Iyo Shanduko yeHIV Kurapwa

Zvemukati

• Mashandiro anoita mishonga yeHIV
• Mhando dzema antiretroviral zvinodhaka
• Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• Unganisa strand yekuchinjisa inhibitors (INSTIs)
• Protease inhibitors (PIs)
• Kwete-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Kupinda inhibitors
• Mushonga weantiretroviral
• Kutevedzera kunokosha
  
• Kubatanidza mapiritsi
• Zvinodhaka zvave pedyo

Mhedziso

Makore makumi matatu apfuura, vanopa hutano vanga vasina nhau dzinokurudzira dzekupa vanhu vakagashira hutachiona hweHIV. Nhasi, hunhu hunogoneka hwehutano.

Hakuna mushonga weHIV kana AIDS izvozvi. Zvisinei, kufambira mberi kunoshamisa mukurapa uye kunzwisisa kwekiriniki nezvekuti HIV inofambira mberi sei iri kubvumidza vanhu vane HIV kuti vararame hupenyu hwakareba, huzere.

Ngatitarisei kuti kupi kurapwa kweHIV nhasi, mhedzisiro yekurapa kutsva kuri kuita, uye kupi kurapwa kunogona kuenda mune ramangwana.

Mashandiro anoita mishonga yeHIV

Mushonga mukuru weHIV nhasi mishonga yemaARV. Iyi mishonga hairape HIV. Asi, ivo vanodzvinyirira hutachiona uye vanononoka kufambira mberi kwayo mumuviri. Kunyangwe vasinga bvise HIV kubva mumuviri, vanogona kuidzvinyirira kusvika kumazinga asingaonekwe mune dzakawanda zviitiko.

Kana mushonga weantiretroviral ukabudirira, unogona kuwedzera makore mazhinji ane hutano, ane zvibereko kuhupenyu hwemunhu uye kuderedza njodzi yekutapurirana kune vamwe.

Mhando dzema antiretroviral zvinodhaka

Mishonga inowanzo gadzirirwa vanhu vanotanga maantiretroviral therapy inogona kugoverwa muzvikamu zvishanu zvemishonga:

• nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• integrase strand transfer inhibitors (INSTIs)
• protease inhibitors (PIs)
• isiri-nucleoside reverse transcriptase inhibitors (NNRTIs)
• kupinda inhibitors

Mishonga yakanyorwa pazasi yese yakatenderwa neFood and Drug Administration (FDA) yekurapa HIV.

Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)

NRTIs inochengetedza masero ane hutachiona hweHIV kubva mukugadzira makopi avo nekukanganisa kugadzirisazve hutachiona hweDNA keteni painoshandisa iyo enzyme reverse transcriptase. NRTIs dzinosanganisira:

• abacavir (inowanikwa seyakamira-yega zvinodhaka Ziagen kana sechikamu chematatu akasiyana emishonga inosanganisa)
• lamivudine (inowanikwa seyakamira-yega mushonga Epivir kana sechikamu chemapfumbamwe akasiyana emishonga inosanganisa)
• emtricitabine (inowanikwa seyakamira-yega zvinodhaka Emtriva kana sechikamu chemapfumbamwe akasiyana emishonga inosanganisa)
• zidovudine (inowanikwa seyakamira-yega mishonga Retrovir kana sechikamu chemaviri akasanganiswa emishonga)
• tenofovir disoproxil fumarate (inowanikwa seyakamira-yega zvinodhaka Viread kana sechikamu chezvipfumbamwe zvakasiyana zvinodhaka zvinodhaka)
• tenofovir alafenamide fumarate (inowanikwa seyakamira-yega mushonga weVemlidy kana sechikamu chemashanu akasiyana zvinodhaka zvinodhaka)

Zidovudine inozivikanwawo seazidothymidine kana AZT, uye yaive yekutanga mishonga inogamuchirwa neFood and Drug Administration (FDA) kurapa HIV. Mazuva ano, ari mukana wekuti ushandiswe se post-exposure prophylaxis (PEP) yevana vachangozvarwa vane vanaamai vane hutachiwana hweHIV pane sekurapa kwevanhu vakuru vane HIV.

