Ukuvela Kokwelapha kwe-HIV

-Delile

• Isebenza kanjani imishanguzo ye-HIV
• Izinhlobo zezidambisigciwane
• I-Nucleoside / nucleotide reverse transcriptase inhibitors (ama-NRTIs)
• I-Integrase strand transfer inhibitors (ama-INSTI)
• Ama-Protease inhibitors (ama-PIs)
• Ama-non-nucleoside reverse transcriptase inhibitors (ama-NNRTIs)
• Ama-inhibitor okungena
• Ukwelashwa ngezidambisigciwane
• Ukunamathela kuyisihluthulelo
  
• Inhlanganisela amaphilisi
• Izidakamizwa zisondele

Ukubuka konke

Eminyakeni engamashumi amathathu edlule, abahlinzeki bezempilo babengenazo izindaba ezikhuthazayo zokunikeza abantu ababezothola ukuxilongwa kwe-HIV. Namuhla, yisimo sezempilo esilawulekayo.

Alikho ikhambi le-HIV noma i-AIDS okwamanje. Kodwa-ke, intuthuko ephawulekayo ekwelashweni nasekuqondeni imitholampilo ukuthi i-HIV iqhubeka kanjani ivumela abantu abane-HIV ukuthi baphile isikhathi eside, izimpilo ezigcwele.

Ake sibheke ukuthi ukwelashwa nge-HIV kukuphi namuhla, imiphumela yokwelashwa okusha okuba nayo, nokuthi ukwelashwa kungabhekiswa kuphi ngokuzayo.

Isebenza kanjani imishanguzo ye-HIV

Ukwelashwa okuyinhloko kwe-HIV namuhla yimishanguzo yokuthithibalisa igciwane lengculazi. Le mithi ayilapheki i-HIV. Esikhundleni salokho, bacindezela leli gciwane futhi banciphise ukukhula kwalo emzimbeni. Yize bengayiqedi i-HIV emzimbeni, bangayicindezela ize iye emazingeni angatholakali ezimweni eziningi.

Uma umuthi wezidambisigciwane uphumelela, ungangeza iminyaka eminingi enempilo, nokukhiqiza empilweni yomuntu futhi unciphise nengozi yokudluliselwa kwabanye.

Izinhlobo zezidambisigciwane

Imithi ejwayele ukunikezwa abantu abaqala ukwelashwa ngezidambisigciwane ingahlukaniswa ngezigaba ezinhlanu zemithi:

• i-nucleoside / nucleotide reverse transcriptase inhibitors (ama-NRTIs)
• i-integrase strand transfer inhibitors (ama-INSTI)
• ama-protease inhibitors (ama-PIs)
• ama-non-nucleoside reverse transcriptase inhibitors (ama-NNRTIs)
• ama-entry inhibitors

Izidakamizwa ezibalwe ngezansi zonke zivunyelwe yi-Food and Drug Administration (FDA) ukwelapha i-HIV.

I-Nucleoside / nucleotide reverse transcriptase inhibitors (ama-NRTIs)

Ama-NRTI agcina amaseli atheleleke nge-HIV ukuthi angazenzeli amakhophi awo ngokuphazamisa ukwakhiwa kabusha kwe-DNA chain yegciwane lapho isebenzisa i-enzyme reverse transcriptase. Ama-NRTI afaka phakathi:

• i-abacavir (etholakala njengesidakamizwa esizimele sodwa i-Ziagen noma njengengxenye yezidakamizwa ezintathu ezihlanganisiwe)
• I-lamivudine (etholakala njengesidakamizwa esizimele i-Epivir noma njengengxenye yezidakamizwa eziyisishiyagalolunye ezihlanganisiwe)
• i-emtricitabine (etholakala njengesidakamizwa esizimele u-Emtriva noma njengengxenye yezidakamizwa eziyisishiyagalolunye ezihlanganisiwe)
• i-zidovudine (etholakala njengesidakamizwa esizimele i-Retrovir noma njengengxenye yezidakamizwa ezimbili ezihlanganisiwe)
• i-tenofovir disoproxil fumarate (etholakala njengesidakamizwa esizimele i-Viread noma njengengxenye yemithi eyisishiyagalolunye ehlanganisiwe)
• i-tenofovir alafenamide fumarate (etholakala njengesidakamizwa esizimele i-Vemlidy noma njengengxenye yezinhlanganisela zemithi ehlukene emihlanu)

