Shin sababbin kwayoyin cutar sun canza dokokin game da kamuwa da HIV?
Dheg adherence ya kasance babban mahimmanci don samun nasara wajen magance cutar HIV. Sabanin magani na yau da kullum da ake amfani dashi don magance cututtuka irin su cututtukan zuciya ko ciwon sukari-wanda ke bukatar kusan kashi 70 cikin dari don cimma burin maganin asibiti - maganin rigakafi (ko ART) yana buƙatar kusa da cikakken daidaituwa don kiyaye maganin cututtukan kwayoyi da kuma hana ci gaba da ciwon ƙwayoyi juriya .
Amma an ba da cewa yanzu muna da sababbin magungunan magungunan maganin rigakafi , shin dokoki ne daidai?
Mantra na 95%
Shirye-shiryen maganin cutar HIV ya nuna cewa marasa lafiya suna bukatar kiyayewa fiye da 95% don tabbatar da maganin cututtuka. Ga wani tsari na yau da kullum na yau da kullum, wanda ke fassara har zuwa kwanaki 14 na wani lokaci, an rasa asibiti a cikin shekara guda.
Duk da haka, wasu sun fara jayayya cewa "95% mantra" ya dogara ne akan bayanan da aka tattara a ƙarshen shekarun 1990, lokacin da miyagun ƙwayoyi suka fi rikitarwa kuma kwayoyi sun ragu da rabi. Duk da yake akwai 'yan wanda za su yi shelar 85% ko 90% a matsayin "sabon" daidaituwa, mutane da yawa sun gaskata cewa buƙatar yin ƙyama ko gurgunta marasa lafiya saboda kasancewa marar cikakke ba shi da wuri kamar yadda yake da muhimmanci kamar yadda ya kasance shekaru 10 da suka gabata.
Duk da haka, akwai yalwa da suka gaskanta cewa rage girman ƙofar kofa (ko ma bayar da shawarar canji) kuskure ne, yana barin matakan slippage wanda zai kara yawan lokaci kawai.
Akwai hujjoji don tallafawa wannan jayayya. Bisa ga bayanan da Cibiyar Kula da Cututtuka da Rigakafin {asashen Amirka (CDC) ta shirya, kimanin kashi 30 cikin 100 na jama'ar Amirka a kan ART ba su iya cimma burin maganin hoto ba. Yawancin yarda cewa haɗin kai na tsakiya yana taka muhimmiyar rawa a wannan, yayin da wasu nazarin ya nuna cewa haɗuwa da al'ada ya ragu bayan watanni na farko na '' gudun hijira 'bayan da aka fara samarda ART.
Duk da haka, akwai shaida mai yawa don tallafawa sababbin ƙwayoyin magungunan sun kasance mafi "gafartawa" saboda yanayin juriya, musamman magungunan "inganta" da suka iya taimakawa wajen magance ƙwayar magungunan ƙwayar ƙwayar cutar ƙwayar plasma a tsawon lokaci.
Amma akwai shaidar da ya isa ya kira don shakatawa na ayyukan haɗin kai? Koda ma mafi kyau, magungunan maganin antiretroviral mafi mahimmanci, shin muna cikin wannan mataki tukuna?
Ana ƙaddamar da Shaida
Masu haɓaka masu tsaro (PIs) suna samfurin misali ne na cigaba a cikin ART ta zamani. A yau, PIs kusan kusan dukkanin duniya suna "bunkasa" -ace suna haɗuwa tare da miyagun ƙwayoyi na biyu don ƙaddamar da kwayoyin halittar PI. Misali-bincike na manyan bincike guda biyar ya nuna cewa sabon ƙarni ya bunkasa PIs-kamar Prezista (darunavir) - a gaskiya, kawai yana bukatar 81% haɗuwa don cimma burbushin hoto.
Ya bambanta, kamar yadda Kaletra (lopinavir + ritonavir) ya kasance mai zurfi kamar yadda Kaletra (lopinavir + ritonavir) ya kasance ba tare da tasiri ba, tare da binciken daya cewa kawai kashi 53 cikin dari na marasa lafiya zasu iya samun nauyin nau'i na kyamaran da ke ƙasa a wannan matakin hadewa.
Bincike ya yi nisa sosai game da tasiri na haɗuwa kan wasu nau'o'in antiretrovirals. Yayin da wasu nazarin sun nuna cewa magunguna masu ƙwayar transcriptase (NNRTI) wadanda basu da magungunan ƙwayoyin cuta (NNRTI) kamar na Sustiva (efavirenz) na iya buƙatar 80% zuwa 90% haɗuwa idan aka yi amfani da haɗin tare da PI wanda aka ƙarfafa, wasu suna jayayya cewa matakan haɗaka suna da ake bukata saboda zuwa ga yiwuwar juriya da tsayayya da sauran kwayoyi NNRTI.
Hakazalika, CPCRA FIRST Study ya gano cewa jigilar juriya a tsakanin magungunan sake maido da magungunan transcriptase (NRTI) kamar Retrovir (AZT, zidovudine) ya karu cikin daidaitaccen daidaituwa tare da raguwar ƙulla maganin miyagun ƙwayoyi.
Akwai ƙananan binciken da ake samuwa don tantance dangantaka tsakanin haɗuwa da sababbin magungunan miyagun ƙwayoyi irin su Intra (etravirine) ko ma masanin analogues nucleotide, Viread (tenofovir). Bugu da ƙari, daga masu haɓaka masu haɗin gwiwa da aka yarda su yi amfani da su, kawai ƙananan ƙananan binciken Isentress (raltegravir) ya nuna cewa matsayi na 90% na iya yarda.