Tenofovir alafenamide fumarate inoshandiswa mumapiritsi akawanda ehutachiwana hweHIV. Semushonga wakamira-wega, unongogamuchirwa tendero yekurapa HIV. Iyo inomira-yega mishonga yanga iri FDA-inogamuchirwa kurapa chirwere chisingaperi chehepatitis B. Dzimwe NRTIs (emtricitabine, lamivudine, uye tenofovir disoproxil fumarate) inogona zvakare kushandiswa kurapa hutachiona hwehepatitis B.

Kubatanidza NRTIs kunosanganisira:

• abacavir, lamivudine, uye zidovudine (Trizivir)
• abacavir uye lamivudine (Epzicom)
• lamivudine uye zidovudine (Combivir)
• lamivudine uye tenofovir disoproxil fumarate (Cimduo, Temixys)
• emtricitabine uye tenofovir disoproxil fumarate (Truvada)
• emtricitabine uye tenofovir alafenamide fumarate (Descovy)

Pamusoro pekushandisirwa kurapa hutachiwana hweHIV, Descovy naTruvada inogona zvakare kushandiswa sechikamu che pre-exposure prophylaxis (PrEP) regimen.

Kubva muna 2019, US Preventive Services Task Force inokurudzira chirongwa chePrEP chevanhu vese vasina hutachiwana vari panjodzi yekuwana Mukondombera.

Unganisa strand yekuchinjisa inhibitors (INSTIs)

INSTIs inodzivisa integrase, enzyme inoshandiswa neHIV kuisa HIV DNA muDNA yemunhu mukati memasero eCD4 T. INSTI ndeyechikamu chemishonga inozivikanwa seinonzi integrase inhibitors.

INSTIs mishonga yakasimbiswa. Iwo mamwe mapoka e integrase inhibitors, senge integrase binding inhibitors (INBIs), anoonekwa semishonga yekuyedza. INBI hadzina kugamuchira FDA tendero.

INSTIs inosanganisira:

• raltegravir (Isentress, Isentress HD)
• dolutegravir (inowanikwa seyakamira-yega zvinodhaka Tivicay kana sechikamu chematatu akasiyana emishonga inosanganisa)
• bictegravir (inosanganiswa ne emtricitabine uye tenofovir alafenamide fumarate mune chinodhaka Biktarvy)
• elvitegravir (inosanganiswa necobicistat, emtricitabine, uye tenofovir alafenamide fumarate mune mushonga Genvoya, kana necobicistat, emtricitabine, uye tenofovir disoproxil fumarate mune chinodhaka Stribild)

Protease inhibitors (PIs)

Zvirwere zvinodzivisa protease, enzyme inodikanwa neHIV sechikamu chehupenyu hwayo. PIs dzinosanganisira:

• atazanavir (inowanikwa seyakamira-yega mushonga Reyataz kana inosanganiswa necobicistat mune mushonga Evotaz)
• darunavir (inowanikwa seyakamira-yega zvinodhaka Prezista kana sechikamu chemaviri akasiyana mishonga inosanganisa)
• fosamprenavir (Lexiva)
• indinavir (Crixivan)
• lopinavir (inongowanikwa chete kana ichibatanidzwa ne ritonavir mune chinodhaka Kaletra)
• nelfinavir (Viracept)
• ritonavir (inowanikwa seyakamira-yega mushonga Norvir kana inosanganiswa ne lopinavir mune chinodhaka Kaletra)
• saquinavir (Invirase)
• tipranavir (Aptivus)

Ritonavir (Norvir) inowanzo shandiswa semushonga wekusimudzira yemimwe mishonga yema antiretroviral.

Nekuda kwemhedzisiro yavo, indinavir, nelfinavir, uye saquinavir hazviwanzo kushandiswa.

Kwete-nucleoside reverse transcriptase inhibitors (NNRTIs)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) inodzivirira HIV kubva mukugadzira makopi ayo nekusunga nekumisa enzyme reverse transcriptase. NNRTIs dzinosanganisira:

• efavirenz (inowanikwa seyakamira-yega zvinodhaka Sustiva kana sechikamu chematatu akasiyana emishonga inosanganisa)
• rilpivirine (inowanikwa seyakamira-yega zvinodhaka Edurant kana sechikamu chematatu akasiyana emishonga inosanganisa)
• etravirine (kusagadzikana)
• doravirine (inowanikwa seyakamira-yega mushonga Pifeltro kana inosanganiswa ne lamivudine uye tenofovir disoproxil fumarate mune chinodhaka Delstrigo)
• nevirapine (Viramune, Viramune XR)

