Gano abubuwan da ke faruwa da Zaɓin Sabon Yanayin Safiyar Sabuwar
Samun maganin cutar HIV ya auku ne lokacin da aka ƙaddara cewa ƙwayoyin maganin rigakafi ba su iya cimma burin farfadowa ba-wato kawar da ayyukan kyakyawan cutar HIV ko sabuntawa na aikin rigakafi don hana cututtuka masu haɗari . Kuskuren rashin lafiya za a iya lasafta shi a matsayin tsinkaye (dangane da cutar), immunologic (dangane da tsarin rigakafi), ko duka biyu.
Lokacin da rashin nasarar rashin lafiya ya faru, mataki na farko shi ne gano ainihin abin da zai iya taimakawa ga rashin nasarar, wanda zai haɗa da:
- Amfani da miyagun ƙwayoyi na suboptimal
- Samun maganin likita
- Kuskuren rashin lafiya na baya (s)
- Rashin daidaituwa ga ƙuntatawa da abinci
- A low pre-magani CD4 count
- Magunguna (irin su hepatitis C ko tarin fuka)
- Damag-miyagun ƙwayoyi
- Matsaloli da miyagun ƙwayoyi ko metabolism
- Drug effects effects, wanda zai iya tasiri adherence
- Cire ba tare da ɓarna ba ko amfani da kayan abu, wanda kuma zai iya tasiri
Ƙarƙwarar Virologic
An lasafta rashin cin nasara na yaudara a matsayin rashin yiwuwar cimmawa ko kula da nauyin hoto na kwayar cutar HIV wanda bai kai 200 kofe / mL ba. Wannan ba yana nufin cewa mutum ya kamata sauya sauya saurin ya kamata ya kamata adadin kwayar cutar ta sauka a kasa da 200. Yana yin aiki kawai a matsayin ma'auni wanda likita zai iya yin sanarwa ta asibiti a yayin da aka yarda da haƙuri da kuma aiwatar da ayyuka.
Hakazalika, ma'anar bai kamata ya nuna cewa yana da karɓa don kula da ƙasa da ƙarancin hoto mai kyau. Ko da "nauyin kyamaran bidiyo" (watau 50-199 kofi / mL) ya kamata ya damu, tare da binciken nan na baya-bayan nan wanda ya nuna cewa wannan aiki mai cike da sauri a cikin watanni shida zai iya ƙara haɓakar rashin cin nasara a cikin shekara guda by 400%.
(A bambanta, bidiyo mai hoto "blips" ba sa tsinkaye akan rashin cin nasara.)
Rashin amincewa da miyagun ƙwayoyi da kuma samo maganin miyagun ƙwayoyi suna yaudarar mahimman abu guda biyu na rashin cin nasara, musamman ma a cikin jigon farko. Bisa ga binciken, kimanin daya daga cikin marasa lafiya hudu zasu fuskanci rashin cin nasara sakamakon rashin daidaituwa, yayin da tsakanin 4% da 6% na marasa lafiya zasu kasa saboda mummunan magani.
Idan mummunan haɗuwa yana cikin zuciya na rashin cin nasara, yana da mahimmanci ga likita da kuma haƙuri don gano duk wani dalili mai mahimmanci. A lokuta da dama, sauƙaƙe na farfadowa (misali, rage nauyin pill, dosing mita) zai iya taimakawa wajen rage shingen aikin aiki ga biyayyar. Ya kamata a magance matsalolin motsa jiki ko maganin abubuwa, tare da waɗanda aka sanya su zuwa wuraren kulawa ko tallafa wa masu bada shawara, idan an buƙata.
Ko da yake an tabbatar da rashin cin nasara na kwayar cutar ta hanyar jarabawar gwajin jinsi , yana da muhimmanci a gyara duk wani maganganu na haɗuwa kafin ya cigaba da sabon maganin. Sai dai idan an magance shi a matsayin hanyar ci gaba da cutar HIV, zai yiwu a sake dawowa.
Canjin Canjin Bayan Bayanai na Lafiya
Cutar rashin lafiya ya nuna cewa yawancin yawan kwayar cuta a cikin "tafkin hoto" mai haɗari yana da tsayayya ga magungunan miyagun ƙwayoyi ko ɗaya.
Idan aka yarda yayi girma, cutar mai cutar zai haifar da juriya a kan juriya har sai yawancin miyagun ƙwayoyi ya auku.
Idan ana tsammanin tsayayyen miyagun ƙwayoyi kuma adadin hoto na kwayar cutar ya fi sama da 500 kofe / mL, ana gwada gwajin gwajin gwaji . Ana gwada gwajin ko dai yayin da mai haƙuri ke ci gaba da tsarin tsarin kasa ko cikin makonni hudu na farfadowa na farfadowa. Wannan, tare da nazari na tarihin lafiyar mai haƙuri, zai taimaka wajen jagorancin zaɓin farfadowa na cigaba.
Da zarar an tabbatar da tabbatar da maganin miyagun ƙwayoyi, yana da mahimmanci don sauya farfadowa da wuri-wuri domin ya hana karin maye gurbin miyagun kwayoyi daga tasowa.
Tabbas, sabon tsarin zai kunshi akalla biyu, amma ya fi dacewa uku, sababbin magunguna. Ƙara yawan miyagun ƙwayoyi mai mahimmanci ba'a ba da shawarar ba saboda yana iya ƙaruwa da ƙarfin maganin miyagun ƙwayoyi.
Zaɓin likitancin ya kamata ya dogara ne akan nazari na musamman don tantance juriya na maganin jigilar kwayoyi, ko don ƙayyade ko wasu kwayoyi zasu iya ci gaba da amfani duk da tsayayyar juriya .
