Ukimwi : Tofauti kati ya masahihisho

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Pitio la 13:26, 1 Aprili 2017

Upungufu wa Kinga Mwilini (kwa kifupi UKIMWI; kifupisho cha Kiingereza AIDS) ni ugonjwa unaotokana na virusi ambavyo kwa Kiswahili vinaitwa kifupi VVU ("Virusi vya UKIMWI"; kwa Kiingereza: HIV) na vinashambulia mwili kwa kuondoa nguvu zake za kupambana na maradhi.

Ukimwi ni ugonjwa hatari sana katika maisha ya binadamu kwa kuwa husababisha vifo (yaani kupotea kwa uhai wa watu hao). Kwa mujibu wa Shirika la Afya Duniani, kufikia mwaka 2014 ugonjwa huu umeua watu milioni 39, hasa wanaoishi barani Afrika upande wa kusini kwa Sahara. Kwa mwaka 2015 pekee wamefariki watu milioni 1.2 na kati yao watoto wengi.

UKIMWI umekuwa na madhara makubwa katika jamii, kama ugonjwa wa mwili na kama chanzo cha ubaguzi. Kuna sintofahamu kuhusu UKIMWI kama vile kwamba eti, unaweza kusambazwa kwa kugusana tu bila ngono.

Ugonjwa huu pia unasababisha madhara ya kiuchumi ambayo ni makubwa, hasa kwa nchi maskini.

UKIMWI hadi hivi sasa haina dawa, lakini tunaweza kuuepuka ugonjwa huu kwa kuachana na ngono ambayo huweza kusababisha ugonjwa wa Ukimwi, pia tunaweza kujikinga na ugonjwa huo kwa kuepuka kuchangia vifaa au vitu vyenye ncha kali.

Tarehe 1 Desemba kila mwaka ni siku ya UKIMWI duniani.

Maana ya jina

UKIMWI ni kifupisho cha "Upungufu wa Kinga Mwilini"

Upungufu maana yake UKIMWI unaharibu uwezo wa mwili kupambana na magonjwa. Si UKIMWI moja kwa moja unaoweza kuua lakini mashambulio ya magonjwa ambayo kwa kawaida yasingekuwa tatizo kubwa.
Kinga inahusu mfumo wa kingamwili ambao ni uwezo wa mwili kujitetea dhidi ya ugonjwa.
Mwili usio na kinga unapatwa na matatizo mbalimbali kwa sababu mfumo wa kinga umeharibika, na hauwezi kupigana na ugonjwa wowote.

Jina la Kiingereza ni AIDS= Acquired Immuno Deficiency Syndrome.

acquired - maana mtu hawezi kuwa na hali hii kiasili, ameipata
immuno - hii inataja ya kwamba tatizo linahusu "immune system" yaani mfumo wa kingamwili
deficiency - inamaanisha ya kwamba kuna kasoro
syndrome - ni mkusanyiko wa matatizo ya kiafya; ilhali kingamwili haufanyi kazi tena, mgonjwa anaathiriwa na magonjwa mbalimbali na kuonyesha dalili za magonjwa hayo yote.

Mfumo wa kingamwili na virusi za HIV

Kila mtu huwa na mfumo wa kingamwili ndani yake. Seli za ulinzi zinazunguka mwilini na kutafuta vidubini vya nje vinavyoweza kuleta mvurugo na zinaviharibu. Kati ya seli hizi za ulinzi ni seli nyeupe za damu (lukosaiti) ambazo ni muhimu sana.

Ukimwi unasababishwa na virusi vya HIV. Kama virusi vyote, VVU inaingia katika mwili kwa kusudi la kuzaa. Virusi haviwezi kuzaa peke yake: vinahitaji seli vinapoweza kuingia ndani yake na kutumia mfumo wa seli kwa kunakili DNA yake.

Kwa kawaida virusi vinashambuliwa na mfumo wa kingamwili na kuharibika. Lakini VVU vina tabia mbili za pekee ambazo zinavifanya vvya hatari hasa:

vinafaulu mara nyingi kuepukana na seli za ulinzi mwilini
vinaingia hasahasa katika seli nyeupe za damu za aina "seli za T". VVU vikianza kuongezeka katika seli nyeupe ya damu vinadhoofisha na hatimaye kuharibu seli hii.

Maana yake VVU vinashambulia moja kwa moja seli ambazo ni sehemu ya kingamwili na zinazohusika kukinga mwili. Kuenea kwa VVU mwilini kunapunguza idadi ya seli za ulinzi na hivyo kupunguza kiwango cha kingamwili.

Baada ya kupungua kwa kingamwili vidubini vingine vinaendelea kufika mwilini lakini sasa vinaenea zaidi kwa sababu seli za ulinzi zimekuwa chache. Kila ambukizo linaendelea kwa muda mrefu zaidi na hivyo mwili kwa jumla unateswa kwa muda mrefu zaidi.

Kadiri Ukimwi unavyoendelea vipindi vya magonjwa vinakuwa virefu zaidi na nguvu za mwili zinapunguapungua. Katika ngazi za mwisho idadi ya maambukizo inazidi uwezo wa mwili wa kupambana nayo na hapo mtu unakaribia kifo.

