Daawooyinka jiilka cusub ma bedelaan xeerarka ku saabsan ku-tiirsanaanta HIV?
Ku-adkaysiga daroogada ayaa weli ah qayb muhiim ah oo lagu maareyn karo daaweynta HIV-ga. Si ka duwan sida daawada joogtada ah loo isticmaalo daaweynta cudurrada sida wadnaha wadnaha ama sonkorowga-taas oo u baahan in ka yar 70% u hoggaansamida himilooyinka daaweynta-daaweynta antiretroviral (ama ART) waxay u baahan tahay u dhawaansho dhow oo lagu ilaaliyo xakameynta faayraska iyo ka hortagga horumarka hore ee daroogada iska caabin .
Laakiin marka la eego in aan hadda haysanno cusub, horumarinta daawooyinka daawooyinka antiretrovoviral , miyay shuruudaha u dhigmaan isku mid?
95% Adherence Mantra
Tilmaamaha daaweynta HIV-ga waxay caadiyan ku qeexayaan in bukaanku u baahan yahay inuu ilaaliyo in ka badan 95% u hoggaansamida si loo xaqiijiyo xakamaynta fayraska ee joogtada ah. Loogu talagalay dawo marmarka ah, taas oo u dhiganta qiyaastii 14 cisho oo marmar ah, qiyaaso qiyaas ah muddada hal sano ah.
Si kastaba ha noqotee, qaar ayaa bilaabay in ay ku doodaan in "95% mantra" ay ku saleysantahay xogta la soo ururiyey dhamaadkii 1990-meeyadii, markii daweenta daawadu ay ahaayeen kuwo aad u adag oo daroogadu ay u badnaayeen nus nus. Inkasta oo ay jiraan tiro yar oo si habboon u sheegi kara 85% ama xitaa 90% sida "cusub" u hoggaansamida, qaar badani waxay aaminsan yihiin in baahida loo qabo in la soo bandhigo ama la canaanto bukaanka si aan kaamil ka aheyn meel u dhow sida muhim ah sida 10 sano ka hor.
Hase yeeshee, waxaa jira dad badan oo rumaysan in hoos loo dhigo xarriijinta xajmiga (ama xitaa soo jeedin isbedel) waa qalad, oo u oggolaanaya heerarka isdaba-joogga ee kordhaya oo keliya.
Waxaa jira caddayn lagu taageerayo dooddan. Sida laga soo xigtay xogta ay diyaarisay Xarumaha Xakamaynta iyo Ka Hortagga Cudurrada Maraykanka (CDC), qiyaastii 30% Americans oo ku sugan ART ayaan awoodin inay ku gaaraan xakamaynta fayraska. Inta badan waxay isku raacsan yihiin in adeecnimadu ay tahay door muhiim ah tan, halka daraasado kale ay soo jeediyaan in raacitaanka dhaqan ahaan hoos u dhaco ka dib markii "bilawga" bilawgii ka dib markii la bilaabay ART.
Si kastaba ha ahaatee, waxaa jira caddayn ku filan oo lagu taageeri karo in daroogada cusubi ay ka badan tahay "cafis" marka loo eego iska-caabbinta, gaar ahaan "daroogooyinka" oo awood u leh inay sii wataan xoojinta daawooyinka plasma ee waqti dheer.
Laakiin waa caddayn ku filan oo ku baaqaya in lagu nasto habdhaqanka hoggaanka? Xataa iyada oo daawooyinka antiretroviral-ka ah ee waxtarka leh, ma waxaan dhab ahaantii weli marxaladdan weli?
Miisaamidda Caddaynta
Kaadi-saareyaasha Protease (PIs) waa tusaale wanaagsan oo ah horumarinta ART-da casriga ah. Maanta, PI waxay ku dhow yihiin guud ahaan "kor u qaadis " - iyaga oo la wadaagaya daawo labaad oo awood u leh in ay kordhiyaan Nolosha Nolosha ee PI. Falanqaynta miisaan-kicinta shan cilmi-baaris oo waaweyn ayaa muujinaysa in jiilka cusub uu kor u qaadi doono PIS-ka sida Prezista (darunavir) -ku, dhab ahaantii, kaliya wuxuu u baahan yahay 81% raacitaanka si loo gaaro xakamaynta fayraska.
Taas bedelkeeda, waayeelka PI sida Kaletra (lopinavir + ritonavir) ayaa lagu muujiyay inay yar tahay marka la raacayo dhibcaha ka hooseeya 95%, hal daraasad oo soo jeedinaysa in kaliya 53% bukaannada ay awoodaan in ay helaan culeyska fayraska aan la garan karin ee ka hooseeya heerkan xajmiga.
