Hepatitis C ke lefu le tšoaetsanoang le amang sebete, le fetisoang ke kokoana-hloko ea hepatitis C (HCV) 'me ke e' ngoe ea lisosa tse ka sehloohong tsa ho fumana lefu le ho shoa har'a batho ba nang le HIV.
Mokhatlo oa Amerika oa Thuto ea Mafu a Seoa (AASLD) o tlaleha hore kokoana-hloko ea kokoana-hloko-e akarelletsang lefu la sebete la A, B le la C-ke lona sesosa se ka sehloohong se bolaeang lefats'e ka bophara, le ho lahleheloa ke bophelo ho feta AIDS , lefuba le malaria .
Hona joale ha ho na ente ea lefu la sebete la C.
Coinfection ea HIV / HCV
Ho ata ha sekhooa sa HIV / HCV ho fapana le ho ithuta, empa lipatlisiso li fana ka maikutlo a hore tekanyo ea tšoaetso ea HCV har'a batho ba nang le HIV e ka ba karolo ea 30 lekholong United States le Europe. Lefatšeng ka bophara, moroalo oa HIV / HCV ka kakaretso o pota-potile batho ba limilione tse 4 ho ea ho tse 5, kapa pakeng tsa 10% lekholong ea HIV.
Basebedisi ba lithethefatsi ba entsoeng ka lithethefatsi (IDUs) ba na le kotsi e kholo ka ho fetisisa ea ho tšoaetsoa ha HIV / HCV, ka lebaka la ho ata ho tloha ka liphesente tse 82 ho isa ho 93 lekholong. Ka lehlakoreng le leng, coinfection ka tsela ea thobalano ea thobalano ke hoo e ka bang karolo ea 9 lekholong.
Le hoja banna ba kopanelang liphate le banna (MSM) ba sa kotsing ea ho fumana tšoaetso ea HCV, kotsi e ka eketseha ho feta karolo ea 23 lekholong ho MSM e nang le boitšoaro bo kotsi - joalo ka balekane ba bangata ba thobalano, thobalano ea sehlopha, kapa esita le ho kopanela lithethefatsi tse nkiloeng ka letsoho kapa ka bobeli.
Batho ba lichelete ba nang le likokoana-hloko ba na le meroalo e phahameng ea kokoana-hloko ea HCV ho feta balekane ba bona ba monoinfected, e leng se etsang hore ho be le tsoelo-pele e potlakileng ho fibrosis , cirrhosis le hepatocellular carcinoma (mofuta o tloaelehileng oa kankere ea sebete).
Ho feta moo, batho ba coinfected ba na le monyetla o moholo ka makhetlo a mararo oa tšoaetso ea antiretroviral e amanang le lefu la sebete ho feta ba nang le HIV feela.
Lipalo tsena li bontša hore ho na le tlhokahalo e kholo ea ho tsebahatsoa ha HCV har'a batho ba nang le HIV, hammoho le phekolo e atlehileng ho feta ho hlakola tšoaetso ea HCV kapa, bonyane, ho tsoela pele ho fokola ha lefu.
Nako ea ho Qala Phekolo
Nako ea ho qala HCV e ka ba taba e rarahaneng. Ka kakaretso, phekolo ea HCV e bontšoa ho batho ba nang le mefuta e sa tloaelehang ea sebete e bontšitsoeng HCV. Lefapha la Bophelo le Lits'ebeletso tsa Botho tsa United States (DHHS) hona joale le khothalletsa hore phekolo ea HCV e qaloe ho batho ba nang le li-coinfected ba nang le fibrosis ea bohlokoa 'me ba le kotsing e kholo ea tsoelo-pele ea lefu la seoa.
Ka lebaka la matla a mangata a litla-morao-hammoho le taba ea hore phekolo ha e tiise ka ho feletseng hore ho na le tumello ea HCV-qeto ea ho phekola e itšetlehile haholo ka ho itokisetsa mokuli, hammoho le ho hlahloba matšoao a ho fana ka katleho ea phekolo (mohlala, HCV genotype , HCV tšoaetso ea kokoana-hloko ).
Leha ho le joalo, ke habohlokoa ho hlokomela hore lithethefatsi tsa HCV tse ntseng li ntlafala li potlakisa ho fokotsa lithibelo tsa phekolo, le melemo ea phekolo e fetang hōle le liphello tse ka 'nang tsa e-ba teng.
DHHS e boetse e khothalletsa tšebeliso ea phekolo ea mafu a khahlanong le li-antiretroviral (ART) ho batho bohle ba li-coinfected ho sa tsotellehe palo ea CD4 , e bontšitsoeng ho fokotsa tsoelo-pele ea mafu a amanang le HCV. Ho feta moo:
- Bakeng sa batho ba nang le litlaleho tse tlase tsa CD4 (tlasa 200 lisele / mL), phekolo ea HCV e lokela ho lieha ho fihlela nako eo CD4 e eketsehang ka eona. Khetho ea meriana ea antiretroviral e itšetlehile ka ho feletseng litšebelisanong tsa lithethefatsi le lithethefatsi, hammoho le toxicities e feteletseng. (Ntho e ka sehloohong e amehang ke hore lithethefatsi tse ling tse sebelisoang kalafo ea HCV li sebelisoa ka tsela e tšoanang le li-antiretroviral tse ling, ho fokotsa ts'ebetso ea lithethefatsi tsa bobeli ha li ntse li phahamisa likotsi tse mpe.)