Dalili

UKIMWI ni ugonjwa wa mfumo wa kingamwili wa binadamu unaosababishwa na virusi vya ukosefu wa kinga mwilini.^[1]Mwanzoni, baada ya kuambukizwa, mtu anaweza kukumbwa na kipindi kifupi cha maradhi ya aina ya mafua. Kwa kawaida, hali hii hufuatwa na kipindi kirefu kisicho na dalili. Ugonjwa huu huendelea kutatiza kingamwili jinsi unavyozidi, hivyo kumfanya mtu kuwa katika hatari zaidi ya kupata maambukizi, ikiwa ni pamoja na maambukizi nyemelezi, na kansa ambayo kwa kawaida hayawaathiri watu walio na kingamwili njema.

Kuna awamu tatu kuu za maambukizi ya VVU: maambukizi makali, awamu fiche na UKIMWI.^[2]^[3]

Maambukizi makali

Kipindi cha kwanza kufuatia maambukizi ya VVU huitwa VVU vikali, VVU vya kimsingi au dalili kali za kudhibiti virusi. ^[2]^[4] Watu wengi hupata maradhi ya mfano wa mafua au maambukizi ya mfano wa mononukleosi wiki 2 - 4 baada ya kuambukizwa ilhali wengine hawana dalili zozote kuu.^[5]^[6]Dalili hutokea katika asilimia 40-90 ya visa vyote na mara nyingi hujumuisha homa, tezi kubwa na chungu za limfu, inflamesheni ya koo, upele, maumivu ya kichwa, na/au vidonda vya kinywa na sehemu za uzazi.^[4]^[6]Upele huu, unaotokea katika asilimia 20 - 50 ya visa, hutokea katika kiwiliwili, na kwa kawaida huwa wa makiulopapula.^[7]

Baadhi ya watu pia hupata maambukizi nyemelezi katika awamu hii.^[4]Dalili za tumboni na utumboni kama vile kichefuchefu, kutapika au kuharisha zinaweza kutokea, sawa na dalili za kinuroni za niuropathia ya pembeni au sindromu ya Guillain-Barre.^[6] Muda ya dalili hutofautiana, ingawa kwa kawaida huwa wiki 1 - 2.^[6]

Kufuatia sifa zake za kutokuwa dalili maalum, hizi mara nyingi haziwezi kutambulika kama dalili za maambukizi ya VVU. Hata visa vinavyotambuliwa na daktari wa familia au katika hospitali mara nyingi hutambulika vibaya kama baadhi ya visababishi vingi vya magonjwa ambukizi yaliyo na dalili zinazoingiliana. Kwa hivyo, inapendekezwa kuchunguza VVU katika watu wanaoonyesha homa isiyoelezeka ambao wanaweza kuwa na vipengele hatari vya kuambukizwa.^[6]

Awamu fiche

Dalili za kwanza hufuatwa na awamu fiche (VVU visivyo na dalili au VVU vya muda mrefu).^[3]Bila ya matibabu, awamu hii ya pili ya historia asilia ya maambukizi ya VVU inaweza kudumu kutoka miaka 3 ^[8] hadi zaidi ya miaka 20;^[9] (wastani wa miaka 8).^[10]Ingawa kwa kawaida mwanzoni kuna dalili chache, au hata zisiwemo, karibu mwishoni mwa awamu hii, watu wengi hupatwa na homa, kukonda, matatizo ya tumbo na utumbo, na maumivu ya misuli. ^[3]Kati ya asilimia 50 na 70 ya wagonjwa pia hupata limfadenopathia ya mwili wote inayorejea, ambayo hudhihirika kwa uvimbe usio na kisababishi na usio chungu wa zaidi ya kikundi kimoja cha tezi za limfu (ila katika sehemu za uzazi) kwa zaidi ya miezi 3 hadi 6.^[2]

Ingawa watu wengi walioambukizwa VVU-1 wana kiwango cha virusi kinachoweza kutambulika, na ambacho bila matibabu kitaendelea na kuwa UKIMWI, idadi ndogo (5%) huwa na kiwango kikubwa cha seli za CD4⁺(seli saidizi za T) bila matibabu ya kudhibiti virusi kwa zaidi ya miaka 5. ^[6]^[11]Watu hao huainishwa kama wadhibiti wa VVU au watu wasioendeleza kwa muda mrefu, ilhali wale ambao pia hudumisha kiwango cha chini au kisichotambulika cha virusi bila matibabu hujulikana kama "wadhibiti hodari" au "wagandamizaji hodari" ^[11].

Ukosefu wa Kinga Mwilini

Ukosefu wa Kinga Mwilini (UKIMWI) hufasiliwa kwa msingi wa kiwango cha seli za CD4 ⁺ cha chini ya seli 200 kwa kila µL au kutokea kwa magonjwa maalumu yanayohusiana na maambukizi ya VVU. ^[6] Bila matibabu maalum, takriban nusu ya watu walioambukizwa VVU hupata UKIMWI katika muda wa miaka 10.^[6]Hali zinazotokea mara nyingi zaidi kudhihirisha uwepo wa UKIMWI ni numonia ya numosistisi (40%), kakeksi kwa muundo wa dalili dhoofishi za VVU (20%) na kandidiasi ya umio.^[6]Dalili nyingine ni pamoja na maambukizi ya njia ya pumzi^[6].