Cilmi-baaristu waa mid aan caddaynin saameynta ay ku yeelato dariiqyada kale ee antiretrovirals. Inkasta oo daraasadihii qaarkood ay muujiyeen in daroogooyinka lakabadaha transcriptase (NNRTI) ee aan ahayn nukleoside (NNRTI) sida Sustiva (efavirenz) ay ubaahantahay kaliya 80% ilaa 90% adherence marka lagu daro PI-ga kor loogu qaado, kuwa kale waxay ku doodaan in heerarka sare ee is-qabsiga wali loo baahan yahay suurtogalka suurtagalka ah ee iska caabinta iyo is-diidmada iska caabinta dawooyinka kale ee NNRTI.
Sidoo kale, Daraasad Tijaabo ah oo CPCRA ah ayaa waxay ogaatay in heerarka iska caabinta ee dawooyinka nukleoside dib u celinta daawooyinka transcriptase inhibitor (NRTI) sida Retrovir (AZT, zidovudine) korodhka tooska ah ee isugeynta iyo hoos u dhac ku yimaada daroogada.
Hadda waxaa jira daraasado yar oo la heli karo si loo qiimeeyo xiriirka u dhexeeya adkeynta iyo daroogada cusub ee cusub sida Intelens (etravirine) ama xitaa kuwa ugu caansan nukleotide, Viread (tenofovir). Sidoo kale, ka mid noqoshada isdhexgalka ee loo isticmaalo isticmaalka, kaliya hal daraasad oo yar oo Isidress ah (raltegravir) ayaa soo jeedinaysa in heerarka xajinta ee 90% laga yaabo in la aqbalo.
Miyay Iskuulka Ka Maqan (ama Dhawr Joog)?
Ka maqnaashada marmar marmar ah ama ku guul daraysato in la qaato qiyaasta waqtigii loogu talagalay waa wax kasta oo ku dhaco qof kasta oo daawada raagta.
Inta badan, tani waa inaysan keenin walaac aan walaac lahayn. Si kastaba ha noqotee, muddo dheer ama ka badan oo kufilmaamadani dhacaan, yaraanta daawooyinka waa inay ilaaliyaan xakamaynta faayraska ee aan la garan karin.
Daraasad ay sameeyeen machadka qaranka ee cudurada faafa ee Roomaanku waxay muujiyeen in khariidada daaweynta ee laba maalmood oo keliya lagu jiro muddada bisha gudaheeda ay sababtay koror shan jeer ah oo ku dhaca dhacdooyinka waxqabadka cirridka la ogaan karo. Taageerada cilmi baarista ee 2013 ayaa muujisay in xitaa la sii wado, culeyska fayruuska ee "dhow" la ogaan karo (inta u dhaxaysa 50 illaa 199 nuqul / mL) wuxuu keeni karaa 400% khatarta ka iman karta fayraska.
Sidoo kale, cilmi-baaris ka socota Cusbitaalka Jaamacadda Côte de Nacre ee Faransiiska ayaa muujisay in farqiyada dheeraadka ah ee ART ay kordheen suurtagalnimada daaweyn la'aan , iyada oo la joojiyo 15 maalmood iyada oo la siinayo 50% oo ah suurogalnimada fayraska dib-u-dhaca.
Dhiig la mid ah, Adkeysiga iyo Hufnaanta Daaweynta Protease Inhibitor Therapy (AEPIT) ayaa daraasad ku sameeyay saameynta qiyaasaha qiyaasidda qiyaasaha ee waxqabadka viral. Sida laga soo xigtay cilmibaarista, bukaannada u oggolaaday illaa saddex saacadood oo ka baxsan labada dhinac ee muddada daaweynta ee caadiga ah waxay lahaayeen waxqabadyo fayruus ah oo ka badan 300% oo ka badan kuwa qaata dawadooda waqtigooda.
Taas Taas Taas Taas?
Waxaa jira shaki yar in daroogada cusubi ay u fududahay in la isticmaalo oo dulqaato, oo bixiya "cafis" ka badan haddii bukaanku uu seegayo qiyaasta dufan. In kasta oo aan si cad udhaqaaqno daawooyinka dheeraadka ah ee loo baahan yahay in la yareeyo qiyaasta soo noqnoqashada, xeerbeegtu weli way ka baxaysaa sidii haddii qaladkan dhabta ah isbedel dhab ah ee talooyinka raacsan.
