Ka Hoʻolālā ʻana o nā mālama ʻana i ka maʻi HIV

Anter

• Pehea e hana ai nā lāʻau HIV
• Nā ʻano o nā lāʻau antiretroviral
• Nā Nucleoside / nukelotide hoʻohuli transcriptase inhibitors (NRTI)
• Hoʻopili i nā mea hoʻopili hoʻoili strand (INSTI)
• Nā mea kāohi i nā protein (PI)
• Nā mea kūpale hoʻohuli transcriptase non-nucleoside (NNRTI)
• Nā mea kāohi komo
• ʻO Antiretroviral therapy
• ʻO ke kūpaʻa ke kī
  
• Nā hua hoʻohui
• Nā lāʻau i ka pae

Hōʻike Overview

I kanakolu mau makahiki i hala aku nei, ʻaʻole i loaʻa i nā mea lawelawe olakino ka ʻōlelo hōʻoluʻolu e hāʻawi i ka poʻe i loaʻa ka hōʻailona o ka maʻi HIV. I kēia lā, he kūlana olakino hiki ke mālama ʻia.

ʻAʻohe maʻi HIV a AIDS paha i kēia manawa. Eia nō naʻe, nā holomua holomua i ka mālama ʻana a me ka ʻike hoʻokolohua o ka holomua ʻana o ka maʻi HIV e ʻae nei i ka poʻe me ka HIV e ola ʻoi aku ka lōʻihi, ke ola piha.

E nānā kāua i kahi e mālama ai i ka maʻi HIV i kēia lā, nā hopena i loaʻa i nā hoʻoponopono hou, a ma kahi e alakaʻi ʻia ai ka lāʻau i ka wā e hiki mai ana.

Pehea e hana ai nā lāʻau HIV

ʻO ka lapaʻau nui no ka HIV i kēia lā ʻo nā lāʻau antiretroviral. ʻAʻole mālama kēia mau lāʻau i ka maʻi HIV. Akā, kāohi lākou i ka maʻi a hoʻolohi i kona holomua i ke kino. ʻOiai ʻaʻole lākou e hoʻopau i ka maʻi HIV mai ke kino, hiki iā lākou ke kāohi iā ia i nā pae ʻike ʻole i nā hanana he nui.

Inā kūleʻa kahi lāʻau antiretroviral, hiki iā ia ke hoʻohui i nā makahiki olakino, hua i ke ola o ke kanaka a hoʻemi i ka makaʻi o ka lawe i nā poʻe ʻē aʻe.

Nā ʻano o nā lāʻau antiretroviral

ʻO nā hana i kuhikuhi pinepine ʻia i ka poʻe e hoʻomaka ana i ka antiretroviral therapy hiki ke hoʻokaʻawale ʻia i ʻelima mau papa lāʻau:

• nā mea hoʻohiwahiwa nucleoside / nucleotide huli transcriptase (NRTI)
• hoʻohui i nā mea hoʻohuli hoʻoili strand (INSTI)
• nā mea hoʻohiwahiwa protease (PIs)
• non-nucleoside hoʻohuli transcriptase nā mea hoʻopale (NNRTI)
• nā mea hoʻokipa komo

Ua ʻae ʻia nā lāʻau i helu ʻia ma lalo e ka Food and Drug Administration (FDA) e mālama i ka maʻi HIV.

Nā Nucleoside / nukelotide hoʻohuli transcriptase inhibitors (NRTI)

Mālama ʻo NRTI i nā pūnaewele i loaʻa i ka maʻi HIV mai ka hana kope ʻana iā lākou iho ma ke kāpae ʻana i ke kūkulu hou ʻia ʻana o ke kaula DNA o ka maʻi ke hoʻohana ia i ka enzyme reverse transcriptase. Aia nā NRTI:

• abacavir (loaʻa ma ke ʻano he lāʻau kū wale Ziagen a i ʻole mahele ʻekolu o nā lāʻau hoʻohui like ʻekolu)
• lamivudine (loaʻa ma ke ʻano he lāʻau lapaʻau kū hoʻokahi ʻo Epivir a i ʻole mahele he ʻeiwa o nā lāʻau hoʻohui like)
• emtricitabine (loaʻa e like me ka lāʻau kū hoʻokahi Emtriva a i ʻole mahele o ʻeiwa mau lāʻau hoʻohui like)
• zidovudine (loaʻa ma ke ʻano he lāʻau kū kū hoʻokahi Retrovir a i ʻole he ʻāpana o ʻelua mau lāʻau hoʻohui like ʻelua)
• tenofovir disoproxil fumarate (loaʻa ma ke ʻano he lāʻau lāʻau kū hoʻokahi ʻo Viread a i ʻole mahele he ʻeiwa mau ʻano lāʻau hoʻohui like).
• tenofovir alafenamide fumarate (loaʻa ma ke ʻano he lāʻau kū hoʻokahi ʻo Vemlidy a i ʻole mahele o ʻelima mau lāʻau hoʻohui like)

