Kusintha kwa Chithandizo cha HIV

Zamkati

• Momwe mankhwala osokoneza bongo amagwirira ntchito
• Mitundu ya ma ARV
• Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• Onjezani zoletsa ma strand transfer (INSTIs)
• Ma Protease inhibitors (PIs)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Kulowa zoletsa
• Mankhwala ochepetsa mphamvu ya kachilombo ka HIV
• Kutsatira ndikofunikira
  
• Mapiritsi osakaniza
• Mankhwala ali pafupi

Chidule

Zaka makumi atatu zapitazo, opereka chithandizo chamankhwala analibe nkhani zolimbikitsa zopereka kwa anthu omwe adzalandire kachilombo ka HIV. Lero, ndimakhala okhoza kusamalira thanzi.

Palibe mankhwala a HIV kapena Edzi panobe. Komabe, kupita patsogolo modabwitsa pamankhwala ndi kumvetsetsa kwamatenda momwe kachilombo ka HIV kamathandizira kumathandiza kuti anthu omwe ali ndi kachilombo ka HIV akhale ndi moyo wautali, wathanzi.

Tiyeni tiwone komwe kuli kachilombo ka HIV lerolino, zotsatira za mankhwala atsopano, komanso komwe chithandizo chazachipatala chikhoza kupita mtsogolo.

Momwe mankhwala osokoneza bongo amagwirira ntchito

Chithandizo chachikulu cha HIV masiku ano ndi mankhwala ochepetsa mphamvu ya kachilombo ka HIV. Mankhwalawa samachiza HIV. M'malo mwake, amapondereza kachilomboka ndikuchepetsa kukula m'thupi. Ngakhale samachotsa HIV mthupi, amatha kuipondereza kuti isawonekere nthawi zambiri.

Ngati mankhwala ochepetsa mphamvu ya kachilombo ka HIV akuyenda bwino, akhoza kuwonjezera zaka zambiri zathanzi, zopindulitsa pamoyo wa munthu ndikuchepetsa chiopsezo chotengera ena.

Mitundu ya ma ARV

Mankhwala omwe amapatsidwa kwa anthu omwe amayamba kugwiritsa ntchito ma ARV atha kugawidwa m'magulu asanu azakumwa:

• nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• integrase strand transfer inhibitors (INSTIs)
• protease inhibitors (PIs)
• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• zoletsa kulowa

Mankhwala omwe atchulidwa pansipa onse avomerezedwa ndi Food and Drug Administration (FDA) kuti athetse HIV.

Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)

Ma NRTI amasunga maselo omwe ali ndi kachilombo ka HIV kuti asadzipange okha mwa kusokoneza kumanganso kwa chingwe cha DNA cha kachilomboka akagwiritsa ntchito enzyme reverse transcriptase. NRTI zikuphatikizapo:

• abacavir (yomwe imapezeka ngati mankhwala odziyimira pawokha a Ziagen kapena ngati gawo la mankhwala atatu osakanikirana)
• lamivudine (yopezeka ngati mankhwala odziyimira payokha a Epivir kapena ngati gawo limodzi mwa mankhwala asanu ndi anayi osakanikirana)
• emtricitabine (yopezeka ngati mankhwala odziyimira pawokha Emtriva kapena ngati gawo la mankhwala asanu ndi anayi osakanikirana)
• zidovudine (yopezeka ngati mankhwala odziyimira pawokha a Retrovir kapena ngati gawo limodzi la mankhwala osakanikirana awiri)
• tenofovir disoproxil fumarate (yomwe imapezeka ngati mankhwala odziimira okhaokha a Viread kapena ngati gawo limodzi la mankhwala asanu ndi anayi osakanikirana)
• tenofovir alafenamide fumarate (yomwe imapezeka ngati mankhwala odziyimira pawokha a Vemlidy kapena ngati gawo limodzi la mankhwala asanu osakanikirana)

Zidovudine amadziwikanso kuti azidothymidine kapena AZT, ndipo anali mankhwala oyamba kuvomerezedwa ndi Food and Drug Administration (FDA) kuchiza HIV. Masiku ano, ndizotheka kuti azigwiritsidwa ntchito ngati post-exposure prophylaxis (PEP) ya makanda omwe ali ndi kachilombo ka HIV kuposa chithandizo cha achikulire omwe ali ndi HIV.

