Hepatitis C Genotype: Pane ʻia kāu mau nīnau

Anter

• He aha nā genotypes hepatitis C?
• He mau genotypes ʻokoʻa ko Hepatitis C. He aha ka manaʻo o kēia?
• He aha ka ʻokoʻa ma waena o nā genotypes hepatitis C?
• He aha ka noiʻi e kū nei i nā genotypes a me nā mālama ʻana no kēlā me kēia ʻano?
• Kuhi paha ka genotype i ka pane i ka DAA therapy e like me ia no interferon therapy?
• Hoʻoholo pinepine ka Genotype i ke ʻano o ka lapaʻau e loaʻa i ke kanaka. Aia kekahi mau kumu ʻē aʻe e hoʻopili i ka lāʻau?
• Hoʻopili paha kaʻu genotype i ka likelihood e ulu wau i ka cirrhosis a i ʻole ka maʻi ʻaʻai ate?
• E pili ana i ke kauka

Nā kiʻi Getty

ʻO Hepatitis C kahi maʻi viral i kumu e hoʻāhu i ke ake. Hoʻouna ʻia ka maʻi ma o ke koko a liʻiliʻi ma o ka pili kolohe ʻana.

Nui a hewahewa nā ʻano maʻi o ka maʻi hepatitis C. Akā ʻo nā ʻano āpau o ka hepatitis C kaʻana like i nā mea nui.

Ma hope o kou loaʻa ʻana i kahi kuhi o ka maʻi hepa C, e hana kāu kauka e ʻike i ke ʻano āu i loaʻa ai iā ʻoe ka lāʻau maikaʻi loa.

E ʻike i nā ʻokoʻa ma nā ʻano hepatitis C. Hāʻawi ʻia e nā kauka loea e Kauka Kenneth Hirsch, ka mea hana nui i ka hana me ka poʻe i loaʻa i ka maʻi hepitis C.

He aha nā genotypes hepatitis C?

ʻO kahi loli no ka poʻe me ka maʻi hepatitis C maʻi mau (HCV) ka "genotype," a i ʻole ke ʻino o ka maʻi i ka wā e loaʻa ai kahi maʻi. Hoʻoholo ʻia ka genotype e kahi hōʻike koko.

ʻAʻole pono ka genotype i ka holomua o ka maʻi, akā ma ke ʻano he kumu i ke koho ʻana i nā lāʻau kūpono no ka mālama ʻana iā ia.

Wahi a ka, ma ka liʻiliʻi he ʻehiku mau ʻano genotypes HCV, a ʻoi aku ma mua o, ua ʻike ʻia.

Loaʻa nā ʻano like ʻole o nā genotypes HCV a me nā subtypes i ka honua holoʻokoʻa.

Loaʻa nā genotypes 1, 2, a me 3 i ka honua holoʻokoʻa. Aia ʻo Genotype 4 ma ka Hikina Waena, ʻAigupita, a me ʻApelika Waena.

Aia ʻo Genotype 5 ma aneane wale nō ma ʻApelika Hema. ʻIke ʻia ka Genotype 6 ma Asia Hikina Hema. Ua hōʻike ʻia ʻo Genotype 7 ma ka Lepupalika Kemokalaka o Kongo.

He mau genotypes ʻokoʻa ko Hepatitis C. He aha ka manaʻo o kēia?

ʻO HCV kahi maʻi RNA pale hoʻokahi. ʻO ia ke kumu o ka helu kuhi o kēlā me kēia huna huna i loko o hoʻokahi ʻāpana hoʻomau o ka RNA acidic acid.

Kuhi ʻia kēlā me kēia pae o ka waikawa nukelika (RNA a i ʻole DNA) i kahi kaulahao o nā palaka hale. Hoʻoholo ke kaʻina o kēia mau palaka i nā protein i makemake ʻia e kahi meaola, inā he virus paha, mea kanu, a holoholona paha.

ʻAʻole like me HCV, lawe ʻia ke code genetical kanaka e DNA pālua. Hele ka code genetic kanaka ma o ka loiloi loa i ke kaʻina hana o DNA replication.

Hoʻololi kaulike (hoʻololi) i ke code genetic o ke kanaka ma kahi haʻahaʻa haʻahaʻa. ʻO ia no ka mea ʻike ʻia a hoʻoponopono ʻia ka hapa nui o nā kuhi hewa o ka replication DNA.

I ka hoʻohālikelike ʻana, ʻaʻole hōʻoia ka helu kuhi a ko HCV ke hoʻohālikelike ʻia. Kūpono nā loli a noho i ke code.

