Hepatitis C Genotype: An Amsa tambayoyinku

Wadatacce

• Menene cututtukan hepatitis C?
• Hepatitis C yana da nau'ikan halittar jini daban. Menene ma'anar wannan?
• Menene bambanci tsakanin hepatitis C genotypes?
• Menene bincike na yanzu game da jinsin halitta da magunguna ga kowane nau'i?
• Shin genotype yayi hango koyaswa game da maganin DAA kamar yadda yayi don maganin interferon?
• Genotype yawanci yana tantance nau'in magani da mutum yake karɓa. Shin akwai wasu abubuwan da ke shafar magani?
• Shin nau'ikan halittar jikina ya shafi yiwuwar in kamu da cutar hauka ko ciwon hanta?
• Game da likita

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Hepatitis C cuta ce ta kwayar cuta da ke haifar da kumburin hanta. Ana kamuwa da kwayar cutar ta jini kuma da wuya ta hanyar jima'i.

Akwai nau'ikan cutar hepatitis C. Amma duk nau'ikan hepatitis C suna da kamanceceniya mai mahimmanci.

Bayan ka sami ganewar asali na hepatitis C, likitanka zai yi aiki don gano nau'in da kake da shi don haka zaka sami mafi kyawun magani.

Gano bambance-bambance a cikin nau'in hepatitis C. Ana ba da amsoshin ƙwararrun ta Dokta Kenneth Hirsch, wanda ke da aikin likita da yawa tare da mutanen da ke da cutar hepatitis C.

Menene cututtukan hepatitis C?

Canji ga waɗanda ke fama da cutar hepatitis C mai ɗorewa (HCV) shine "genotype," ko kuma kwayar cutar lokacin da suka kamu da cuta. Jinsi ya bayyana ne ta hanyar gwajin jini.

Jinsi ba lallai bane ya taka rawa wajen ci gaban kwayar ba, sai dai a matsayin wani bangare na zabar magungunan da suka dace don magance ta.

Dangane da, aƙalla jinsin jinsin HCV guda bakwai, kuma fiye da, an gano su.

Nau'in nau'ikan halittun HCV da ƙananan nau'ikan suna da rarrabuwa daban-daban a duk duniya.

Jinsin 1, 2, da 3 ana samun su a duniya. Genotype 4 yana faruwa a Gabas ta Tsakiya, Misira, da Afirka ta Tsakiya.

Genotype 5 yana kusan kusan a Afirka ta Kudu. Genotype 6 ana gani a kudu maso gabashin Asiya. An bayar da rahoton jinsi na 7 a Jamhuriyar Demokradiyyar Kongo.

Hepatitis C yana da nau'ikan halittar jini daban. Menene ma'anar wannan?

HCV ƙwayar RNA guda ɗaya ce. Wannan yana nufin lambar kwayar halittar kowane kwayar cuta tana dauke da kwayar halitta guda daya ta kwayar RNA.

Kowane zare na nucleic acid (RNA ko DNA) an yi shi da sarkar tubalin gini. Jerin wadannan tubalan yana tantance sunadaran da kwayar halitta take bukata, ko kwayar cuta ce, ko tsiro, ko dabba.

Ba kamar HCV ba, lambar kwayar halittar mutum tana dauke da DNA mai ruɓi biyu. Kundin tsarin rayuwar dan adam yana cikin zurfin karantawa yayin aiwatar da kwafin DNA.

Canza canjin yanayi (maye gurbi) zuwa lambar kwayar halittar dan adam da take faruwa a karamin mizani. Wancan ne saboda yawancin kuskuren kwafin DNA ana gane su kuma an gyara su.

Sabanin haka, lambar kwayar cutar ta HCV ba hujja bace idan aka sake buga ta. Canjin yanayi ya faru kuma ya kasance cikin lambar.

