IHepatitis C Genotype: Izimpendulo Zemibuzo Yakho

-Delile

• Yini ama-genotypes e-hepatitis C?
• I-Hepatitis C inezakhi zofuzo ezahlukahlukene. Kusho ukuthini lokhu?
• Uyini umehluko phakathi kohlobo lwe-hepatitis C genotypes?
• Luthini ucwaningo lwamanje kuma-genotypes nokwelashwa kohlobo ngalunye?
• Ngabe i-genotype ibikezela impendulo ekwelashweni kwe-DAA njengoba kwenza ukwelashwa kwe-interferon?
• I-genotype imvamisa inquma uhlobo lokwelashwa umuntu alutholayo. Ingabe zikhona ezinye izinto ezithinta ukwelashwa?
• Ngabe i-genotype yami iyawathinta yini amathuba okuthi ngizoba nesifo sokuqina kwesibindi noma umdlavuza wesibindi?
• Mayelana nodokotela

Izithombe ze-Getty

I-Hepatitis C ukutheleleka ngegciwane okubangela ukuvuvukala kwesibindi. Leli gciwane lidluliselwa ngegazi futhi akuvamile ngokuthintana ngokocansi.

Kunezinhlobo eziningi zegciwane le-hepatitis C. Kepha zonke izinhlobo zesifo sokusha kwesibindi kohlobo C zabelana ngokufana okubalulekile.

Ngemuva kokuthola ukuxilongwa kwesifo sokusha kwesibindi kohlobo C, udokotela wakho uzosebenza ukukhomba uhlobo onalo ukuze uthole ukwelashwa okuhle kakhulu.

Thola umehluko ezinhlotsheni ze-hepatitis C. Izimpendulo zesazi zihlinzekwa nguDkt. Kenneth Hirsch, onomkhuba omningi womtholampilo osebenza nabantu abane-hepatitis C.

Yini ama-genotypes e-hepatitis C?

Ukuhlukahluka kwalabo abanegciwane lesifo sokusha kwesibindi kohlobo C (HCV) okuyi- “genotype,” noma uhlobo lwegciwane lapho bethola ukutheleleka. I-genotype inqunywa ukuhlolwa kwegazi.

Uhlobo lwe-genotype aludingi iqhaza ekuqhubekeni kwegciwane, kepha kunalokho njengesici ekukhetheni imithi efanele yokuyelapha.

Ngokusho kwe-, kutholakale okungenani ama-genotypes ayisikhombisa ahlukile we-HCV, nangaphezulu koku-.

Izinhlobo ezahlukahlukene ze-HCV nama-subtypes anokusatshalaliswa okuhlukile emhlabeni jikelele.

Izinhlobo zofuzo 1, 2, no-3 zitholakala emhlabeni wonke. IGenotype 4 yenzeka eMiddle East, Egypt nase-Central Africa.

IGenotype 5 ikhona cishe eNingizimu Afrika kuphela. IGenotype 6 ibonakala eSoutheast Asia. Kubikwe uGenotype 7 eDemocratic Republic of Congo.

I-Hepatitis C inezakhi zofuzo ezahlukahlukene. Kusho ukuthini lokhu?

I-HCV iyigciwane le-RNA elilodwa elilahlekile. Lokho kusho ukuthi ikhodi yofuzo yenhlayiyana ngayinye yegciwane iqukethwe engxenyeni eyodwa eqhubekayo ye-nucleic acid RNA.

Yonke imicu ye-nucleic acid (i-RNA noma i-DNA) yakhiwa ngochungechunge lwamabhulokhi wokwakha. Ukulandelana kwalawa mabhulokhi kunquma amaprotheni adingwa ngumzimba, noma ngabe yigciwane, isitshalo, noma isilwane.

Ngokungafani ne-HCV, ikhodi yofuzo yomuntu ithathwa yi-DNA enemicu emibili. Ikhodi yezakhi zofuzo yomuntu ihlolwa ngokuqinile lapho kwenziwa ukuphindaphindeka kwe-DNA.

Izinguquko ezingahleliwe (ukuguqulwa) kwekhodi yofuzo yomuntu zenzeka ngesilinganiso esiphansi. Lokho kungenxa yokuthi amaphutha amaningi okuphindaphindeka kwe-DNA ayabonwa futhi alungiswe.

