Juyin Halittar Magungunan HIV

Wadatacce

• Yadda magungunan HIV ke aiki
• Ire-iren magungunan rage kaifin cutar
• Nucleoside / nucleotide baya masu hana rubutun (NRTIs)
• Haɗa masu hana canjin yanayi (INSTIs)
• Masu hana masu kare protein (PIs)
• Wadanda ba masu hana yaduwar kwayar halitta ba (nucleoside) (NNRTIs)
• Masu hana shigarwa
• Maganin cutar kanjamau
• Yin biyayya shine mabuɗi
  
• Kwayoyin haɗin gwiwa
• Kwayoyi a sararin sama

Bayani

Shekaru talatin da suka wuce, masu ba da kiwon lafiya ba su da labarai masu ƙarfafawa don ba wa mutanen da suka karɓi ganewar kanjamau. A yau, yana da yanayin kula da lafiya.

Babu maganin cutar kanjamau ko kanjamau tukuna. Koyaya, ci gaba na ƙwarai a cikin jiyya da kuma fahimtar asibiti game da yadda cutar HIV ke ci gaba yana bawa mutane masu cutar HIV damar rayuwa mafi tsawo.

Bari mu kalli inda maganin kanjamau yake a yau, illolin da sababbin hanyoyin kwantar da hankali ke haifarwa, da kuma inda magani zai iya zuwa nan gaba.

Yadda magungunan HIV ke aiki

Babban maganin cutar kanjamau a yau shine magungunan rage kaifin cutar. Wadannan magungunan ba sa warkar da kwayar HIV. Madadin haka, suna murkushe kwayar cutar da rage saurin ci gabanta a cikin jiki. Kodayake ba sa kawar da kwayar cutar HIV daga jiki, amma suna iya danne shi zuwa matakan da ba za a iya ganowa ba a lokuta da yawa.

Idan magungunan rigakafin cutar ya yi nasara, zai iya ƙara lafiya da yawa, shekaru masu amfani ga rayuwar mutum da rage haɗarin kamuwa zuwa wasu.

Ire-iren magungunan rage kaifin cutar

Magungunan da aka saba ba wa mutane don fara maganin rigakafin cutar za a iya raba su zuwa azuzuwan shan magani biyar:

• nucleoside / nucleotide baya masu hana rubutu (NRTIs)
• haɗa masu hana canza wuri (INSTIs)
• masu hana kare lafiyar jiki (PIs)
• wadanda ba masu hana bayanan kwayar halitta ba (NNRTIs)
• masu hana shigarwa

Magungunan da aka jera a ƙasa duk Hukumar Abinci da Magunguna (FDA) ta amince da su don magance cutar HIV.

Nucleoside / nucleotide baya masu hana rubutun (NRTIs)

NRTIs suna kiyaye ƙwayoyin HIV masu kwayar halitta daga yin kwafin kansu ta hanyar katse sake fasalin sarkar DNA lokacin da yake amfani da enzyme reverse transcriptase. NRTI sun hada da:

• abacavir (ana samun sa azaman keɓaɓɓen magani Ziagen ko kuma wani ɓangare na magunguna daban-daban guda uku)
• lamivudine (akwai shi azaman shi kadai ne Epivir ko kuma wani ɓangare na tara magunguna daban-daban)
• emtricitabine (wanda ke samuwa azaman magani shi kaɗai Emtriva ko a matsayin ɓangare na tara magunguna daban-daban)
• zidovudine (ana samunsa azaman shi kadai ne kwayar cutar Retrovir ko kuma wani bangare na magungunan hada magunguna daban-daban)
• tenofovir disoproxil fumarate (ana samunsa azaman shi kadai yake shan magani Viread ko kuma wani ɓangare na tara magunguna daban-daban)
• tenofovir alafenamide fumarate (ana samunsa azaman shi kadai yake shan magani Vemlidy ko kuma wani ɓangare ne na magunguna biyar daban daban)

Zidovudine kuma ana kiranta azidothymidine ko AZT, kuma shine magani na farko da Hukumar Abinci da Magunguna (FDA) ta amince dashi don magance cutar HIV. A kwanakin nan, ana iya amfani da shi azaman kamuwa da cutar bayan fage (PEP) ga jarirai jarirai masu ciki masu ɗauke da kwayar cutar HIV fiye da magani ga manya masu ɗauke da kwayar cutar ta HIV.

Ana amfani da Tenofovir alafenamide fumarate a cikin kwayoyi masu haɗuwa da yawa don HIV. A matsayin kaɗaicin magani, an karɓi izini kawai don magance HIV. Magungunan da aka keɓe shi ya sami izinin FDA don magance cutar hepatitis B mai saurin ci gaba. Sauran NRTIs (emtricitabine, lamivudine, da tenofovir disoproxil fumarate) ana iya amfani dasu don magance cutar hepatitis B.

Haɗin NRTI sun haɗa da:

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

Baya ga amfani da su don magance cutar kanjamau, ana iya amfani da Descovy da Truvada a matsayin wani ɓangare na tsarin rigakafin kamuwa da cutar (PrEP).

