Hepatitis C Genotype: Mibvunzo Yako Inopindurwa

Zvemukati

• Chii chinonzi hepatitis C genotypes?
• Hepatitis C ine genotypes dzakasiyana. Izvi zvinorevei?
• Ndeupi musiyano uripo pakati pehepatitis C genotypes?
• Ndechipi tsvagiridzo yazvino mumagenotypes uye marapirwo erudzi rumwe nerumwe?
• Ko genotype inofanotaura mhinduro kune DAA kurapa sezvayakaita kune interferon therapy?
• Genotype inowanzo sarudza mhando yekurapwa kunogamuchirwa nemunhu. Pane here zvimwe zvinhu zvinokanganisa kurapwa?
• Iko genotype yangu inobata mukana wekuti ndichaita cirrhosis kana gomarara rechiropa?
• Nezve chiremba

Getty Mifananidzo

Hepatitis C chirwere chehutachiona chinokonzera kuzvimba kwechiropa. Utachiona hunopfuudzwa kuburikidza neropa uye kashoma kuburikidza nekubatana pabonde.

Kune marudzi mazhinji ehutachiona hwehepatitis C. Asi ese marudzi ehepatitis C anogovera zvakafanana zvakafanana.

Mushure mekugashira kuongororwa kwehepatitis C, chiremba wako anozoshanda kuti aone mhando yauinayo kuti uwane kurapwa kwakanyanya.

Tsvaga mutsauko wehepatitis C mhando. Mhinduro dzehunyanzvi dzinopihwa naDr. Kenneth Hirsch, uyo ane kiriniki yakakura yekushanda nevanhu vane hepatitis C.

Chii chinonzi hepatitis C genotypes?

Musiyano weavo vane chirwere chisingaperi chehepatitis C (HCV) "genotype," kana hosha yehutachiona pavakabata chirwere. Iyo genotype inotsanangurwa nekuongororwa kweropa.

Iyo genotype haina hazvo kutamba chinzvimbo mukufambira mberi kwehutachiona, asi asi sechinhu mukusarudza chaiyo mishonga yekurapa.

Zvinoenderana neiyo, angangoita manomwe akasarudzika HCV genotypes, uye anopfuura, akaonekwa.

Iwo akasiyana HCV genotypes uye subtypes ane akasiyana migove pasirese.

Genotypes 1, 2, uye 3 zvinowanikwa pasi rese. Genotype 4 inoitika kuMiddle East, Egypt, uye Central Africa.

Genotype 5 iripo irimo chete muSouth Africa. Genotype 6 inoonekwa muSoutheast Asia. Genotype 7 yakataurwa muDemocratic Republic of Congo.

Hepatitis C ine genotypes dzakasiyana. Izvi zvinorevei?

HCV chirwere cheRNA chisina mutsindo. Izvi zvinoreva kuti genura kodhi yehutachiona hwega hwega iri mukati mechikamu chimwe chinopfuurira cheiyo nucleic acid RNA.

Tambo yega yega ye nucleic acid (RNA kana DNA) inogadzirwa neketani yezvivakwa. Kurongeka kwezvidhinha izvi kunoisa mapuroteni anodiwa nemuviri, ingave hutachiona, chirimwa, kana mhuka.

Kusiyana neHCV, kodhi yemunhu inotakurwa neDNA ine tambo mbiri. Iyo yemunhu genetic kodhi inoenda kuburikidza neyakaomarara kuverenga kuverenga panguva yeDNA replication.

Random changes (mutations) kuhunhu hwemunhu hunowanikwa nemutengo wakaderera. Imhaka yekuti mhosho zhinji dzekudzokorora kweDNA dzinozivikanwa nekugadziriswa.

Mukupesana, HCV's genetic code haina kuongororwa kana ichidzokororwa. Random shanduko dzinoitika uye dzinogara mukodhi.

HCV inobereka nekukurumidza zvakanyanya - inosvika 1 trillion makopi matsva pazuva. Nekudaro, zvimwe zvikamu zveHCV genetic kodhi zvakasiyana zvakanyanya uye zvinoshanduka kazhinji, kunyangwe mukati memunhu mumwe ane hutachiona.

Magenotypes anoshandiswa kuratidza mamwe maratidziro eHCV. Izvo zvinoenderana nekusiyana mune mamwe matunhu ehutachiona genome. Kune mamwe ekuwedzera matavi madiki mukati meiyo genotype. Zvinosanganisira subtype uye quasispecies.

Ndeupi musiyano uripo pakati pehepatitis C genotypes?

Sezvambotaurwa, akasiyana HCV genotypes uye subtypes ane akasiyana migove pasi rese.

Genotype 1 ndiyo yakajairika HCV genotype muUnited States. Inowanikwa mune ingangoita 75 muzana yehutachiona hwese hweHVV munyika.

Vazhinji vevanhu vakasara muUnited States vane hutachiona hweHCV vanotakura genotypes 2 kana 3.

Iyo HCV genotype haina kunyatsoenderana nehuremu hwekukuvara kwechiropa, kana mukana wekupedzisira kukura kwechirrhosis. Nekudaro, inogona kubatsira kufanotaura mhedzisiro yekurapa.