Maambukizi nyemelezi yanaweza kusababishwa na bakteria, virusi, kuvu na vimelea ambavyo kwa kawaida hudhibitiwa na mfumo wa kingamwili.^[12]Maambukizi yanayotokea hutegemea, kwa upande mmoja, aina ya viumbehai vinavyopatikana kwa wingi katika mazingira ya mtu.^[6]Maambukizi hayo yanaweza kudhuru karibu kila mfumo wa viungo.^[13]

Watu walio na UKIMWI wako katika hatari kuu zaidi ya kupata saratani nyingi zinazosababishwa na virusi, kama vile: Sakoma ya Kaposi, limfoma ya Burkitt, limfoma ya mfumo mkuu wa neva na saratani ya seviksi.^[7]Sakoma ya Kaposi ndiyo saratani inayotokea mara nyingi, yaani katika asilimia 10 hadi 20 ya watu wenye VVU.^[14]Saratani inayoifuata ni limfoma, ambayo imesababisha vifo vya karibu 16% ya watu wanaoishi na UKIMWI, na ndiyo dalili ya kwanza ya UKIMWI katika asilimia 3 - 4 ya watu.^[14]Saratani hizi mbili huhusishwa na virusi vya hepesi ya binadamu aina ya 8.^[14]Saratani ya seviksi hutokea mara nyingi zaidi katika watu walio na UKIMWI kwa sababu ya jinsi inavyohusiana na virusi vya papiloma ya binadamu.^[14]

Isitoshe, watu hao mara nyingi huwa na dalili za kimfumo, kama vile homa ya muda mrefu, jasho (hasa usiku), tezi za limfu zilizofura, ubaridi, udhaifu na kupoteza uzito.^[15]Kuharisha ni dalili nyingine inayotokea katika takriban 90% ya watu wenye UKIMWI.^[16]

Wapi VVU ilianza

Wanasayansi wengi wanaamini binadamu wa kwanza ambaye alipata VVU alikuwa Afrika Magharibi ya Kati. Hii ilitokea mwishoni mwa karne ya 19 au mwanzoni mwa karne ya 20, wakati virusi ya SIV kutoka kwa nyani au sokwe ilikwenda kwa binadamu.^[17]

UKIMWI ulitambuliwa mara ya kwanza na Vituo vya Kuzuia na Kudhibiti Magonjwa mwaka 1981^[14], ilhali kisababishi chake - VVU - kilitambuliwa mwanzoni mwa muongo huo. ^[18]

Tangu kutambuliwa kwake, UKIMWI umepelekea takriban vifo milioni 30 (kufikia mwaka wa 2009).^[19]. Kufikia mwaka wa 2010, takriban watu milioni 34 wameambukizwa UKIMWI kote duniani.^[20] UKIMWI huchukuliwa kama janga — yaani mlipuko wa ugonjwa katika eneo kubwa, na ambao ungali unaenea.^[21]

VVU vilidhihirika nchini Marekani. Matukio ya kwanza yalikuwa katika kikundi kidogo cha waraibu wa dawa za kudungia na wanaume shoga wasiokuwa na visababishi bayana vya udhaifu wa kingamwili na walioonyesha dalili za numonia ya Pneumocystis carinii, maambukizi nyemelezi yanayotokea kwa nadra na maarufu katika watu wenye kingamwili dhaifu sana.^[22]

Punde baadaye, idadi isiyotarajiwa ya mashoga wakapata Sakoma ya Kaposi (SK), saratani ya ngozi iliyokuwa nadra sana hapo awali.^[23]^[24]Visa vingine vingi vya NPC na SK vilitokea huku vikitahadharisha Vituo vya Kudhibiti na Kuzuia Magonjwa nchini Marekani, hivyo kikosi cha kiutendaji kikaundwa ili kuudhibiti mzuko huu.^[25]

Katika siku za kwanza, Kituo hicho hakikuwa na jina rasmi la ugonjwa huu, mara nyingi wakitumia majina ya magonjwa mengine yaliyohusishwa nao, kwa mfano, limfadenopathi, jina ambalo baadaye wavumbuzi wa VVU waliviita virusi hivi.^[26]^[27] Wavumbuzi pia walitumia “Sakoma ya Kaposi na Maambukizi nyemelezi”, jina lililokuwa la kikosi cha kiutendaji kilichoanzishwa mwaka wa 1981.^[28] Wakati mmoja, Kituo cha Kudhibiti na Kuzuia Magonjwa kiliunda msemo "ugonjwa wa 4H", kwani sindromu hii ilionekana kuwaathiri watu wa Haiti, mashoga (homosexuals), wenye hemofilia na watumiaji wa heroini.^[29] Katika vyombo vikuu vya habari liliundwa neno "GRID" lililosimamia gay-related immune deficiency (yaani ukosefu wa kinga uliohusishwa na mashoga.^[30] Hata hivyo, baada ya kutambua kuwa VVU havikuwaathiri jamii ya mashoga pekee,^[28] ilibainika kuwa neno GRID lilikuwa likipotosha, hivyo neno UKIMWI likaanzishwa kwenye mkutano mnamo Julai 1982.^[31] Kufikia Septemba 1982, Kituo cha Kudhibiti na Kuzuia Magonjwa kilianza kuuita UKIMWI.^[32]

