Kuna tunanin cewa zai zama abu mai sauƙi ka yi: ƙirƙirar gel ko cream wanda zaka iya amfani da shi kafin yin jima'i don yaduwar cutar HIV a kan hulɗa. Bayan haka, idan wani abu kamar nonoxynol-9 zai iya rage haɗarin ciki ta hanyar kashe kwayar halitta, yaya zai zama da wuya wajen samar da wani abu don HIV, daidai?
Gaskiyar ita ce, ci gaba da kamfanonin microbicidal sun sha wahala tare da kalubale da rikice-rikicen tun lokacin da aka fara gabatarwa fiye da shekaru 25 da suka shude.
A wasu lokuta, ikon da wakili ya yi na kawar da kwayar cutar ta HIV ya ɓatar da hankali ga lalacewa na kyamaran ƙwayoyin maganin na tsofaffi ko gyare-gyare maimakon hana cutar HIV.
A wasu lokuta, jami'ai ba su da wani amfani wajen hana cutar HIV ko kuma haifar da mummunan sakamako ga wadanda ke shan magani.
Har zuwa yau, babu kwayar cutar kwayar cutar ta HIV ko dai akwai ko aka yi shawarar don amfani. Duk da haka, yawancin 'yan takara suna nazarin rayayye, ciki har da gel na tenofovir, da zobe mai tsayi, da kuma microbicides.
Me ya sa ake dauke da kwayoyi masu mahimmanci?
Ba za a yi amfani da maganin magunguna ba don maye gurbin kwaroron roba ko karɓar ayyukan jima'i mafi aminci , amma don samar da wani kariya mai karewa a lokacin jima'i-musamman a cikin jima'i-mai karɓa ko haɗari mai karɓan jini inda hadarin watsa ya fi girma.
Duk da haka, daga hoto mai mahimmanci, ana ganin microbicides kamar yadda ake amfani da shi wajen rage yaduwar cutar HIV tsakanin mutanen da suka fi haɗari.
Wadannan sun hada da matan da ke da matukar damuwa da zina da zalunci, ko wadanda ba su da haɓaka da jima'i ba kawai ba ne (ko dai saboda sha'awar su haifi 'ya'ya, ko kuma al'adun al'adu da ke iyakance ikon su da iko).
An yi la'akari da cewa microbicides zai iya samar da mata a wata hanya mai mahimmanci na kariya ta kanta yayin da masu amfani da masu amfani su kara ingantawa ya kamata a yi amfani da kwaroron roba ko ɓoyewa a yayin haɗuwa.
Sa'idojin farko a binciken bincike na Microbicidal
Mafi yawan binciken bincike na microbicidal na farko da aka mayar da hankali a kan yin amfani da duk wani abu mai tsauri ko jamiái wanda zai iya canza pH mai lalacewa don kashe (ko rashin aiki) HIV.
Daga cikin 'yan takarar farko sune nonoxynol-9, wanda ake amfani da shi a matsayin mai kashe-kashen jini da kuma wasan kwaikwayo / wasan kwaikwayo. Abin mamaki shine, wani bincike-bincike da aka gudanar a shekara ta 2002 ya tabbatar da cewa amfani da nonoxynol-9 a hakika ya kara yawan cutar HIV a cikin mata ta hanyar kashi 50%, tare da halayen cutar marasa lafiya wanda ke haifar da hadarin.
Sauran ma'aikatan da aka tsara don kula da hawan, an nuna nauyin hakar gine-gine na kare jiki (ciki har da mai bincike BufferGel ) da yawa a cikin mata, amma ba a nuna ba akan ragewar HIV.
Manufofin Ci Gaban
Akwai hanyoyi masu yiwuwa ga cigaban ci gaba da amfani da kwayar cutar HIV, wadda za a iya raguwa cikin kashi biyu.
Na farko za a iya adana shi a matsayin magungunan maganin rigakafin kwayar cuta , wadanda jami'ai zasuyi aiki a matsayin masu ado ga HIV (hana haɗin ƙwayar cutar don magance ƙwayoyin tsofaffin) ko amfani da macromolecules da ake kira dendrimers wanda ke ɗaukar kwayar cutar ta HIV don hana cutar.
Yayinda ƙoƙarin farko ya tabbatar da rashin nasara ( PRO 2000 , Carraguard , cellulose sulphate), an gano sababbin sababbin jami'in-ciki har da dendrimer microbicide VivaGel , da kuma amfani da synergistic dendrimers da kuma mai shigarwa CCR5 Selzentry (maraviroc) maganin antiretroviral (ART) .
Na biyu, kuma mafi girman zancen shahararrun, sashe ne na microbicides antiretroviral . Ci gaban wadannan jami'o'i na dogara ne akan bincike kan amfani da tenofovir da sauran kwayoyi masu maganin rigakafi a cikin gels, zobba, lubricants, da kuma sauran tsarin bayarwa.
CAPRISA 004 Nazarin a shekarar 2010 shi ne na farko da ya nuna yadda tasirin ya kasance tasiri, yana amfani da amfani da 1% 10ofovir gel kafin da kuma bayan jima'i a cikin mata 889 mata masu cutar HIV.