I-Zidovudine yaziwa nangokuthi i-azidothymidine noma i-AZT, futhi kwakuyisidakamizwa sokuqala esivunyelwe i-Food and Drug Administration (FDA) ukwelapha i-HIV. Kulezi zinsuku, kungenzeka kakhulu ukuthi isetshenziswe njenge-post-exposure prophylaxis (PEP) yezinsana ezisanda kuzalwa ezinomama abane-HIV kunokwelashwa kwabantu abadala abane-HIV.

I-Tenofovir alafenamide fumarate isetshenziswa kumaphilisi okuhlanganisa amaningi we-HIV. Njengesidakamizwa esizimele sodwa, sitholwe kuphela imvume yokwelapha i-HIV. Umuthi ozimele wodwa uvunyelwe yi-FDA ukwelapha ukutheleleka okungapheli kwesifo sohlobo lwe-hepatitis B. Amanye ama-NRTI (emtricitabine, lamivudine, ne-tenofovir disoproxil fumarate) nawo angasetshenziswa ekwelapheni ukutheleleka kwesifo sokusha kwesibindi kohlobo B.

Inhlanganisela yamaNRTI ifaka phakathi:

• abacavir, lamivudine, ne-zidovudine (Trizivir)
• abacavir nelamivudine (Epzicom)
• i-lamivudine ne-zidovudine (Combivir)
• I-lamivudine ne-tenofovir disoproxil fumarate (Cimduo, Temixys)
• i-emtricitabine ne-tenofovir disoproxil fumarate (iTruvada)
• i-emtricitabine ne-tenofovir alafenamide fumarate (Descovy)

Ngaphezu kokusetshenziselwa ukwelapha i-HIV, i-Descovy ne-Truvada nayo ingasetshenziswa njengengxenye yohlelo lwe-pre-exposure prophylaxis (PrEP).

Kusukela ngo-2019, i-US Preventive Services Task Force incoma uhlobo lwe-PrEP lwabo bonke abantu abangenayo i-HIV abasengozini enkulu yokuthola i-HIV.

I-Integrase strand transfer inhibitors (ama-INSTI)

Ama-INSTI akhubaza i- integrase, i-enzyme esetshenziswa yi-HIV ukufaka i-HIV DNA kwi-DNA yomuntu ngaphakathi kwamaseli we-CD4 T.Ama-INSTI angaphansi kwesigaba semithi eyaziwa ngokuthi i-integrase inhibitors.

Ama-INSTI yimithi esungulwe kahle. Ezinye izigaba zama-integrase inhibitors, njenge-integrase binding inhibitors (INBIs), zithathwa njengezidakamizwa zokuhlola. Ama-INBI awakatholi ukugunyazwa kwe-FDA.

Ama-INSTI afaka:

• i-raltegravir (i-Isentress, i-Isentress HD)
• i-dolutegravir (etholakala njengesidakamizwa esizimele iTivicay noma njengengxenye yezidakamizwa ezintathu ezihlanganisiwe)
• i-bictegravir (kuhlanganiswe ne-emtricitabine ne-tenofovir alafenamide fumarate kumuthi i-Biktarvy)
• i-elvitegravir (kuhlanganiswe ne-cobicistat, emtricitabine, ne-tenofovir alafenamide fumarate ku-drug Genvoya, noma ne-cobicistat, emtricitabine, ne-tenofovir disoproxil fumarate ku-drug Stribild)

