Umbiko Wenqubekela phambili Ye-HIV: Ingabe Sisondele Ekwelashweni?

-Delile

• Umuthi wokugoma
• Ukuvimbela okuyisisekelo
• I-pre-exposure prophylaxis (PrEP)
• I-Post-exposure prophylaxis (PEP)
• Ukuxilongwa okufanele
• Izinyathelo zokwelashwa
• Okungatholakali kufana nokungenakudluliswa
• Izimbangela zocwaningo
• Imijovo yanyanga zonke
• Ukukhomba amadamu e-HIV
• Ukuqeda igciwane le-HIV
• ‘Umsebenzi welaphiwe’
• Lapho sikhona manje

Ukubuka konke

I-HIV yenza amasosha omzimba abe buthakathaka futhi ivimbela amandla omzimba okulwa nezifo. Ngaphandle kokwelashwa, i-HIV ingaholela esigabeni sesi-3 se-HIV, noma i-AIDS.

Ubhadane lwengculaza lwaqala e-United States ngawo-1980. Kulinganiselwa ukuthi bangaphezu kwezigidi ezingama-35 abantu asebeshonile ngenxa yalesi simo.

Okwamanje alikho ikhambi le-HIV, kepha izifundo eziningi zomtholampilo zizinikele ekucwaningeni ikhambi. Imishanguzo yamanje yezidambisigciwane ivumela abantu abaphila negciwane lesandulela ngculaza ukuthi bavikele ukuqhubeka kwayo nokuphila isikhathi esijwayelekile sokuphila.

Kwenziwe igxathu elikhulu ekuvikeleni nasekwelapheni i-HIV, sibonga:

• ososayensi
• izikhulu zezempilo zomphakathi
• izinhlaka zikahulumeni
• izinhlangano zomphakathi
• Izishoshovu ze-HIV
• izinkampani ezenza imithi

Umuthi wokugoma

Ukwakhiwa komuthi wokugomela i-HIV kungasindisa izimpilo ezigidini. Kodwa-ke, abacwaningi abakatholi umuthi wokugoma osebenzayo we-HIV. Ngo-2009, ucwaningo olushicilelwe kwi-Journal of Virology lwathola ukuthi umuthi wokugoma wokuhlola uvikele cishe amaphesenti angama-31 amacala amasha. Ucwaningo olwengeziwe lwamiswa ngenxa yezingozi eziyingozi. Ekuqaleni kuka-2013, iNational Institute of Allergy and Infectious Diseases yamisa ukuhlolwa komtholampilo okwakuhlola imijovo yomuthi wokugomela i-HVTN 505. Imininingwane evela ocwaningweni ikhombise ukuthi umuthi wokugoma awuvimbanga ukudluliswa kwe-HIV noma wehlise inani le-HIV egazini. Ucwaningo ngemithi yokugoma luyaqhubeka emhlabeni wonke. Njalo ngonyaka kunokutholwa okusha. Ku-2019, bamemezele ukuthi bathuthukise ukwelashwa okuthembisayo okubavumela ukuthi:

1. fakela amangqamuzana athile omzimba omzimba ukuvuselela i-HIV kumaseli aqukethe i-HIV engasebenzi, noma efihlekile
2. sebenzisa elinye iqoqo lamangqamuzana omzimba omzimba enzelwe ukuhlasela nokususa amaseli ane-HIV evuselelwe

Ukuthola kwabo kunganikeza isisekelo somuthi wokugomela i-HIV. Izivivinyo zomtholampilo zisemisebenzini.

Ukuvimbela okuyisisekelo

Yize ungekho umuthi wokugomela i-HIV okwamanje, kunezinye izindlela zokuvikela ekutheleleni. I-HIV idluliswa ngokushintshana koketshezi lomzimba. Lokhu kungenzeka ngezindlela ezahlukahlukene, kufaka phakathi:

• Ukuthintana ngokocansi. Ngesikhathi sokuya ocansini, i-HIV ingadluliselwa ngokushintshana koketshezi oluthile. Kubandakanya igazi, isidoda, noma uketshezi lwendunu nolwesitho sangasese sowesifazane. Ukuba nezinye izifo ezithathelwana ngocansi (STIs) kungakhuphula ingozi yokudluliswa kwe-HIV ngesikhathi socansi.
• Izinaliti ezabiwe kanye nemijovo. Izinaliti nemijovo ebisetshenziswa umuntu one-HIV ingaqukatha leli gciwane, noma ngabe alikho igazi elibonakalayo kuyo.
• Ukukhulelwa, ukubeletha, nokuncelisa ibele. Omama abane-HIV bangalidlulisela enganeni yabo ngaphambi nangemva kokubeletha. Ezimweni lapho kusetshenziswa khona umuthi we-HIV, lokhu akuvamile neze.