Ya zuwa shekarar 2019, Tasungiyar Servicesungiyar Ayyuka Masu Rarraba Amurka ta ba da shawarar samar da tsarin PrEP ga duk mutanen da ba su da HIV waɗanda ke cikin haɗarin kamuwa da cutar ta HIV.

Haɗa masu hana canjin yanayi (INSTIs)

INSTIs disable integrase, enzyme wanda HIV ke amfani dashi don saka DNA na HIV cikin DNA ɗin mutum a cikin ƙwayoyin CD4 T. INSTIs suna cikin nau'ikan magungunan da aka sani da haɗa masu hanawa.

INSTIs ingantattun magunguna ne. Sauran nau'ikan masu haɓaka masu haɓakawa, kamar su masu haɗawa masu haɗawa (INBIs), ana ɗaukar su magungunan gwaji. INBIs ba su sami izinin FDA ba.

INSTIs sun hada da:

• raltegravir (Isentress, Maɗaukaki HD)
• dolutegravir (wanda ake samu a matsayin Tivicay na shi kaɗai ko kuma wani ɓangare na magunguna daban-daban guda uku)
• bictegravir (hade da emtricitabine da tenofovir alafenamide fumarate a cikin maganin Biktarvy)
• elvitegravir (hade da cobicistat, emtricitabine, da tenofovir alafenamide fumarate a cikin kwayar Genvoya, ko kuma tare da cobicistat, emtricitabine, da tenofovir disoproxil fumarate a cikin kwayar Stribild)

Masu hana masu kare protein (PIs)

PIs na hana protease, enzyme da HIV ke buƙata a matsayin ɓangare na rayuwarta. PI sun hada da:

• atazanavir (ana samun shi azaman shi kadai ne Reyataz ko kuma an haɗa shi da cobicistat a cikin maganin Evotaz)
• darunavir (ana samun shi azaman keɓaɓɓen magani Prezista ko kuma wani ɓangare na magunguna daban-daban iri biyu)
• fosamprenavir (Lexiva)
• indinavir (Crixivan)
• lopinavir (kawai ana samunsa idan aka haɗa shi da ritonavir a cikin maganin Kaletra)
• nelfinavir (Viracept)
• ritonavir (wanda ke samuwa azaman shi kadai ne Norvir ko aka haɗa shi da lopinavir a cikin maganin Kaletra)
• Saquinavir (Invirase)
• tipranavir (Aptivus)

Ritonavir (Norvir) galibi ana amfani dashi azaman magani mai ƙarfafawa don sauran magungunan rigakafin cutar.

Saboda tasirin su, indinavir, nelfinavir, da saquinavir ba safai ake amfani da su ba.

Wadanda ba masu hana yaduwar kwayar halitta ba (nucleoside) (NNRTIs)

Wadanda ba masu hana yaduwar kwayar halitta ba (nucleuside) (NNRTIs) suna hana kwayar cutar kanjamau yin kwafin kanta ta hanyar daurewa da kuma dakatar da enzyme transcriptase. NNRTI sun haɗa da:

• efavirenz (ana samun sa a matsayin keɓaɓɓiyar magani Sustiva ko kuma wani ɓangare na magunguna daban-daban guda uku)
• rilpivirine (ana samun shi azaman tsayayyar kwazo Edurant ko kuma wani ɓangare na magunguna uku daban daban)
• etravirine (Intelence)
• doravirine (ana samunsa azaman shi kadai ne Pifeltro ko aka haɗa shi da lamivudine da tenofovir disoproxil fumarate a cikin maganin Delstrigo)
• nevirapine (Viramune, Viramune XR)

Masu hana shigarwa

Masu hana shigarwa aji ne na magungunan da ke toshe HIV daga shigar ƙwayoyin CD4 T. Wadannan masu hanawa sun hada da:

• enfuvirtide (Fuzeon), wanda ke cikin ajin magani wanda aka fi sani da masu hana fuska
• maraviroc (Selzentry), wanda ke cikin rukunin magungunan da ake kira chemokine coreceptor antagonists (CCR5 antagonists)
• ibalizumab-uiyk (Trogarzo), wanda ke cikin ajin magani wanda aka sani da masu hanawa bayan haɗe-haɗe

Da wuya ake amfani da masu hana shigarwa azaman jiyya-layi-farko.

Maganin cutar kanjamau

HIV na iya canzawa kuma ya zama mai jurewa da magani ɗaya. Sabili da haka, yawancin masu ba da sabis na kiwon lafiya a yau suna ba da magungunan magunguna da yawa tare.

Haɗuwa da magunguna biyu ko fiye na rigakafin cutar ana kiranta maganin rigakafin cutar. Magani ne na farko da aka tsara yau ga mutanen da ke ɗauke da kwayar cutar HIV.

An fara gabatar da wannan maganin mai karfi ne a shekarar 1995. Saboda maganin cutar kanjamau, mutuwar mai alaƙa da cutar kanjamau a Amurka an yanke shi da kashi 47 cikin ɗari tsakanin 1996 da 1997.

