Phetoho ea Phekolo ea HIV

Litaba

• Meriana ea HIV e sebetsa joang
• Mefuta ea lithethefatsi tsa li-antiretroviral
• Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• Kopanya li-inhibitors tsa li-strand (INSTIs)
• Protease inhibitors (di-PIs)
• Li-non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Li-inhibitors tsa ho kena
• Phekolo ea li-antiretroviral
• Ho khomarela ke senotlolo
  
• Lipilisi tsa motswako
• Lithethefatsi li atametse

Kakaretso

Lilemong tse 30 tse fetileng, bafani ba tlhokomelo ea bophelo ba ne ba se na litaba tse khothatsang tsa ho fa batho ba fumaneng tšoaetso ea HIV. Kajeno, ke boemo ba bophelo bo laolehang.

Ha ho na pheko ea HIV kapa AIDS hajoale. Leha ho le joalo, tsoelo-pele e tsotehang ea kalafo le kutloisiso ea bongaka ea hore na HIV e tsoela pele joang e lumella batho ba nang le HIV ho phela bophelo bo bolelele le ho feta.

Ha re shebeng hore na kalafo ea HIV e hokae kajeno, litlamorao tsa liphekolo tse ncha, le hore na kalafo e ka lebisoa kae nakong e tlang.

Meriana ea HIV e sebetsa joang

Kalafo ea mantlha ea HIV kajeno ke litlhare tsa li-antiretroviral. Meriana ena ha e phekole HIV. Ho fapana le moo, ba hatella vaerase mme ba liehisa kholo ea eona 'meleng. Le ha ba sa felise HIV 'meleng, ba ka e hatella hore e fihle maemong a sa bonahaleng maemong a mangata.

Haeba moriana oa li-antiretroviral o atleha, o ka eketsa lilemo tse ngata tse phetseng hantle, tse behang bophelo ba motho le ho fokotsa menyetla ea ho fetisetsa ba bang.

Mefuta ea lithethefatsi tsa li-antiretroviral

Kalafo e atisang ho fuoa batho ba qalang kalafo ea li-antiretroviral e ka aroloa ka lihlopha tse hlano tsa lithethefatsi:

• nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• integrase strand transfer inhibitors (li-INSTI)
• protease inhibitors (li-PIs)
• non-nucleoside reverse transcriptase inhibitors (li-NNRTIs)
• li-inhibitors tsa ho kena

Meriana e thathamisitsoeng ka tlase kaofela e amohetsoe ke Tsamaiso ea Lijo le Lithethefatsi (FDA) ho alafa HIV.

Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)

Li-NRTI li boloka lisele tse nang le tšoaetso ea HIV hore li se ke tsa iketsetsa likopi ka ho sitisa khaho ea ketane ea DNA ea vaerase ha e sebelisa enzyme reverse transcriptase. Li-NRTI li kenyelletsa:

• abacavir (e fumanehang e le sethethefatsi se ikemetseng Ziagen kapa e le karolo ea litlhare tse tharo tse fapaneng tse kopaneng)
• lamivudine (e fumanehang e le sethethefatsi se ikemetseng sa Epivir kapa e le karolo ea lithethefatsi tse fapaneng tse robong tse kopaneng)
• emtricitabine (e fumanehang e le sethethefatsi se ikemetseng Emtriva kapa e le karolo ea lithethefatsi tse fapaneng tse robong tse kopaneng)
• zidovudine (e fumanehang e le sethethefatsi se ikemetseng se bitsoang Retrovir kapa e le karolo ea litlhare tse fapaneng tse kopaneng)
• tenofovir disoproxil fumarate (e fumanehang e le sethethefatsi se ikemetseng Viread kapa e le karolo ea lithethefatsi tse fapaneng tse robong tse kopaneng)
• tenofovir alafenamide fumarate (e fumanehang e le sethethefatsi se ikemetseng Vemlidy kapa e le karolo ea litlhare tse hlano tse fapaneng)

Zidovudine e boetse e tsejoa e le azidothymidine kapa AZT, 'me e ne e le sethethefatsi sa pele se amoheloang ke Tsamaiso ea Lijo le Lithethefatsi (FDA) ho phekola HIV. Matsatsing ana, ho ka etsahala hore e sebelisoe e le post-exposure prophylaxis (PEP) bakeng sa masea a sa tsoa tsoaloa a nang le bo-mme ba nang le tšoaetso ea HIV ho feta kalafo ea batho ba baholo ba nang le tšoaetso ea HIV.

