Aqoonsiga Sababaha iyo Xulashada Nidaamka Cusub ee Cusub
Khasaaraha daaweynta HIV-ga ayaa dhacaya marka la go'aaminayo in daawooyinkaaga daawooyinka antiretrovovirus aysan awoodin in ay gaaraan ujeedooyinka daaweynta - kuwaas oo ah xakameynta waxqabadka fayruska HIV ama dib u soo celinta hawlaha difaaca si looga hortago infakshanka fursadaha . Dhibaatada daaweynta waxaa lagu kala saari karaa sida virologic (oo ku saabsan fayruska), immunologic (oo ku saabsan nidaamka difaaca jirka), ama labadaba.
Markii ay dhacdo daaweyn la'aan, tallaabada ugu horreysa waa in la ogaado qodobada ama qodobbada laga yaabo inay ku guul daraysteen, kuwaas oo ay ku jiraan:
- Ku adkeysiga daroogada ee hoos-u- dhigga
- Ka hortagga daroogada ee soo kacday
- Dhibaatada daaweynta hore (s)
- Xasaasiyadda xun ee xayiraadda cuntada
- Tirada daaweynta kahortagga ee CD4
- Jeermisyada (sida cagaarshowga C ama tiibishada)
- Isdhexgalka daroogada
- Dhibaatooyinka nacasta ama daroogada
- Dhibaatooyinka daroogada, taas oo saameyn ku yeelan karto raacitaanka
- Niyadjab aan la daaweyn ama isticmaalka maandooriyaha, taas oo xitaa saameyn ku yeelan karto
Cillad Virologic
Fayoobaanta fayruska waxaa lagu qeexay awood la'aanta ah in la gaarsiiyo ama lagu ilaaliyo fayraska HIV ee ka yar 200 nuqul / mL. Tani macnaheedu maahan in qofku si dhaqso ah u beddelo daweynta haddii uu hoos u dhaco fayraska ka hooseeya 200. Wuxuu si fudud u adeegsanayaa qiyaasta uu takhtarku samayn karo go'aanka kiliinikada ee la wargeliyay mar haddii loo hoggaansamo bukaanka iyo hababka daaweynta loo qaato.
Sidoo kale, qeexitaanka waa inaanu soo jeedin in ay tahay mid la aqbali karo si loo ilaaliyo wax ka yar cufnaanta fayraska. Xitaa "dhowaan lama arki karo" culeys fara badan (sida, 50 -199 nuqul / mL) waa inay ahaadaan kuwo walaac leh, iyadoo baaritaano dhowaan soo jeedinaya in firfircooni la'aan, hoos-u-dhac fayruus ah muddo lix bilood ah ay kordhin karto khatarta fayaqabka ee sanadka gudihiisa qiyaastii 400%.
(Marka la barbardhigo, marmar fayras "boodbood" guud ahaan maaha saadaalin fara-galin fayras.)
Ku- adkeysiga daroogada oo aan ku filnayn iyo dawada ka soo horjeeda daroogada ayaa maanta la tixgeliyaa laba sababood oo asaas ah ee fashfashinta virologic, gaar ahaan daaweyn-koowaad. Sida laga soo xigtay cilmi-baarista, celcelis ahaan hal qof oo ka mid ah afar bukaan ayaa la kulmi doona guul darradii sababtoo ah u hoggaansanaanta saboolnimada, halka inta u dhaxeysa 4% iyo 6% bukaanada ay ku fashilmi doonaan sababtoo ah iska caabin daroogo ah.
Haddii xajinta liidata ay tahay wadnaha guuldarada, waxaa muhiim u ah dhakhtarka iyo bukaanka labadaba sababaha keena sabab kasta. Xaalado badan, fududaynta daaweynta (tusaale ahaan, yareeynta culeyska kiniinka, xaddiga qiyaasta) ayaa kaa caawin kara yaraynta caqabadaha shaqada ee u hoggaansamida. Arrimaha la xiriira xadgudubka maskaxda ama walaxda waa in sidoo kale lagu xalliyaa, iyada oo loo gudbiyo xarumaha daaweynta ama la taliyeyaasha taageerida, haddii loo baahdo.
Xitaa haddii fayaqabka fayadhowrka lagu xaqiijiyo habka tijaabada unugyada difaaca , waxaa muhiim ah in lagu saxo wixii xajmi ah ee la xidhiidha ka hor inta aan hore loo soconin daaweyn cusub. Haddii aan loo hoggaansameynin sida loo sii wado maareynta HIV-da, waxaa suurtagal ah in dib-u-dhac ku noqoto mid sareeya.