HCV yana hayayyafa da sauri - har zuwa sabbin tiriliyan 1 tiriliyan a kowace rana. Don haka, wasu sassa na lambar kwayar cutar ta HCV suna da bambanci sosai kuma suna canzawa akai-akai, koda a cikin mutum guda da ke da cuta.

Ana amfani da nau'ikan jinsin don gano wasu nau'in HCV. Suna dogara ne akan bambance-bambance a cikin wasu yankuna na ƙwayoyin cuta. Akwai ƙarin suban ƙananan rukunoni a cikin jinsin halittar su. Sun haɗa da ƙananan nau'i da ƙananan abubuwa.

Menene bambanci tsakanin hepatitis C genotypes?

Kamar yadda aka ambata, nau'ikan nau'ikan HCV da ƙananan nau'ikan nau'ikan suna da rarraba daban-daban a duk duniya.

Genotype 1 shine sananniyar ƙwayar HCV a cikin Amurka. An samo shi a kusan kashi 75 na duk cututtukan HCV a cikin ƙasar.

Yawancin sauran mutanen da ke Amurka tare da cutar ta HCV suna ɗauke da nau'in genotypes 2 ko 3.

Kwayar halittar HCV ba ta da cikakkiyar dangantaka da ƙimar lalacewar hanta, ko kuma yiwuwar ci gaba da haifar da cutar sankarau. Koyaya, yana iya taimakawa hango sakamakon maganin.

Jinsi zai iya taimakawa wajen hango sakamakon maganin HCV tare da tsarin maganin interferon. Genotype kuma ya taimaka wajen ƙayyade magani.

A wasu hanyoyin, maganin da ake bayarwa na ribavirin da pegylated interferon (PEG) na mutanen da ke da takamaiman nau'ikan halittar HCV.

Menene bincike na yanzu game da jinsin halitta da magunguna ga kowane nau'i?

Magungunan anti-HCV da aka fi amfani da shi sosai, PEG / ribavirin, baya nufin kwayar cutar kanta. Wannan tsarin kulawa da farko ya shafi tsarin garkuwar mutum. Manufarta ita ce ta tattara ƙwayoyin cuta don ganewa da kuma kawar da ƙwayoyin da ke ɗauke da cutar ta HCV.

Koyaya, bambance-bambancen HCV a cikin mutum guda ba lallai ba ne zai “zama daidai” ga tsarin garkuwar jiki. Wannan shine ɗayan dalilan da yasa cututtukan HCV suka ci gaba kuma suka zama cututtuka na kullum.

Koda tare da wannan bambancin kwayoyin, masu bincike sun gano sunadaran da ake bukata don haifuwar HCV a jiki. Wadannan sunadaran suna nan gaba daya dukkan nau'ikan HCV da yawa.

Sabbin jiyya na HCV suna niyya akan wadannan sunadaran. Wannan yana nufin sun yi niyyar cutar. Yin maganin cutar kanjamau kai tsaye (DAA) yana amfani da ƙananan ƙwayoyin da aka tsara don musamman hana waɗannan sunadaran ƙwayoyin cuta.

Yawancin magunguna na DAA sun kasance a cikin ci gaba a cikin shekaru goma da suka gabata. Kowane magani yana niyya ne ga ɗayan mahimman thean sunadaran HCV.

Magunguna biyu na DAA na farko, boceprevir da telaprevir, sun sami izinin amfani a cikin Amurka a cikin 2011. Dukansu suna niyya ne da wani nau'in HCV enzyme da aka sani da protease. Ana amfani da waɗannan magungunan a haɗe tare da PEG / ribavirin.

Duk waɗannan sabbin magungunan guda biyu suna da tasiri sosai ga genotype na HCV 1. Suna da tasiri matsakaici don genotype 2, kuma basu da tasiri ga genotype 3.

Da farko, an yarda da su ne kawai don amfani da mutanen da ke dauke da nau'in 1 HCV a haɗe tare da PEG / ribavirin.

