Evolution of Daaweynta HIV

Qanacsan

• Sidee dawooyinka HIV u shaqeeyaan
• Noocyada dawooyinka antiretroviral
• Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)
• Isku-darka ka-hortaggayaasha wareejinta xargaha (INSTIs)
• Kahortagayaasha kahortaga (PIs)
• Kahortagayaasha transcriptase non-nucleoside transcriptase (NNRTIs)
• Ka-hortagga gelitaanka
• Daaweynta antiretroviral
• U hoggaansamiddu waa fure
  
• Kiniiniyada isku dhafka ah
• Daroogada oo ku soo food leh

Guudmarka

Soddon sano ka hor, bixiyeyaasha daryeelka caafimaadka ma aysan helin war dhiirigelin ah oo ay ugu deeqaan dadka laga helay cudurka HIV. Maanta, waa xaalad caafimaad oo la maareyn karo.

Weli ma jiro daawo HIV ama AIDS ah. Si kastaba ha noqotee, horumarka la taaban karo ee daaweynta iyo fahamka bukaan eegtada ee sida HIV uu u socdo ayaa u oggolaanaya dadka qaba HIV inay sii noolaadaan nolol dheer.

Aynu eegno meesha daaweynta HIV maanta ay tahay, saameynta daaweynta cusub ay leedahay, iyo halka daaweynta laga yaabo inay u socoto mustaqbalka.

Sidee dawooyinka HIV u shaqeeyaan

Daaweynta ugu weyn ee HIV maanta waa daawooyinka antiretroviral. Daawooyinkani ma daaweynayaan HIV. Taabadalkeed, waxay xakameeyaan fayraska waxayna yareeyaan horumarkiisa jirka. In kasta oo aysan ka saarin HIV jirka, haddana waxay ku xakameyn karaan heerar aan la ogaan karin xaalado badan.

Haddii daawada ladagaalanka fayraska lagu guuleysto, waxay nolosha qofka ku dari kartaa sanado badan oo caafimaad leh, wax soo saar leh waxayna yareyneysaa halista u gudbinta dadka kale.

Noocyada dawooyinka antiretroviral

Daawooyinka sida caadiga ah loo qoro dadka bilaabaya daaweynta antiretroviral waxaa loo qaybin karaa shan nooc oo daroogo ah:

• Nucleoside / Nucleotide gadaal transcriptase inhibitors (NRTIs)
• isku-darka ka-hortaggayaasha wareejinta xargaha (INSTIs)
• Kahortagayaasha loo yaqaan 'protease inhibitors' (PIs)
• Kahortagayaasha transcriptase non-nucleoside transversease (NNRTIs)
• kahortaga gelitaanka

Daawooyinka hoos ku taxan dhamaantood waxaa ansixiyay Maamulka Cuntada iyo Dawooyinka (FDA) si loo daaweeyo HIV.

Nucleoside / nucleotide reverse transcriptase inhibitors (NRTIs)

NRTIs waxay ka ilaaliyaan unugyada HIV-ga qaba inay koobi ka sameystaan ​​ayaga oo carqaladeynaya dib u dhiska silsiladda DNA-da ee virus-ka markii ay isticmaasho transcriptase enzyme reverse transcriptase. NRTIs waxaa ka mid ah:

• abacavir (oo loo heli karo sida daroogada keligood ah ee Ziagen ama qayb ka mid ah saddex daroogo oo isku dhafan oo kala duwan)
• lamivudine (oo loo heli karo sida dawada kelida ah ee Epivir ama qayb ka mid ah sagaal daroogo isku dhafan oo kala duwan)
• emtricitabine (oo loo heli karo daawada kaligeed Emtriva ama qayb ka mid ah sagaal daawo oo isku dhafan oo kala duwan)
• zidovudine (oo loo heli karo dawada kelida ah ee loo yaqaan 'Retrovir' ama qayb ka mid ah laba daawo oo isku dhafan oo kala duwan)
• tenofovir disoproxil fumarate (oo loo heli karo dawada kelida ah ee Viread ama qayb ka mid ah sagaal dawooyin isku dhafan oo kala duwan)
• tenofovir alafenamide fumarate (oo loo heli karo dawada keligeed la daaweyn karo ee Vemlidy ama qayb ka mid ah shan dawooyin isku dhafan oo kala duwan)

Zidovudine waxaa sidoo kale loo yaqaan azidothymidine ama AZT, waxayna ahayd dawadii ugu horeysay ee ay ogolaato Maamulka Cuntada iyo Dawooyinka (FDA) ee lagu daaweeyo HIV. Maalmahan, waxay u badan tahay in loo isticmaalo ka-hortagga ka-hortagga ka-hortagga (PEP) ee loogu talagalay dhallaanka cusub ee qaba hooyooyinka qaba HIV-ka marka loo eego daaweynta dadka waaweyn ee qaba HIV.