Ukuthatha izinyathelo ezithile zokuzivikela kungavikela umuntu ekutholeni i-HIV:

• Hlolela i-HIV. Buza abalingani ocansini ngesimo sabo ngaphambi kokuya ocansini.
• Hlolelwa bese welashelwa izifo zocansi. Cela ophathina ocansini benze okufanayo.
• Uma uzibandakanya ocansini lomlomo, lwesitho sangasese sowesifazane kanye nolwangemuva, sebenzisa indlela yokuvimbela njengamakhondomu njalo (futhi uyisebenzise kahle).
• Uma ujova izidakamizwa, qiniseka ukusebenzisa inaliti entsha, engenazinzalo engasetshenziswanga omunye umuntu.

I-pre-exposure prophylaxis (PrEP)

I-Pre-exposure prophylaxis (PrEP) umuthi wansuku zonke osetshenziswa abantu abangenayo i-HIV ukwehlisa amathuba abo okuthola i-HIV, uma kuvezwa. Kusebenza kahle kakhulu ekuvimbeleni ukudluliswa kwe-HIV kulabo abanezici eziyingozi ezaziwayo. Abantu abasengozini bafaka:

• amadoda alala namadoda, uma eye ocansini lwangasese ngaphandle kokusebenzisa ikhondomu noma abe ne-STI ezinyangeni eziyisithupha ezedlule
• abesilisa noma abesifazane abangasebenzisi indlela yokuvimbela njengamakhondomu njalo futhi babe nabalingani abanobungozi obandayo be-HIV noma isimo se-HIV esingaziwa
• noma ngubani owabelane ngezinaliti noma usebenzise izidakamizwa ezijojowe ezinyangeni eziyisithupha ezedlule
• abesifazane abacabanga ukukhulelwa nabalingani abane-HIV

Ngokusho kwe-PrEP inganciphisa ubungozi bokuthola i-HIV ocansini ngamaphesenti acishe abe ngama-99 kubantu abanezici eziyingozi ze-HIV. Ukuze i-PrEP isebenze, kufanele ithathwe nsuku zonke futhi ngokungaguquguquki. Wonke umuntu osengozini ye-HIV kufanele aqale uhlobo lwemithi ye-PrEP, ngokwesincomo sakamuva esivela e-US Preventive Services Task Force.

I-Post-exposure prophylaxis (PEP)

IPost-exposure prophylaxis (PEP) iyinhlanganisela yemishanguzo ephuthumayo yezidambisigciwane. Isetshenziswa ngemuva kokuthi umuntu kungenzeka avezwe i-HIV. Abahlinzeki bezempilo bangancoma i-PEP ezimweni ezilandelayo:

• Umuntu ucabanga ukuthi kungenzeka ukuthi wayechayekile kwi-HIV ngesikhathi socansi (isb., Ikhondomu laphuka noma kungasetshenziswanga ikhondomu).
• Umuntu wabelane ngezinaliti lapho ejova izidakamizwa.
• Umuntu unukubeziwe ngokocansi.

I-PEP kufanele isetshenziswe kuphela njengendlela yokuvikela ephuthumayo. Kumele iqalwe kungakapheli amahora angama-72 kokuchayeka kwi-HIV. Ngokufanelekile, i-PEP iqalwa eduze nesikhathi sokuchayeka ngangokunokwenzeka. I-PEP imvamisa ifaka inyanga yokubambelela ekwelashweni ngezidambisigciwane.

Ukuxilongwa okufanele

Ukuhlonza i-HIV ne-AIDS kuyisinyathelo esibalulekile ekuvimbeleni ukudluliswa kwe-HIV. Ngokwe-UNAIDS, isigaba se-United Nations (UN), cishe amaphesenti angama-25 abantu abane-HIV emhlabeni jikelele abasazi isimo sabo se-HIV. Kunokuhlolwa kwegazi okuhlukahlukene abahlinzeki bezokunakekelwa kwempilo abangakusebenzisa ukuhlola i-HIV. Ukuzihlola kwe-HIV kuvumela abantu ukuthi bahlole amathe noma igazi labo ngasese futhi bathole umphumela kungakapheli imizuzu engama-20 noma ngaphansi.