Mnamo 1983, vikundi viwili tofauti vya utafiti vilivyoongozwa na Robert Gallo na Luc Montagnier bila kutegemeana vilitangaza kuwa retrovirusi mpya ilikuwa ikiwaambukiza wagonjwa wa UKIMWI, hivyo wakachapisha matokeo yao katika jarida la Science.^[33]^[34] Gallo alidai kuwa virusi vilivyokuwa vimetambuliwa kwa mara ya kwanza na kikundi chake kilikuwa sawa katika umbo na virusi vya binadamu vya limfotrophia-T. Kikundi cha Gallo kiliviita virusi hivi HTLV-III.

Wakati huohuo, kikundi cha Montagnier kilitambua virusi kutoka kwa mgonjwa aliyekuwa na uvimbe wa tezi za limfu kwenye shingo na udhaifu wa mwili ambazo ni dalili mbili bainifu za UKIMWI. Huku wakikanusha ripoti ya kikundi cha Gallo, Montagnier na wenzake walionyesha kuwa viini vya protini vya virusi hivyo vilikuwa tofauti na HTLV-I kiukingamwili. Kikundi cha Montagnier kiliviita virusi walivyovitambua virusi vinavyohusishwa na limfadenopathi.^[25] Virusi hivi vilibainika kuwa sawa mwaka wa 1986 na kubadilishwa na kuitwa VVU.^[35]

Asili

VVU-1 na VVU-2 vinaaminika kutokana na jamii ya sokwe ambao si binadamu, huko Magharibi mwa Kati ya Afrika, kisha kuambukiza wanadamu mwanzoni mwa karne ya 20. ^[17] VVU-1 vinaaminika kutoka kusini mwa Cameroon kupitia kugeuka kwa VSVU(cpz), (virusi vya sokwe vinavyosababisha ukosefu wa kinga mwilini) vinavyoambukiza sokwe wa mwituni (VVU-1 hutokana na mzuko wa magonjwa ya VSVUcpz katika nususpishi ya sokwe iitwayo Pan troglodytes troglodytes).^[36]^[37]

Virusi vinavyohusiana kwa karibu na VVU-2 ni VSVU(smm) ambavyo ni virusi vya mangabi mwenye masizi (Cercocebus atys atys), tumbili wa kale anayeishi Afrika Magharibi (kutoka kusini mwa Senegali hadi magharibi mwa Côte d'Ivoire).^[38] Tumbili wa kisasa kama vile tumbili bundi wana ukinzani wa maambukizi ya VVU-1 kwa sababu ya uunganishaji wa jeni mbili zinazokinzana na virusi.^[39] VVU-2 inadhaniwa kuruka kizuizi cha spishi katika angalau matukio matatu tofauti, hivyo kupelekea vikundi vitatu vya virusi hivi ambavyo ni M, N na O. ^[40]

Kuna ushahidi kuwa wanadamu wanaoshiriki shughuli za nyama za mwituni kwa kuwinda au kuziuza nyama za mwituni, kwa kawaida hupata VSVU.^[40]Hata hivyo, virusi hivi ni dhaifu na hukandamizwa na mfumo wa kingamwili baada ya wiki kadhaa za kuambukizwa. Inadhaniwa kuwa maambukizi kadhaa ya virusi hivi kutoka kwa mtu hadi mwingine katika mfululizo wa haraka huhitajika ili vipate wakati unaotosha wa kubadilika na kuwa VVU.^[41] Zaidi ya hayo, kwa sababu ya kiwango chake kidogo cha kuambukiza kutoka kwa mtu hadi mwingine, virusi hivyo vinaweza tu kuenea katika wingi wa watu iwapo kuna njia moja au mbili za hatari ya kiwango cha juu ya kuambukizana. Njia hizi zinadhaniwa kutokuwepo barani Afrika kabla ya karne ya 20.