Tenofovir alafenamide fumarate waxaa loo isticmaalaa kiniinno isku dhafan oo fara badan oo loogu talagalay HIV. Daawooyinka keligood ah, waxaa kaliya la helaa oggolaansho go'an oo lagu daaweeyo HIV. Daawada keligood ah ayaa loo ansixiyay FDA si loogu daaweeyo infekshinka cagaarshowga B ee joogtada ah. NRTIs kale (emtricitabine, lamivudine, iyo tenofovir disoproxil fumarate) ayaa sidoo kale loo isticmaali karaa in lagu daaweeyo infekshinka cagaarshowga B.

Isku-darka NRTIs waxaa ka mid ah:

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

Ka sokow in loo isticmaalo in lagu daaweeyo HIV, Descovy iyo Truvada ayaa sidoo kale loo isticmaali karaa qayb ka mid ah nidaamka kahortaga kahortaga cudurka (PrEP).

Laga bilaabo sannadka 2019, Kooxda Task Force ee Adeegyada Ka-hortagga waxay ku talinayaan in PrEP loo sameeyo dhammaan dadka aan qabin HIV ee halista ugu jira qaadista HIV.

Isku-darka ka-hortaggayaasha wareejinta xargaha (INSTIs)

INSTIs disable integrase, enzyme in HIV u adeegsado inuu DNA DNA galiyo DNA-da aadanaha gudaha unugyada CD4 T. INSTIs waxay ka tirsan yihiin nooc daroogo ah oo loo yaqaan 'integrase inhibitors'.

INSTIs waa dawooyin si fiican loo aasaasay. Qaybaha kale ee isku-dhafka ka-hortaggayaasha, sida isku-darka ka-hortaggayaasha isku-xidhka (INBIs), ayaa loo tixgeliyaa daawooyinka tijaabada ah. INBIs ma helin ogolaanshaha FDA.

INSTIs waxaa ka mid ah:

• raltegravir (Isentress, Isentress HD)
• dolutegravir (waxaa loo heli karaa daroogada kaligeed taagan Tivicay ama qeyb ka mid ah seddex daawo oo isku dhafan oo kala duwan)
• bictegravir (oo lagu daro emtricitabine iyo tenofovir alafenamide fumarate oo ku jirta daroogada Biktarvy)
• elvitegravir (oo ay weheliso cobicistat, emtricitabine, iyo tenofovir alafenamide fumarate ee dawada Genvoya, ama cobicistat, emtricitabine, iyo tenofovir disoproxil fumarate ee dawada Stribild)

Kahortagayaasha kahortaga (PIs)

PIs waxay curyaamisaa protease, enzyme uu HIV u baahan yahay qayb ka mid ah meertadiisa nololeed. PIs waxaa ka mid ah:

• atazanavir (oo loo heli karo dawada kaligeed Reyataz ama lagu daro cobicistat ee dawada Evotaz)
• darunavir (oo loo heli karo inay tahay daawada kelida ah ee Prezista ama qayb ka mid ah laba daawo oo isku dhafan oo kala duwan)
• fosamprenavir (Lexiva)
• indinavir (Crixivan)
• lopinavir (waxaa la heli karaa oo keliya marka lagu daro ritonavir ee daawada Kaletra)
• nelfinavir (Viracept)
• ritonavir (oo loo heli karo sida daroogada kaligeed Norvir ama lagu daro lopinavir ee daawada Kaletra)
• saquinavir (Invirase)
• tipranavir (Aptivus)

Ritonavir (Norvir) waxaa badanaa loo isticmaalaa daroogada xoojinta daawooyinka kale ee antiretroviral.

Dhibaatooyinkooda awgood, indinavir, nelfinavir, iyo saquinavir waa dhif in la isticmaalo.

