Cagaarshow C waa cudur faafa oo saameeya beerka, kaas oo lagu kala qaado fayraska cagaarshowga C (HCV) waana mid ka mid ah sababaha keena isbitaalada iyo dhimashada dadka qaba HIV.
Ururka Ameerika ee Daraasaadka Cudurrada Beerka (AASLD) wuxuu soo tebiyaa in cagaarshow nooca Viral-oo ay ku jiraan cagaarshowga A, B , iyo C-maanta ay tahay sababta keentay geerida adduunka oo dhan, iyadoo lumisay nolol ka sarraysa AIDS , qaaxada, iyo duumada .
Ma jiraan wax tallaal ah oo loogu talagalay cagaarshow C.
Cudurka HIV / HCV
Cudurka HIV / HCV ee soo kordhay ayaa u muuqda in ay ku kala duwan yihiin daraasadda, laakiin cilmi-baaristu waxay si xooggan u soo jeedineysaa in heerka infekshanka HCV ee dadka qaba HIV ay aad u sareeyaan boqolkiiba 30 Maraykanka iyo Yurub. Guud ahaan, culeyska guud ee HIV / HCV wuxuu qiyaastii 4-5 milyan oo qof, ama inta u dhaxaysa 10-15 boqolkiiba dadka qaba HIV.
Isticmaalayaasha daroogada ee loo yaqaan 'IDUs' ayaa leh khatarta ugu sareysa ee saamiga HIV / HCV, iyadoo tirada guud ay ka hooseyso 82 boqolkiiba illaa 93 boqolkiiba. Taas bedelkeeda, iskuxiridda habka isu gudbinta galmada ayaa ku dhowaad 9 boqolkiiba.
In kasta oo ragga galmoodka ah (MSM) aaney waligood khatar u aheyn infekshanka HCV, halista waxay kordhin kartaa ilaa 23 boqolkiiba MSM oo leh dabeecado khatar badan - sida wada-hawlgalo badan, galmo koox, ama xitaa daroogada la wadaago ayaa la qaatey nasasho ama afba.
Dadku waxay qabaan culeys fara badan oo HCV ah marka loo eego ilayshada loo yaqaan 'mono-fibreed', taas oo keentay koritaanka degdega ah ee fibrosis , cirrhosis , iyo xanuunka hepatocellular (nooca ugu badan ee kansarka beerka).
Waxaa intaa dheer, dadka la duubay waxay leeyihiin halis sedexaad oo khatar ah oo ah khatarta cudurka cagaarshowlaha ee loo yaqaan 'hepatotxicity' (beer toxicity) marka loo eego kuwa qaba HIV.
Tirooyinkani waxay muujinayaan baahida loo qabo aqoonsiga weyn ee HCV ee dadka qaba HIV, iyo sidoo kale daaweyn wax ku ool ah si loo caddeeyo infekshanka HCV ama, ugu yaraan, horumarka cudurkan gaabis ah.
Goorma Bilaabaan Daaweynta Daaweynta
Marka la bilaabayo HCV waxay noqon kartaa arrin adag. Guud ahaan, daaweynta HCV waxaa lagu tilmaamaa shakhsiyaadka qaba calaamadaha HCV ee la xidhiidha cilladaha beerka. Waaxda Caafimaadka iyo Adeegyada Dadweynaha ee Maraykanka (DHHS) waxay hadda ku talinaysaa in daaweynta HCV loo bilaabo shaqsiyaadka laf-dhabarka leh ee leh fibro-ba'an weyn oo khatar sare ugu ah horumarka cirrhosis.
Sababtoo ah waxyeellada ugu weyn ee saameynta daawooyinka daroogada - oo ay weheliso xaqiiqda ah in daaweyntu aysan si buuxda u damaanad qaadin HCV nadiifinta - go'aanka lagu daaweynayo wuxuu ku salaysan yahay diyaargarowga bukaanka, iyo sidoo kale qiimeynta tilmaamayaasha qeexaya ee guulaha daaweynta (sida, HCV genotype , HCV galka fayruska ).
Si kastaba ha ahaatee, waxaa muhiim ah in la ogaado in waligeed kor u qaadayo daawooyinka HCV ay si dhakhso ah u yareynayaan caqabadaha daaweynta, iyadoo faa'iidooyinka daaweynta ay aad uga badan tahay cawaaqibta dhici karta.