Beddelidda Daaweynta Kadib Ka Dib Qalitaan Virus
Cilad fayadhowrka macnaheedu waa fayruuska hoose ee fayraska ku jira "viral pool" bukaanku wuxuu u adkaysan karaa hal ama dhowr wakiilo daroogo ah.
Haddii loo oggol yahay in uu koro, fayruska iska caabida ayaa u adkeyn doona caabbinta marka caabbinta illaa iyo inta uu dhaco daroogada badan.
Haddii caabbinta daroogada laga shakiyo iyo xajinta fayraska bukaanku ka sarreyso 500 nuqul / mL, baaritaanka iska caabinta hiddaha ayaa lagula talinayaa . Baaritaan ayaa la sameeyaa inta bukaanku wali qaato nidaamka ku fashilmay ama afar toddobaad gudahood joojinta daaweynta. Tani, oo ay weheliso dib u eegista taariikhda daaweynta bukaan-socodka, ayaa gacan ka geysan doonta in la xakameeyo xulashada daaweynta hore u socota.
Marka dawada adkaysiga la xaqiijiyo, waxaa muhiim ah in la beddelo daweynta sida ugu dhakhsaha badan ee suurtagalka ah si looga hortago isku-dhafnaanta mukhaadaraadka u-adkeysiga ah ee horumarinta.
Fikrad ahaan, habka cusubi wuxuu ku jiri doonaa ugu yaraan laba, laakiin doorbidayo saddex, daawooyinka cusub ee firfircoon. Ku darida hal daroogo firfircoon lama talinayo maaddaama ay kaliya kordhin karto horumarinta daawada daroogada.
Xulashada daroogada waa inay ku saleysnaato dib u eegis takhasus ah si loo qiimeeyo isbeddelka daawada daroogada ee iskudhafka ah, ama in la go'aamiyo in daroogooyinka qaarkood laga yaabo inay sii socdaan adeegga inkastoo qayb iska caabin ah .
Cilmi baaris ayaa muujisay in bukaanku ay u muuqdaan in ay si fiican uga jawaab celiyaan daaweynaha dambe. Tan waxaa laga yaabaa inay sabab u tahay xaqiiqda ah in bukaanku guud ahaan haysto tiro ka badan CD4 / fayras hoose oo hooseeya marka la bilaabayo daaweynta cusub, ama daawooyinka cusub ee cusubi ay si fiican ugu fiican yihiin daaweynta bukaanka qoto dheer iska caabin. Daraasaduhu waxay sidoo kale muujiyeen in bukaannadu ay ku guuldareysteen daaweynta sababtoo ah u hoggaansanaanta saboolka ah waxay u muuqdaan inay sare u qaadayaan heerarka xajinta ee daaweynta labaad.
Si kastaba ha ahaatee, waxaa muhiim ah in la ogaado in dhammeystirka fayruuska ah ee suurtagalka ah in aanay suurogal ahayn dhammaan bukaannada, gaar ahaan kuwa ku jiray daaweyno badan oo la xidhiidha muddada sano ah. Xaaladaha noocaas ah, daaweyntu waa in had iyo jeer la sii wadaa iyada oo ujeedadu tahay in la hubiyo sunta daroogada yar iyo ilaalinta bukaanka bukaanka CD4.
Bukaannada qibrada leh ee CD4 waxay tirin karaan in ka yar 100 unug / mL iyo fursado daaweyn oo yar, ku darida wakiil kale ayaa laga yaabaa in ay yareeyaan khatarta ah in si deg deg ah u socdaan cudurka.
Ciladda Immunologic Failure
Qeexitaanka ficil-celinta difaaca jirka waa mid aad udheer badan, qaar ka mid ahna sharxaya sida
- awood la'aanta in kor loo qaado tirada CD4 ee bukaanka ka sarreeya xadad gaar ah (tus., in ka badan 350 ama 500 unugyada / mL) inkastoo xakamaynta cirbadaha, ama;
- awood la'aanta in la kordhiyo CD4 bukaan-socodka oo qadar ah oo ka sarreeya heerarka daaweynta ka hor intaan la saarin cirbadaha fayraska.
Inkastoo xogtu ay tahay mid aad u qiime badan, haddana daraasadihii qaarkood ayaa soo jeediyay in saamiga bukaanada leh CD4 aan caadi ahayn hoos udhacaan inkastoo xakamaynta fayrasku ay noqon karto mid aad u saraysa 30%.