An ba da izinin ƙarin magungunan DAA don amfani tare da PEG / ribavirin. Waɗannan sababbin magungunan suna niyya ƙarin ƙarin sunadaran HCV. Daya daga cikin wadannan kwayoyi shine sofosbuvir.

Tare da maganin PEG / ribavirin kadai, genotype 1 HCV ana amfani dashi don buƙatar tsawon lokacin magani tare da yiwuwar samun nasara. Tare da sofosbuvir, genotype 1 yanzu ana iya warkewa a cikin sama da kashi 95 na mutanen da aka warkar da su makonni 12 kawai.

Sofosbuvir yana da matukar karfi don hana yaduwar kwayar cuta, ba tare da la'akari da nau'in kwayar halitta ba (a cikin waɗanda aka yi karatun). Saboda nasarar maganin, Turai kwanan nan ta canza jagororin maganin ta.

Yanzu yana ba da shawarar kwaskwarimar mako 12 na magani ga duk mutanen da ke da ƙwayar HCV mai rikitarwa waɗanda ba a taɓa magance su ba.

Tare da sofosbuvir, FDA [Gudanar da Abinci da Magunguna] kuma ta amince da magani na farko da za a ba da kyauta tsakanin interferon (sofosbuvir da ribavirin). Ana amfani da wannan farjin na makonni 12 a cikin mutanen da ke da genotype 2, ko kuma makonni 24 a cikin mutanen da ke da genotype 3.

Shin genotype yayi hango koyaswa game da maganin DAA kamar yadda yayi don maganin interferon?

Wataƙila… wataƙila ba.

Kowane ɗayan mahimman sunadaran na HCV suna aiki iri ɗaya, ba tare da la'akari da jinsin halitta ba. Wadannan mahimman sunadaran na iya zama daban-daban tsarinsu saboda ƙananan maye gurbi.

Saboda suna da mahimmanci ga rayuwar rayuwar HCV, ƙarancin tsarin ayyukansu yana iya yuwuwa ya canza saboda maye gurbi.

Saboda rukunin furotin mai aiki yana da daidaituwa tsakanin nau'ikan jinsin halitta daban-daban, yadda takamaiman wakili na DAA ke aiki yana shafar inda ya ɗaura akan furotin da aka sa gaba.

Ingancin waɗancan wakilai waɗanda ke ɗaure kai tsaye zuwa rukunin furotin na aiki mai yiwuwa cutar ta genotype ta shafi ta.

Duk magunguna na DAA suna kange kwafin HCV mai gudana, amma basa fitar da kwayar daga kwayar garkuwarta. Ba sa kuma cire ƙwayoyin ƙwayoyin cuta. Wannan aikin an bar shi ga garkuwar jikin mutum.

Canjin tasiri na maganin interferon yana nuna cewa tsarin garkuwar jiki zai iya share kwayoyin cututtukan da ke dauke da wasu nau'ikan halittar jini fiye da waɗanda wasu suka kamu da su.

Genotype yawanci yana tantance nau'in magani da mutum yake karɓa. Shin akwai wasu abubuwan da ke shafar magani?

Baya ga genotype, akwai masu canji da yawa da zasu iya shafar yiwuwar samun nasarar magani. Wasu daga cikin mahimman abubuwa sun haɗa da:

• adadin kwayar HCV a cikin jininka
• tsananin cutar hanta kafin magani
• Yanayin tsarin garkuwar ku (tsinkayen kwayar cuta tare da kwayar cutar kanjamau, magani tare da corticosteroids, ko kuma yin dashen gaɓa duk na iya rage garkuwar ku)
• shekaru
• tsere
• ci gaba da shan barasa
• amsa ga hanyoyin kwantar da hankali

Wasu kwayoyin halittar mutum kuma na iya yin hasashen yadda magani zai yi aiki. Kwayar halittar mutum da aka sani da IL28B shine ɗayan mahimman hasashen hangen nesa game da maganin PEG / ribavirin a cikin mutanen da ke da cutar ta HCV 1.

