luso lazachipatala kwabweretsa chithandizo chambiri chaku HIV. Mankhwala opatsirana ochepetsa mphamvu ya kachilombo ka HIV tsopano atha kuyimitsa kukula kwa kachilombo ka HIV ndikuchepetsa kuchuluka kwa ma virus pagulu losaoneka. Kukhala ndi kuchuluka kwa ma virus sikungowonjezera thanzi la munthu yemwe ali ndi kachilombo ka HIV, komanso kumachotsa chiopsezo chotenga kachirombo ka HIV kwa yemwe amagonana naye. Chithandizo chamankhwala chomwe chingayang'anitsidwe chingatetezenso amayi apakati omwe ali ndi HIV kuti asafalitse kachilomboko kwa ana awo. Chaka chilichonse, mayesero mazana ambiri azachipatala amayesetsa kupeza njira zabwino zothandizira kachilombo ka HIV akuyembekeza kuti tsiku lina adzachiritsidwa. Ndi mankhwala atsopanowa pakubwera njira zabwino zopewera kufalitsa kachirombo ka HIV. Werengani nkhaniyi m'Chisipanishi.