Ua ʻike ʻia ʻo Zidovudine ʻo azidothymidine a i ʻole AZT, a ʻo ia ka lāʻau mua i ʻae ʻia e ka Food and Drug Administration (FDA) e mālama i ka maʻi HIV. I kēia mau lā, ʻoi aku paha ka hoʻohana ʻia ʻana ma ke ʻano he prophylaxis post-exp (PEP) no nā keiki hānau hou me nā makuahine HIV-maikaʻi ma mua o ka hoʻomaʻamaʻa ʻana no nā mākua HIV-maikaʻi.

Hoʻohana ʻia ʻo Tenofovir alafenamide fumarate i nā pila hoʻohui like no ka maʻi HIV. Ma ke ʻano he lāʻau kū kaʻawale, loaʻa wale ka ʻae ʻia no ka mālama ʻana i ka maʻi HIV. ʻO ka lāʻau kū hoʻokahi i ʻae ʻia e FDA e mālama i ka maʻi hepatitis B mau loa. Hiki ke hoʻohana ʻia kekahi mau NRTI (emtricitabine, lamivudine, a me tenofovir disoproxil fumarate) e mālama ai i ka maʻi hepitis B.

ʻO nā NRTI hui pū ʻia:

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

Ma waho aʻe o ka hoʻohana ʻia ʻana e mālama i ka maʻi HIV, hoʻohana ʻia ʻo Descovy a me Truvada ma ke ʻano he ʻāpana o kahi reghylaxis (PrEP) mua.

E like me ka 2019, ua koi aku ka US Preventive Services Task Force i kahi regimen PrEP no nā poʻe āpau me ka ʻole o ka maʻi HIV ka mea e māhuahua nei i ka loaʻa ʻana o ka maʻi HIV.

Hoʻopili i nā mea hoʻopili hoʻoili strand (INSTI)

Hoʻopio nā INSTI i ka integrase, kahi enzyme a ka HIV e hoʻohana ai e hoʻokomo i ka HIV DNA i loko o nā DNA kanaka i loko o nā pūnaewele CD4 T. Pili nā INSTI i kahi mahele o nā lāʻau i ʻike ʻia me nā mea hoʻopili integrase.

Hoʻokomo maikaʻi ʻia nā INSTI. ʻO nā waeʻano ʻē aʻe o nā mea hoʻopihapiha integrase, e like me nā mea hoʻopili hoʻopili paʻa (INBI), i manaʻo ʻia he lāʻau hoʻokolohua. ʻAʻole i loaʻa i nā INBI ka ʻae a FDA.

Hoʻokomo ʻia nā INSTI:

• raltegravir (Isentress, Isentress HD)
• dolutegravir (loaʻa ma ke ʻano he lāʻau kū hoʻokahi ʻo Tivicay a i ʻole mahele o ʻekolu mau lāʻau hoʻohui like)
• bictegravir (i hui pū ʻia me emtricitabine a me tenofovir alafenamide fumarate i ka lāʻau Biktarvy)
• elvitegravir (i hui pū ʻia me cobicistat, emtricitabine, a me tenofovir alafenamide fumarate i ka lāʻau Genvoya, a i ʻole me cobicistat, emtricitabine, a me tenofovir disoproxil fumarate i ka lāʻau Stribild)

Nā mea kāohi i nā protein (PI)

Hoʻopau nā PI i ka protease, kahi ʻenemema e pono ai ka HIV ma ke ʻano he mahele o kona ola ola. Pili nā PI:

• atazanavir (loaʻa ma ke ʻano he lāʻau kū hoʻokahi ʻo Reyataz a i hui pū ʻia paha me ka cobicistat i ka lāʻau Evotaz)
• darunavir (loaʻa ma ke ʻano he lāʻau kū hoʻokahi Prezista a i ʻole mahele ʻelua o nā lāʻau hoʻohui like ʻelua)
• fosamprenavir (Lexiva)
• indinavir (Crixivan)
• lopinavir (loaʻa wale ke hoʻohui ʻia me ritonavir i ka lāʻau Kaletra)
• nelfinavir (Viracept)
• ritonavir (loaʻa ma ke ʻano he lāʻau kū hoʻokahi Norvir a i hui pū ʻia me lopinavir i ka lāʻau Kaletra)
• saquinavir (Hoʻokele)
• tipranavir (Aptivus)

Hoʻohana pinepine ʻia ʻo Ritonavir (Norvir) ma ke ʻano he lāʻau booster no nā lāʻau antiretroviral ʻē aʻe.