Kope koke ʻo HCV - a i 1 trillion mau kope hou i kēlā me kēia lā. No laila, ʻano ʻokoʻa a loli pinepine kekahi mau ʻāpana o ka helu kuhi HCV a i loko hoʻi o kahi kanaka me ka maʻi.

Hoʻohana ʻia nā genotypes e ʻike i nā ʻano kikoʻī o ka HCV. Hoʻokumu ʻia lākou i nā ʻokoʻa i nā wahi kikoʻī o ka genome viral. Aia nā subcategory lālā hou i loko o kahi genotype. Hoʻopili lākou i nā subtype a me nā quasispecies.

He aha ka ʻokoʻa ma waena o nā genotypes hepatitis C?

E like me ka mea i ʻōlelo ʻia, nā ʻokoʻa like ʻole o nā genotypes HCV a me nā subtypes ma ka honua holoʻokoʻa.

ʻO Genotype 1 ka genotype HCV maʻamau loa i United States. Loaʻa ia ma kahi o 75 pākēneka o nā maʻi HCV āpau i ka ʻāina.

ʻO ka hapa nui o ka poʻe i koe i United States me ka maʻi HCV e halihali i nā genotypes 2 a i ʻole 3.

ʻAʻole pili loa ka genotype HCV i ka helu o ka hōʻino o ke ake, a i ʻole ka likelike o ka hoʻomohala ʻana i ka cirrhosis. Eia nō naʻe, hiki ke kōkua i ka wānana i ka hopena o ka lāʻau.

Hiki i ke genotype ke kōkua i ka wānana i ka hopena o ka anti-HCV therapy me nā regimens lapaʻau e pili ana i ka interferon. Ua kōkua pū kekahi ʻo Genotype i ka hoʻoholo ʻana i ka lāʻau.

I kekahi mau formulated, nā ʻōlelo i koi ʻia o ribavirin a me pegylated interferon (PEG) no ka poʻe me nā genotypes HCV kikoʻī.

He aha ka noiʻi e kū nei i nā genotypes a me nā mālama ʻana no kēlā me kēia ʻano?

ʻO ka anti-HCV therapy i hoʻohana ākea ākea ʻia, PEG / ribavirin, ʻaʻole ia e māka i ka maʻi o ka maʻi. Hoʻololi kēia regimen lapaʻau i ka ʻōnaehana pale o ke kanaka. ʻO kāna pahuhopu ka hōʻuluʻulu ʻana i ka ʻōnaehana pale e ʻike a hoʻopau i nā hunaola i hoʻopili ʻia me ka HCV.

Eia nō naʻe, ʻaʻole ʻokoʻa ka nānā ʻana o nā HCV i ke kanaka hoʻokahi "e nānā like" i ka ʻōnaehana pale. ʻO kēia kekahi o nā kumu e hoʻomau ai nā maʻi HCV a lilo i mau maʻi mau.

ʻOiai me kēia ʻano lāhui, ua ʻike nā kānaka noiʻi i nā protein i koi ʻia no ka hana kope ʻana o HCV i ke kino. Aia kēia mau protein i ka nui o nā ʻano like ʻole o ka HCV.

Hoʻokumu nā lāʻau lapaʻau hou no ka HCV i kēia mau protein. ʻO ia ka mea i māka i ka virus. Hoʻohana ka lāʻau antiviral (DAA) kuhikuhi pololei i nā mole liʻiliʻi i hoʻolālā ʻia e kāohi pono i kēia mau protein viral.

Nui nā lāʻau DAA i hoʻomohala ʻia i loko o nā makahiki he 10 i hala. Hoʻolālā kēlā me kēia lāʻau i hoʻokahi o ka lima o nā protein HCV pono.

ʻO nā lāʻau DAA mua ʻelua, boceprevir a me telaprevir, i ʻae ʻia no ka hoʻohana ʻia ma ʻAmelika Hui Pū ʻIa i ka makahiki 2011. Kūleʻa lāua ʻelua i kekahi ʻano o ka HCV enzyme i kapa ʻia ʻo protease. Hoʻohana ʻia kēia mau lāʻau i ka hui pū ʻia me PEG / ribavirin.

ʻO kēia mau lāʻau hou ʻelua e kūpono loa no ka genotype HCV 1. He kūpono kūpono lākou no ka genotype 2, a ʻaʻole pono no ka genotype 3.

I ka mua, ua ʻae wale ʻia lākou no ka hoʻohana ʻana i ka poʻe me ka genotype 1 HCV i hui pū ʻia me PEG / ribavirin.