Ya kamata Mutuwa daya (ko Da dama) ya damu da ni?
Samun kwancen lokaci ko kasawa don daukar kashi a lokaci shine wani abu da yake faruwa ga kowa da kowa akan magani na yau da kullum.
Ga mafi yawancin, wannan bazai haifar da damuwa ba. Duk da haka, mafi tsawo ko fiye da akai-akai waɗannan lapses na faruwa, ƙananan ƙwayoyi suna da kulawa da kulawar maganin hoto.
Ɗaya daga cikin binciken da Cibiyar Nazarin Ciwon Kwayoyin cuta ta Roma ta gudanar a Roma ta nuna cewa raguwa a cikin kwanaki biyu kawai a cikin wata guda ya haifar da karuwar sau biyar a cikin abubuwan da ke tattare da ayyukan bidiyo. Taimakawa bincike a shekara ta 2013 ya nuna cewa koda za'a ci gaba da yin amfani da nauyin kwayar cutar hoto (tsakanin 50 zuwa 199 kofe / mL) zai iya haifar da mummunan haɗari na rashin lafiya.
Hakazalika, bincike daga asibitin asibitin Cote de Nacre a Faransa ya nuna cewa raguwa a cikin ART ya kara yawan yiwuwar rashin lafiya , tare da katsewar kwanaki 15 da ke ba da damar yin amfani da kashi 50%.
A cikin irin wannan yanayin, jarrabawar magancewa da gwagwarmayar lafiya ta AEPIT (AEPIT) sunyi nazarin tasiri na kurakuran lokaci akan ayyukan bidiyo. Bisa ga binciken, marasa lafiya da suka bar har tsawon sa'o'i uku a kowane bangare na sababbin lokuta suna da nauyin ayyukan hoto fiye da 300% fiye da waɗanda suka dauki maganin su a lokaci.
To me Menene wannan Ma'anar Na?
Babu shakku cewa sababbin kwayoyin tsarawa sun fi sauƙi don amfani da juriya, bada "gafara" mafi girma idan mai haƙuri ya rasa kuskure. Kuma yayin da muke cikin motsi zuwa ga kwayoyi masu tsayi da yawa da ake bukata ba tare da jinkirta ba, masu juriya har yanzu ba su san ko wannan fadi ba ne ainihin canji a shawarwarin da za a bi.
Daga qarshe, ART ta dogara ne akan hadewar magunguna, kowannensu yana da rabi mai rabi da pharmacokinetics. Wasu daga cikin tsarin suna da ƙananan hanyoyi don kurakurai; wasu mafi girma. Daga hanyar da za a iya amfani dashi, zai zama marar tasiri don canza ginshiƙan sakonni tare da kowane tsarin kulawa.
Maimakon haka, matsalolin haɗin kai dole ne a haɗu da mafi haƙuri daga masu bi da kuma rashin jin tsoro daga masu jin tsoro suna jin tsoron shigar da su. Idan wani abu, yana kira don haɓaka mai haɗaka mai haɗaka, tare da manufofi da ƙayyadadddu don tabbatar da daidaituwa, haɗin kai. Wadannan ya hada da:
- Gwaninta mai kyau na ƙuntatawar haɗi kafin ingancin ART (misali, aikin aiki, yara, ƙididdiga, rabuwa, da dai sauransu)
- Binciken ci gaba da haɗin kai don magance matsalolin sabon ko data kasance (ciki har da sakamakon maganin cutar, matsalolin iyali, matsalolin motsa jiki, da dai sauransu)
- Saukar da tsarin kulawa, inda aka nuna
- Yin magana da wasu abubuwa masu mahimmanci da suka haɗa da mummunan haɗuwa (misali, cin zarafi, damuwa, rashin gida, da dai sauransu)
- Yin amfani da na'urorin haɗi (misali, masu shirya maganin magunguna, na'urori masu tuni) ko tsarin tallafi.
A takaice dai, yana da kyau don magance haɗuwa ba sosai a cikin " Mene ne isa?" Amma a matsayin hanyar gano kayan aiki don tabbatar da cewa ART wani aiki ne, ɓangaren ƙarfin zuciya na aikin yau da kullum na mutum .
Idan za a iya samun wannan, to, tambaya na "nawa" zai iya fada gaba ɗaya.
Sources:
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Martin, M. Del Cacho, E; Codina, C .; et al. "Huldar da ke tsakanin Matsayin Haɗakarwa, Tsarin Harkokin Cutar Gida, da Kwayar cutar HIV Kwayar 1 RNA Gwaji Na Yarin Gida: Nazarin Kwango da Kwarewa." AIDS Research Human Retroviruses. Oktoba 2008; 24 (10): 1263-1268.
Mena, A; Blanco, F .; Cordoba, M; et al. "Nazarin Nazarin Pilot na Gwajin Raltegravir QD BAYAN BAYA A Cikin Masarautar HIV dauke da Cikin Gudanar da Ƙaddamarwa." An gabatar da shi a taron 49 na Interscience a kan Masanan Antimicrobial da Chemotherapy (ICAAC). San Francisco, California; Satumba 12-15, 2009.
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Ammassari, A; Trotta, M .; Zaccarelli, M .; et al. "Rashin Imanin Daban Dabbobi daban-daban Abubuwan da ke ciki da na CART Abubuwan da ke kan cutar HIV-1 RNA ganowa a karkashin Ƙananan Ƙididdigar Ƙaddamarwa a Gidan Gida na Real Time." An gabatar da shi a taron 12 na AIDS AIDS. Cologne, Jamus; Nuwamba 11-14, 2009.