Njia maalum za hatari kubwa ya maambukizi zinazoruhusu virusi hivi kubadilika ili kuweza kuishi katika wanadamu na kuenea katika jamii yote hutegemea wakati uliopendekezwa wa kuvuka kutoka kwa mnyama hadi mwanadamu. Tafiti za kijeni za virusi hivi zinadokeza kuwa chanzo cha hivi karibuni zaidi cha VVU-1 ya kikundi M kilianza takriban mnamo 1910. ^[42] Watetezi wa kipindi hiki maalumu huhusisha mzuko wa janga la VVU na kuibuka kwa ukoloni na ukuaji wa miji mikubwa ya kikoloni ya Afrika, huku ukisababisha mabadiliko ya jamii pamoja na kiwango kikubwa cha uasherati, uenezi wa ukahaba na matukio ya kila mara ya ugonjwa wa kidonda vya viungo vya uzazi (kama vile kaswende) katika miji iliyochipuka.^[43]

Ingawa viwango vya uambukizaji wakati wa ngono ya kupitia uke viko chini katika hali ya kawaida, kuna ongezeko kubwa iwapo mmoja wa wapenzi hao anaathiriwa na ugonjwa wa zinaa na kusababisha vidonda vya viungo vya uzazi. Miji ya kikoloni ya miaka ya kwanza ya 1900 ilifahamika kwa maambukizi ya viwango vya juu kutokana na ukahaba na vidonda vya viungo vya uzazi, hivi kwamba, kufikia mwaka 1928, 45% ya wanawake wakaazi wa mashariki mwa Kinshasa walidhaniwa kuwa makahaba. Kufikia mwaka 1933, takriban 15% ya wakaazi wote wa mji huo walikuwa wameambukizwa mojawapo ya aina za kaswende.^[43]

Maono mengine yanadokeza kuwa hatua zisizo salama za uuguzi barani Afrika katika miaka ya baada ya Vita vya pili vya dunia, kama vile kutumia tena na tena sindano zisizosafishwa kuchanja umati, antibayotiki na kampeni dhidi ya malaria ndizo njia za kwanza zilizoruhusu virusi hivyo kujibadilisha vikiwa ndani ya wanadamu kisha kuenea.^[41]^[44]^[45]

Visa vilivyonakiliwa vyema vya VVU katika mwanadamu ni vya mwaka 1959 katika nchi ya Kongo.^[46] Kuna uwezekano kuwa virusi hivyo vilikuwemo huko Marekani mwaka 1966,^[47]lakini maambukizi mengi yanayotokea nje ya Kusini kwa Sahara yanaweza kufuatiliwa hadi kwa mtu mmoja aliyeambukizwa na VVU katika nchi ya Haiti na kisha kuyapeleka maambukizi hayo nchini Marekani takriban mwaka 1969.^[48] Janga hili kisha lilienea kwa haraka katika vikundi vilivyo katika hatari kubwa ya kuambukizwa (mwanzoni ilikuwa ni wanaume waliofanya ngono na wanaume). Kufikia mwaka 1978, maambukizi ya VVU-1 katika mashoga wenyeji wa New York na San Francisco yalikadiriwa kuwa 5%, kuonyesha kuwa maelfu ya watu nchini Marekani tayari walikuwa wameambukizwa.^[48]

Uenezi na kinga

VVU husambaa hasa kupitia njia tatu kuu: ngono (ikiwa ni pamoja na ulawiti na hata ngono ya mdomoni), kuingiliana na viowevu vya mwili vilivyoambukizwa (hasa kuongezewa damu au kudungwa sindano) na kutoka kwa mama hadi mtoto wakati wa ujauzito, kuzaa au kunyonyesha^[49]Baadhi ya viowevu vya mwili, kama vile mate na machozi, havisambazi VVU.^[50]Kuzuia maambukizi ya VVU, hasa kupitia ngono salama na miradi ya kubadilisha sindano, ni mikakati mikuu inayotumika kudhibiti kuenea kwa ugonjwa huu.

Kupitia ngono

Kufanya ngono zembe kumepelekea visa vingi zaidi vya maambukizi ya VVU kote ulimwenguni, huku mwingiliano baina ya watu wa jinsia tofauti ukichangia visa zaidi ya mwingiliano wa mashoga kote ulimwenguni (kwa sababu mashoga ni wachache zaidi).^[49] Hata hivyo, mtindo wa usambazaji hutofautiana pakubwa baina ya mataifa mbalimbali.

Nchini Marekani, visa vingi zaidi vya usambazaji wa kingono vilitokea katika wanaume wanaofanya ngono na wanaume (kwa sababu huko ushoga umeenea zaidi)^[49]huku idadi hii ikichangia 64% ya visa vyote vipya.^[51]

Kuhusu ngono zembe baina ya watu wa jinsia tofauti, makadirio ya hatari ya kusambazwa kwa VVU kwa kila kitendo cha ngono yanaonekana kuwa zaidi kwa mara 10 katika mataifa yasiyostawi kuliko mataifa yaliyostawi.^[52]Katika mataifa yasiyostawi, hatari ya usambazaji wa mwanamke hadi mwanamume imekadiriwa kuwa 0.38% kwa kila kitendo, huku usambazaji wa mwanamume hadi mwanamke ukiwa 0.30%; makadirio mbadala katika mataifa yaliyostawi ni 0.04% kwa kila kitendo katika usambazaji wa mwanamke hadi mwanamume, na 0.08% kwa kila kitendo katika maambukizi ya mwanamume hadi mwanamke.^[52]

Hatari ya kuambukizwa kutokana na ngono ya kinyeo (ulawiti) iko juu sana, ikikadiriwa kuwa 1.4 – 1.7% kwa kila kitendo (katika ngono ya watu wa jinsia moja na tofauti pia).^[52]^[53]