DHHS waxay sidoo kale ku talineysaa isticmaalka daaweynta daawada antiretroviral (ART) ee dhammaan dadka la duubay iyada oo aan loo eegin tirinta CD4 , taas oo la tusay inay hoos u dhigto horumarka cudurka HCV. Waxaa intaa dheer:
- Dadka qaba CD4 hooseeya (ka yar 200 unug / mL), daaweynta HCV waa inay dib u dhacaan illaa iyo inta ay CD4 sii kordheyso. Xulashada daawada antiretroviral waa mid si buuxda ugu xiran isdhexgalka daroogooyinka daroogada ah, iyo sidoo kale sunta isku dhafan. (Walaaca ugu weyni waa in qaar ka mid ah daawooyinka loo isticmaalo daaweynta HCV ay la simanyihiin waddooyinka isku midka ah sida daawooyinka dabiiciga ah, hoos u dhigista waxtarka daroogada labadaba iyada oo kor loo qaadayo halista saameynta dhinaca.
- Qofka horayba ugu jiray ART, tixgelin waa in la sameeyaa si loo daaweeyo daaweynta si loo yareeyo saameynta ay dhici karto, iyo faa'iidooyinka kale ee isbedelaya walaac dheeraad ah oo ku saabsan horumarka suurtagalka ah ee adkaynta daawada HIV .
- Kuwa shakhsiyaadka aan la daaweyn CD4 waxay tirinayaan in ka badan 500 unug / mL, rugaha caafimaadku waxay dooran karaan inay dib u dhigaan ART illaa dhammaadka daaweynta HCV.
Faahfaahinta daaweynta HCV ee Dawooyinka
Laf-dhabarka daaweynta HCV ayaa muddo dheer ku jirtay isku-darka interferon alpha (ama PEG-IFN) iyo ribavirin . PEG-IFN waa isku-dar ah saddexda daawooyinka fayraska ah ee ka soo baxa unugyada si ay u soo saaraan qadar fara badan oo enzymes ah oo awood u leh in ay dilaan unugyada iyo unugyada martida loo yaqaanno.
Ribavirin, wakiilka kale ee fayraska, wuxuu farageliyaa dheef-shiid kiimikaadka RNA ee lagama maarmaanka u ah feyruuska faayraska.
Daawooyinka cusub ee ficil-celinta tooska ah (DAAs) ayaa sii kordhaya awood u leh inay daaweeyaan noocyo kala duwan oo cagaarshow C ah oo aan lahayn isticmaalka PEG-INF iyo, xaalado badan, ribavirin. Marka sidaas la sameeyo, dhibaatooyinka soo raaca daaweynta HCV si weyn ayaa loo yareeyaa, sida waa muddada khiyaanada.
Waxaa ka mid ah DAA-da la ansixiyay ee loo isticmaalo daaweynta infakshanka cagaarshowga C ee daba-dheer (iyadoo la raacayo amarka FDA):
| Daroogada | La ansixiyey | Waxaa la soo qoray | Goynta | Muddada |
| Epclusa (sofosbuvir + velpatasvir) | genotypes 1, 2, 3, 4, 5, iyo 6 annaga oo aan lahayn cirrhosis | ribavirin kiisaska cirrhosis decree-ka iyo iyada oo aan ribavirin dhammaan kiisaska kale | hal kiniin maalin walba la socda ama aan lahayn cunto | 12-16 toddobaad |
| Zepatier (Elbasvir + grazoprevir) | genotypes 1 iyo 4 oo leh ama aan lahayn cirrhosis | ribavirin ama aan lahayn ribavirin, taas oo ku xidhan taariikhda daaweynta iyo taariikhda daaweynta | hal kiniin maalin walba la socda ama aan lahayn cunto | 12-16 toddobaad |
| Daklinza (daclatasvir) | genotypes 3 aan lahayn cirrhosis | Sovaldi (sofosbuvir) | hal kiniin maalinle ah oo cunto ah | 12 toddobaad |
| Technivie (ombitasvir + paritaprevir + ritonavir) | genotypes 4 oo aan lahayn cirrhosis | ribavirin | Labo maalin kaste oo cunto ah | 12 toddobaad |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, oo lagu duubo dasabuvir) | genotypes 1 oo leh ama aan lahayn cirrhosis | ribavirin ama lagu qaado keligiis, halkaasoo lagu tilmaamay | laba kiniin oo ah ombitasvir + paritaprevir + ritonavir la qaato hal mar maalin kasta cunto, oo lagu daray hal kiniin oo ah dasabuvir maalin walba la qaato cunto | 12 todobaad |
| Harvoni (sofosbuvir + ledipasvir) | genotype 1 oo leh ama aan lahayn cirrhosis | laftiisa ayaa loo qaaday | hal kiniin maalin walba la socda ama aan lahayn cunto | 12 todobaad |
| Sovaldi (sofosbuvir) | genotypes 1, 2, 3 iyo 4 oo qaba cirrhosis, oo ay ku jiraan kuwa qaba cirrhosis ama hepatocellular carcinoma (HCC) | peginterferon + ribavirin, ribavirin oo keliya, ama Olysio (simeprevir) leh ama aan lahayn ribavirin | hal kiniin maalin walba la socda ama aan lahayn cunto | 12 todobaad |
| Olysio (simeprevir) | genotype 1 oo leh ama aan lahayn cirrhosis | peginterferon + ribavirin, ama Sovaldi (sofosbuvir), halka lagu tilmaamay | hal caag oo maalinle ah oo cunto ah | 24-48 asbuuc |
Saameynada Caadiga ah
Mid ka mid ah welwelka ugu muhiimsan ee lagu daaweynayo dhiig-miirashada HIV / HCV waa ciladaha soo noqnoqda ee laga yaabo inay dhici karto natiijada daaweynta. Inkastoo hirgelinta daroogada cusubi ay bedeshay daaweynta HCV, haddana ma jiraan wax caqabado ah oo ka mid ah bukaanada qaarkood.