Mutane suna da ɗayan daidaitattun abubuwa uku na IL28B:

• CC
• CT
• TT

Mutanen da ke da sanyi na CC suna amsawa da kyau tare da PEG / ribavirin. A zahiri, sun fi sau biyu zuwa sau uku fiye da mutanen da ke da wasu abubuwan daidaitawa don samun cikakken amsa ga magani.

Tabbatar da IL28B daidaitawa yana da mahimmanci a cikin shawarar magance tare da PEG / ribavirin. Koyaya, mutane da ke da nau'ikan genotypes 2 da 3 galibi ana iya magance su tare da PEG / ribavirin koda kuwa basu da tsarin CC.

Wannan saboda gabaɗaya, PEG / ribavirin yana aiki da kyau kan waɗannan nau'ikan halittar jini. Don haka, IL28B sanyi ba ya canza yiwuwar tasirin magani.

Shin nau'ikan halittar jikina ya shafi yiwuwar in kamu da cutar hauka ko ciwon hanta?

Yiwuwa. Wasu suna ba da shawarar cewa mutanen da ke da kamuwa da cutar ta HCV genotype 1 (musamman waɗanda ke da subtype 1b) suna da saurin kamuwa da cututtukan cirrhosis fiye da waɗanda ke da kamuwa da wasu nau'in halittar.

Ko da kuwa ko wannan lura gaskiya ne, shirin gudanarwa da aka ba da shawara ba ya canzawa sosai.

Ci gaban lalacewar hanta ya yi jinkiri. Sau da yawa yakan faru tsawon shekaru. Don haka, duk wani sabon da aka gano tare da HCV ya kamata a tantance shi don cutar hanta. Lalacewar hanta alama ce ta far.

Rashin haɗarin kamuwa da cutar kansar hanta bai bayyana yana da alaƙa da genotype na HCV ba. A cikin cututtukan HCV na yau da kullun, cututtukan hanta na hanta (ciwon hanta) kawai ke ɓullowa da zarar an kafa cirrhosis.

Idan mutumin da ke dauke da kwayar cutar ta HCV ya warke yadda ya kamata kafin ya kamu da cutar cirrhosis, to cutuwar kwayar cutar ba wani abu bane.

Koyaya, a cikin mutanen da suka riga sun kamu da cutar cirrhosis, akwai shawarar cewa genotypes 1b ko 3 na iya ƙara haɗarin cutar kansa.

Ana ba da shawarar duba kan cutar hanta ga duk wanda ke da cutar ta HCV tare da cututtukan cirrhosis. Wasu likitocin suna ba da shawarar a yawaita bincike kan wadanda suka kamu da jinsi na 1 da na 3.

Game da likita

Dr. Kenneth Hirsch ya sami likitansa na magani daga Jami'ar Washington a St. Louis, Missouri. Ya yi karatun digiri na biyu a likitancin ciki da na asibiti a Jami'ar California, San Francisco (UCSF). Ya yi ƙarin karatun digiri na biyu a Cibiyar Kiwon Lafiya ta inasa game da rashin lafiyar jiki da rigakafi. Dokta Hirsch ya kuma yi aiki a matsayin shugaban cutar hepatology a Washington, DC, VA Medical Center. Dr. Hirsch ya gudanar da alƙawarin malamai a makarantun likitanci na Jami'o'in Georgetown da George Washington.

Dokta Hirsch yana da aikin likita mai yawa wanda ke yiwa marasa lafiya da cutar hepatitis C virus. Har ila yau, yana da kwarewar shekaru a cikin binciken magunguna. Ya yi aiki a kan kwamitocin shawarwari na masana'antu, ƙungiyoyin likitancin ƙasa, da hukumomin tsara dokoki.