Tenofovir alafenamide fumarate imagwiritsidwa ntchito m'mapiritsi angapo ophatikizira HIV. Monga mankhwala odziyimira pawokha, amangolandira chilolezo chongochizira HIV. Mankhwala omwe amayimilira pawokha avomerezedwa ndi FDA kuti athetse matenda opatsirana a hepatitis B. Ma NRTIs ena (emtricitabine, lamivudine, ndi tenofovir disoproxil fumarate) atha kugwiritsidwanso ntchito kuthana ndi matenda a hepatitis B.

Kuphatikiza ma NRTI ndi monga:

• abacavir, lamivudine, ndi zidovudine (Trizivir)
• abacavir ndi lamivudine (Epzicom)
• lamivudine ndi zidovudine (Combivir)
• lamivudine ndi tenofovir disoproxil fumarate (Cimduo, Temixys)
• emtricitabine ndi tenofovir disoproxil fumarate (Truvada)
• emtricitabine ndi tenofovir alafenamide fumarate (Descovy)

Kuphatikiza pa kugwiritsidwa ntchito pochiza HIV, Descovy ndi Truvada itha kugwiritsidwanso ntchito ngati gawo la pre-exposure prophylaxis (PrEP).

Kuyambira mu 2019, US Preventive Services Task Force ikulimbikitsa mtundu wa PrEP kwa anthu onse omwe alibe HIV omwe ali pachiwopsezo chotenga kachilombo ka HIV.

Onjezani zoletsa ma strand transfer (INSTIs)

Ma INSTI amalepheretsa kuphatikiza, michere yomwe HIV imagwiritsa ntchito kuyika DNA ya DNA mu DNA ya munthu mkati mwa ma CD4 T. Ma INSTI ali mgulu la mankhwala omwe amadziwika kuti integrase inhibitors.

Ma INSTI ndi mankhwala okhazikika. Magulu ena a integrase inhibitors, monga integrase binding inhibitors (INBIs), amawerengedwa kuti ndi mankhwala oyesera. Ma INB sanalandire chilolezo cha FDA.

Ma INST ndi monga:

• raltegravir (Isentress, Isentress HD)
• dolutegravir (yopezeka ngati mankhwala odziyimira pawokha a Tivicay kapena ngati gawo limodzi la mankhwala osakaniza atatu)
• bictegravir (kuphatikiza emtricitabine ndi tenofovir alafenamide fumarate mu mankhwala a Biktarvy)
• elvitegravir (kuphatikiza cobicistat, emtricitabine, ndi tenofovir alafenamide fumarate mu mankhwala a Genvoya, kapena ndi cobicistat, emtricitabine, ndi tenofovir disoproxil fumarate mu mankhwalawa Stribild)

Ma Protease inhibitors (PIs)

PIs amaletsa protease, enzyme yomwe HIV imafunikira ngati gawo la moyo wake. Ma AI amaphatikizapo:

• atazanavir (yopezeka ngati mankhwala odziyimira pawokha a Reyataz kapena kuphatikiza ndi cobicistat mu mankhwala a Evotaz)
• darunavir (yopezeka ngati mankhwala odziyimira pawokha a Prezista kapena ngati gawo limodzi la mankhwala osakaniza awiri)
• fosamprenavir (Lexiva)
• indinavir (Crixivan)
• lopinavir (imapezeka pokhapokha ngati ikuphatikizidwa ndi ritonavir mu mankhwala a Kaletra)
• nelfinavir (Viracept)
• ritonavir (yomwe imapezeka ngati mankhwala osokoneza bongo a Norvir kapena ophatikizidwa ndi lopinavir mu mankhwala a Kaletra)
• saquinavir (Invirase)
• nsonga (Aptivus)

Ritonavir (Norvir) amagwiritsidwa ntchito ngati mankhwala olimbikitsira mankhwala ena ochepetsa mphamvu ya kachilombo ka HIV.

Chifukwa cha zovuta zawo, indinavir, nelfinavir, ndi saquinavir sizigwiritsidwa ntchito kawirikawiri.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) imalepheretsa kachilombo ka HIV kuti isadzipange yokha mwa kumangirira ndi kuyimitsa enzyme reverse transcriptase. NNRTI zikuphatikizapo:

• efavirenz (yomwe imapezeka ngati mankhwala odziyimira pawokha Sustiva kapena ngati gawo limodzi la mankhwala osakaniza atatu)
• rilpivirine (yopezeka ngati mankhwala odziyimira payokha a Edurant kapena ngati gawo limodzi la mankhwala osakaniza atatu)
• etravirine (Kusasunthika)
• doravirine (yomwe imapezeka ngati Pifeltro yokhayokha kapena kuphatikiza lamivudine ndi tenofovir disoproxil fumarate mu mankhwala a Delstrigo)
• nevirapine (Viramune, Viramune XR)

Kulowa zoletsa

Ophatikizira olowera ndi gulu la mankhwala omwe amaletsa HIV kuti isalowe m'ma CD4 T. Izi zoletsa zikuphatikizapo:

• enfuvirtide (Fuzeon), yomwe ndi ya gulu lazamankhwala lotchedwa fusion inhibitors
• maraviroc (Selzentry), omwe ali m'gulu la mankhwala omwe amadziwika kuti chemokine coreceptor antagonists (CCR5 antagonists)
• ibalizumab-uiyk (Trogarzo), yomwe ndi ya gulu la mankhwala lotchedwa post-attachment inhibitors.