Ama-Protease inhibitors (ama-PIs)

Ama-PI akhubaza i-protease, i-enzyme edingwa yi-HIV njengengxenye yomjikelezo wayo wempilo. Ama-PI afaka:

• i-atazanavir (etholakala njengesidakamizwa esizimele i-Reyataz noma ihlanganiswe ne-cobicistat kumuthi we-Evotaz)
• I-darunavir (etholakala njengesidakamizwa esizimele i-Prezista noma njengengxenye yezidakamizwa ezimbili ezihlanganisiwe)
• i-fosamprenavir (Lexiva)
• indinavir (Crixivan)
• i-lopinavir (itholakala kuphela uma ihlanganiswe ne-ritonavir kumuthi we-Kaletra)
• i-nelfinavir (i-Viracept)
• i-ritonavir (etholakala njengesidakamizwa esizimele iNorvir noma ihlanganiswe ne-lopinavir kumuthi we-Kaletra)
• i-saquinavir (i-Invirase)
• i-tipranavir (Aptivus)

I-Ritonavir (i-Norvir) ivame ukusetshenziswa njengesidakamizwa esikhuthazayo seminye imishanguzo ye-antiretroviral.

Ngenxa yemiphumela yabo emibi, i-indinavir, i-nelfinavir, ne-saquinavir akuvamile ukusetshenziswa.

Ama-non-nucleoside reverse transcriptase inhibitors (ama-NNRTIs)

Ama-non-nucleoside reverse transcriptase inhibitors (NNRTIs) avimbela i-HIV ukuthi izenzele amakhophi ayo ngokuzibophezela nokumisa i-enzyme reverse transcriptase. Ama-NNRTI afaka phakathi:

• i-efavirenz (etholakala njengesidakamizwa esizimele sodwa i-Sustiva noma njengengxenye yezidakamizwa ezintathu ezihlanganisiwe)
• i-rilpivirine (etholakala njengesidakamizwa esizimele u-Edurant noma njengengxenye yezidakamizwa ezintathu ezihlanganisiwe)
• i-etravirine (Intelence)
• I-doravirine (itholakala njengesidakamizwa esizimele iPifeltro noma ihlanganiswe ne-lamivudine ne-tenofovir disoproxil fumarate kumuthi i-Delstrigo)
• i-nevirapine (i-Viramune, i-Viramune XR)

Ama-inhibitor okungena

Ama-Entry inhibitors yisigaba semithi esivimba i-HIV ukuthi ingangeni kuma-CD4 T cell. Lezi zivimbeli zifaka:

• enfuvirtide (Fuzeon), okungeyesigaba sezidakamizwa esaziwa njenge-fusion inhibitors
• i-maraviroc (i-Selzentry), engeyesigaba sezidakamizwa esaziwa ngokuthi yi-chemokine coreceptor antagonists (CCR5 antagonists)
• ibalizumab-uiyk (Trogarzo), okungeyesigaba sezidakamizwa esaziwa ngokuthi i-post-attachment inhibitors

Ama-entry inhibitors awavamile ukusetshenziswa njengezindlela zokwelapha zomugqa wokuqala.

Ukwelashwa ngezidambisigciwane

I-HIV ingashintsha futhi imelane nomuthi owodwa. Ngakho-ke, iningi labahlinzeki bezempilo namuhla linikeza imishanguzo eminingi ye-HIV ndawonye.

Inhlanganisela yemithi emibili noma ngaphezulu yezidambisigciwane ibizwa ngokuthi yi-antiretroviral therapy. Yindlela yokwelashwa ejwayelekile yokuqala enikezwe namuhla kubantu abane-HIV.

Lokhu kwelashwa okunamandla kwethulwa okokuqala ngo-1995. Ngenxa yokwelashwa ngezidambisigciwane, ukufa kwabantu okuhlobene nengculaza e-United States kwehla ngamaphesenti angama-47 phakathi kuka-1996 no-1997.