Izinyathelo zokwelashwa

Ngenxa yentuthuko kwezesayensi, i-HIV ibhekwa njengesifo esingalapheki esilawulekayo. Imishanguzo yokuthithibalisa igciwane lengculazi ivumela abantu abaphila ne-HIV ukuthi bagcine impilo yabo. Kuphinde kwehlise nengozi yabo yokudlulisela leli gciwane kwabanye. Cishe amaphesenti angama-59 abo bonke abantu abane-HIV bathola uhlobo oluthile lokwelashwa, ngokusho kwe-UNAIDS. Imithi esetshenziselwa ukwelapha i-HIV yenza izinto ezimbili:

• Yehlisa umthamo wegciwane. Umthamo wegciwane ulinganisa inani le-HIV RNA egazini. Inhloso yokwelashwa ngezidambisigciwane ze-HIV ukunciphisa igciwane libe sezingeni elingatholakali.
• Vumela umzimba ukuthi ubuyisele isibalo se-CD4 cell sawo esijwayelekile. Amaseli e-CD4 anesibopho sokuvikela umzimba ezifweni ezingadala i-HIV.

Kunezinhlobo eziningi zemithi ye-HIV:

• Ama-non-nucleoside reverse transcriptase inhibitors (ama-NNRTIs) khubaza iprotheni esetshenziswa yi-HIV ukwenza amakhophi ezakhi zofuzo zayo kumaseli.
• I-Nucleoside reverse transcriptase inhibitors (ama-NRTIs) inikeze i-HIV amabhlogo wokwakha anamaphutha ngakho-ke ayikwazi ukwenza amakhophi ezinto zayo zofuzo kumaseli.
• Ama-Protease inhibitors khubaza i-enzyme i-HIV edinga ukuzenzela amakhophi ayo asebenzayo.
• Ukungena noma i-fusion inhibitors ukuvimbela i-HIV ukuthi ingene kumaseli e-CD4.
• I-Integrase inhibitors vimbela umsebenzi we-integrase. Ngaphandle kwale enzyme, i-HIV ayikwazi ukuzifaka kwi-DNA yeseli le-CD4.

Imithi ye-HIV ivame ukuthathwa ngezinhlanganisela ezithile ukuvimbela ukukhula kokumelana nemithi. Imithi ye-HIV kufanele iphuzwe njalo ukuze isebenze. Umuntu one-HIV kufanele akhulume nomhlinzeki wakhe wezempilo ngaphambi kokucabanga ngokushintsha imishanguzo yokwehlisa imiphumela emibi noma ngenxa yokwehluleka kokwelashwa.

Okungatholakali kufana nokungenakudluliswa

Ucwaningo lukhombisile ukuthi ukufeza kanye nokugcina inani legciwane egazini elingatholakali ngokusebenzisa i-antiretroviral ngempumelelo kususa ingozi yokudlulisela i-HIV kumlingani ocansini. Ucwaningo olukhulu alutholanga zimo zokudluliswa kwe-HIV kusuka kumlingani one-HIV ocindezelwa njalo (ongatholakali) kumlingani one-HIV kumlingani ongenayo i-HIV. Lezi zifundo zilandele izinkulungwane zemibhangqwana enezimo ezixubile eminyakeni eminingana. Kwakunezinkulungwane zezimo zocansi ngaphandle kwamakhondomu. Ngokwazi ukuthi i-U = U ("ayibonakali = ayidluliseki") kugcizelelwa kakhulu “ekwelashweni njengokuvimbela (i-TasP).” I-UNAIDS inenhloso “90-90-90” yokuqeda ubhadane lwengculaza. Ngo-2020, lolu hlelo luhlose lokhu:

• Amaphesenti angama-90 abo bonke abantu abaphila ne-HIV ukuze bazi isimo sabo
• Amaphesenti angama-90 abo bonke abantu abatholakala bene-HIV ukuthi bathola imishanguzo yokuthithibalisa leli gciwane
• Amaphesenti angama-90 abo bonke abantu abathola ukwelashwa ngezidambisigciwane ukuthi bacindezelwe ngegciwane

Izimbangela zocwaningo

Abaphenyi basebenza kanzima befuna imishanguzo emisha kanye nokwelashwa kwe-HIV. Bahlose ukuthola izindlela zokwelapha ezinweba nezithuthukisa izinga lempilo labantu abakulesi simo. Ngaphezu kwalokho, banethemba lokuthi bazokwakha umuthi wokugoma bese bethola ikhambi le-HIV. Nakhu ukubheka kafushane izindlela eziningana ezibalulekile zocwaningo.

Imijovo yanyanga zonke

Umjovo we-HIV nyangazonke uhlelelwe ukutholakala ekuqaleni kuka-2020. Uhlanganisa imishanguzo emibili: i-integrase inhibitor cabotegravir kanye ne-NNRTI rilpivirine (Edurant). Ucwaningo lwezemitholampilo luthole ukuthi umjovo wanyanga zonke ubusebenza ngempumelelo ekucindezeleni i-HIV njengohlobo lwemithi ejwayelekile yansuku zonke yemithi emithathu yomlomo.