Ingawa hatari ya kuambukizwa kupitia ngono ya mdomoni iko chini, bado ipo. ^[54]Hatari ya kila kitendo imekadiriwa kuwa 0 – 0.04% kwa ngono pokezi ya mdomoni.^[55]^[56] kwa kuwa visa vichache vimeripotiwa.^[57]

Katika miktadha inayohusisha ukahaba kote ulimwenguni, hatari ya maambukizi ya mwanamke hadi mwanamume imekadiriwa kuwa 2.4% kwa kila kitendo, huku maambukizi ya mwanamume kwa mwanamke yakiwa 0.08% kwa kila kitendo.^[52]

Hatari ya kuambukizwa huongezeka katika wingi wa magonjwa ya zinaa^[58] na vidonda vya uzazi.^[52]Vidonda vya sehemu za uzazi vimekisiwa kuongeza hatari hadi mara tano. ^[52] Maambukizi mengine ya zinaa, kama vile kisonono, klamidia, trikomoniasi, vaginosi ya kibakteria, huhusishwa na aghalabu ongezeko dogo la hatari ya kuambukizwa.^[55]

Wingi wa virusi kwa mtu aliyeambukizwa ni suala kuu la hatari katika usambazaji wa kingono na pia wa kutoka kwa mama hadi mtoto.^[59] Katika miezi 2.5 ya kwanza baada ya kuambukizwa VVU, uwezo wa mtu kuambukiza ni mara 12 zaidi kwa sababu ya wingi wa virusi. ^[55] Iwapo mtu yuko katika awamu za mwisho za VVU, viwango vya kuambukizana ni takriban mara 8 zaidi.^[52]

Ngono shari inaweza kuwa suala linalochangia ongezeko la hatari ya kuambukizwa. ^[60]

Ubakaji pia unaaminika kuongezeka hatari ya kusambaza VVU kwa sababu ni nadra kondomu kutumika, huwa na uwezekano wa kujeruhiwa ukeni au kinyeo, na pia kuna uwezekano wa magonjwa ya zinaa yanayoambatana na VVU. ^[61]

Viowevu vya mwili

Njia ya pili maarufu zaidi ya usambazaji wa VVU ni kupitia kwa damu na mazao yake.^[49] Usambazaji wa kupitia damu unaweza kuwa kupitia sindano inayotumiwa na watu wengi wanapoongezwa viowevu mwilini, majeraha ya sindano, kuongezwa damu chafu au mazao ya damu, au kudungwa kwa vifaa visivyotakaswa.

Hatari inayotokana na kutumia sindano baina ya watu wengi wakati wa kudungwa dawa ni kati ya 0.63-2.4% kwa kila kitendo, wastani wake ukiwa 0.8%^[62] Hatari ya kuambukizwa VVU kwa sindano iliyotumiwa na mtu aliyeambukizwa VVU hukadiriwa kuwa 0.3% (takriban mara 1 kwa 133) kwa kila kitendo, ilhali hatari inayofuatia tando za ute kuingiliana na damu iliyoambukizwa ni 0.09% (takriban 1 kwa 1000) kwa kila kitendo.^[63] Nchini Marekani, watu wanaodungwa dawa ndani ya misuli walichangia 12% ya visa vyote vipya vya VVU mwaka wa 2009, ^[51] huku 80% ya watu katika sehemu fulani wanaodungwa dawa wakiwa wameambukizwa VVU. ^[49]

Kuongezewa damu iliyoambukizwa huchangia maambukizi kwa takriban 93% ya visa vyote.^[62]Katika mataifa yaliyostawi, hatari ya kuambukizwa VVU kutokana na kuongezewa damu iko chini sana (chini ya 1 kwa 500,000) ambapo viwango vya juu vya kuchagua mtu atakayetoa damu na pia upimaji VVU hufanywa.^[49] Kule Uingereza, hatari iliyoripotiwa ni 1 kwa milioni 5.^[64] Hata hivyo, katika mataifa yenye mapato ya chini, nusu tu ya damu inayoongezwa huwa imepimwa vyema (kufikia mwaka wa 2008). ^[65]Inakadiriwa kuwa hadi 15% ya maambukizi ya VVU katika maeneo hayo hutokana na kuongeza damu au mazao ya damu yaliyoambukizwa, hii ikiwa ni asilimia 5 - 10 ya maambukizi ya ulimwengu mzima. ^[49]^[66]

Sindano za tiba zisizo salama huchangia pakubwa katika kueneza UKIMWI katika eneo la Kusini kwa Sahara. Mnamo 2007, kati ya 12% na 17% ya maambukizi katika eneo hilo yalichangiwa na matumizi ya sindano hizo.^[67] Shirika la Afya Duniani linakadiria hatari ya kuambukizwa kupitia sindano hizo barani Afrika kuwa 1.2%. Hatari kuu huhusishwa na taratibu vamizi, kusaidiwa kuzaa na utunzaji wa meno katika sehemu hii ya dunia.^[68]