Ngokuphambene, ikhodi yofuzo ye-HCV ayihlolwa uma iphindaphindwa. Ukuguqulwa okungahleliwe kuyenzeka futhi kuhlala kukhodi.

I-HCV ikhiqiza ngokushesha okukhulu - kufika kumakhophi amasha ayizigidigidi ezi-1 ngosuku. Ngakho-ke, izingxenye ezithile zekhodi yezakhi zofuzo ye-HCV ziyehluka kakhulu futhi zishintsha njalo, ngisho nasemuntwini oyedwa onesifo.

Ama-genotypes asetshenziselwa ukukhomba izinhlobo ezithile ze-HCV. Zisekelwe okwehlukile ezifundeni ezithile zofuzo lwegciwane. Kunezigaba ezingeziwe zegatsha ngaphakathi kohlobo lwe-genotype. Kubandakanya ama-subtype nama-quasispecies.

Uyini umehluko phakathi kohlobo lwe-hepatitis C genotypes?

Njengoba kushiwo, izinhlobo ezahlukahlukene ze-HCV genotypes kanye nama-subtypes anokwabiwa okuhlukile emhlabeni jikelele.

IGenotype 1 uhlobo oluvame kakhulu lwe-HCV e-United States. Kutholakala cishe kumaphesenti angama-75 azo zonke izifo ze-HCV ezweni.

Iningi labantu abasele e-United States abane-HCV ukutheleleka baphatha ama-genotypes 2 noma 3.

Uhlobo lwe-HCV genotype aluhlobene ngokuphelele nezinga lokulimala kwesibindi, noma amathuba okuthi ekugcineni kukhule i-cirrhosis. Kodwa-ke, kungasiza ukubikezela umphumela wokwelashwa.

I-genotype ingasiza ukubikezela umphumela wokwelashwa kwe-anti-HCV ngemithi yokwelashwa esekwe nge-interferon. IGenotype nayo isizile ekutholeni ukwelashwa.

Kokunye ukwakheka, imithamo enconywayo ye-ribavirin ne-pegylated interferon (i-PEG) eyabantu abanezinhlobo ezithile ze-HCV genotypes.

Luthini ucwaningo lwamanje kuma-genotypes nokwelashwa kohlobo ngalunye?

Ukwelashwa kwe-anti-HCV okusetshenziswa kakhulu, i-PEG / ribavirin, ayikhombisi igciwane uqobo. Le ndlela yokwelashwa ithinta kakhulu amasosha omzimba womuntu. Inhloso yawo ukuhlanganisa amasosha omzimba ukuze aqaphele futhi aqede amaseli atheleleke nge-HCV.

Kodwa-ke, ukuhluka kwe-HCV kumuntu oyedwa ngeke "kubukeke kufana" kumasosha omzimba. Lesi ngesinye sezizathu zokuthi ukutheleleka kwe-HCV kuqhubeke futhi kube izifo ezingapheli.

Noma kunokuhlukahluka kofuzo, abacwaningi bathole amaprotheni adingekayo ekukhiqizeni i-HCV emzimbeni. Lawa maprotheni akhona kuzo zonke izinhlobo eziningi ze-HCV.

Izindlela zokwelapha ezintsha ze-HCV zikhomba la maprotheni. Lokho kusho ukuthi bakhomba igciwane. Ukwelashwa kwe-antiviral antiviral (DAA) okuqondile kusebenzisa ama-molecule amancane enzelwe ukuvimbela ngqo lawa maprotheni egciwane.

Izidakamizwa eziningi zeDAA bezisakhiwa eminyakeni eyishumi edlule. Isidakamizwa ngasinye sikhomba eyodwa yamaprotheni abalulekile e-HCV.

Izidakamizwa ezimbili zokuqala zeDAA, i-boceprevir ne-telaprevir, zathola imvume yokuthi zisetshenziswe e-United States ngo-2011. Zombili lezi zinhloso zikhomba uhlobo oluthile lwe-enzyme ye-HCV eyaziwa nge-protease. Le mithi isetshenziswa ngokuhlangana ne-PEG / ribavirin.

Yomibili le mithi emisha iphumelela kakhulu kuhlobo lwe-HCV 1. Iyasebenza ngokulingene i-genotype 2, futhi ayisebenzi ku-genotype 3.