Kahortagayaasha transcriptase non-nucleoside transcriptase (NNRTIs)

Kahortagayaasha transcriptase non-nucleoside transcriptase (NNRTIs) waxay kahortagayaan HIV inay samayso nuqullo lafteeda ah adoo ku xiraya oo joojinaya transcriptase enzyme reverse transcriptase. NNRTIs waxaa ka mid ah:

• efavirenz (oo loo heli karo sida daroogada kelida ah ee Sustiva ama qayb ka mid ah seddex daawo oo isku dhafan oo kala duwan)
• rilpivirine (waxaa loo heli karaa sida daawada kalida ah Edurant ama qeyb ka mid ah seddex daawo oo isku dhafan oo kala duwan)
• etravirine (Qalqal)
• doravirine (oo loo heli karo sida dawada kaligeed ah Pifeltro ama lagu daro lamivudine iyo tenofovir disoproxil fumarate ee daawada Delstrigo)
• nevirapine (Viramune, Viramune XR)

Ka-hortagga gelitaanka

Ka-hortagga gelitaanka waa nooc ka mid ah daroogada ka xannibaysa HIV inuu galo unugyada CD4 T. Kahortagayaashaas waxaa ka mid ah:

• enfuvirtide (Fuzeon), oo ka tirsan fasalka daroogada ee loo yaqaan 'fusion inhibitors'
• maraviroc (Selzentry), oo ka tirsan fasalka daroogada ee loo yaqaan 'chemokine coreceptor antagonists' (CCR5 antagonists)
• ibalizumab-uiyk (Trogarzo), oo ka tirsan fasalka daroogada ee loo yaqaan ka-hortagayaasha lifaaqa dambe

Ka-hortagga gelitaanka ayaa si dhif ah loogu istcimaalaa daweynta koowaad.

Daaweynta antiretroviral

HIV wuu is beddeli karaa oo wuxuu u adkaysan karaa hal dawo. Sidaa darteed, bixiyeyaasha daryeelka caafimaadka badankood maanta waxay isla qoraan dhowr daawo oo HIV ah.

Isku darka laba ama in ka badan daawada ladagaalanka fayraska waxaa loo yaqaan antiretroviral therapy. Waa daaweynta caadiga ah ee bilowga ah ee maanta loo qoro dadka qaba HIV.

Daaweyntan xoogga badan waxaa markii ugu horreysay la soo saaray 1995. Daaweynta antiretroviral therapy awgeed, dhimashada la xiriirta cudurka AIDS-ka ee Mareykanka waxaa la dhimay boqolkiiba 47 intii u dhaxeysay 1996 iyo 1997.

Nidaamyada ugu caansan maanta waxay ka kooban yihiin laba NRTIs iyo INSTI, ama NNRTI, ama PI oo lagu xoojiyay cobicistat (Tybost). Waxaa jira xog cusub oo taageerta isticmaalka kaliya laba daawo sidoo kale, sida INSTI iyo NRTI ama INSTI iyo NNRTI.

Horumarka daawooyinka sidoo kale wuxuu fududeynayaa u hogaansanaanta daroogada. Horumarkaani wuxuu yareeyay tirada kaniini ee qofku qaadan karo. Waxay yareeyeen dhibaatooyinka soo raaca ee dad badan oo isticmaala daawooyinka antiretroviral. Ugu dambeyntiina, horumarka ayaa waxaa kujiray astaamaha isdhexgalka daroogada-daroogada ee la hagaajiyay.

U hoggaansamiddu waa fure

1. U hoggaansamid macnaheedu waa ku dhajinta qorshaha daaweynta. U hoggaansamida ayaa muhiim u ah daaweynta HIV. Haddii qofka qaba HIV uusan u qaadan daawooyinkiisa sida laguu qoray, daawooyinka way ka joojin karaan inay u shaqeeyaan iyaga iyo fayrasku wuxuu bilaabi karaa inuu ku faafo jirkiisa markale. U hoggaansamida waxay u baahan tahay qaadasho kasta, maalin kasta, sida ay tahay in loo qaato (tusaale ahaan, cunno la'aan ama cunto la'aan, ama ka duwan dawooyinka kale).