Watu wanaochanja au kuchanjwa chale, chale za mwili na kutia kovu hudhaniwa kuwa katika hatari ya kuambukizwa, ingawa hakuna visa vilivyothibitishwa ambavyo vimenakiliwa.^[69] Haiwezekani mbu au wadudu wengine kusambaza VVU. ^[70]

Mama hadi mtoto

VVU vinaweza kusambazwa kutoka kwa mama hadi mtoto wakati wa ujauzito, kuzaa au kunyonyesha.^[71]^[72] Njia hii ni ya tatu kwa umaarufu wa kusambaza VVU kote duniani.^[49] Bila matibabu, hatari ya kusambazwa wakati wa au baada ya kuzaliwa ni takriban 20%, na 35% kwa watoto wanaonyonya.^[71]Kufikia mwaka wa 2008, usambazaji wima ulichangia takriban 90% ya visa vya VVU katika watoto.^[71]

Hatari ya kusambazwa kutoka kwa mama hadi mtoto inaweza kupunguzwa hadi 1% kwa kutumia matibabu mwafaka.^[71] Matibabu ya kukinga hujumuisha mama kutumia dawa za kudhibiti virusi wakati wa ujauzito na kuzaa, kuchagua kuzaa kwa kupasuliwa, kutonyonyesha na kumpa mtoto dawa za kudhibiti VVU.^[73]Hata hivyo, idadi kubwa ya mbinu hizi hazipatikani katika mataifa yanayostawi.^[73] Iwapo damu itachafua chakula wakati wa mtoto kutafuna, itaongeza hatari ya kuambukiza.^[69]

VVU na UKIMWI

Virusi vyenyewe

VVU ndivyo kisababishi cha mkusanyiko wa magonjwa yanayojulikana kijumla kama VVU/UKIMWI. VVU ni retrovirusi ambavyo hasa huambukiza vipengele vya mfumo wa kingamwili ya binadamu kama vile seli za CD4⁺T, makrofaji na seli za dendraiti. Virusi hivi huharibu seli za CD4⁺ T moja kwa moja au vinginevyo.^[74]

VVU ni mshirika wa jenasi ya Lentivirus,^[75] sehemu ya familia ya Retroviridae.^[76] Virusi vyote vya lenti huwa na sifa sawa za kimofolojia na biolojia. Spishi nyingi za mamalia huambukizwa na virusi vya lenti, ambavyo haswa huwa ndivyo visababishi vya maradhi ya muda mrefu yaliyo na kipindi cha kupevuka kirefu.^[77]Virusi vya lenti husambazwa kama virusi vya RNA chanya za uzi mmoja hisia zilizo ndani ya kigamba. Inapoingia ndani ya seli iliyolengwa, jenomu ya RNA ya kivirusi hugeuzwa (hubadilishwa kinakala) na kuwa DNA ya nyuzi mbili ambayo husafirishwa pamoja na jenomu ya virusi katika chembe ya virusi vile. DNA ya virusi inayoundika huingia katika kiini cha seli ambapo huchangamana na seli ya DNA kwa kutumia integresi iliyofasiliwa kama virusi, na pia vipengele husika vya kiini kikuu.^[78] Vinapochangamana na DNA ya seli, virusi hivi vinaweza kuingia katika awamu fiche, hivyo kuwezesha virusi hivi pamoja na seli inayovipokea kuepuka kutambuliwa na mfumo wa kingamwili.^[79]

Aina mbili za VVU zimetambulika: VVU-1 na VVU-2. VVU-1 ni virusi vilivyotambulika kwanza (na ambavyo mwanzoni vilijulikana pia kama LAV au HTLV-III). Virusi hivi vina sumu kali, vyenye kuambukiza,^[80] na ndivyo visababishi vikuu vya visa vingi vya maambukizi ya VVU kote ulimwenguni. Kiwango cha chini zaidi cha uambukizaji wa VVU-2 ikilinganishwa na VVU-1 huonyesha kuwa watu wachache zaidi walio katika hatari ya VVU-2 wataambukizwa kila wanapokumbana na virusi hivi. VVU-2 hupatikana zaidi Afrika Magharibi kwa sababu ya uwezo wake wa chini wa kuambukiza.^[38]

Kifaa kikubwa cha duara cha rangi ya buluu, na kifaa chekundu kilichounganishwa nacho. Vifaa vyote viwili vina madoa ya kijani yaliyotapakaa juu yake. — Mikrografu ya elektroni ya ukaguzi wa VVU-1, vya rangi ya kijani, vinavyochipuka kutoka kwa limfositi iliyokaguliwa.