Ma muli o kā lākou hopena, indinavir, nelfinavir, a me ka saquinavir ʻaʻole hoʻohana pinepine ʻia.

Nā mea kūpale hoʻohuli transcriptase non-nucleoside (NNRTI)

Pale aku nā mea pāpā ʻole non-nucleoside huli transcriptase (NNRTI) i ka maʻi HIV mai ka hana kope ʻana iā ia iho ma ka hoʻopaʻa ʻana a me ka hoʻokū ʻana i ka transcriptase enzyme hoʻohuli. Loaʻa nā NNRTI:

• efavirenz (loaʻa ma ke ʻano he lāʻau lāʻau kū hoʻokahi ʻo Sustiva a i ʻole mahele he ʻekolu o nā lāʻau hoʻohui like ʻekolu)
• rilpivirine (loaʻa ma ke ʻano he lāʻau lāʻau kū hoʻokahi ʻo Edurant a i ʻole he ʻāpana o ʻekolu mau lāʻau hoʻohui like ʻekolu)
• etravirine (Intelence)
• doravirine (loaʻa i ka lāʻau kū hoʻokahi Pifeltro a i hui pū ʻia me lamivudine a me tenofovir disoproxil fumarate i ka lāʻau Delstrigo)
• nevirapine (Viramune, Viramune XR)

Nā mea kāohi komo

ʻO nā mea pāpā komo kahi papa o nā lāʻau e ālai i ka maʻi HIV mai ke komo ʻana i nā pūnaewele CD4 T. Hoʻopili kēia mau mea kāohi i:

• enfuvirtide (Fuzeon), i pili i ka papa lāʻau i ʻike ʻia me nā mea hoʻopili kuʻi
• maraviroc (Selzentry), i pili i ka papa lāʻau i ʻike ʻia ʻo chemokine coreceptor antagonists (CCR5 antagonists)
• ibalizumab-uiyk (Trogarzo), no ka papa lāʻau lapaʻau i ʻike ʻia ʻo nā mea kāohi hope

Hoʻohana ʻole ʻia nā mea hoʻopili komo i nā lālani mua.

ʻO Antiretroviral therapy

Hiki i ka HIV ke hoʻololi a lilo i pale i ka lāʻau hoʻokahi. No laila, ʻo ka hapa nui o nā mea lawelawe i kēia lā e kuhikuhi pū i kekahi mau lāʻau HIV.

ʻO ka hui pū ʻana o ʻelua a ʻoi mau lāʻau antiretroviral i kapa ʻia ʻo antiretroviral therapy. ʻO ia ka lāʻau lapaʻau mua maʻamau i kau ʻia i kēia lā no ka poʻe me ka maʻi HIV.

Ua hoʻolauna mua ʻia kēia mana ikaika ma 1995. Ma muli o ka antiretroviral therapy, ua hōʻemi ʻia nā make e pili ana i ka maʻi AIDS ma United States e 47 pākēneka ma waena o 1996 a me 1997.

ʻO nā regimens maʻamau i kēia lā nā ʻelua mau NRTI a i ʻole kahi INSTI, kahi NNRTI, a i ʻole kahi PI i hoʻonui ʻia me cobicistat (Tybost). Aia kekahi ʻikepili hou e kākoʻo ana i ka hoʻohana ʻana i nā lāʻau ʻelua wale nō, e like me INSTI a me NRTI a i ʻole INSTI a me kahi NNRTI.

ʻO ka holomua i nā lāʻau e hana maʻalahi nei i ka mālama ʻana i ka lāʻau. Ua hōʻemi kēia mau holomua i ka helu o nā pila i pono i ke kanaka. Ua hoʻemi lākou i nā hopena ʻino no nā poʻe he nui e hoʻohana ana i nā lāʻau antiretroviral. ʻO ka mea hope loa, ua hoʻokomo nā holomua i nā papa hana launa lāʻau hoʻōla lāʻau maikaʻi.

ʻO ke kūpaʻa ke kī

1. ʻO ke kūpaʻa ʻo ia hoʻi ka hoʻopili ʻana me kahi hoʻolālā mālama. He mea koʻikoʻi ka mālama ʻana no ka mālama ʻana i ka maʻi HIV. Inā ʻaʻole lawe kahi kanaka me ka HIV i kā lākou mau lāʻau e like me ka mea i kauoha ʻia, hiki i nā lāʻau ke hōʻoki i ka hana no lākou a hiki i ka maʻi hoʻomaʻemaʻe ke hoʻomaka hou e hoʻolaha i ko lākou kino. Pono ka mālama i ka lawe ʻana i kēlā me kēia lāʻau, i kēlā me kēia lā, no ka mea e lawelawe ʻia (e laʻa me, me ka ʻole o ka meaʻai a i ʻole ka hoʻokaʻawale ʻia mai nā lāʻau ʻē aʻe.