Kiniiniyada isku dhafka ah

Mid ka mid ah horumarka muhiimka ah ee ka dhigaya u hoggaansamida fudud dadka qaata daaweynta antiretroviral waa horumarinta kiniiniyada isku dhafan. Daawooyinkan ayaa hadda ah kuwa ugu badan ee loo qoro dadka qaba HIV ee aan horey loo daweyn.

Kiniiniyada isku dhafka ah waxaa ku jira dawooyin badan oo ku jira hal kaniini. Waqtigaan la joogo, waxaa jira 11 kaniini oo isku dhafan oo ka kooban laba daawo oo ka hortaga fayraska. Waxaa jira 12 kiniinno isku dhafan oo ay ku jiraan saddex ama in ka badan oo daawooyinka fayraska ah:

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

Atripla, oo ahayd FDA-la ansixiyay 2006, waxay ahayd kiniinigii ugu horreeyay ee wax ku ool ah oo lagu daro saddex daawo oo ka hortagga fayraska ah. Si kastaba ha noqotee, waxaa loo isticmaalaa wax ka yar inta badan hadda sababtoo ah saameynaha sida hurdo la'aanta iyo isbeddelada niyadda.

Kiniiniyada isku-dhafan ee ku-saleysan INSTI ayaa ah nidaamyada lagula taliyay hadda dadka badankood ee qaba HIV. Tani waa sababta oo ah waxay wax ku ool yihiin oo ay keenaan waxyeellooyin yar oo ka yar nidaamyada kale. Tusaalooyinka waxaa ka mid ah Biktarvy, Triumeq, iyo Genvoya.

Qorshaha daaweynta oo ay ku jiraan kiniin isku dhafan oo ka kooban seddex daawo oo antiretroviral ah ayaa sidoo kale loo gudbin karaa hal nidaam kiniin ah (STR).

STR wuxuu dhaqan ahaan u gudbiyay daaweynta seddex daawo oo antiretroviral ah. Si kastaba ha noqotee, qaar ka mid ah isku-darka laba-dawooyin ee cusub (sida Juluca iyo Dovato) waxaa ka mid ah daawooyin ka kala socda laba fasal oo kala duwan oo FDA loo oggolaaday inay yihiin nidaamyo dhammaystiran oo HIV ah. Natiijo ahaan, iyagana waxaa loo tixgeliyaa inay yihiin STRs.

In kasta oo kaniiniyada isku dhafan ay yihiin horumar rajo leh, haddana ma noqon karaan kuwo ku habboon qof kasta oo qaba HIV. Kala hadal ikhtiyaarradan daryeel caafimaad bixiye.

Daroogada oo ku soo food leh

Sannad kasta, daaweynta cusub ayaa sii heleysa dhul badan oo lagu daaweynayo lagana yaabo in lagu daaweeyo HIV iyo AIDS.

Tusaale ahaan, cilmi baarayaashu waxay baarayaan daaweynta HIV iyo ka hortagga labadaba. Daawooyinkan waxaa la qaadan lahaa 4 ilaa 8 toddobaad kasta. Waxay hagaajin karaan u hoggaansamida iyagoo yareynaya tirada kaniiniyada dadku u baahan yihiin inay qaataan.

Leronlimab, oo ah cirbad toddobaadle ah oo loogu talagalay dadka u adkaystay daaweynta HIV, ayaa u aragtay guul tijaabooyin caafimaad. Waxaa sidoo kale laga helay FDA, taas oo dedejin doonta habka horumarinta daroogada.

Cirbadda billaha ah ee isku darka rilpivirine iyo INSTI, cabotegravir, ayaa loo qorsheeyay inay diyaar u noqoto daaweynta cudurka HIV-1 horraanta sannadka 2020. HIV-1 waa nooca ugu badan ee fayraska HIV.

Waxaa sidoo kale jira shaqo socota oo ku saabsan tallaalka HIV-ga.

Si aad wax badan uga ogaato daawooyinka HIV ee hadda la heli karo (iyo kuwa mustaqbalka imaan kara), la hadal bixiye daryeel caafimaad ama farmashiistaha.

Tijaabooyin caafimaad, oo loo adeegsado in lagu tijaabiyo daroogooyinka soo koraya, ayaa sidoo kale laga yaabaa inay xiiso leeyihiin. Halkan ka raadi tijaabo caafimaad oo maxalli ah oo laga yaabo inay habboon tahay.