Haddii infakshanka HIV-ga la xaqiijiyay, baaritaan ayaa si joogta ah loo sameeyaa si loo ogaado xaaladda xaaladda habdhiska difaaca jirka iyo heerka falgalka fayruska ee jirka. Kuwaas waxaa lagu qeexayaa waxa loo yaqaano tirooyinkaaga CD4 iyo culeyska fayraska .
Maxay Tahay Tirada CD4?
Imtixaanka CD4 waa mid ka mid ah baaritaanada la ogaado ee la ogaado dadka qaba HIV. Baaritaanku wuxuu cabbirayaa heerka caawiyaha T4 ee T-cells ee unugyada dhiigga ee aan muhim u ahayn hawlaha difaaca laakiin waa bartilmaameedka ugu muhiimsan ee cudurka HIV.
Iyadoo HIV-gu si tartiib tartiib ah u tirtiro unugyadaas, jidhku wuxuu awoodaa inuu iska difaaco isaga oo ka difaacaya cudurrada faafa ee fursadaha fursadaha.
Baaritaanka waxaa lagu sameeyaa adigoo qaadanaya sambal dhiig ah, natiijooyinka kuwaas oo cabbiraya tirada unugyada CD4 ee mikroliter (μL) ee dhiigga. Tirada aasaasiga ah ayaa dejinaysa xaalada nidaamka difaaca jirka, halka imtixaannada la socoshada inta badan noo sheegeyso
- marxaladda caabuqa iyo xaddiga socodka cudurka
- suurtagalnimada in infekshannada qaarkood ay horumaraan sidii unugyada CD4 la dhimi lahaa
- sida fiican ee aad uga jawaabayso daaweynta adiga oo ilaalinaya ama dib-u-habaynaya hawlahaaga difaaca
Tirada CD4 caadi ah waa meel kasta oo udhaxeysa 500-1,500 unug / μL. Taa bedelkeeda, tirada CD4 ee 200 unug ama / ama ka yar ayaa farsamo ahaan loo kala saaraa AIDS . Cilmi-baaris ayaa muujisay in bilaabista daweynta ee ka hooseysa ama ka hooseeya heerkani ay la xiriirto natiijooyinka caafimaad ee saboolka ah iyo dhimista rajada nolosha ilaa 15 sano.
Tilmaamaha daaweynta ee hore waxay ku taliyeen in daaweynta antiretroviral (ART) lagu soo bandhigo bukaanka leh CD4 oo ka hooseeya 500 unug ama / ama jiritaanka jiritaanka cudurka AIDS-ka . Sannadka 2016, nidaamyada la cusbooneysiiyay ayaa la ansixiyay ART dhammaan bukaanada qaba HIV-ga, iyada oo aan loo eegin tirinta CD4, meesha, dakhliga, ama heerka cudurka.
Maanta, tirinta CD4 waxaa loo isticmaalaa si loo saadaaliyo natiijada cudurka sida ugu badan ee loo cabbiro awoodda difaaca jirka ee qofka. Tusaale ahaan, CD4 nadir (heerka ugu hooseeya ee tirada CD4 hoos u dhacday) ayaa saadaalinaya cudurrada muddada dheer, iyada oo qiimaha hoose ay muujinayso khatarta sii kordheysa ee HIV-ga la xidhiidha iyo kuwa aan HIV-ga la xiriirin, iyo sidoo kale Dib u soo kabashada difaaca jirka.
Waa maxay Viral Load?
Inkastoo tirada CD4 ay tahay calaamad muujinaysa heerka difaaca jirka iyo daaweynta waxtarkeeda, culeyska fayruska ayaa si aad ah u qiyaasaya tallaabooyinka muhiimka ah marka daaweynta antiretroviral la bilaabo.
Cirbadda fayrasku waxay cabirtaa fiiruska fayruska ee dhiigga, oo sidoo kale loo yaqaano "culeyska viral". Shaybaarka ayaa isticmaali doona tiknoolojiyada baaritaanka hiddaha-caadi ahaan, fal-celinta silsiladda polymerase (PCR) ama bDNA (jeexa DNA) - qiyaasta tirada qaybaha fayraska ee milliliter (mL) ee dhiigga. Xanuunada viral HIV-ga waxay ka gedisan yihiin wax aan la garan karin (ka hooseeya heerka ogaanshaha baaritaanka imtixaannada iminka socda) ilaa tobanka malyan.
Natiijada aan la ogaan karin macnaheedu maahan inay jirto fayruus ku jira dhiiggaaga ama waxaa lagaa jaray "caabuq". (Dhab ahaan 5% ka mid ah HIV-ga jidhka waxaa laga heli karaa dhiigga.) Undetectable ayaa macnaheedu yahay in dadka fayrusku ka hooseeyo heerarka baaritaanka dhiigga ee dhiigga laakiin waxaa laga yaabaa in lagu ogaan karo meelo kale, sida shahwada.