- Bakeng sa batho ba seng ba ntse ba e-na le ART, ho lokela ho etsoa tlhahlobo ea ho ntlafatsa phekolo ho fokotsa litla-morao tse ka 'nang tsa e-ba teng, le melemo ea ho fetola maikutlo a eketsehileng ka tsoelo-pele e ka bang teng ea ho hanyetsa lithethefatsi tsa HIV .
- Bakeng sa batho ba sa tšoaroeng ba nang le li-CD4 tse fetang lisele tse 500 / mL, lingaka li ka 'na tsa khetha ho lieha ho fihlela ART e phethoa kalafo ea HCV.
Kakaretso ea Likhetho tsa Meriana ea HCV
Mokokotlo oa phekolo ea HCV e 'nile ea e-ba motsoako oa pegylated interferon alpha (kapa PEG-IFN) le ribavirin . PEG-IFN ke motsoako oa likokoana-hloko tse tharo tse etsang hore lisele li hlahise li-enzyme tse ngata tse khonang ho bolaea likokoana-hloko le lisele tse nang le tšoaetso.
Ribavirin, e leng e 'ngoe ea likokoana-hloko, e kena-kenana le RNA metabolism e hlokahalang bakeng sa pheta-pheto ea kokoana-hloko.
Meriana e thibelang likokoana-hloko ka morao-rao (DAAs) e ntse e khona ho phekola liphatsa tsa lefutso tse fapa-fapaneng tsa hepatitis C ntle le tšebeliso ea PEG-INF le, maemong a mangata, ribavirin. Ka ho etsa joalo, litla-morao tse amanang le phekolo ea HCV li fokotsehile haholo, joalo ka nako ea nako.
Har'a li-DAA tse amoheloang hona joale tse sebelisetsoeng ho phekola tšoaetso e sa foleng ea lefu la sebete la lefu la sebete (ka tumello ea tumello ea FDA):
| Lithethefatsi | E amoheletsoe | E ngotsoe | Khetho | Nako |
| Epclusa (sofosbuvir + velpatasvir) | li-genotypes 1, 2, 3, 4, 5 le 6 tse nang le li-cirrhosis | ribavirin maemong a ho thatafala ha cirrhosisi le ntle le ribavirin maemong a mang kaofela | letlapa le le leng letsatsi ka letsatsi le nang le lijo kapa le se nang lijo | Libeke tse 12-16 |
| Sefate (elbasvir + grazoprevir) | liphatsa tsa lefutso tsa 1 le tse 4 tse nang le kapa ntle le boloetse | ribavirin kapa ntle le ribavirin, ho itšetlehile ka pale ea genotype le pale ea phekolo | letlapa le le leng letsatsi ka letsatsi le nang le lijo kapa le se nang lijo | Libeke tse 12-16 |
| Daklinza (daclatasvir) | liphatsa tsa lefutso tse 3 ntle le boloetse | Sovaldi (sofosbuvir) | tefo e le 'ngoe letsatsi ka leng le lijo | Libeke tse 12 |
| Technivie (ombitasvir + paritaprevir + ritonavir) | li-genotype tse 4 ntle le boloetse | ribavirin | matlapa a mabeli letsatsi ka leng le lijo | Libeke tse 12 |
| Viekira Pak (ombitasvir + paritaprevir + ritonavir, e kopantsoe ka dasabuvir) | li-genotypes 1 tse nang le kapa ntle le ho se sebetse | ribavirin kapa e nkiloe, moo ho bontšoang teng | matlapa a mabeli a ombitasvir + paritaprevir + ritonavir e nkiloeng hang ka letsatsi le lijo, hammoho le letlapa le le leng la dasabuvir le nkiloeng habeli ka letsatsi le lijo | Libeke tse 12-24 |
| Harvoni (sofosbuvir + ledipasvir) | genotype 1 e nang le kapa ntle le boloetse | e nkiloe ka boeona | letlapa le le leng letsatsi ka letsatsi le nang le lijo kapa le se nang lijo | Libeke tse 12-24 |
| Sovaldi (sofosbuvir) | li-genotypes 1, 2, 3 le 4 tse nang le boloetse ba ho ruruha, ho akarelletsa le ba nang le lefu la cirrhosis kapa hepatocellular carcinoma (HCC) | peginterferon + ribavirin, ribavirin feela, kapa Olysio (simeprevir) e nang le kapa ntle le ribavirin, moo ho bontšitsoeng | letlapa le le leng letsatsi ka letsatsi le nang le lijo kapa le se nang lijo | Libeke tse 12-24 |
| Olysio (simeprevir) | genotype 1 e nang le kapa ntle le boloetse | peginterferon + ribavirin, kapa Sovaldi (sofosbuvir), moo ho bontšoang teng | ngoe ea capsule letsatsi le leng le le leng le lijo | Libeke tse 24-48 |
Liphello tse Tloaelehileng
E 'ngoe ea li amehileng haholo ka ho phekola tšoaetso ea HIV / HCV ke litla-morao tse ka' nang tsa e-ba teng ka lebaka la phekolo. Ha ts'ebetso ea lithethefatsi tse ncha e fetohile phekolo ea HVV, ha ho na ho bapala mathata ao bakuli ba bang ba tobanang le 'ona.