Izinhlobo ezijwayelekile kakhulu namuhla ziqukethe ama-NRTI amabili noma i-INSTI, i-NNRTI, noma i-PI ekhuliswe nge-cobicistat (iTybost). Kunemininingwane emisha esekela ukusetshenziswa kwezidakamizwa ezimbili kuphela, njenge-INSTI ne-NRTI noma i-INSTI ne-NNRTI.

Ukuthuthuka emithini nakho kwenza ukunamathela kwezidakamizwa kube lula kakhulu. Le ntuthuko inciphise inani lamaphilisi umuntu okufanele awadle. Banciphise imiphumela emibi kubantu abaningi abasebenzisa imishanguzo yokuthithibalisa leli gciwane. Okokugcina, intuthuko ifake phakathi amaphrofayili wokusebenzisana nezidakamizwa athuthukisiwe.

Ukunamathela kuyisihluthulelo

1. Ukunamathela kusho ukunamathela kuhlelo lokwelashwa. Ukunamathela emthethweni kubalulekile ekwelashweni kwe-HIV. Uma umuntu one-HIV engayiphuzi imishanguzo yakhe njengokuyalelwa, imishanguzo ingayeka ukubasebenzela bese igciwane liqala ukusabalala emzimbeni wabo futhi. Ukunamathela kudinga ukuthatha wonke umthamo, nsuku zonke, njengoba kufanele unikezwe (ngokwesibonelo, ngokudla noma ngaphandle kokudla, noma ngokuhlukile kweminye imithi).

Inhlanganisela amaphilisi

Intuthuko eyodwa esemqoka eyenza ukubambelela kube lula kubantu abathola imishanguzo yokuthithibalisa igciwane ukwenziwa kwamaphilisi ayinhlanganisela. Le mithi manje sekuyimithi ebekwa kakhulu kubantu abane-HIV abangakaze belashwe phambilini.

Amaphilisi okuhlanganisa aqukethe imishanguzo eminingi ngaphakathi kwepilisi elilodwa. Njengamanje, kunamaphilisi okuhlanganisa ayi-11 aqukethe imishanguzo emibili yezidambisigciwane. Kunamaphilisi okuhlanganisa ayi-12 aqukethe imishanguzo emithathu noma ngaphezulu yezidambisigciwane:

• I-Atripla (efavirenz, emtricitabine, ne-tenofovir disoproxil fumarate)
• I-Biktarvy (i-bictegravir, i-emtricitabine, ne-tenofovir alafenamide fumarate)
• I-Cimduo (lamivudine ne-tenofovir disoproxil fumarate)
• I-Combivir (lamivudine ne-zidovudine)
• IComplera (emtricitabine, rilpivirine, ne-tenofovir disoproxil fumarate)
• UDelstrigo (doravirine, lamivudine, ne-tenofovir disoproxil fumarate)
• I-Descovy (emtricitabine ne-tenofovir alafenamide fumarate)
• I-Dovato (i-dolutegravir ne-lamivudine)
• I-Epzicom (abacavir ne-lamivudine)
• I-Evotaz (atazanavir necobicistat)
• UGenvoya (elvitegravir, cobicistat, emtricitabine, kanye ne-tenofovir alafenamide fumarate)
• I-Juluca (i-dolutegravir ne-rilpivirine)
• I-Kaletra (lopinavir ne-ritonavir)
• U-Odefsey (emtricitabine, rilpivirine, ne-tenofovir alafenamide fumarate)
• I-Prezcobix (darunavir ne-cobicistat)
• Stribild (elvitegravir, cobicistat, emtricitabine, kanye ne-tenofovir disoproxil fumarate)
• I-Symfi (efavirenz, lamivudine, ne-tenofovir disoproxil fumarate)
• Symfi Lo (efavirenz, lamivudine, ne-tenofovir disoproxil fumarate)
• Symtuza (darunavir, cobicistat, emtricitabine, ne-tenofovir alafenamide fumarate)
• I-Temixys (lamivudine ne-tenofovir disoproxil fumarate)
• I-Triumeq (abacavir, dolutegravir, ne-lamivudine)
• I-Trizivir (abacavir, lamivudine, ne-zidovudine)
• ITruvada (emtricitabine kanye ne-tenofovir disoproxil fumarate)