Kupinda inhibitors

Entry inhibitors kirasi yemishonga inodzivirira HIV kupinda mumaCD4 T masero. Izvi zvinodzivirira zvinosanganisira:

• enfuvirtide (Fuzeon), iri yekirasi yemishonga inozivikanwa seye fusion inhibitors
• maraviroc (Selzentry), iri yekirasi yemishonga inozivikanwa se chemokine coreceptor vanopikisa (CCR5 vanopikisa)
• ibalizumab-uiyk (Trogarzo), iri yekirasi yemushonga inozivikanwa se post-attachment inhibitors.

Kupinda inhibitors kashoma kushandiswa senzira yekutanga kurapwa.

Mushonga weantiretroviral

HIV inogona kuchinja uye kusagadzikana nemushonga mumwe chete. Naizvozvo, vazhinji vanopa hutano nhasi vanopa mishonga yakati wandei yeHIV pamwechete.

Musanganiswa wemishonga inorwisa hutachiona miviri kana kupfuura unonzi mushonga weantiretroviral. Ndiwo marapirwo akaitwa kutanga kune vanhu vane HIV.

Mushonga uyu une simba wakatanga kuunzwa muna 1995. Nekuda kwechirwere cheantiretroviral, kufa kwakabatana neAIDS muUnited States kwakatemwa ne47 muzana pakati pa1996 na1997.

Iwo akajairika marejimendi nhasi ane maNRTI maviri uye ingave INSTI, NNRTI, kana PI inosimudzirwa necobicistat (Tybost). Pane dhata nyowani inotsigira kushandiswa kwemishonga miviri chete zvakare, senge INSTI neNRTI kana INSTI neNNRTI.

Kufambira mberi mumishonga kuri kuitawo kuti kutevedza zvinodhaka kuve nyore. Kufambira mberi uku kwaderedza huwandu hwemapiritsi munhu anofanirwa kunwa. Vakadzora mhedzisiro kune vanhu vazhinji vachishandisa mishonga yemaARV. Chekupedzisira, kufambira mberi kwakasanganisira yakagadziriswa mapiritsi-ekudyidzana maprofiles.

Kutevedzera kunokosha

1. Kuomerera kunoreva kunamatira nehurongwa hwekurapa. Kutevedzera mutemo kwakakosha pakurapwa kweHIV. Kana munhu ane hutachiwana hweHIV akasatora mishonga yake sekurairwa, mishonga inogona kumira kuvashandira uye hutachiona hunogona kutanga kupararira mumuviri wavo zvakare. Kunamatira kunoda kutora dosi rega rega, zuva rega rega, sekufanirwa kupihwa (semuenzaniso, uine kana usina chikafu, kana zvakasiyana nemimwe mishonga).

Kubatanidza mapiritsi

Imwe fambiro mberi yakakosha iri kuita kuti kunamatira kuve nyore kuvanhu vari kurapwa maantiretroviral kurapwa kusimudzira kwemapiritsi anosanganiswa. Iyi mishonga ndiyo yave mishonga inonyanyozivikanwa kuvanhu vane HIV vasina kumborapwa kare.

Mishonga yekubatanidza ine mishonga yakawanda mukati meimwe piritsi. Parizvino, pane mapiritsi akabatanidzwa gumi nerimwe ane maviri maantiretroviral mishonga. Kune gumi nemaviri mapiritsi akasanganiswa ane matatu kana anopfuura maantiretroviral mishonga:

• Atripla (efavirenz, emtricitabine, uye tenofovir disoproxil fumarate)
• Biktarvy (bictegravir, emtricitabine, uye tenofovir alafenamide fumarate)
• Cimduo (lamivudine uye tenofovir disoproxil fumarate)
• Combivir (lamivudine uye zidovudine)
• Complera (emtricitabine, rilpivirine, uye tenofovir disoproxil fumarate)
• Delstrigo (doravirine, lamivudine, uye tenofovir disoproxil fumarate)
• Descovy (emtricitabine uye tenofovir alafenamide fumarate)
• Dovato (dolutegravir uye lamivudine)
• Epzicom (abacavir uye lamivudine)
• Evotaz (atazanavir uye cobicistat)
• Genvoya (elvitegravir, cobicistat, emtricitabine, uye tenofovir alafenamide fumarate)
• Juluca (dolutegravir uye rilpivirine)
• Kaletra (lopinavir uye ritonavir)
• Odefsey (emtricitabine, rilpivirine, uye tenofovir alafenamide fumarate)
• Prezcobix (darunavir uye cobicistat)
• Stribild (elvitegravir, cobicistat, emtricitabine, uye tenofovir disoproxil fumarate)
• Symfi (efavirenz, lamivudine, uye tenofovir disoproxil fumarate)
• Symfi Lo (efavirenz, lamivudine, uye tenofovir disoproxil fumarate)
• Symtuza (darunavir, cobicistat, emtricitabine, uye tenofovir alafenamide fumarate)
• Temixys (lamivudine uye tenofovir disoproxil fumarate)
• Triumeq (abacavir, dolutegravir, uye lamivudine)
• Trizivir (abacavir, lamivudine, uye zidovudine)
• Truvada (emtricitabine uye tenofovir disoproxil fumarate)

Atripla, iyo yaive FDA-yakatenderwa muna 2006, ndiyo yekutanga yekubatanidza piritsi yekubatanidza matatu maantiretroviral mishonga. Zvisinei, inoshandiswa zvishoma kazhinji ikozvino nekuda kwemigumisiro yakadai sekuvhiringidzika kwekurara uye kuchinja kwemanzwiro.

INSTI-based mubatanidzwa mapiritsi ndiwo marongero anokurudzirwa izvozvi kune vanhu vazhinji vane HIV. Izvi zvinodaro nekuti zvinoshanda uye zvinokonzeresa mhedzisiro pane mamwe maratidziro. Mienzaniso inosanganisira Biktarvy, Triumeq, uye Genvoya.

Chirongwa chekurapa chinosanganisira mubatanidzwa piritsi rakaumbwa nematatu maantiretroviral mishonga inogona zvakare kunzi seyechete-piritsi regimen (STR).

STR yakagara ichinongedzera kurapwa nemishonga mitatu yemaARV. Nekudaro, mimwe mitsva mitsva yemishonga miviri (yakadai saJuluca naDovato) inosanganisira mishonga kubva kumakirasi maviri akasiyana uye yakave yakabvumidzwa neFDA sehurongwa hwakakwana hweHIV. Nekuda kweizvozvo, ivo vanoonekwawo seDS.

Kunyangwe mapiritsi akasanganiswa ari kusimudzira kusimudzira, anogona kunge asiri akakodzera kumunhu wese ane HIV. Kurukurai sarudzo idzi nemubatsiri wezvehutano.

Zvinodhaka zvave pedyo

Gore rega rega, kurapa kutsva kuri kuwana nzvimbo yekurapa uye pamwe kurapa HIV neAIDS.

Semuenzaniso, vaongorori vari kuongorora zvese kurapwa kweHIV nekudzivirira. Iyi mishonga yaizotorwa ese mana kusvika masvondo masere. Ivo vanogona kuvandudza kunamatira nekuderedza huwandu hwemapiritsi anodiwa nevanhu kunwa.

Leronlimab, jekiseni revhiki nevhiki revanhu vakapikiswa nemishonga yeHIV, vaona kubudirira mumakiriniki ekuedzwa. Izvo zvakare zvakagamuchirwa kubva kune iyo FDA, inozokurumidzisa chirongwa chekuvandudza zvinodhaka.

Jekiseni remwedzi wega wega rinosanganisa rilpivirine neINSTI, cabotegravir, yakarongerwa kuwanikwa kurapa hutachiona hweHIV-1 kutanga kwa2020. HIV-1 ndiyo mhando yehutachiona hweHIV.

Kune zvakare basa riri kuenderera pane inogona kubatira mushonga weHIV.

Kuti uwane zvimwe pamusoro pemishonga yeHIV iripo (uye iyo inogona kuuya mune ramangwana), taura nemupi wezvehutano kana wemishonga.

Kliniki miedzo, iyo inoshandiswa kuyedza zvinodhaka mukusimudzira, inogona zvakare kuve yekufarira. Tsvaga pano muyedzo yemakiriniki yemuno inogona kukodzera.