Kiwon lafiya mafi kyau, ƙananan ƙwayar ƙwayar cuta tsakanin wadata
Ranar 30 ga watan Satumba, 2015, Hukumar Lafiya ta Duniya (WHO) ta sake nazarin maganganun kula da cutar kanjamau na duniya game da maganin cutar HIV don bayar da shawara ga farawar maganin antiretroviral (ART) a lokacin ganewar asali.
Har zuwa kwanan nan, akwai muhawara tsakanin masu tsara manufofin da masu bincike game da ko za a fara shirin ART nan da nan ko jinkirta har sai lokacin da aikin na rashin lafiya ya kasance a ƙasa da wani ƙayyadadden ma'auni (kamar yadda aka auna CD4 na mutum).
Magoya bayan ART din sun nuna bayanai wanda ya nuna cewa safarar mataki ya rage yawan lalacewa na tsawon lokaci HIV zai iya haifar da lalacewa na mutum-lalacewa wanda zai iya haifar da haɗarin cututtuka na tsawon lokaci. Masu sukar sunyi gargadin cewa babu wani shaida game da ko fara ART a sama da ƙofar da ake bukata a yanzu (CD4 ƙidaya a ƙarƙashin Kwayoyin 500 / ML) yana da muhimmancin gaske akan tasirin cutar ko kwanakin mai haƙuri.
Canje-canje a cikin manufofin WHO zai kara yawan yawan mutane da ake bukata a cikin ART, daga yawan mutane miliyan 15 zuwa miliyan 100 na duniya HIV.
Binciken Tambaya na Gyara Tsarin Gidajen Duniya ta Duniya
Ranar 27 ga watan Mayu, 2015, masana kimiyya a Cibiyar Harkokin Kwayoyi da Kwayoyin cuta na kasa (NIAID) sun kawo ƙarshen muhawarar ta tsawon lokacin da aka dakatar da Kwanan Tsarin Lantarki (START) binciken fiye da shekara guda saboda tsabtacewa. shaida cewa magani a kan ganewar asali, ba tare da la'akari da CD4 ba, yana da amfani mai mahimmanci ga marasa lafiya da ke dauke da kwayar cutar HIV.
Aikin binciken, wanda ya sa mutane 4,685 da ke dauke da kwayar cutar kanjamau da mata masu shekaru 18 da haihuwa, an yi nufin kammalawa a karshen shekara ta 2016, amma an kammala su a lokacin da lokacin da aka samu a cikin lokaci ya nuna kashi 53 cikin dari na yawan cututtuka masu tsanani a cikin wadanda wadanda aka ba da su nan da nan tare da waɗanda suka dakatar da ART.
Sakamakon sun kasance daidai a fadin makamai na bincike, ko marasa lafiya ne daga kasashe masu girma, ko ƙasashen tsakiya.
A sakamakon haka, masana kimiyya da masu tsara manufofi sun bayar da sanarwa a ranar 19 ga Yuli, 2015, sun yi la'akari da yarjejeniyar da aka yi a Vancouver, wadda ta bukaci a fara gabatar da ART a duk marasa lafiya. A cikin sanarwar su, ƙungiyar ta bayyana dalilan da ART ta samo asali game da samfurin magance cutar da cutar HIV.
Gwanin farko ya rage tasirin kumburi mai tsawo
Kafin wannan gwaji na farko, masu bincike sun yi hankali game da maganin cutar kanjamau a kan ganewar asali a matsayin yawan mace-mace ga marasa lafiya da suka fara Tsara na CD fiye da CD4 na kwayoyin 350 / ML sun kasance ainihin yanayin rai kamar yawan jama'a. Me yasa, sun yi jayayya, ya kamata mu fuskanci rikitarwa na rashin kulawa da rashin lafiya lokacin da muka fara la'akari da ƙididdigar CD4 ba tare da ƙarin ƙarin amfani ba dangane da bunkasa rayuwa?