Tenofovir alafenamide fumarate e sebelisoa lipilisi tse ngata tsa motswako oa HIV. Joaloka sethethefatsi se ikemetseng, se fumane tumello ea nakoana ea ho alafa HIV. Lithethefatsi tse ikemetseng li amohetsoe ke FDA ho phekola tšoaetso e sa foleng ea lefu la hepatitis B. Li-NRTI tse ling (emtricitabine, lamivudine, le tenofovir disoproxil fumarate) le tsona li ka sebelisoa ho alafa tšoaetso ea hepatitis B.

Motsoako oa li-NRTI o kenyelletsa:

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

Ntle le ho sebelisoa ho phekola HIV, Descovy le Truvada le tsona li ka sebelisoa e le karolo ea melao ea pre-exposure prophylaxis (PrEP).

Ho tloha ka 2019, US Preventive Services Task Force e khothaletsa mofuta oa PrEP bakeng sa batho bohle ba se nang HIV ba kotsing e kholo ea ho fumana tšoaetso ea HIV.

Kopanya li-inhibitors tsa li-strand (INSTIs)

Li-INSTI li thibela integrase, enzyme eo HIV e e sebelisang ho kenya DNA ea DNA ka har'a DNA ea motho ka har'a lisele tsa CD4 T. Li-INSTI ke tsa sehlopha sa lithethefatsi tse tsejoang ka hore ke integrase inhibitors.

Li-INSTI ke lithethefatsi tse tsebahalang hantle. Likarolo tse ling tsa integrase inhibitors, joalo ka integrase binding inhibitors (INBIs), li nkuoa e le lithethefatsi tsa liteko. Li-INB ha li so fumane tumello ea FDA.

Li-INSTI li kenyelletsa:

• raltegravir (Isentress, Isentress HD)
• dolutegravir (e fumanehang e le sethethefatsi se ikemetseng Tivicay kapa e le karolo ea litlhare tse tharo tse fapaneng tse kopaneng)
• bictegravir (e kopantsoe le emtricitabine le tenofovir alafenamide fumarate ka sethethefatsi sa Biktarvy)
• elvitegravir (e kopantsoe le cobicistat, emtricitabine, le tenofovir alafenamide fumarate ka sethethefatsi sa Genvoya, kapa ka cobicistat, emtricitabine, le tenofovir disoproxil fumarate ka sethethefatsi sa Stribild)

Protease inhibitors (di-PIs)

Li-PI li thibela protease, enzyme eo HIV e e hlokang e le karolo ea potoloho ea bophelo ba eona. Li-PI li kenyelletsa:

• atazanavir (e fumanehang e le sethethefatsi se ikemetseng Reyataz kapa e kopantsoe le cobicistat ka har'a lithethefatsi Evotaz)
• darunavir (e fumanehang e le sethethefatsi se ikemetseng Prezista kapa e le karolo ea lithethefatsi tse peli tse fapaneng tse kopaneng)
• fosamprenavir (Lexiva)
• indinavir (Crixivan)
• lopinavir (e fumaneha feela ha e kopantsoe le ritonavir ka hara sethethefatsi sa Kaletra)
• nelfinavir (Viracept)
• ritonavir (e fumanehang e le sethethefatsi se ikemetseng se bitsoang Norvir kapa se kopantsoe le lopinavir ka sethethefatsi sa Kaletra)
• saquinavir (Sehlaseli)
• tipranavir (Aptivus)

Ritonavir (Norvir) hangata e sebelisoa e le setlhare se matlafatsang bakeng sa meriana e meng ea li-antiretroviral.