Bincike ya nuna cewa marasa lafiya sunyi dacewa da hanyoyin magance cutar. Wannan yana iya kasancewa saboda gaskiyar cewa marasa lafiya kullum suna da ƙwayar CD4 da yawa a yayin da suke fara sabuwar farfadowa, ko kuma sababbin kwayoyin tsarawa sun fi dacewa wajen magance marasa lafiya da zurfi. juriya. Binciken ya nuna cewa marasa lafiya da suka kasa maganin saboda mummunar haɗin kai sun inganta yawan haɗin kai a kan layi na biyu.
Duk da haka, yana da muhimmanci a lura cewa maye gurbin hoto na hoto bazai yiwu ba a duk marasa lafiya, musamman wadanda suka kasance a kan hanyoyin tarin yawa a cikin shekaru. A irin waɗannan lokuta, ya kamata a ci gaba da farfadowa tare da manufar tabbatar da ƙwayar magungunan ƙwayoyi da kuma adana yawan adadin CD4.
A cikin marasa lafiyar marasa lafiya da CD4 suna ƙidayar ƙasa da 100 kwayoyin / mL da ƙananan zaɓuɓɓukan magani, adadin wani wakili na iya taimakawa rage hadarin cutar ci gaba da sauri.
Immunologic Failure
Ma'anar rashin nasarar immunologic yana da yawa da yawa, tare da wasu suna kwatanta shi
- rashin iyawa don ƙara yawan CD4 na marasa lafiya a sama da takamaiman ƙofar (misali, fiye da 350 ko 500 sel / mL) duk da maye gurbin hoto, ko;
- rashin yiwuwar ƙara yawan CD4 na mai haƙuri ta wani adadin sama da magungunan rigakafi duk da maye gurbin hoto.
Kodayake bayanai sun kasance masu saurin gaske, wasu nazarin sun nuna cewa yawancin marasa lafiya da ƙananan CD4 ba tare da la'akari ba, duk da murfin hoto na iya zama kamar yadda ya kai 30%.
Matsalar magance rashin nasarar immunologic ita ce mafi yawancin abin da ya haɗa da ko dai ƙididdigar CD4 mai mahimmanci ko ƙididdigar CD4 na "nadir" (watau, mafi ƙasƙanci, tarihin CD4 akan rikodin). Sakamakon haka, yawancin tsarin kulawa da marasa lafiya ya rigaya an daidaita kafin a farfadowa, mafi wuya shine a sake mayar da wannan aikin.
Dalilin da ya sa ka'idodin cutar HIV na yau da kullum sun bada shawara a farkon farawar farfadowa lokacin da aikin rigakafi har yanzu ya kasance.
A wani ɓangare, rashin cin nasara na immunologic zai iya faruwa har ma da CD4 mafi mahimmanci. Wannan na iya haifar da ciwon haɗuwa da suka wuce ko haɗin gwiwa, tsofaffi, ko ma tasirin ciwo mai ci gaba da cutar ta HIV. A wasu lokuta, babu dalilin da ya sa hakan ya faru.
Ko da mawuyacin matsalar shine gaskiyar cewa babu wata yarjejeniya a kan yadda za a magance rashin nasarar immunologic. Wasu masu bayar da shawarwari suna bayar da shawarar canza farfadowa ko ƙara ƙarin wakili na maganin rigakafi, ko da yake babu shaidar da cewa wannan yana da tasiri sosai.
Duk da haka, idan an gane rashin cin nasara na immunologic, ana bukatar cikakken nazarin marasa lafiya idan akwai
- duk wani magunguna wanda zai iya rage yawan tarin jini (musamman CD4 + T ), maye gurbin ko dakatar da kwayoyi idan ya yiwu, ko;
- duk wani cututtukan da ba a yalwatawa ba ko yanayin kiwon lafiya mai tsanani wanda zai iya taimakawa ga amsawar immunologic low.
Ana gudanar da bincike kan hanyoyin maganin rigakafi da dama, duk da cewa babu wanda ake ba da shawarar a halin yanzu a waje da yanayin gwaji.
> Sources:
> Ma'aikatar Kiwon Lafiyar Jama'ar Amirka da Harkokin Dan Adam (DHHS). "Gudanar da Jiyya-Kwarewar Kwarewa: Kwayoyin Halitta da Lafiyar Immunologic." Rockville, Maryland; isa ga Fabrairu 21, 2014.
> Paredes, R .; Lalama, C. Ribaudo, J. et al. "Yanayin ƙwayar cuta HIV-1 da ke cikin ƙananan marasa rinjaye na zamani, da haɗin kai, da kuma hadarin maganin cututtuka na maganin rigakafi." Journal of Diseases Diseases . Maris 2010; 201 (5): 662-671.
> Laprise, C. de Pokomandy, A .; Baril, J. et al. "Harkokin maganganu na yau da kullum da ke ci gaba da ci gaba da ci gaba da kasancewa a cikin wani ɓangare na marasa lafiya HIV-positive: sakamako daga shekaru 12 na kallo." Cututtuka na cututtuka na asibiti. Nuwamba 2013; 57 (10): 1489-96.
> Hammer, S .; Vaida, F .; Bennett, K .; et al. "Dual vs single protease maganin farfadowa bayan rashin nasarar maganin cututtuka: gwajin gwagwarmaya." Journal of the American Medical Association (JAMA) . Yuli 10, 2002; 288 (2): 169-180.
> Gazzola, L ;; Tincati, C. Bellistri, G .; et al. "Rashin CD4 + T ƙwaƙwalwar ƙwayoyin cuta ba tare da samo asibiti na maganin cututtuka ba: maganin haɗari, ƙananan immunological, da kuma hanyoyin warkewa." Cututtuka na cututtuka na asibiti. Fabrairun 2009; 48 (3): 328-337.