A takaice dai, kashi 39 cikin 100 na yawan kamuwa da ƙwayar cuta ya ragu a cikin ƙungiyar ba-wuribo, yayin da masu haɗaka da matsakaicin matsayi (fiye da kashi 80) na da kashi 54 cikin dari.
A bambanta, ana ganin ƙwararrun VOICE a matsayin wani abu mai mahimmanci. Sakamakon bayanan CAPRISA, Muryar Muryar ta bincika nau'o'in ƙwayar cutar HIV guda biyu-yin amfani da kwayar cutar kanjamau (ko dai Viread ko Truvada ) ko amfani da yau da kullum na yara 10ofovir - a cikin 5,029 matan. An gama shari'ar a lokacin da babu wani hanyoyin da zai iya tasiri.
Bayanan nazarin binciken ya yanke shawarar cewa rashin nasarar da aka samu bai dace da hanyoyin kwantar da hankali ba, amma ga rashin daidaituwa a tsakanin mahalarta (musamman a tsakanin matasa, marasa aure). Ƙarin bincike zai taimaka wajen inganta yanayin ƙaddamarwa.
Hanyar Wayar
Bayan an dawo da jarrabawar VOICE, an yi tura turawa don gano hanyoyin da za a ci gaba da bunkasa magungunan microbicidal. Sakamakon yawancin sunadaran. Daga cikin gwajin II da III na kwanan nan ya kammala:
- Binciken FACT 001, wanda ya karbi mata 2,900 a Afirka ta Kudu, ya ba wa mahalarta wannan tsari kamar yadda yayi amfani da CAPRISA 004 (1% na 10ofovir kafin da bayan jima'i). Bisa ga sakamakon binciken, babu rage yawan adadin cutar HIV tsakanin masu amfani.
- ASPIRE (MTN-020) yayi nazari akan ingancin wani nau'i na ciki wanda ke dauke da dapivrine (wata mawuyacin hali, magungunan rigakafin gwaji) idan aka yi amfani dashi na wata daya a cikin mata 3,476 a Afirka. Sakamako a 2015 ya nuna kusan kashi 27 cikin dari na haɗarin cutar HIV a tsakanin mata ta yin amfani da zoben dapivirine, musamman a cikin matan da shekarunsu suka kai 21. An sami kariya a kananan yara ko a shekarun da suka wuce 21, musamman saboda rashin amfani da na'urar .
- Hakazalika, RING (IPM 027) Binciken ya binciko zanen dapivirine a cikin mata 1,650 a Uganda da Afirka ta Kudu a cikin bazuwar, gwaji ta III. Masu shiga za su yi amfani da zoben su na tsawon shekaru biyu. Sakamako sun kasance mafi kyau fiye da waɗanda aka gani a nazarin ASPIRE, tare da rage yawan kashi 37%. Har ila yau, sakamakon ya fi kyau tsakanin mata masu shekaru 21 da haihuwa. Ba a samu amfani ga mata a shekarun 18-21 ba.
- A halin yanzu, MTN 017 za ta gano yadda ake amfani da gel din na gomaofovir wanda ya hada da amfani yau da kullum na Truvada a cikin rukuni na maza 186 da suka yi jima'i tare da maza (MSM) da kuma mata masu sintiri . An gudanar da binciken na Phase II a cikin makonni takwas, tare da matakan da za a yarda da su da kuma biyan tsarin tsarin da yawa. Tsarin karatu zai iya mayar da hankali akan inganci da kuma amfani da gel din gyare-gyare don kare kariya kafin da bayan jima'i.
- A ƙarshe, a cikin watan Maris na 2014, Cibiyar Kula da Lafiya da Rigakafin Cututtuka ta CDC ta gudanar da bincike na dabba wanda ya nuna cewa gel din da ke amfani da ita (ratelgravir) zai iya haifar da yaduwar cutar HIV a cikin mata bayan bayyanar jima'i. Babu wata kalma a kan ko za a faɗakar da binciken fiye da hujja ta yanzu.
Sauran bangarori na bincike suna bincike akan ci gaba da fina-finai mai mahimmanci, da magunguna, da magunguna daban-daban (ko takaddun shaida) don gels ko kuma zobba.
Sources:
Abdool Karim, Q .; Abdool Karim, S .; Frohlich, J .; et al. "Kyakkyawan Tsaro da Tsaro Tenofovir Gel, Microbicide na Antiretroviral, don Rigakafin cutar HIV a cikin Mata." Kimiyya. Satumba 3, 2010; 329 (5996): 1168-1174.
Cibiyar gwaji ta Microbicide (MTN). "Game da Rubutun Magunguna na Microbicides: Cibiyar Gudanar da Microbicide." Pittsburgh, Pennsylvania. Takardar shaidar da aka bayar ranar 25 ga Maris, 2014.
Dobard, C .; Sharma, S .; Parikh, U. et al. "Kariya na Bayani na Macaques daga Cutar SHIV Ƙwayar cuta ta Ƙwararrun Masu Maƙalli." Science Translational Medicine . Maris 12, 2014. 6 (227): 227ra35.