Ua ʻae ʻia nā lāʻau DAA hou aʻe no ka hoʻohana pū ʻana me PEG / ribavirin. Hoʻopaʻa kēia mau lāʻau hou i kekahi mau protein HCV hou aʻe. ʻO sofosbuvir kekahi o kēia mau lāʻau.

Me ka lāʻau PEG / ribavirin wale nō, hoʻohana ʻia ka genotype 1 HCV e koi i ka lōʻihi o ka hoʻomaʻamaʻa me ka likelihood liʻiliʻi o ka kūleʻa Me sofosbuvir, genotype 1 i kēia manawa curable ma mua o 95 pakeneka o ka poʻe i mālama ʻia no 12 mau pule wale nō.

He mana nui loa ʻo Sofosbuvir no ka kaohi ʻana i ka hana hou ʻana o ka viral, me ka nānā ʻole i ka genotype (i waena o nā mea i hoʻopaʻa ʻia). Ma muli o ke kūleʻa o ka lāʻau, ua hoʻololi hou ʻo ʻEulopa i kāna mau kuhikuhi mālama.

Paipai kēia manawa i kahi papa hana he 12 mau pule no ka poʻe āpau me ka HCV paʻakikī ʻole i mālama mua ʻia.

Me sofosbuvir, ua ʻae pū ka FDA [Food and Drug Administration] i ka interferon-free hui pū ʻia (sofosbuvir plus ribavirin). Hoʻohana ʻia kēia lāʻau no 12 mau pule i ka poʻe me ka genotype 2, a i ʻole 24 mau pule i ka poʻe me ka genotype 3.

Kuhi paha ka genotype i ka pane i ka DAA therapy e like me ia no interferon therapy?

Malia paha ... ʻaʻole paha.

Hana like kēlā me kēia protein o ka HCV, me ka nānā ʻole i ka genotype. ʻO kēia mau protein pono pono ʻokoʻa ʻokoʻa ma muli o nā hoʻololi liʻiliʻi.

No ka mea nui lākou no ka pōʻaiapuni HCV, hiki ke loli ke ʻano o kā lākou mau pūnaewele hana ma muli o ka hoʻololi maʻamau.

Ma muli o ke kūlike o ka pūnaewele hana protein i waena o nā genotypes ʻokoʻa, pehea ka hopena o ka hana ʻana o kahi agena DAA e kahi e paʻa ai i ka protein i hoʻopaʻa ʻia.

ʻO ka maikaʻi o kēlā mau ʻākena e hoʻopili pono loa i ka pūnaewele hana o ka protein ʻaʻole hiki ke loli ʻia e ka genotype virus.

Hoʻopau nā lāʻau DAA āpau i ka hoʻomau ʻana i ka HCV replication, akā ʻaʻole lākou e kipaku aku i ka maʻi mai kona pūnao hoʻokipa ʻAʻole lākou e hemo i nā hunaola maʻi. Waiho ʻia kēia hana i ka ʻōnaehana pale o ke kanaka.

Hōʻike ka loli o ka hoʻoponopono interferon i ka hiki i ka ʻōnaehana pale pale ke hoʻomaʻemaʻe i nā hunaola i hoʻopili ʻia me kekahi mau genotypes ʻoi aku ka maikaʻi ma mua o ka poʻe i loaʻa i nā poʻe ʻē aʻe.

Hoʻoholo pinepine ka Genotype i ke ʻano o ka lapaʻau e loaʻa i ke kanaka. Aia kekahi mau kumu ʻē aʻe e hoʻopili i ka lāʻau?

Ma waho o ka genotype, nui nā loli i hiki ke hoʻopili i ka likelike o ka kūleʻa lapaʻau. ʻO kekahi o nā mea nui aʻe e komo pū me:

• ka nui o nā maʻi virus HCV i kou koko
• ke koʻikoʻi o ka hōʻino o ke ake ma mua o ka mālama ʻana
• ke kūlana o kāu ʻōnaehana pale (coinfection me HIV, mālama ʻana me nā corticosteroids, a i ʻole ke loaʻa ʻana o kahi trans organ i hiki ke hoʻoliʻiliʻi i kou pale
• makahiki
• heihei
• hoʻohana ʻino mau nei i ka waiʻona
• pane i nā hoʻoponopono mua

Hiki i kekahi mau genes kanaka ke wānana i ka maikaʻi o ka hana ʻana. ʻO ka moʻo kanaka ʻike ʻia IL28B ʻo ia kekahi o nā wānana ikaika loa o ka pane ʻana i ka mālama ʻana iā PEG / ribavirin i ka poʻe me ka HCV genotype 1.