Ka lebaka la litla-morao tsa bona, indinavir, nelfinavir le saquinavir ha li sebelisoe hangata.

Li-non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) e thibela HIV ho iketsetsa likopi ka ho itlama le ho emisa enzyme reverse transcriptase. Li-NNRTI li kenyelletsa:

• efavirenz (e fumanehang e le sethethefatsi se ikemetseng Sustiva kapa e le karolo ea litlhare tse tharo tse fapaneng tse kopaneng)
• rilpivirine (e fumanehang e le sethethefatsi se ikemetseng Edurant kapa e le karolo ea litlhare tse tharo tse fapaneng tse kopaneng)
• etravirine (Tšusumetso)
• doravirine (e fumanehang e le sethethefatsi se ikemetseng Pifeltro kapa e kopantsoe le lamivudine le tenofovir disoproxil fumarate ka sethethefatsi sa Delstrigo)
• nevirapine (Viramune, Viramune XR)

Li-inhibitors tsa ho kena

Entry inhibitors ke sehlopha sa litlhare tse thibelang HIV ho kena liseleng tsa CD4 T. Li-inhibitors tsena li kenyelletsa:

• enfuvirtide (Fuzeon), eo e leng ea sehlopha sa lithethefatsi se tsejoang e le fusion inhibitors
• maraviroc (Selzentry), eo e leng ea sehlopha sa lithethefatsi se tsejoang ka hore ke bahanyetsi ba chemokine coreceptor (bahanyetsi ba CCR5)
• ibalizumab-uiyk (Trogarzo), eo e leng ea sehlopha sa lithethefatsi se tsejoang ka hore ke post-attachment inhibitors.

Entry inhibitors ha e sebelisoe hangata joalo ka kalafo ea mohala oa pele.

Phekolo ea li-antiretroviral

HIV e ka fetoha 'me ea hanyetsa moriana o le mong. Ka hona, bafani ba bangata ba tlhokomelo ea bophelo kajeno ba fana ka meriana e 'maloa ea HIV hammoho.

Motsoako oa litlhare tse peli kapa ho feta tsa li-antiretroviral o bitsoa antiretroviral therapy. Ke kalafo e tloaelehileng e fuoang batho ba nang le HIV kajeno.

Phekolo ena e matla e qalile ho hlahisoa ka 1995. Ka lebaka la kalafo ea li-antiretroviral, mafu a amanang le AIDS United States a felisitsoe ka liperesente tse 47 lipakeng tsa 1996 le 1997.

Mefuta e atileng haholo kajeno e na le li-NRTI tse peli le INSTI, NNRTI, kapa PI e matlafalitsoeng ke cobicistat (Tybost). Ho na le lintlha tse ncha tse tšehetsang ts'ebeliso ea lithethefatsi tse peli feela, joalo ka INSTI le NRTI kapa INSTI le NNRTI.

Tsoelo-pele ea meriana le eona e nolofalletsa tšebeliso ea lithethefatsi hampe. Tsoelo-pele ena e fokolitse palo ea lipilisi tseo motho a lokelang ho li noa. Ba fokolitse litla-morao ho batho ba bangata ba sebelisang meriana ea li-antiretroviral. Qetellong, tsoelo-pele e kenyelelitse lifaele tse ntlafalitsoeng tsa tšebelisano le lithethefatsi.

Ho khomarela ke senotlolo

1. Ho khomarela ho bolela ho khomarela leano la kalafo. Ho khomarela kalafo ho bohlokoa kalafong ea HIV. Haeba motho ea nang le HIV a sa noe meriana ea hae kamoo a laetsoeng kateng, litlhare li ka emisa ho li sebeletsa 'me vaerase ea qala ho hasana' meleng oa hae hape. Ho khomarela ho hloka ho noa lethal dose ka leng, letsatsi le leng le le leng, joalo ka ha le lokela ho fuoa (mohlala, ka lijo kapa ntle le lijo, kapa ka thoko le meriana e meng).