Ekuqaleni, zazivunyelwe ukusetshenziswa kubantu abane-genotype 1 HCV ngokuhlangana ne-PEG / ribavirin.

Imithi eyengeziwe ye-DAA ivunyelwe ukusetshenziswa kanye ne-PEG / ribavirin. Le mithi emisha ihlose amaprotheni amaningi e-HCV. Enye yalezi zidakamizwa yi-sofosbuvir.

Ngokulashwa kwe-PEG / ribavirin kuphela, i-genotype 1 HCV isetshenziselwa ukudinga ukwelashwa isikhathi eside kunamathuba amancane okuphumelela. Nge-sofosbuvir, i-genotype 1 manje iyelapheka kubantu abangaphezu kwamaphesenti angama-95 belashwa amasonto ayi-12 kuphela.

I-Sofosbuvir inamandla amakhulu kakhulu okucindezela ukuphindaphindeka kwamagciwane, ngaphandle kohlobo lwe-genotype (phakathi kwalabo abafundelwe). Ngenxa yokuphumelela kwalesi sidakamizwa, iYurophu isanda kushintsha imihlahlandlela yayo yokwelashwa.

Manje itusa ukwelashwa kwamasonto onke ayi-12 kubo bonke abantu abane-HCV engenzima abangakaze belashwe ngaphambilini.

Nge-sofosbuvir, i-FDA [Ukuphathwa Kwezokudla Nezidakamizwa] nayo yavuma ukwelashwa kokuhlanganiswa okungenayo i-interferon (sofosbuvir plus ribavirin) yokuqala. Lokhu kwelashwa kusetshenziselwa amasonto ayi-12 kubantu abane-genotype 2, noma amasonto angama-24 kubantu abane-genotype 3.

Ngabe i-genotype ibikezela impendulo ekwelashweni kwe-DAA njengoba kwenza ukwelashwa kwe-interferon?

Mhlawumbe… mhlawumbe cha.

Ngayinye yamaprotheni abalulekile e-HCV asebenza ngokufanayo, kungakhathalekile uhlobo lohlobo lwazo. Lawa maprotheni abalulekile angahluka ngokwesakhiwo ngenxa yezinguquko ezincane.

Ngoba zibalulekile kumjikelezo wempilo we-HCV, ukwakheka kwamasayithi azo asebenzayo kungenzeka kungashintshi ngenxa yokuguquka okungahleliwe.

Ngoba isiza esisebenzayo seprotheni siyalingana phakathi kwama-genotypes ahlukene, ukuthi umenzeli othile we-DAA usebenza kanjani kuthinteka lapho kubopha khona kuphrotheni eqondisiwe.

Ukusebenza kwalawo ma-ejenti abopha kakhulu ngqo kusayithi elisebenzayo lamaprotheni cishe kungenzeka kuthintwe uhlobo lwegciwane lohlobo lwegciwane.

Yonke imishanguzo ye-DAA icindezela ukuphindaphindeka kwe-HCV okuqhubekayo, kodwa ayilikhiphi igciwane kuseli lomphathi wayo. Futhi awasusi amaseli athelelekile. Lo msebenzi ushiyelwa amasosha omzimba womuntu.

Ukusebenza okuguquguqukayo kokwelashwa kwe-interferon kukhombisa ukuthi amasosha omzimba akwazi ukusula amaseli atheleleke kwezinye izinhlobo zofuzo kangcono kunalawo angenwe abanye.

I-genotype imvamisa inquma uhlobo lokwelashwa umuntu alutholayo. Ingabe zikhona ezinye izinto ezithinta ukwelashwa?

Ngaphandle kwe-genotype, kunokuhlukahluka okuningi okungathinta amathuba okuphumelela kokwelashwa. Ezinye zezinto ezibaluleke kakhulu zifaka:

• inani legciwane le-HCV egazini lakho
• ubunzima bokulimala kwesibindi ngaphambi kokwelashwa
• isimo samasosha akho omzimba (ukutheleleka nge-HIV, ukwelashwa ngama-corticosteroids, noma ukufakelwa isitho somzimba kunganciphisa ukuzivikela komzimba wakho)
• ubudala
• umjaho
• ukuphuza ngokweqile okuqhubekayo
• impendulo ekwelashweni kwangaphambili

Izinhlobo ezithile zofuzo zomuntu zingabikezela nokuthi ukwelashwa kungasebenza kanjani. Isakhi sofuzo somuntu esaziwa ngokuthi IL28B ngesinye sezibikezelo ezinamandla zokuphendula ukwelashwa kwe-PEG / ribavirin kubantu abane-HCV genotype 1.