Dadka bilaaba daaweynta markii ugu horeysay, saameynaha ugu badan ee daaweynta HCV (ee ku dhaca ugu yaraan 5% kiisaska) waa:
- Epclusa: daal, madax xanuun
- Zepatier : daal, madax xanuun, lallabo
- Daklinza : daal, madax xanuun, lallabo, shuban
- Technivie : daciifnimo jireed, daal, lallabo, hurdo la'aan
- Viekira Pak : daal, lallabo, maqaarka cuncunka, maqaarka maqaarka, cabsida, daciifnimo, daal
- Harvoni : daal, madax xanuun
- Sovaldi + PEG / INF + ribavirin: daal, hurdo, lallabo, madax xanuun, dhiig yaraan
- Sovaldi + ribavirin: daal, madax xanuun
- Olysio + PEG / INF + ribavirin: finan, cuncun cuncun leh, lallabo, murqo xanuun, neeftuurid la'aan
Inkastoo qaar badan oo ka mid ah dhibaatooyinka soo noq-noqosho ay noqdaan kuwo ku-meel-gaadhsiis ah, xalinta hal usbuuc ama labo bilawga ah, calaamadaha qaar ayaa sii dheeraan kara oo loo yaqaan (gaar ahaan daawooyinka PEG / INF-ku saleysan). Si dhakhso leh ula hadal dhakhtarkaaga haddii ay calaamaduhu ku saabsanyihiin iyo / ama joogaan.
Kahor bilaabista HCV Therapy
Fahamka iyo saadaalinta saameynta daaweyntu waxay fure u tahay daaweynta shakhsi ahaaneed iyo helitaanka ujeedooyinka daaweynta ee ugu fiican. Kiniinka kiniinka, jadwalka daaweynta, iyo isbeddelada cuntada (sida, kordhinta qaadashada dufanka ee kuwa ku jira cuntooyinka dufan-yar) waa qaar ka mid ah arrimaha u baahan in lagu xaliyo si loo hubiyo diyaargarowga bukaanka.
Inkastoo xulashada daroogada loo tixgelin karo furaha guulaha daaweynta, markaa, sidoo kale, waa xakamaynta daroogada . Waxay la xidhiidhaa ma aha oo keliya natiijooyinka ka sii wanaagsan, hase yeeshee xaalado badan ayaa yareeya dhacdooyinka iyo darnaanta waxyeelada. Ku adkaanta hooseeyaashu waa, xaqiiqda, inta badan waxa weeye in laga yaabo in ay suuragal tahay in daaweyn la'aanta ay tahay dhacdooyin daaweyneed oo xun.
Beerka beerka
Cirrhosis-ku wuxuu sabab u yahay infakshanka HCV ee soo noqnoqonaya waa calaamad hor leh oo loogu talagalay beerista beerka ee Maraykanka, Yurub, iyo Japan, inkasta oo fayruska la og yahay in uu ku soo noqdo qiyaastii boqolkiiba 70 dadka qaata bedelka saddex sano gudahood. Intaa waxaa dheer, infekshinka lafdhabarka laftiisa wuxuu keeni karaa inta u dhaxaysa 10-30 boqolkiiba bukaanka qaba cudurka cirrhosis muddo shan sano ah.
Shakhsiyaadka u baahan beerka qaliinka beerka, bilaabista daaweynta saddex-geeska ah ee HCV waxay si weyn u yareyn kartaa khatarta luminta lafa-dilka illaa 30%.
In kasta oo khatarta iskaashiga ah, waxaa muhiim ah in la ogaado in heerka bukaanku uu isbarbardhigo dhammaan calaamadaha kale ee beerka loo yaqaan 'transplants-to-transplant' - oo leh heerarka badbaadada post-operative ee u dhexeeya 68% ilaa 84% shantii sano ee hore.
Daawooyinka cusub ee HCV ayaa laga yaabaa inay suurtogalaan in ay natiijooyinkaas soo gudbiyaan, iyada oo la isku haleynayo heerka sare ee saameynta daawooyinka ee la xidhiidha daaweynta.
> Ilo:
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