I-Atripla, eyayigunyazwe yi-FDA ngo-2006, yayiyithebhulethi yokuqala yokuhlanganisa esebenzayo ukufaka imishanguzo emithathu yezidambisigciwane. Kodwa-ke, isetshenziswa kaningi manje ngenxa yemiphumela emibi njengokuphazamiseka kokulala nokushintsha kwemizwelo.

Amaphilisi okuhlanganiswa asuselwa ku-INSTI ayizinhlobo zemithi ezinconywayo manje kubantu abaningi abane-HIV. Lokhu kungenxa yokuthi ziyasebenza futhi zidala imiphumela emibi embalwa kunamanye ama-regimens. Izibonelo zifaka iBiktarvy, Triumeq, neGenvoya.

Uhlelo lokwelashwa olufaka phakathi ithebhulethi elihlanganisiwe elenziwe ngemishanguzo emithathu yezidambisigciwane lingabizwa nangokuthi i-single-tablet regimen (STR).

Ngokwesiko i-STR ibhekise ekwelashweni ngemishanguzo emithathu yezidambisigciwane. Kodwa-ke, ezinye izinhlanganisela ezintsha zezidakamizwa ezimbili (ezifana noJuluca noDovato) zifaka phakathi izidakamizwa ezivela ezigabeni ezimbili ezihlukene futhi zamukelwe njenge-FDA njengezinhlobo eziphelele ze-HIV. Ngenxa yalokho, babhekwa njenge-STRs.

Yize amaphilisi ayinhlanganisela eyintuthuko ethembisayo, kungenzeka angalungeli wonke umuntu one-HIV. Xoxa ngalezi zinketho nomhlinzeki wezokunakekelwa kwempilo.

Izidakamizwa zisondele

Unyaka nonyaka, izindlela ezintsha zokwelapha zithola indawo eyengeziwe yokwelapha futhi mhlawumbe kwelaphe i-HIV ne-AIDS.

Isibonelo, abacwaningi baphenya ukwelashwa nokuvikela i-HIV. Le mithi ibizothathwa njalo emavikini amane kuya kwayisishiyagalombili. Bangakhuphula izinga lokunamathela ngokunciphisa inani lamaphilisi abantu abadinga ukuwaphuza.

ILeronlimab, umjovo wamasonto onke wabantu abangazweli ekwelashweni nge-HIV, ibone impumelelo ezivivinyweni zokwelashwa. Iphinde yathola i-FDA, ezosheshisa inqubo yokuthuthukiswa kwezidakamizwa.

Umjovo wanyanga zonke ohlanganisa i-rilpivirine ne-INSTI, i-cabotegravir, uhlelelwe ukutholakala ukwelashwa kokutheleleka nge-HIV-1 ekuqaleni kuka-2020. I-HIV-1 uhlobo oluvame kakhulu lwegciwane lesandulela ngculaza.

Kukhona nomsebenzi oqhubekayo ngomuthi wokugomela i-HIV ongaba khona.

Ukuthola kabanzi ngemishanguzo ye-HIV esikhona njengamanje (kanye naleyo engase ize ngokuzayo), khuluma nomhlinzeki wezokunakekelwa kwezempilo noma usokhemisi.

Ukuhlolwa komtholampilo, okusetshenziselwa ukuhlola izidakamizwa ekukhuleni, nakho kungaheha. Sesha lapha isivivinyo somtholampilo wasendaweni esingahle silunge kahle.