Iyo genotype inogona kubatsira kufanotaura mhedzisiro yeanti-HCV kurapa neiyo interferon-yakavakirwa kurapwa marongero. Genotype yakabatsirawo kuona kurapwa.

Mune mamwe mafomu, iyo inokurudzirwa doses ye ribavirin uye pegylated interferon (PEG) ndeyevanhu vane HCV genotypes chaiyo.

Ndechipi tsvagiridzo yazvino mumagenotypes uye marapirwo erudzi rumwe nerumwe?

Iyo yakanyanya kushandiswa anti-HCV kurapa, PEG / ribavirin, haina kunanga hutachiona pachahwo. Iyi regimen yekurapa inonyanya kukanganisa immune system yemunhu. Chinangwa chayo ndechekuunganidza immune system kuti ione uye kubvisa masero ane hutachiona hweHCV.

Zvisinei, kusiyana kweHCV mumunhu mumwe chete hakuzoiti "kutaridzika zvakafanana" kune immune system. Ichi ndicho chimwe chezvikonzero nei hutachiona hweHCV huchipfuurira uye huve hutachiona husingaperi.

Kunyangwe iine aya akasiyana magene, vatsvagiridzi vakaona mapuroteni anodikanwa pakuzvara kweHCV mumuviri. Aya mapuroteni aripo mune ese akawanda emhando zhinji dzeHCV dzakasiyana.

Mishonga mitsva yeHCV inotarisa mapuroteni aya. Izvi zvinoreva kuti vanovavarira hutachiona. Direct-inoshanda antiviral (DAA) kurapa inoshandisa mamorekuru madiki akagadzirirwa kunyatso kudzivirira aya mapuroteni ehutachiona.

Mishonga yakawanda yeDAA yanga iri kuvandudzwa mukati memakore gumi apfuura. Chirwere chega chega chinotarisa chimwe chezvishoma zvakakosha zveHCV mapuroteni.

Mishonga miviri yekutanga yeDAA, boceprevir uye telaprevir, yakawana mvumo yekuti ishandiswe muUnited States muna 2011. Ose anotarisa imwe enzyme yeHCV inozivikanwa seprotease. Iyi mishonga inoshandiswa pamwe chete neEGI / ribavirin.

Ose ari maviri mishonga mitsva inoshanda zvakanyanya kune HCV genotype 1. Inoshanda zvine mutsindo kune genotype 2, uye haishande kune genotype 3.

Pakutanga, ivo vaingobvumidzwa chete kushandiswa muvanhu vane genotype 1 HCV pamwe chete neEGI / ribavirin.

Kuwedzera DAA zvinodhaka zvakagamuchirwa kuti zvishandiswe pamwe neEGI / ribavirin. Iyi mishonga mitsva inotarisa akati wandei ekuwedzera HCV mapuroteni. Imwe yemishonga iyi sofosbuvir.

Iine PEG / ribavirin kurapwa chete, genotype 1 HCV inoshandiswa kuda nguva refu yekurapa ine mikana shoma yekubudirira. Ne sofosbuvir, genotype 1 ikozvino inorapika mune zvinopfuura 95 muzana yevanhu vanorapwa kwemasvondo gumi nemaviri chete.

Sofosbuvir ine yakasimba kwazvo potency yekudzora hutachiona kudzokorora, zvisinei neiyo genotype (pakati peavo vakadzidza). Nekuda kwekubudirira kwemushonga, Europe nguva pfupi yadarika yakashandura marongero ayo ekurapa.

Ikozvino inokurudzira kurapwa kwemavhiki gumi nemaviri kuvanhu vese vane HCV isina kuomarara vasina kumbobatwa.

Ne sofosbuvir, iyo FDA [Kudya neDrug Administration) zvakare yakabvumidza yekutanga interferon-yemhando yekubatanidza kurapa (sofosbuvir pamwe ribavirin). Iyi kurapa inoshandiswa kwemasvondo gumi nemaviri muvanhu vane genotype 2, kana masvondo makumi maviri nemana mune vanhu vane genotype 3.

Ko genotype inofanotaura mhinduro kune DAA kurapa sezvayakaita kune interferon therapy?

Pamwe… pamwe kwete.

Imwe yeeprotein yakakosha yeHCV inoshanda zvakafanana, zvisinei neiyo genotype. Aya mapuroteni akakosha anogona kunge akasiyana zvakasiyana nekuda kweshanduko diki.

Nekuti iwo akakosha kune iyo HCV yehupenyu kutenderera, chimiro chemasaiti avo anoshanda chinenge chingangoita shanduko nekuda kwekuchinja kusarongeka.

Nekuti saiti inoshanda yeprotein inowirirana pakati pemageneti akasiyana, sei mushandi weDAA anoshanda zvinokanganiswa nekwaanosunga puroteni yakanangwa.

Kubudirira kweavo vamiririri vanosunga zvakanyanya kunzvimbo yeprotein inoshingairira ingangove inokanganiswa nehutachiona genotype.