Lipilisi tsa motswako

Khatelo-pele e le 'ngoe e etsang hore ho be bonolo ho khomarela batho ba fumanang kalafo ea li-antiretroviral ke nts'etsopele ea lipilisi tse kopaneng. Meriana ena e se e le litlhare tse laeloang haholo bakeng sa batho ba nang le HIV ba so kang ba phekoloa pele.

Lipilisi tsa motsoako li na le lithethefatsi tse ngata ka har'a pilisi e le 'ngoe. Hajoale, ho na le lipilisi tse kopaneng tse 11 tse nang le litlhare tse peli tsa li-antiretroviral. Ho na le lipilisi tse 12 tsa motsoako o nang le meriana e meraro kapa ho feta ea li-antiretroviral:

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

Atripla, e ileng ea amoheloa ke FDA ka 2006, e ne e le letlapa la pele la kopanyo le sebetsang ho kenyelletsa litlhare tse tharo tsa li-antiretroviral. Leha ho le joalo, ha e sebelisoe hangata hajoale ka lebaka la litla-morao tse kang pherekano ea boroko le ho fetoha ha maikutlo.

Matlapa a kopantsoeng a INSTI ke mefuta e khothalletsoang hona joale ho batho ba bangata ba nang le HIV. Sena ke hobane li sebetsa hantle 'me li baka litla-morao tse fokolang ho feta mefuta e meng. Mehlala e kenyelletsa Biktarvy, Triumeq, le Genvoya.

Morero oa kalafo o kenyelletsang letlapa le kopaneng le entsoeng ka meriana e meraro ea li-antiretroviral le eona e ka bitsoa mofuta oa letlapa le le leng (STR).

Ka tloaelo STR e bua ka kalafo ka meriana e meraro ea li-antiretroviral. Leha ho le joalo, mefuta e meng e mecha ea lithethefatsi tse peli (joalo ka Juluca le Dovato) e kenyelletsa lithethefatsi tse tsoang lihlopheng tse peli tse fapaneng mme li amohetsoe ke FDA e le mefuta e felletseng ea HIV. Ka lebaka leo, le tsona li nkuoa e le li-STR.

Le ha lipilisi tsa motswako e le tsoelo-pele e ts'episang, li kanna tsa se tšoanele motho e mong le e mong ea nang le HIV. Buisanang ka likhetho tsena le mofani oa tlhokomelo ea bophelo.

Lithethefatsi li atametse

Selemo se seng le se seng, mekhoa ea kalafo e mecha e ntse e fumana matla a mangata a ho phekola HIV le AIDS.

Mohlala, bafuputsi ba ntse ba batlisisa kalafo le thibelo ea HIV. Meriana ena e ne e tla nooa libeke tse 4 ho isa ho tse 8. Ba ka ntlafatsa ts'ebeliso ea meriana ka ho fokotsa palo ea lipilisi tseo batho ba hlokang ho li noa.

Leronlimab, ente ea beke le beke bakeng sa batho ba hananang le kalafo ea HIV, e bone katleho litekong tsa bongaka. E boetse e amohetse ho tsoa ho FDA, e tla potlakisa ts'ebetso ea nts'etsopele ea lithethefatsi.

Ente ea khoeli le khoeli e kopanyang rilpivirine le INSTI, cabotegravir, e reretsoe ho ba teng bakeng sa kalafo ea tšoaetso ea HIV-1 mathoasong a selemo sa 2020. HIV-1 ke mofuta o atileng ka ho fetisisa oa vaerase ea HIV.

Ho boetse ho na le mosebetsi o tsoelang pele mabapi le vaksine e ka bang teng ea HIV.

Ho tseba haholoanyane ka litlhare tsa HIV tse fumanehang ha joale (le tse ka tlang nakong e tlang), bua le mofani oa tlhokomelo ea bophelo kapa rakhemisi.

Liteko tsa bongaka, tse sebelisetsoang ho hlahloba lithethefatsi nts'etsopele, le tsona li ka khahla. Batla mona bakeng sa teko ea bongaka ea lehae e ka bang e tšoanelehang hantle.