Waxaad u maleyneysaa in ay noqon doonto wax fudud in la sameeyo: In la abuuro jel ama miir ah oo aad codsan kartid ka hor inta galmada la isku galmoodin si ay si waxtar leh u dilaan HIV. Dhamaantiis, haddii wax sida sida nonoxynol-9 ay yareeyaan khatarta uurka, adigoo miyir-beelka dila, sida ay u adagtahay in ay wax ka qabato HIV-ga, sax?
Xaqiiqadu waxay tahay in horumarinta wakiilada microbicidal ay la qabsadeen caqabado iyo dhibaatooyin tan iyo markii la soo jeediyay in ka badan 25 sano ka hor.
Xaaladaha qaarkood, awoodda wakiilka ee ah in la joojiyo HIV-ga ayaa si aan macquul ahayn u horseeday in ay sii xumaato unugyada mucosal ah ee xubinta taranka haweenka ama malawadka - halkii looga hortagi lahaa gudbinta HIV.
Xaaladaha kale, wakiillada ayaa si fudud wax uga qaban waayay caabuqa HIV-ga ama waxay keeneen saameyn aan caqli-gal ahayn oo loogu talagalay dadka daaweyntooda.
Ilaa imminka, ma jirto microbidis-ka HIV-ga oo la heli karo ama laguma talinayo isticmaalka. Si kastaba ha ahaatee, tiro badan oo musharrixiin ah ayaa si firfircoon loo baaray, oo ay ku jiraan jeel tobanlaha ku salaysan, tenjiraha dheeriga ah ee wax lagu sameeyo, iyo microbicides.
Maxay Microbicides Lagu Qaadanayaa Muhiim?
Microbicides looma maleynayo inay bedeli karto cinjirrada ama maaweelo dhaqdhaqaaqyo galmo ammaan ah , laakiin waa inay bixiyaan xannibaad dheeraad ah oo galmada ah inta lagu jiro galmada-gaar ahaan is -goysyada ama galmada-wareersan ee khatarta gudbinta.
Si kastaba ha noqotee, laga bilaabo muuqaal ballaadhan, microbicides waxaa loo arkaa macnaheedu yahay in la yareeyo faafitaanka HIV ee dadka ugu khatarta ugu jira.
Kuwaas waxaa ka mid ah dumarka u nugul xadgudubka galmada ama xad-gudubka, ama ciddii ka-madax-bannaanida galmoodka ah maahan mid dhab ah (sababtoo ah rabitaanka caruurtu, ama caqabadaha dhaqanka ee xaddidaya madax-bannaanida iyo awoodda).
Waxaa la saadaaliyay in microbicides ay ugu dambeyntii awood u lahaan karto inay dumarka khatarta ugu jira inay si isdaba-joog ah u ilaaliyaan is-badbaadinta marka ay isticmaalaan dadka isticmaala badbaado dheeraad ah haddii uu kondhomku qarxo ama ka-goosho inta lagu guda jiro galmada.
Dib-u-celinta Hore ee Baaritaanka Microbicidal
Badanaa baaritaanka hore ee microbicidal wuxuu diirada saarey isticmaalka shaybaarka ama wakiilada wax ka bedeli kara siilka pH si ay si waxtar leh u dilaan (ama aan firfircooneyn) HIV.
Musharixiinta ugu horreeya waxa ka mid ahaa nonoxynol-9 oo la yiraahdo, shimbiraha dabiiciga ah ayaa loo isticmaalaa labadaba sida jeermiska iyo wajiga / jimicsiga. Nasiib-darro, falanqeyn lagu sameeyey 2002-dii ayaa gabagabaysay in isticmaalka nonoxynol-9 dhab ahaantii ay kordheen khatarta HIV ee haweenka boqolkiiba 50%, iyada oo ay jiraan waxyeelo ka soo gaartey dhaawacyada hoosta haweenka.
Wakaaladaha kale ee loogu talagalay in lagu ilaaliyo aashitada siilka, oo ay ka mid yihiin BufferGel -badan oo cilmi baaris ah ayaa lagu muujiyay inay si fiican ugu dulqaatay haweenka, laakiin ugu dambeyntii muujisay hoos u dhac ku yimaada gudbinta HIV.