Mishonga yese yeDAA inodzvinyirira kuenderera kweHCV kuenderera, asi haibudise hutachiona kubva kune yayo inomiririra sero. Izvo zvakare hazvibvise masero ane hutachiona. Iri basa rinosiirwa immune system yemunhu.

Iko kushanda kwakasiyana kwekurapa kweInterferon kunoratidza kuti immune system inokwanisa kujekesa masero ane hutachiona nemajenotypes zvirinani pane ayo akabatwa nevamwe.

Genotype inowanzo sarudza mhando yekurapwa kunogamuchirwa nemunhu. Pane here zvimwe zvinhu zvinokanganisa kurapwa?

Kunze kweiyo genotype, kune zvakawanda zvakasiyana zvinogona kukanganisa mukana wekurapa kubudirira. Zvimwe zvezvakakosha zvinosanganisira:

• huwandu hwehutachiona hweHCV muropa rako
• kuoma kwekukuvara kwechiropa usati warapwa
• mamiriro e immune system yako (kubatira mari nehutachiwana hweHIV, kurapwa necorticosteroids, kana kuve nechinhengo chemuviri kunogona kudzora hutachiona hwako)
• zera
• mujaho
• kunwa doro zvisina kufanira
• kupindura kurapwa kwekutanga

Mamwe majeni emunhu anogona kufungidzira kuti kurapwa kungashande sei. Rudzi rwemunhu rwunozivikanwa se IL28B ndechimwe chekufungidzira kwakasimba kwekupindura PEG / ribavirin kurapwa mune vanhu vane HCV genotype 1.

Vanhu vane chimwe chezvinhu zvitatu zvinogadziriswa zve IL28B:

• CC
• CT
• TT

Vanhu vane gadziriso yeCC vanopindura mushe pakurapwa neEGI / ribavirin. Muchokwadi, ivo vari vaviri kana katatu zvakapetwa zvakanyanya kupfuura vanhu vane mamwe marongero ekuti vave nemhinduro yakakwana kurapa.

Kusarudza iyo IL28B kumisikidzwa kwakakosha muchisarudzo chekurapa neEGI / ribavirin. Zvisinei, vanhu vane genotypes 2 ne3 vanogona kurapwa pamwe neEGI / ribavirin kunyangwe vasina CC yekumisikidza.

Izvi zvinodaro nekuti kazhinji, PEG / ribavirin inoshanda nemazvo kupokana nemageneti aya. Saka, IL28B Kugadziriswa hakuchinje mukana wekurapa kushanda.

Iko genotype yangu inobata mukana wekuti ndichaita cirrhosis kana gomarara rechiropa?

Pamwe. Vamwe vanoratidza kuti vanhu vane hutachiona neHCV genotype 1 (kunyanya avo vane subtype 1b) vane huwandu hukuru hwechirrhosis kupfuura avo vane hutachiona nemamwe magenotypes.

Zvisinei kuti kucherechedza uku ndokwechokwadi here, chirongwa chinokurudzirwa chekutungamira hachichinje zvakanyanya.

Kufambira mberi kwekukuvara kwechiropa kunononoka. Zvinowanzoitika pamusoro pemakumi emakore. Saka, chero munhu achangobva kuongororwa ane HCV anofanirwa kuongororwa nekukuvara kwechiropa. Kukuvara kwechiropa chiratidzo chekurapa.

Ngozi yekuva nekenza yechiropa haitaridzika kunge iine hukama neHCV genotype. Mune chirwere chisingaperi cheHCV, hepatocellular carcinoma (kenza yechiropa) inongokura kana cirrhosis yagadzwa.

Kana munhu ane hutachiona hweHCV akarapwa zvine mutsigo vasati vaita cirrhosis, saka hutachiona hwehutachiona hahusi chinhu.

Zvisinei, kune vanhu vakatoita cirrhosis, pane zvinoratidza kuti genotypes 1b kana 3 inogona kuwedzera njodzi yekenza.

Kuongororwa gomarara rechiropa kunokurudzirwa kune wese munhu ane HCV ine cirrhosis. Vamwe vanachiremba vanokurudzira kuwedzera kuongororwa kweavo vane hutachiona nemagenotypes 1 ne3.

Nezve chiremba

Dr. Kenneth Hirsch akawana chiremba wake wemishonga kubva kuYunivhesiti yeWashington kuSt. Louis, Missouri. Akaita postgraduate kosi mune zvese zvemukati mushonga uye hepatology kuYunivhesiti yeCalifornia, San Francisco (UCSF). Akaita imwezve kosi yekupedza kudzidza kuNational Institutes of Health mune zvekurwisa uye zvekuzvidzivirira. Dr. Hirsch akashandawo semukuru wehepatology kuWashington, D.C., VA Medical Center. Dr. Hirsch akabata musangano wekugadzwa pazvikoro zvekurapa zveGeorgetown neGeorge Washington University.

Dr. Hirsch ane yakakura kiriniki yekudzidzira kushandira varwere vane hepatitis C hutachiona. Iye zvakare ane makore echiitiko mukutsvaga kwemishonga. Akashanda pamabhodhi ezvekupa indasitiri, masangano ezvekurapa emunyika, nematare anotonga.