Dhibaatada wax ka qabashada ficil la'aanta 'immunologic failure' waxaa ka mid ah in badanaa la xiriirta mid ka mid ah daawooyinka hormarinta daaweynta ee CD4 ama 'low-rare' CD4 (ie, tirada ugu hooseeysa, taariikhda CD4 taariikhda ku jirta diiwaanka). Si fudud loo dhigo, inta badan nidaamka difaaca bukaanka ayaa la qallajiyey ka hor intaan daweynin, way ka sii adag tahay in la soo celiyo hawlaha difaaca.
Waa sababta talooyinka hadda jira ee HIV ay ku talinayaan bilowga hore ee daaweynta marka hawlaha difaaca ay weli baaqi ku yihiin.
Dhinaca kale, fashfashka difaaca jirka ayaa dhici kara xittaa marka la eego daaweynta kahor ee CD4. Tani waxay noqon kartaa natiijo ka dhalatay jeermisyo horey ama firfircoon, da 'weyn, ama xitaa saameynta infakshinka joogtada ah ee uu keeno HIV laftiisa. Marar kale, ma jiraan sabab cad oo sababta ay taasi u dhacdo.
Xitaa dhib badan ayaa ah xaqiiqda ah inaysan jirin wax isku mid ah oo ku saabsan sida loo daweynayo fashil la'aanta xagga maskaxda. Qaar ka mid ah daweynayaashu waxay soo jeedinayaan in ay bedelaan daaweynta ama ay ku daraan wakiil dheeraad ah antiretroviral, inkastoo aysan jirin wax caddeymo ah in tani ay leedahay saameyn dhab ah.
Si kastaba ha noqotee, haddii la ogaado fashil la'aanta immunologi, bukaanka waa in si buuxda loo qiimeeyaa haddii ay jiraan
- wax kasta oo daaweyn ah oo yarayn kara wax soo saarka unugyada dhiigga cad (gaar ahaan CD4 + T unugyada ), beddelidda ama joojinta daawooyinka markasta oo ay suurtogal tahay, ama;
- wixii daaweyn ah ee aan la daaweyn ama xaalado caafimaad oo halis ah oo laga yaabo inay ka qaybqaataan jawaab celinta hoose ee tallaalka.
Qaar badan oo ka mid ah daweynta difaaca jirka ayaa lagu baarayaa, inkastoo midna aan lagu talin meel ka baxsan duruufaha tijaabada caafimaadka.
> Ilo:
> Waaxda Caafimaadka ee Mareykanka iyo Adeegyada Dadweynaha (DHHS). "Maareynta bukaanka daaweynta ee qibrada leh: Cilad fayadhowrka iyo ciladaha Immunologic." Rockville, Maryland; heley Febraayo 21, 2014.
> Paredes, R .; Lalama, C .; Ribaudo, J .; et al. "Waayahan hore ee jira ee noocyada kala duwan ee HIV-1 u adkeysta daawooyinka, u hoggaansamida, iyo khatarta daaweynta antiretroviral daaweynta" Journal of Infectious Disease . Maarso 2010; 201 (5): 662-671.
> Laprise, C .; de Pokomandy, A .; Baril, J .; et al. "Dhibaatada fayruska ee ka timaadda cudurka dabaysha ee aan caadiga ahayn ee ku jira cudurka bukaanka qaba HIV-ga: natiijooyinka laga soo bilaabo 12 sano oo kormeer." Cudurada Cudurrada Cudurrada ah. Nofeembar 2013; 57 (10): 1489-96.
> Hammer, S .; Vaida, F .; Bennett, K .; et al. "Dual-One Therapy inhibitor daaweynta maskaxda ah oo keliya kadib markii daawada antiretroviral lagu guul daraysto: maxkamad la kala soocay" Journal of American Medical Association (JAMA) . July 10, 2002; 288 (2): 169-180.
> Gzazola, L .; Tincati, C .; Bellistri, G .; et al. "Maqnaanshaha CD4 + T dib-u-tirinta tirinta unugyada xitaa inkastoo helitaanka daaweynta dabiiciga ah ee firfircoon ee firfircoon ee la xakameynayo: Khatarta kiliinka, farqiga qalliinka, iyo fursadaha daaweynta." Cudurada Cudurrada Cudurrada ah. Febraayo 2009; 48 (3): 328-337.