Xeeladaha Horumarinta
Waxaa jira dhowr habab oo suurtagal ah in lagu horumariyo microbidis HIV oo wax ku ool ah, kaas oo la jebin karo laba qaybood oo guud.
Marka ugu horeysa waxaa lagu magacaabi karaa microbicides-yada antiretroviral , wakiilada midkoodna u dhaqmo sida soo-celinta xasaasiyadaha HIV-ga (ka hortagga isku-xirka fayruska si loo beegsado unugyada xubinta taranka) ama isticmaalka macromolecules la yiraahdo dendrimers kuwaas oo si firfircoon ugu xira HIV si looga hortago cudurka.
In kastoo dadaallada hore loo xaqiijiyay in badanaa lagu guuleystey ( PRO 2000 , Carraguard , sulphate cellulose), waxaa jira dhowr wakiil oo cusub oo la raadinayo-oo ay ku jiraan mishiinka microfiska ee VivaGel , iyo isticmaalka sinjiga ee dendrimers iyo daaweynta gelitaanka CCR5 ee Selzentry (maraviroc) daaweynta antiretroviral (ART) .
Midda labaad, iyo si murugo leh oo caan ah, qaybta ayaa ah microbicides antiretroviral . Horumarinta wakiilladaasi waxay ku saleysan tahay baaritaanka isticmaalka tobanofovir iyo daawooyinka kale ee antiretrovoviral ee jelicsan maqaarka, qoryaha, saliidaha, iyo nidaamyada kale ee dhalmada.
CAPRISA 004 Daraasada sannadkii 2010 wuxuu ahaa tii ugu horaysay ee muujisa wax ku oolnimada habka loo isticmaalo, isticmaalka 1% tenofovir gel ka hor iyo ka dib galmada siilka 889 haweenka HIV-ga.
Guud ahaan, heerarka caabuqa ayaa hoos u dhacay 39 boqolkiiba kooxda non-placebo, halka kaqeybgalayaasha heerarka sare ee adherence (in ka badan 80 boqolkiiba) ay hoos u dhaceen 54 boqolkiiba.
Taas bedelkeeda, maxkamadeynta VOICE waxaa loo arkaa inay tahay wax dib u dhac ah. Kadib markii ay cirifka CAPRISA, Garsoore Voice wax ka bartay laba nooc oo kala duwan oo ka hortag ah HIV - isticmaalka maalin walba ee daawada antiretroviral ( Viread ama Truvada ) ama isticmaalka maalin kasta ee jimicsiga tenofovir 5,029. Maxkamadeynta ayaa la joojiyay markii mid ka mid ah hababka la ogaaday in ay wax ku ool yihiin.
Falanqaynta dambe ee cilmi-baarista ayaa go'aamisay in fashilka aaney aheyn mid aan loo baahneyn daaweyn, laakinse si joogta ah ufudud u ah ka qaybgalayaasha (gaar ahaan kuwa dhalinyarada ah ee aan guursan). Cilmi-baaris dheeraad ah ayaa gacan ka geysanaysa in ay ka sii fiicnaato sababaha asluubta.
Waddada u socota
Kadib dib-u-dhaca dib-u-eegista VOICE, waxaa loo sameeyay fara badan oo xoog leh si loogu sahlo habab kale oo loo horumariyo wakiillada microbicidal. Natiijooyinka ayaa inta badan isku dhafan. Tijaabooyinka Wajiga II iyo III ee dhowaan la dhameeyey:
- FACT 001 Trial, oo shaqaaleysiiyay 2,900 haween ah oo ku nool Koonfur Afrika, ayaa ka qaybgalayaashu si isku mid ah u adeegsadeen sida CAPRISA 004 (1% tenofovir gel ka hor ama ka dib galmada). Sida laga soo xigtay natiijooyinka tijaabada ka dib, ma jirin hoos u dhac tirada cudurka infekshinka HIV dhexdooda.