Abubuwan da aka saba da su a yau sun ƙunshi NRTI guda biyu kuma ko dai INSTI, NNRTI, ko PI da aka haɓaka tare da cobicistat (Tybost). Akwai sabbin bayanai da ke tallafawa amfani da magunguna biyu kawai, kamar su INSTI da NRTI ko INSTI da kuma NNRTI.

Ci gaban magunguna yana kuma sauƙaƙa bin kwayoyi. Wadannan ci gaban sun rage yawan kwayoyin da dole ne mutum ya sha. Sun rage illolin ga mutane da yawa masu amfani da magungunan ƙwayoyin cuta. Aƙarshe, ci gaba ya haɗa da ingantattun bayanan hulɗar miyagun ƙwayoyi-miyagun ƙwayoyi.

Yin biyayya shine mabuɗi

1. Kasancewa yana nufin tsayawa tare da shirin magani. Kasancewa yana da mahimmanci ga maganin cutar kanjamau. Idan mutumin da ke dauke da kwayar cutar HIV ba ya shan magungunansa kamar yadda aka tsara, magungunan za su iya daina yi musu aiki kuma kwayar cutar za ta iya sake yaduwa a cikin jikinsa kuma. Biya na buƙatar ɗaukar kowane kashi, kowace rana, kamar yadda ya kamata a gudanar da shi (misali, tare da ko ba tare da abinci ba, ko dabam da sauran magunguna).

Kwayoyin haɗin gwiwa

Keyaya daga cikin mahimmin ci gaba wanda ke sauƙaƙa bin mutanen da ke fama da cutar ta rigakafin ƙwayar cutar ita ce haɓakar magungunan haɗin gwiwa. Wadannan magunguna yanzu sune magungunan da aka fi badawa ga mutanen da ke dauke da kwayar cutar kanjamau wadanda ba a basu magani ba a da.

Magungunan hadewa suna dauke da kwayoyi da yawa a cikin kwaya daya. A yanzu haka, akwai magungunan hada magunguna guda 11 wadanda ke dauke da kwayoyi guda biyu na rigakafin cutar. Akwai kwayoyi hade guda 12 wadanda suke dauke da kwayoyi uku ko fiye na kwayar cutar kanjamau:

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

Atripla, wacce FDA ta amince da ita a 2006, ita ce ta fara amfani da kwamfutar hannu wacce ta hada da magungunan rage yaduwar cutar. Koyaya, ana amfani dashi ba sau da yawa yanzu saboda sakamakon illa kamar rikicewar bacci da canjin yanayi.

INTI tushen allunan haɗuwa sune tsarin da aka bada shawara yanzu ga mafi yawan mutane masu cutar HIV. Wannan saboda suna da tasiri kuma suna haifar da ƙananan sakamako masu illa fiye da sauran gwamnatoci. Misalan sun hada da Biktarvy, Triumeq, da Genvoya.

Tsarin magani wanda ya hada da kwamfutar hannu mai hade da kwayoyi uku masu rigakafin kwayar cutar kuma ana iya kiran su tsarin kwaya daya (STR).

Wani STR a al'adance ana magana ne akan magani tare da magungunan cutar ta HIV guda uku. Koyaya, wasu sabbin hanyoyin hada magunguna biyu (kamar su Juluca da Dovato) sun haɗa da magunguna daga aji biyu daban daban kuma an amince dasu da FDA azaman cikakkun tsarin HIV. A sakamakon haka, an kuma dauke su STRs.

Kodayake kwayoyin haɗin gwiwa ci gaba ne mai gamsarwa, maiyuwa basu dace da kowane mai cutar HIV ba. Tattauna waɗannan zaɓuɓɓukan tare da mai ba da lafiya.

Kwayoyi a sararin sama

Kowace shekara, sababbin hanyoyin kwantar da hankali suna samun ƙarin ƙarfi a warkar da yiwuwar warkar da kwayar cutar HIV da AIDS.

Misali, masu bincike suna bincike game da maganin HIV da rigakafinsa. Wadannan magunguna za a sha kowane mako 4 zuwa 8. Zasu iya inganta bin su ta hanyar rage yawan kwayoyin da mutane ke bukata su sha.

Leronlimab, allura ce ta mako-mako don mutanen da suka ƙi jure maganin HIV, sun ga nasara a cikin gwajin asibiti. Hakanan an karɓa daga FDA, wanda zai hanzarta aiwatar da ci gaban ƙwayoyi.

Allurar wata-wata wacce take hada rilpivirine tare da INSTI, cabotegravir, an shirya samar dashi don maganin cutar kanjamau-1 a farkon shekarar 2020. HIV-1 ita ce nau'in kwayar cutar HIV mafi yawanci.

Har ila yau akwai aiki mai gudana kan yiwuwar rigakafin HIV.

Don neman ƙarin bayani game da ƙwayoyin cutar kanjamau waɗanda ake da su a halin yanzu (da waɗanda za su iya zuwa nan gaba), yi magana da mai ba da lafiya ko likitan magunguna.

Gwaje-gwajen asibiti, waɗanda ake amfani da su don gwada ƙwayoyi a cikin ci gaba, na iya zama mai ban sha'awa. Bincika anan don gwajin gwaji na gida wanda zai iya dacewa da kyau.