Dangane da mace-mace kadai, wannan zai iya zama wata hujja mai kyau. Game da ainihin rashin lafiya, duk da haka, hujja suna magana daban.
Yayin da wani kamuwa da cuta zai yi, jiki zai fuskanci amsawar ƙoshin lafiya a gaban wani kwayar cutar kamar HIV. Idan aka bari ba tare da izini ba, ci gaba, ci gaba da ƙonewa zai iya haifar da lalacewa marar lalacewa da kwayoyin jikin jiki.
Saboda cutar HIV ne mai ciwo na kullum, ko da ci gaba, ƙananan ƙumburi zai iya haifar da tsufa na kwayoyin halitta-wanda aka sani da tsohuwar ƙwayar jiki ko kuma "flammaging" - wadanda ke dauke da yawan cututtukan zuciya da cututtukan da ke cikin mutanen da ke dauke da kwayar cutar HIV, sau da yawa 10- Shekaru 15 da suka gabata fiye da takwarorinsu marasa lafiya.
Koda a cikin mutanen da ke dauke da kwayar cutar HIV da ake kira "masu jagoranci" - tasirin mummunan ciwon ciki yana haifar da mummunan sakamako da kuma rashin lafiyar marasa lafiya idan aka kwatanta da mutane a kan ART tare da ciwon maganin cutar .
Sakamakon haka, ta hanyar sanya mutum a kan ART a farkon farkon kamuwa da cuta , za ka ceci mutumin da rashin tasiri na kumburi da ke fama da rashin lafiya.
Tsayawa kawai yana ba da damar ƙonewa don ci gaba, ba tare da ɓoye ba, don ko'ina daga tsakanin shekaru 5-10.
Sabbin magungunan ƙwayoyi suna ba da ƙananan ƙwayar cuta, haɓaka haɓaka
Yawancin damuwa da aka danganta da maganin miyagun ƙwayoyi na dogon lokaci an samo shi ne a kan abubuwan da aka gani tare da tsararru na baya-bayan nan, inda yaduwar amfani yakan haifar da mummunar tasiri ga mai haƙuri.
An yi amfani da kwayoyi irin su stavudine, wadanda ke haifar da mummunan maganin miyagun ƙwayoyi a marasa lafiya, wanda ya fito daga lipodystophy (sassauran jikin jiki) zuwa neuropathy (mummunan lalacewar kwayoyin jikinsu) zuwa lactic acidosis (barazanar rai mai barazana ginawa na lactic acid).
Hakazalika, da dama daga cikin tsoffin antiretrovirals suna da bayanan maganin magunguna. Amfani da nevirapine a monotherapy, alal misali-aiki marar gajeren aiki a 2002 don hana yaduwar mahaifiyar-yarinya-ya ci gaba da zama a tsayayyen jigilar nevirapine, wani lokaci bayan an samu kashi daya.
Wadannan damuwa sunyi amfani da sababbin kwayoyin halittar, wanda ba wai kawai ya ba da bayanan tasiri ba amma ya zama mafi girma da gafarar kwayoyi da kuma "gafara" (watau ikon kula da magungunan maganin warkewa ko da an dakatar da dosin).
Bugu da ƙari, jin tsoro game da maganin magungunan miyagun ƙwayoyi - wucewar juriya daga mutum daya zuwa na gaba-an ragu da yawa, tare da bayanan yanzu daga Hukumar Lafiya ta Duniya da ke bayar da shawarar samar da juriya na kimanin 7% a ƙasashe masu ƙasƙanci zuwa matsakaici. kamar rabin abin da ke gani a Amurka da Turai).
A kasashe masu tasowa mafi girma, yawancin magungunan miyagun ƙwayoyi sun fi dacewa da sababbin kwayoyin halittar da aka gabatar da su a cikin shekaru 10-15 a baya fiye da yawancin kasashe masu tasowa.