Yoolalka Cadaadiska Viral
Ujeedada daaweynta antiretroviral waa in si buuxda loo xakameeyo dhaqdhaqaaqa fayruuska ah ee heerarka aan la ogaan karin, taas oo, marka la eego,
- adkeysiga daaweynta ee weyn
- khatarta hoose ee horumarinta fayruska daawada u adkaysta
- Natiijooyin caafimaad oo ka wanaagsan oo la xidhiidha rajada nolosha,
- yareynta khatarta HIV-ga ee lamaanaha galmada aan loo sharaxin (istaraatajiyad caan ah oo loogu yeedho daaweynta sida ka hortagga (Tasp) .
Dhanka kale, kororka xajinta fayraska ayaa badanaa noqon kara calaamad muujinaysa in daaweyn la'aan , daaweyn daroogo liita, ama labadaba.
Waxaa muhiim ah in la ogaado in raacitaanka daroogada ugu yaraan 95% loo baahan yahay si loo hubiyo in ciribtirka fayruuska ee heerarka aan la ogaan karin.
Xaqiijin aan sinnayn ah ma yareyn karto awoodda qofku u leeyahay inuu ku guulaysto oo keliya, waxay kordhisaa suurtagalnimada daaweyn la'aanta iyadoo loo oggol yahay fayraska u adkaysta daawada. Xiriirkani wuxuu saameyn ku yeelanayaa sababaha waa in mar walba la eego ka hor intaan daweynta la beddelin.
Taasi waxay tidhi, kala duwanaanshaha isbeddelka ee fayruska (ama "blips") ayaa ku dhici kara xitaa dadka leh 100% raacitaan. Kuwani caadi ahaan waa mid aad u yar oo aan aheyn sababaha digniinta.
Kormeerka joogtada ah ee tirinta CD4 iyo culeyska fayruska ayaa lagula talinayaa, badanaa seddex ilaa lix bilood ka dib marka CD4 la baari karo 6 ama 12 bilood kasta haddii u dhexeeyo 350 iyo 500 unug / xay. Bukaanka awood u leh in ay sii wadaan CD4 waxay tirinayaan in ka badan 500 unugyada / μL waxaa laga yaabaa in mar mar la baaro sida loogu talagalay daaweynta dhakhtarka.
Faa'iidooyinka Viral Control
Sida laga soo xigtay cilmibaarista ka soo baxday cilmi-baarista Wadajirka Wadajir ee UK (UK CHIC), dadka qaba lumis fayras oo aan la ogaan karin oo ku guulaystay tiradii CD4 ee 350 unug ama / ama in ka badan sanad gudaheed daweynta bilawga ah waxay u badantahay in ay leeyihiin nolol caadi ah.
Dhinaca faleebada, ku guuldareysiga helitaanka cirbadaha fayrasku wuxuu yareeyaa rajada nolosha ilaa 11 sano oo u dhiganta sigaarka 40 sigaar ah maalintii.
Falanqaynta dib-u-celinta lagu sameeyay 2013-kii jaamacadda Montreal ayaa sidoo kale soo gabagabeysay in dadka "ku dhowaad" loo yaqaan "si aan la garan karin" mudo lix bilood ah (tusaale ahaan, inta u dhaxaysa 50 iyo 199 nuqul / mL) waxay ku dhowdahay 400% khatarta ka iman karta fayraska sanad gudaheed marka loo eego kuwa awood u leh in ay gaaraan ciribtirka fayruuska dhamaystiran.
Daraasaddan, oo kormeeraysay 1,357 ragga HIV-ga qaba laga bilaabo 1999 ilaa 2011, ayaa sidoo kale muujiyay heerka foosha la'aanta ah ee ku dhowaad 60% dadka qaba cuduro fara badan oo u dhexeeya 500 iyo 999 nuqul / mL.
Ilaha:
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May, M .; Gompels, M .; iyo Sabin. C. "Mudada noolaanshaha dadka qaba HIV-1-ga waxay la xiriiraan shuruudaha caadiga ah ee jawaab-celinta daaweynta antiretroviral: Baaritaanka HIV-da ee Iskaashiga HIV-da ee UK." Wargeyska Ururka Caalamiga ah ee AIDS. Nofeembar 11, 2012; 15 (4): 18078.
Baligh, Y .; Fleishman, J .; Metlay, J .; et al. "Dheellitiraafka Viral ee joogtada ah ee bukaan-jiifka qaba ee qaata daaweynta antiretroviral." Wargeyska Ururka Caafimaadka Maraykanka. Luuliyo 25, 2012; 308 (4): 339-342.
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.
Kooxda Daraasada ee INSIGHT START. "Initiinta Daaweynta Antiretroviral ee Hore ee Asymptomatic HIV Infection." Somali Journal of Medicine. Julaay 20, 2015; DOI: 10.1056 / NEJMoa1506816.