- ASPIRE (MTN-020) waxay qiimeeyeen saamaynta giraan ka baxsan oo ay ku jirto dapivrine (daroogo xoog leh oo tijaabo ah oo daawada antiretroviral) marka loo isticmaalo muddo bil ah 3,476 haween ah oo Afrika ah. Natiijooyinka sannadka 2015 ayaa muujiyey guud ahaan boqolkiiba 27 hoos u dhaca khatarta HIV-ga ee haweenka adoo isticmaalaya giraanta nudaha, ugu horreyntii dumarka da'doodu ka weyn tahay 21 jir. Ilaalin yar ama aan ilaalin ayaa lagu arkay dumarka da'doodu ka yar tahay 21 sano, taas oo ay ugu wacan tahay isticmaalka qaldan ee qalabka .
- Sidoo kale, Daraasad RING (IPM 027) ayaa sidoo kale baaritaan ku sameeynaysa giraanta nacasta ah ee 1,650 haween ah ee ku sugan Uganda iyo Koonfur Afrika iyaga oo maraya tijaabo, marxaladda III. Ka qaybgalayaashu waxay isticmaali doonaan siddooyinkooda muddo laba sano ah. Natiijooyinka ayaa waxoogaa ka fiicnaa kuwa lagu arkay daraasadda ASPIRE, iyadoo guud ahaan hoos u dhigtay 37%. Mar labaad, natiijooyinka waxay ku fiicnayeen dumarka da'doodu tahay 21 jir iyo ka weyn. Waxtarrada laguma arag dumarka da'doodu tahay 18-21.
- Dhanka kale, MTN 017 wuxuu sahmin doonaa isticmaalka qalabka jilicsan ee tenofovir-ku salaysan ee la socota isticmaalka maalinlaha ah ee Truvada koox koox ah 186 rag ah oo galmo la yeeshay ragga (MSM) iyo haweenka isu gudbiya . Daraasada Wajiga 2aad ayaa la qabtey siddeed usbuuc, oo leh heerar sare oo la aqbalo oo loo hoggaansamo nidaamka isdaba joogga ah. Daraasaadka cilmi-baarista waxaa laga yaabaa inay xoogga saaraan waxtarka iyo isticmaalka jeelka malawadka ee habka ilaalinta ka hor iyo ka dib galmada.
- Ugu dambayntii, bishii Maarso 2014, daraasadda xayawaanka ee ay sameeyeen Xarumaha Xakamaynta iyo Ka Hortagga Cudurrada (CDC) waxay muujisay in jeelka jirka la mariyo ee loo isticmaalo habka daawada antiretroviral (ratelgravir) ay si waxtar leh uga hortagi karto caabuqa HIV ee haweenka ka dib soo-gaadhista galmada. Ma jiro ereyo ku saabsan haddii daraasadda la balaarin doono wixii ka dambeeya caddaynta hadda jirta.
Noocyada kale ee cilmi baarista ayaa baaraya horumarinta foormooyin khafiif ah, filim-dhaqaajiya oo si dhaqsi ah hawada uga shaqeeya, iyo sidoo kale noocyo kala duwan oo antiretroviral ah (ama shuruudaha) ee jelicsan ama maqaar.
Ilaha:
Abdool Karim, Q .; Abdool Karim, S .; Frohlich, J .; et al. "Wax-ku-oolnimada iyo Ammaanka Tenofovir Gel, Antiretroviral Microbicide, ee ka hortagga Hurgumada HIV ee Haweenka." Sayniska. Sebtembar 3, 2010; 329 (5996): 1168-1174.
Shabakadaha Dhibaatooyinka Microbicide (MTN). "Ku Saabsan Xaqiiqda Xaqiiqda Microbicides: Iskudhinjabid Microbicide Trials Network." Pittsburgh, Pennsylvania. Xaashida xaqiiqda ee la soo bandhigay Maarso 25, 2014.
Dobard, C .; Sharma, S .; Parikh, U .; et al. "Ka ilaalinta ilaalinta maqaarka ee Macaques ee ka yimaada SHIV Infection-ka ee ka hortagga" Topical Integrase Inhibitors ". Caafimaadka Daawada Sayniska . March 12, 2014. 6 (227): 227ra35.