Ukukhomba amadamu e-HIV

Ingxenye yalokho okwenza ukuthola ikhambi le-HIV kube nzima ukuthi amasosha omzimba anenkinga yokuqondisa amachibi amaseli ane-HIV. Amasosha omzimba imvamisa awakwazi ukubona amaseli ane-HIV noma aqede amaseli akhiqiza igciwane ngenkuthalo. Ukwelashwa ngezidambisigciwane akuqedi amadamu e-HIV. bahlola izinhlobo ezimbili ezahlukene zokwelashwa kwe-HIV, zombili lezo ezingabhubhisa amadamu e-HIV:

• Ukwelapha okusebenzayo. Lolu hlobo lokwelashwa luzolawula ukuphindaphindeka kwe-HIV uma ingekho imishanguzo yokuthithibalisa leli gciwane.
• Ukwelashwa ngokuhlanzayo. Lolu hlobo lokwelapha lungaqeda nya igciwane elikwazi ukuziphindaphinda.

Ukuqeda igciwane le-HIV

Abaphenyi e-University of Illinois e-Urbana-Champaign bebelokhu besebenzisa ukufaniswa kwamakhompyutha ukutadisha i-HIV capsid. I-capsid iyisitsha sezinto zofuzo zegciwane. Ivikela igciwane ekubhujisweni amasosha omzimba. Ukuqonda ukwakheka kwe-capsid nokuthi ihlangana kanjani nemvelo yayo kungasiza abacwaningi ukuthi bathole indlela yokuyivula. Ukwephula i-capsid kungakhipha imfuza ye-HIV emzimbeni lapho ingacekelwa phansi amasosha omzimba. Kungumngcele othembisayo ekwelashweni nasekwelapheni i-HIV.

‘Umsebenzi welaphiwe’

UTimothy Ray Brown, waseMelika owayehlala eBerlin, wathola ukuxilongwa nge-HIV ngo-1995 nokuxilongwa kwe-leukemia ngo-2006. Ungomunye wabantu ababili ngezinye izikhathi ababizwa ngokuthi "isiguli saseBerlin." Ngo-2007, uBrown wathola ukufakelwa kwe-stem cell ukwelapha i-leukemia - futhi wayeka ukwelashwa ngezidambisigciwane. I-HIV kuye selokhu kwenziwa leyo nqubo. Ukuhlolwa kwezingxenye eziningi zomzimba wakhe e-University of California, eSan Francisco kumkhombisile ukuthi akanalo igciwane lengculazi. Ubhekwa "njengokwelapheka okuphumelelayo," ngokocwaningo olushicilelwe ku-PLOS Pathogens. Ungumuntu wokuqala ukwelashwa nge-HIV. NgoMashi 2019, kwenziwa ucwaningo kwamanye amadoda amabili athola ukuxilongwa nge-HIV kanye nomdlavuza. NjengoBrown, womabili la madoda athole ukufakelwa ama-stem cell ukuze elaphe umdlavuza wawo. Womabili la madoda ayekile ukwelashwa ngezidambisigciwane ngemuva kokuthola ukufakelwa kwawo. Ngesikhathi kwenziwa ucwaningo, "isiguli saseLondon" besikwazile ukuhlala kuthethelelo lwe-HIV izinyanga eziyi-18 nokubala. "Isiguli saseDusseldorf" besikwazile ukuhlala ekuxolelweni kwe-HIV izinyanga ezintathu nohhafu nokubala.

Lapho sikhona manje

Abaphenyi babengayiqondi kahle i-HIV eminyakeni engama-30 edlule, ingasaphathwa eyokuthi ilashwa noma yelashwa kanjani. Emashumini eminyaka edlule, ukuthuthuka kwezobuchwepheshe namakhono ezokwelapha kulethe izindlela zokwelashwa ezisezingeni eliphakeme ze-HIV. Imithi elwa negciwane eliphumelelayo manje ingamisa ukuqhubeka kwe-HIV futhi yehlise umthamo wegciwane lomuntu kumazinga angatholakali. Ukuba nomthamo wegciwane engabonakali akugcini nje ngokuthuthukisa impilo yomuntu one-HIV, kodwa futhi kuqeda nengozi yokudlulisela i-HIV kumlingani ocansini. Ukwelashwa kwezidakamizwa okuhlosiwe kungavimbela nabantu abakhulelwe abane-HIV ukuthi bangadluliseli leli gciwane ezinganeni zabo. Unyaka ngamunye, izivivinyo eziningi zokwelashwa zihlose ukuthola ukwelashwa okungcono kakhulu kwe-HIV ngethemba lokuthi ngelinye ilanga lizothola ikhambi. Ngalezo zindlela zokwelashwa ezintsha kunezindlela ezingcono zokuvimbela ukudluliselwa kwe-HIV. Funda le ndatshana ngeSpanishi.