Bakeng sa batho ba qalang kalafo ka lekhetlo la pele, litla-morao tse tloaelehileng tsa phekolo ea HCV (e hlahang bonyane maemong a 5%) ke:
- Epclusa: mokhathala, hlooho
- Mofokolisi : mokhathala, hlooho, kelello
- Daklinza : mokhathala, hlooho, ho nyeheloa ke pelo, letšollo
- Technivie : Bofokoli ba 'mele, mokhathala, ho nyeheloa ke pelo, ho hloka boroko
- Viekira Pak : mokhathala, ho nyefoloa ke letlalo, letlalo le hloekileng, ho itšoara ha letlalo, ho hlobaela, bofokoli, mokhathala
- Harvoni : mokhathala, hlooho
- Sovaldi + PEG / INF + ribavirin: mokhathala, ho se robale, ho nyeheloa ke pelo, hlooho ea mali, mali a mali
- Sovaldi + ribavirin: mokhathala, hlooho
- Li-ribavirin tsa Olysio + PEG / INF +: leqeba, letlalo le hloekileng, leqeba, bohloko ba mesifa, ho fokola ha nakoana
Le hoja litla-morao tse ngata li feta nakoana, li rarolla ka hare ho beke kapa tse peli tsa ho qalisoa, matšoao a mang a ka 'na a nka nako e telele le ho phatlalatsoa (haholo-holo litlhapisong tse thehiloeng ho PEG / INF). Buisana le ngaka hang-hang haeba matšoao a amana le / kapa a phehella.
Pele o qala ho phekola HCV
Ho utloisisa le ho lebella litla-morao tse ka khonehang ke senotlolo sa phekolo ea motho ka mong le ho finyella lipakane tse nepahetseng tsa phekolo. Lipilisi tsa lipilisi, litemoso tsa li-dosing, le liphetoho tsa lijo (ke hore, ho eketsa mafura bakeng sa lijo tse fokolang fatše) ke tse ling tsa lintlha tseo ho hlokahalang hore li sebetsane le tsona ho tiisa hore mokuli o itokiselitse hantle.
'Me le hoja khetho ea lithethefatsi e ka nkoa e le senotlolo bakeng sa katleho ea phekolo, ho joalo le ka ho khomarela lithethefatsi . Ha e amane feela le liphello tse molemo empa maemong a mangata ho fokotsa liketsahalo le boima ba litla-morao. Ho khomarela habonolo ke ha e le hantle, ke ntho e ka sehloohong e etsang hore phekolo e hlōlehe ha e ntse e le liketsahalo tse mpe.
Li-transplants tsa sebete
Lefu la cirrhosis ka lebaka la tšoaetso e sa foleng ea HCV ke pontšo e ka sehloohong ea ho fetela ha sebete ho US, Europe le Japane, le hoja kokoana-hloko e tsebahala hore e ka ba karolo ea 70 lekholong ea baeti ba kenyelletsa batho ka hare ho lilemo tse tharo. Ho phaella moo, tšoaetso ea sehlopha ka boeona e ka fella ka karolo ea 10-30 lekholong ea bakuli ba ntseng ba e-ba le lefu la cirrhosis nakong ea lilemo tse hlano.
Bakeng sa batho ba hlokang ho kenyelletsa sebete, ho qalisoa ha phekolo ea tharo ea HCV ho ka fokotsa haholo kotsi ea ho lahleheloa ke greft ka 30%.
Ho sa tsotellehe likotsi tsa maiketsetso, ke habohlokoa ho hlokomela hore tekanyo ea ho pholoha ha mokuli e tšoana le lintlha tse ling tsohle tse bontšang sebete sa ho pata-le litekanyetso tsa ho pholoha kamora 'opereishene pakeng tsa 68% le 84 lekholong lilemong tse hlano tse qalang.
Mefuta e mecha ea mefuta ea HCV ea moloko o mocha e ka 'na ea e-ba le sepheo sa ho ntlafatsa liphello tsena, ha e ntse e fokotsa boemo bo phahameng ba litla-morao tse amanang le phekolo
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