Nā hua hoʻohui

ʻO kahi holomua nui e hoʻomaʻalahi nei i ka paʻa no ka poʻe e hele nei i ka antiretroviral therapy ʻo ia ka hoʻomohala ʻana i nā hua hoʻohui. ʻO kēia mau lāʻau i kēia manawa nā lāʻau i hōʻike pinepine ʻia no nā poʻe me ka maʻi HIV i mālama ʻole ʻia ma mua.

Loaʻa nā hua hoʻohui i nā lāʻau i loko o hoʻokahi pila. I kēia manawa, aia he 11 mau pila hoʻohui i loaʻa i ʻelua mau lāʻau antiretroviral. Aia he 12 mau hua hoʻohui hoʻohui ʻekolu a ʻoi aku nā lāʻau antiretroviral:

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

ʻO Atripla, ka mea i ʻae ʻia e FDA ma 2006, ʻo ia ka papa hoʻohui hoʻohui mua loa e hoʻopili i ʻekolu mau lāʻau antiretroviral. Eia nō naʻe, hoʻohana pinepine ʻia i kēia manawa ma muli o nā hopena e like me nā haunaele hiamoe a me nā loli o ke ʻano.

ʻO nā papa hoʻohui INSTI hoʻokumu ʻia nā regimens i paipai ʻia i kēia manawa no ka hapanui o nā poʻe me ka maʻi HIV. ʻO kēia no ka mea he hopena lākou a kumu i ka hopena o nā hopena ʻē aʻe ma mua o nā regimens ʻē aʻe. ʻO nā laʻana me Biktarvy, Triumeq, a me Genvoya.

ʻO ke kumumanaʻo lapaʻau e hoʻopili ana i ka papa hoʻohui i ʻekolu mau lāʻau antiretroviral i kapa ʻia paha ma ke ʻano he papa hoʻokahi (STR).

Ua ʻōlelo maʻamau kahi STR i ka mālama ʻana me ʻekolu mau lāʻau antiretroviral. Eia nō naʻe, ʻo kekahi mau hoʻohui lāʻau ʻelua mau lāʻau hou (e like me Juluca a me Dovato) e komo pū me nā lāʻau mai nā papa ʻelua a ʻae ʻia e FDA ma ke ʻano he regimens HIV piha. A ʻo kahi hopena, manaʻo ʻia lākou ʻo STRs.

ʻOiai he holomua holomua nā pilina hoʻohui, ʻaʻole paha lākou he kūpono kūpono no kēlā me kēia kanaka me ka maʻi HIV. Kūkākūkā i kēia mau koho me kahi mea mālama ola.

Nā lāʻau i ka pae

I kēlā me kēia makahiki, ke loaʻa nei nā lāʻau hou i ka honua hou i ka mālama ʻana a me ka hoʻōla ʻana paha i ka maʻi HIV a me ka maʻi ʻo AIDS.

Eia kekahi la, ke ʻimi nei nā mea noiʻi no ka hoʻomaʻamaʻa HIV a me ka pale ʻana. Lawe ʻia kēia mau lāʻau i kēlā me kēia 4 a 8 mau pule. Hiki iā lākou ke hoʻomaikaʻi i ka mālama ʻana ma o ka hōʻemi ʻana i ka nui o nā pila e pono ai nā kānaka.

ʻO Leronlimab, kahi ʻoki o kēlā me kēia pule no ka poʻe i kū kūʻē i ka mālama ʻana i ka maʻi HIV, ua ʻike ʻia ka kūleʻa ʻana i nā hoʻokolohua hoʻokolohua. Ua loaʻa pū kekahi mai ka FDA, kahi e wikiwiki ai i ke kaʻina hana hoʻomōhala lāʻau.

Hoʻonohonoho ʻia kahi injection o ka mahina e hoʻohui i ka rilpivirine me ka INSTI, cabotegravir, no ka mālama ʻana i ka maʻi HIV-1 i ka hoʻomaka mua o ka makahiki 2020. ʻO ka maʻi HIV-1 ka maʻa maʻamau o ka maʻi HIV.

Ke hoʻomau nei nō ka hana ma kahi lāʻau hoʻomaʻamaʻa HIV kūpono.

No ka ʻike hou aku e pili ana i nā lāʻau i loaʻa i kēia manawa (a me nā mea e hiki mai ana i ka wā e hiki mai ana), e kamaʻilio me kahi kauka olakino a i ʻole kauka lāʻau.

ʻO nā hoʻokolohua hoʻokolohua, i hoʻohana ʻia e hoʻāʻo i nā lāʻau i ka hoʻomohala ʻana, hoihoi paha ia. E ʻimi ma aneʻi no kahi hoʻokolohua hoʻokolohua kūloko i kūpono paha.