Irin wannan binciken ya nuna cewa cutar ta HIV a ƙasashen da ba su da kudin shiga , inda aka sani cewa cutar ta kamu da cutar, ya zama mafi mahimmanci, a wani ɓangare mai yawa, da gaske cewa an rage yawan mutane a likitoci idan aka kwatanta da Amurka da Turai.
Jiyya kan Bincike na iya rage Rashin HIV
Jiyya a matsayin Rigakafin (TasP) wata hanya ce da za ta rage rage yawan abin da ake kira "tsibirin hoto na al'umma" ta hanyar sa ƙungiyar jama'a a kan ART. A yin haka, yiwuwar cutar HIV ya rage sosai yayin da mutane da yawa zasu iya samun cikakken magance ayyukan aikin bidiyo .
Shaidar da aka fi sani da San Francisco, wani birni wanda ya samu kashi 30-33% a cikin kwayar cutar HIV daga 2006-2008 saboda yaduwar cutar antiretrovirals. Bisa ga wadannan sakamakon, jami'an gari sun gabatar da manufofin ART game da ganewar asali a farkon shekarar 2010.
Hakazalika, binciken da aka yi a shekarar 2015 daga lardin Henan ya nuna cewa an ragu da kashi 67 cikin dari na hadarin watsawa a tsakanin ma'aurata da ke tsakanin mata da maza (watau abokin tarayya guda daya da cutar HIV). An sanya abokan hulɗa da kwayar cutar HIV a kan ART.
A cikin aiwatar da manufar shirin duniya na ART a kan ganewar asali, yawancin jami'an kiwon lafiya sun yi imanin cewa za a iya samun irin wannan gagarumar yawanci kamar yawancin mutane kamar Afirka ta Kudu, inda yawancin cututtuka na ci gaba da haɓakawa duk da yawan ƙididdigar ART.
Ko hukumomin duniya zasu iya cimma burin wadannan manufofi da aka ba da gudunmawar kudi daga kasashe G8 masu arziki ne wani abu ne gaba ɗaya. Tare da kimanin mutane miliyan 35 da ke fama da cutar HIV a yau-kuma kimanin miliyan 13 a kan ART-babbar kalubalen zai iya fadada magani a ƙasashe inda ba a fahimci hanyoyin gina kiwon lafiya, a mafi kyau.
Sources:
Cibiyar Kula da Lafiya ta Duniya (NIH). "Farawa na Early Antirioviral Amfani da Sakamakon HIV-Cutar Mutane Daya." Bethesda, Maryland; bayar da Mayu 27, 2015.
Hasse, B; Ledergerber, B; Egger, M., et al. "Yara da kuma (Abun da ba tare da HIV ba) Co-Morbidity a cikin HIV-tabbatacce Mutane: Nazarin Jakadancin Siyasa (SHCS)." Taron 18 na Harkokin Kasuwanci da Hanyoyi (CROI). Boston, Massachusetts; Fabrairu 27-Maris 2, 2011; m 792.
Pantazis, N .; Porter, K .; Costagliola, D .; et al. "Maganganun Tsakanin Tsakanin Masanan Masarufi na HIV-1 Kwayoyin cuta da Tsarkewa: Nazarin Jakadancin Kulawa." Lancet HIV. Disamba 2015; 1 (3): e119-126.
Smith, K ;; Westreich, D .; Liu, H .; et al. "Jiyya don hana yaduwar cutar HIV a cikin 'yan uwan juna biyu a Henan, Sin, daga 2006 zuwa 2012." Cututtuka na cututtuka na asibiti. Maris 13, 2015; fara: civ200. [Afubu gaba].
Masana kimiyya ta mutum (HSRC). " Cibiyar Binciken Kasuwancin Afirka ta Kudu ta Afirka ta Kudu , Bincike da Rashin Lafiya, 2012." Pretoria, Afirka ta Kudu; bayar da Disamba 1, 2012.