Ugu dambeyntii, ART waxay ku saleysantahay isku-darka walxaha antiretroviral, mid kasta oo leh kala duwan kala duwan iyo farmasokokinetics. Qaar ka mid ah nidaamyadu waxay leeyihiin khaladaad yar oo khalad ah; kuwo kale ayaa ka weyn. Marka laga eego aragtida wax ku oolka ah, waxay noqon laheyd wax khasaare ah si loo bedelo xajmiga xajinta ee leh qaab kasta oo daaweyn ah.
Taa baddalkeeda, arimaha u hoggaansamida waa in ay la kulmaan dulqaad badan oo ka yimaada daaweeyayaasha iyo walaaca ka yareeya bukaannada ka baqaya in ay qiraan dhibaatooyinkooda. Hadday wax jiraan, waxay ku baaqeysaa is-gaadhsiin ballaaran oo bukaanka ah, oo leh ujeedooyin gaar ah iyo waxqabadyo si loo hubiyo in la helo hab-nololeedka dhabta ah. Kuwani waa inay ku jiraan:
- Qiimaynta asaasiga ah ee caqabadaha u hoggaansan ka hor intaysan bilaabin ART (Tusaale ahaan, jadwalka shaqada, carruurta, shaacinta, go'doominta, iwm.)
- Qiimeyn joogto ah iyo wadashaqeyn si wax looga qabto dhibaatooyinka cusub ama hadda jira (oo ay ku jiraan saamaynta daaweynta, dhibaatooyinka qoyska, arrimaha dareenka iwm)
- Sifeynta habka daaweynta, halka lagu tilmaamay
- Wax ka qabashada arrimo isbeddel leh oo la xidhiidha raacitaanka saboolka ah (sida, isticmaalka maandooriyaha, niyadjab, guri la'aan, iwm.)
- Isticmaalidda qalabka xajinta (tusaale ahaan, qabanqaabiyeyaasha daawada, qalabka xasuusinta) ama nidaamyada taageerada.
Marka la eego, waa wax soo saar badan oo wax looga qabanayo adeeyn la'aanta badan marka la eego " intee in le'eg ayey ku filan tahay?" Laakiin halkii ay tahay macneheedu waa in la ogaado qalabka si loo hubiyo in ART ay tahay qayb ka mid ah hawlaha, cadaadiska-la'aanta qaybaha caadiga ah ee qofka .
Haddii arrintan la gaari karo, markaas su'aasha ah "inta ay le'eg tahay" ayaa dhici karta dhammaanteed.
Ilaha:
Kobin, A. iyo Sheth, N. "Heerarka Qaadashada ee Loo Baahan Yahay Xakameynta Virological ee Daawooyinka Cusub ee Antiretroviral." Annals Pharmacology. 2011; 45 (3): 372-379.
Martin, M .; Del Cacho, E .; Codina, C .; et al. "Xiriirka u dhexeeya Heerka Xaddidan, Nooca Antiretroviral Regimen, iyo Plasma HIV Type 1 RNA Viral Load: Daraasad Doho-doon ah." AIDS-ka Cilmi-baarista Cilmi-nafsiga. Oktoobar 2008; 24 (10): 1263-1268.
Mena, A ;; Blanco, F .; Cordoba, M; et al. "Daraasad tijaabo ah oo lagu qiimeynayo Raltegravir QD Versus BID ee bukaanada qaba HIV oo ay ku jiraan tijaabinta fududeynta." Waxaa lagu soo bandhigay Shirka 49aad ee Qabsoomidda ee Aaladaha Antimicrobial iyo Chemotherapy (ICAAC). San Francisco, California; Sebtembar 12-15, 2009.
Laprise, C .; de Pokomandy, A .; Baril, J .; et al. "Cillad fayaqaale ah oo ka dambeysay Ba'an Ba'an oo Fudud ah oo Hooseeya oo kuyaala Bukaan-jiifka Bukaanka-HIV-ga: Natiijooyinka laga soo bilaabo 12 Sano oo Kormeer ah." Cudurada Cudurrada Cudurrada ah. Nofeembar 2013; 57 (10): 1489-96.
Ammassari, A .; Trotta, M .; Zacarelli, M .; et al. "Saameynta noocyada kala duwan ee dabeecadaha xajinta iyo cARTada Calaamadaha lagu ogaado Qalitaanka HIV-1 RNA Baaritaanka Xaddiga Hoosadda ee Baarista Real-Time." La soo bandhigay Shirka Caalamiga ah ee AIDS-ka ee 12aad. Cologne, Jarmalka; Nofembar 11-14, 2009.