Loaʻa i ka poʻe kekahi o ʻekolu mau hoʻonohonoho hoʻonohonoho o IL28B:

• CC
• CT
• TT

ʻO ka poʻe me ka hoʻonohonoho CC e pane maikaʻi i ka mālama ʻana me PEG / ribavirin. I ka ʻoiaʻiʻo, ʻelua a ʻekolu paha manawa ʻoi aku ka nui o ka poʻe ma mua o ka hoʻonohonoho ʻana o nā poʻe i kahi pane piha i ka lapaʻau.

Ke hoʻoholo nei i ka IL28B He mea nui ka hoʻonohonoho i ka hoʻoholo e mālama me PEG / ribavirin. Eia nō naʻe, hiki ke mālama pinepine ʻia ka poʻe me nā genotypes 2 a me 3 me PEG / ribavirin ʻoiai inā ʻaʻohe o lākou ka hoʻonohonoho CC.

ʻO kēia no ka mea ma ke ʻano laulā, hana maikaʻi ʻo PEG / ribavirin e kūʻē i kēia mau genotypes. No laila, IL28B ʻAʻole hiki i ka hoʻonohonoho hoʻonohonoho ke hoʻololi i ka likelihood o ka hoʻomaikaʻi maikaʻi.

Hoʻopili paha kaʻu genotype i ka likelihood e ulu wau i ka cirrhosis a i ʻole ka maʻi ʻaʻai ate?

Malia paha. Hōʻike kekahi i ka poʻe i loaʻa ka maʻi me ka HCV genotype 1 (ʻo ia hoʻi nā mea me ka subtype 1b) ʻoi aku ka nui o ka maʻi cirrhosis ma mua o ka poʻe i loaʻa i ka maʻi me nā genotypes ʻē aʻe.

Nānā ʻole inā he ʻoiaʻiʻo kēia nānā ʻana, ʻaʻole e loli ka papa kuhikuhi hoʻomalu i manaʻo nui ʻia.

Lohi ka holomua o ka hōʻino o ke ake. Hana pinepine ia i loko o mau makahiki. No laila, ʻo kēlā me kēia mea i ʻike hou ʻia me ka HCV e nānā ʻia no ka hōʻino o ke ake. ʻO ka hōʻino o ke ake he hōʻailona no ka lāʻau.

ʻAʻole pili ka makaʻu o ka hoʻomohala ʻana i ka maʻi ʻaʻai ate i ka genotype HCV. I ka maʻi HCV mau loa, hoʻomōhala wale ka maʻi maʻi hepatocellular (maʻi ʻaʻai akepau) i ka manawa i hoʻokumu ʻia ai ka cirrhosis.

Inā mālama maikaʻi ʻia kahi kanaka me ka maʻi HCV ma mua o ka hoʻomohala ʻana i ka cirrhosis, a laila ʻaʻole ka genotype maʻi.

Eia nō naʻe, i ka poʻe i hoʻomohala i ka cirrhosis, aia kekahi manaʻo e hiki i nā genotypes 1b a i ʻole 3 ke hoʻonui i ka makaʻu o ka maʻi ʻaʻai.

Paipai ʻia ka loiloi no ka maʻi ʻaʻai ate no kēlā me kēia kanaka i loaʻa ka HCV me ka cirrhosis. Paipai kekahi mau kauka i ka loiloi pinepine ʻana no ka poʻe i loaʻa i nā genotypes 1 a me 3.

E pili ana i ke kauka

Ua loaʻa iā Kauka Kenneth Hirsch i kāna kauka kauka no ke Kulanui ʻo Wakinekona ma St. Louis, Missouri. Ua hoʻomaʻamaʻa postgraduate ʻo ia i nā lāʻau lapaʻau kūloko a me ka hepatology ma ke Kulanui o Kaleponi, Kapalakiko (UCSF). Ua hana ʻo ia i kahi hoʻomaʻamaʻa postgraduate hou ma nā National Institutes of Health i nā maʻi āpau a me nā immunology. ʻO Kauka Hirsch kekahi i lilo i poʻokela o ka hepatology ma Wakinekona, D.C., VA Medical Center. Ua mālama ʻo Kauka Hirsch i nā koho kumu ma nā kula kauka o Georgetown a me George Washington University.

He hana lapaʻau koʻikoʻi kā Kauka Hirsch e lawelawe ana i nā mea maʻi me ka maʻi hepatitis C. He mau makahiki kona i ka ʻike i ka noiʻi lāʻau. Ua lawelawe ʻo ia ma nā papa aʻoaʻo no ka ʻoihana, nā hui kaiaulu kūloko, a me nā kino hoʻonohonoho.