Zoletsa zoletsa sizimagwiritsidwa ntchito ngati mankhwala oyamba.

Mankhwala ochepetsa mphamvu ya kachilombo ka HIV

HIV imatha kusintha komanso kukhala yolimbana ndi mankhwala amodzi. Chifukwa chake, opereka chithandizo chamankhwala ambiri masiku ano amapereka mankhwala angapo a HIV limodzi.

Kuphatikiza kwa mankhwala ochepetsa mphamvu ya kachilombo ka HIV kapena awiri amatchedwa antiretroviral therapy. Ndi mankhwala oyamba omwe amaperekedwa masiku ano kwa anthu omwe ali ndi kachilombo ka HIV.

Chithandizo champhamvu ichi chinayambitsidwa koyamba mu 1995. Chifukwa cha mankhwala ochepetsa mphamvu ya kachilombo ka HIV, anthu omwe amafa chifukwa cha Edzi ku United States adachepetsedwa ndi 47 peresenti pakati pa 1996 ndi 1997.

Njira zofala kwambiri masiku ano zimakhala ndi ma NRTI awiri komanso INSTI, NNRTI, kapena PI yolimbikitsidwa ndi cobicistat (Tybost). Pali deta yatsopano yothandizira kugwiritsa ntchito mankhwala awiri okha nawonso, monga INSTI ndi NRTI kapena INSTI ndi NNRTI.

Kupita patsogolo kwa mankhwala kumathandizanso kuti anthu azigwiritsa ntchito mankhwala mosavutikira. Kupita patsogolo kumeneku kwachepetsa kuchuluka kwa mapiritsi omwe munthu ayenera kumwa. Achepetsa zovuta zoyipa kwa anthu ambiri ogwiritsa ntchito mankhwala ochepetsa mphamvu ya kachilombo ka HIV. Pomaliza, kupita patsogolo kwaphatikizanso mbiri yabwino yolumikizirana ndi mankhwala osokoneza bongo.

Kutsatira ndikofunikira

1. Kutsatira kumatanthauza kumamatira ndi dongosolo lamankhwala. Kumamatira ndikofunikira pa chithandizo cha HIV. Ngati munthu yemwe ali ndi kachilombo ka HIV samamwa mankhwala ake monga momwe akufunira, mankhwalawo akhoza kusiya kuwagwirira ntchito ndipo kachilomboka kakhoza kuyambanso kufalikira mthupi lake. Kutsatira kumafuna kumwa mulingo uliwonse, tsiku lililonse, monga momwe ziyenera kuperekedwera (mwachitsanzo, kapena wopanda chakudya, kapena mosiyana ndi mankhwala ena).

Mapiritsi osakaniza

Kupititsa patsogolo kwakukulu komwe kumapangitsa kuti anthu omwe akumwa mankhwala ochepetsa mphamvu ya kachilombo ka HIV apeze chithandizo chamankhwala ndi kupangira mapiritsi osakaniza. Mankhwalawa tsopano ndi mankhwala omwe amaperekedwa kwa anthu omwe ali ndi HIV omwe sanalandirepo mankhwala kale.

Mapiritsi osakaniza ali ndi mankhwala angapo mkati mwa piritsi limodzi. Pakadali pano pali mapiritsi 11 ophatikiza omwe ali ndi mankhwala awiri ochepetsa mphamvu ya kachilombo ka HIV. Pali mapiritsi 12 ophatikizira omwe ali ndi ma ARV atatu kapena kupitilira apo:

• Atripla (efavirenz, emtricitabine, ndi tenofovir disoproxil fumarate)
• Biktarvy (bictegravir, emtricitabine, ndi tenofovir alafenamide fumarate)
• Cimduo (lamivudine ndi tenofovir disoproxil fumarate)
• Combivir (lamivudine ndi zidovudine)
• Complera (emtricitabine, rilpivirine, ndi tenofovir disoproxil fumarate)
• Delstrigo (doravirine, lamivudine, ndi tenofovir disoproxil fumarate)
• Descovy (emtricitabine ndi tenofovir alafenamide fumarate)
• Dovato (dolutegravir ndi lamivudine)
• Epzicom (abacavir ndi lamivudine)
• Evotaz (atazanavir ndi cobicistat)
• Genvoya (elvitegravir, cobicistat, emtricitabine, ndi tenofovir alafenamide fumarate)
• Juluca (dolutegravir ndi rilpivirine)
• Kaletra (lopinavir ndi ritonavir)
• Odefsey (emtricitabine, rilpivirine, ndi tenofovir alafenamide fumarate)
• Prezcobix (darunavir ndi cobicistat)
• Kugulitsa (elvitegravir, cobicistat, emtricitabine, ndi tenofovir disoproxil fumarate)
• Symfi (efavirenz, lamivudine, ndi tenofovir disoproxil fumarate)
• Symfi Lo (efavirenz, lamivudine, ndi tenofovir disoproxil fumarate)
• Symtuza (darunavir, cobicistat, emtricitabine, ndi tenofovir alafenamide fumarate)
• Temixys (lamivudine ndi tenofovir disoproxil fumarate)
• Anayankha (abacavir, dolutegravir, ndi lamivudine)
• Trizivir (abacavir, lamivudine, ndi zidovudine)
• Truvada (emtricitabine ndi tenofovir disoproxil fumarate)

Atripla, yomwe idavomerezedwa ndi FDA mu 2006, inali pulogalamu yoyamba kuphatikiza kuphatikiza ma ARV. Komabe, amagwiritsidwa ntchito mochepa tsopano chifukwa cha zovuta zina monga kusokonezeka kwa tulo komanso kusintha kwa malingaliro.

Mapiritsi ophatikizira a INSTI ndi njira zomwe zimalangizidwa tsopano kwa anthu ambiri omwe ali ndi HIV. Izi ndichifukwa choti ndizothandiza ndipo zimayambitsa zovuta zochepa kuposa mitundu ina. Zitsanzo ndi Biktarvy, Triumeq, ndi Genvoya.

Ndondomeko yamankhwala yomwe imaphatikizira piritsi limodzi lopangidwa ndi ma ARV lingatchulidwenso ngati piritsi limodzi (STR).

STR mwachizolowezi imanena za chithandizo chamankhwala atatu ochepetsa mphamvu ya kachilombo ka HIV. Komabe, kuphatikiza mankhwala atsopano awiri (monga Juluca ndi Dovato) kumaphatikizapo mankhwala ochokera m'magulu awiri osiyana ndipo akhala akuvomerezedwa ndi FDA ngati njira zonse zapa HIV. Zotsatira zake, amawonedwanso ngati ma STR.

Ngakhale mapiritsi osakaniza ndi chitukuko chodalirika, mwina sangakhale oyenera kwa munthu aliyense yemwe ali ndi HIV. Kambiranani njirazi ndi wothandizira zaumoyo.

Mankhwala ali pafupi

Chaka chilichonse, njira zatsopano zochiritsira zikuwonjezeranso njira zochizira komanso kuchiritsa HIV ndi Edzi.

Mwachitsanzo, ofufuza akufufuza zamankhwala komanso kupewa kachilombo ka HIV. Mankhwalawa amatha kumwa masabata 4 kapena 8 aliwonse. Atha kukulitsa kutsatira mankhwala pochepetsa kuchuluka kwa mapiritsi omwe anthu akuyenera kumwa.

Leronlimab, jakisoni mlungu uliwonse kwa anthu omwe alimbana ndi kachilombo ka HIV, awona kupambana m'mayesero azachipatala. Amalandilidwanso kuchokera ku FDA, yomwe idzafulumizitsa njira yopangira mankhwala.

Jakisoni wamwezi uliwonse wophatikiza rilpivirine ndi INSTI, cabotegravir, akuyembekezeka kupezeka kuti azitha kuchiza kachilombo ka HIV-1 koyambirira kwa chaka cha 2020. HIV-1 ndiye mtundu wofala kwambiri wa HIV.

Palinso ntchito yopitilira ya katemera wa kachilombo ka HIV.

Kuti mudziwe zambiri zamankhwala omwe ali ndi kachilombo ka HIV omwe alipo (komanso omwe angabwere mtsogolo), lankhulani ndi othandizira azaumoyo kapena wamankhwala.

Mayesero azachipatala, omwe amagwiritsidwa ntchito poyesa mankhwalawa pakukula, amathanso kukhala achidwi. Sakani pano kuti muyesedwe kuchipatala komwe kungakhale koyenera.