Abantu banokunye kokulungiselelwa kokungenzeka okungathathu kwe- IL28B:

• CC
• I-CT
• TT

Abantu abanokucushwa kwe-CC basabela kahle ekwelashweni nge-PEG / ribavirin. Eqinisweni, maningi amathuba aphindwe kabili kuya kathathu kunabantu abanokunye ukulungiselelwa kokuba nempendulo ephelele ekwelashweni.

Ukunqunywa kwe- IL28B ukumiswa kubalulekile esinqumweni sokulapha nge-PEG / ribavirin. Kodwa-ke, abantu abane-genotypes 2 no-3 bavame ukuphathwa nge-PEG / ribavirin noma ngabe abanakho ukucushwa kwe-CC.

Lokhu kungenxa yokuthi ngokujwayelekile, i-PEG / ribavirin isebenza kahle ngokumelene nalezi genotypes. Ngakho-ke, IL28B ukumiswa akuguquli amathuba okusebenza ngempumelelo kokwelashwa.

Ngabe i-genotype yami iyawathinta yini amathuba okuthi ngizoba nesifo sokuqina kwesibindi noma umdlavuza wesibindi?

Mhlawumbe. Abanye basikisela ukuthi abantu abanesifo se-HCV genotype 1 (ikakhulukazi labo abane-subtype 1b) banesifo esikhulu sokuqina kwesibindi kunalabo abanesifo esinezifo ezithile zofuzo.

Akunandaba noma ngabe lokhu kubheka kuyiqiniso, uhlelo lokuphatha olunconywayo aluguquki kakhulu.

Ukuqhubeka kokulimala kwesibindi kuhamba kancane. Kuvame ukwenzeka ngaphezu kwamashumi eminyaka. Ngakho-ke, noma ngubani osanda kutholakala ukuthi une-HCV kufanele ahlolwe ukulimala kwesibindi. Ukulimala kwesibindi kuyinkomba yokwelashwa.

Ingozi yokuba nomdlavuza wesibindi ayibonakali ihlobene nohlobo lwe-HCV. Ngokutheleleka okungapheli kwe-HCV, i-hepatocellular carcinoma (umdlavuza wesibindi) iqala kuphela lapho i-cirrhosis isunguliwe.

Uma umuntu onesifo se-HCV elashwa ngempumelelo ngaphambi kokuba aqale isifo sokuqina kwesibindi, khona-ke i-genotype ethelelanayo ayiyona into.

Kodwa-ke, kubantu asebevele bahlakulele i-cirrhosis, kukhona okusikisela ukuthi i-genotypes 1b noma i-3 ingandisa ingozi yomdlavuza.

Kunconywa ukuhlolwa kwesifo somdlavuza wesibindi kuwo wonke umuntu one-HCV ene-cirrhosis. Abanye odokotela batusa ukuhlolwa okuvame ukwedlula konke kwalabo abatheleleke nge-genotypes 1 no-3.

Mayelana nodokotela

UDkt. Kenneth Hirsch wathola udokotela wakhe wezokwelapha eWashington University eSt. Louis, eMissouri. Wenza ukuqeqeshwa ngemuva kokuphothula izifundo zombili kwezokwelapha zangaphakathi kanye ne-hepatology e-University of California, eSan Francisco (UCSF). Wenza ukuqeqeshwa okwengeziwe kokuphothula iziqu eNational Institutes of Health ku-allergies kanye ne-immunology. UDkt. Hirsch waphinde wasebenza njengenhloko ye-hepatology eWashington, D.C., e-VA Medical Center. UDkt Hirsch ubambe ukuqokwa kwabafundi ezikoleni zezokwelapha zaseGeorgetown naseGeorge Washington University.

UDkt. Hirsch unomkhuba omkhulu wokuhlinzeka iziguli ezinegciwane le-hepatitis C. Ubuye abe nesipiliyoni seminyaka ocwaningweni lwezemithi. Usebenze kumabhodi okweluleka izimboni, izinhlangano zikazwelonke zezokwelapha, nezinhlangano ezilawulayo.