Baada ya virusi kuingia mwilini, kuna kipindi cha kugawanyika kwa virusi, hali inayopelekea wingi wa virusi katika damu ya pembeni. Katika kipindi cha kwanza cha maambukizi, kiwango cha VVU kinaweza kufika milioni kadhaa za chembe za virusi kwa kila mililita ya damu.^[81] Mwitikio huu huandamana na kiwango kikubwa cha kushuka kwa idadi ya seli za CD4⁺ T zinazozunguka. Viremia kali mara nyingi huhusishwa na kuwezeshwa kwa CD8⁺ seli za T, ambazo huangamiza seli zilizoambukizwa VVU na kisha kuhusishwa na kuzalishwa kwa zindiko, au kuzalishwa kwa zindiko mpya. Mwitikio wa seli za CD8⁺ T huchukuliwa kuwa muhimu katika kudhibiti viwango vya virusi, ambavyo hupanda na kushuka, huku viwango vya seli za CD4⁺ T vikirejea. Mwitikio bora wa seli za CD8⁺ T umehusishwa na kupungua kwa mwendo wa ugonjwa na pia prognosi bora zaidi, ingawa mwitikio huu hauondoi virusi.^[82]

Pathofisiolojia ya UKIMWI ni tata.^[83] Mwishowe, VVU husababisha UKIMWI kwa kuharibu CD4⁺seli za T. Hali hii hudhoofisha mfumo wa kingamwili hivyo kuwezesha mambukizi vamizi. Seli za T ni muhimu kwa mwitikio wa kingamwili, hivyo bila ya seli hizi, mwili hauwezi kukabiliana na maambukizi wala kuharibu seli za saratani. Utendakazi wa kuharibiwa kwa seli za CD4⁺ T hutofautiana katika awamu kali na za muda mrefu.^[84] Katika awamu kali, lisisi ya seli inayosababishwa na VVU, na pia kuangamizwa kwa seli za T angamizi huchangia katika kuharibiwa kwa seli za CD4⁺ T, ingawa apoptosi pia inaweza kuchangia hali hii. Katika awamu ya muda mrefu, matokeo ya uwezeshaji wa kijumla wa kingamwili ukiandamana na udhaifu wa pole pole wa uwezo wa mfumo wa kingamwili kuzalisha seli mpya za T hukisiwa kuchangia kupungua kwa pole pole kwa idadi ya seli za CD4⁺ T. ^[85]

Ingawa dalili za udhaifu wa kingamwili kama ulivyo katika UKIMWI hazitokei kwa miaka mingi baada ya kuambukizwa, kiwango kikubwa cha kuharibika kwa seli za CD4⁺ T hutokea katika wiki za kwanza baada ya kuambukizwa, hasa katika ute wa utumbo, ambao huwa na kiwango kikubwa cha limfosaiti zote za mwili.^[86] Sababu ya kiwango hiki kikubwa cha kuharibiwa kwa seli za CD4⁺ T ni kuwa kiwango kikubwa cha seli za ute za CD4⁺ T huzalisha protini ya CCR5 inayotumika na VVU kama kipokezi kishiriki ili kuweza kufikia seli hizo, ilhali kipande kidogo tu cha seli za CD4⁺ T katika mkondo wa damu hufanya hivyo.^[87]

VVU hutafuta na kuharibu CCR5 inayotolesha seli za CD4⁺ T katika awamu kali ya maambukizi. ^[88] Mwitikio mkubwa wa kingamwili hatimaye huyadhibiti maambukizi hayo kisha kuanzisha awamu fiche ya kiutambuzi. Seli za CD4⁺ T katika tishu za ute husalia zikiwa zimeathiriwa sana. ^[88] Ugawanyikaji endelevu wa VVU husababisha hali ya uwezeshaji wa kijumla wa kingamwili, ambao hudumu katika awamu yote ya muda mrefu.^[89] Uwezeshaji wa kingamwili, ambao hutambulika kwa ongezeko la uwezeshaji wa hali ya seli za kingamwili na kutoleshwa kwa saitokini inayosababisha inflemesheni, husababishwa na utendakazi wa zao la jeni na mwitikio wa kingamwili dhidi ya ugawanyikaji wa VVU unaoendelea. Uwezeshaji wa kingamwili pia huhusishwa na kuharibika kwa mfumo wa uchunguzi wa kingamwili wa kizuizi cha ute wa tumbo na utumbo, hali inayosababishwa na kuangamizwa kwa seli za CD4⁺ T za ute katika awamu kali ya ugonjwa huu.^[90]

Hivyo si kila mtu aliye na VVU ana UKIMWI. Wakati watu wanapata VVU, wanaweza kuwa na afya kwa miaka mpaka akakutwa na aina maalumu ya magonjwa na vipimo vya damu vikionyesha kuwa ina idadi ndogo sana ya seli nyeupe za damu ambazo ndizo zinazopambana na maambukizi.

Kuna maradhi ambayo kwa kawaida ni ishara kwamba mtu ana UKIMWI kwa kuwa watu wenye afya njema hawapati magonjwa haya, kwa sababu mfumo wa kinga mwilini una nguvu ya kutosha ya kupigana na magonjwa hayo. Hivyo kupata ugonjwa wa aina hiyo ni ishara kwamba mfumo wa kinga umeharibika.

Baadhi ya magonjwa hayo ni:

Sarkoma ya Kaposi - aina ya kansa ambayo kwa kawaida huathiri ngozi (mara nyingi husababisha vidonda vyekundu au zambarau, au majeraha juu ya ngozi). Wakati mwingine huathiri tu ngozi, bali pia mifumo mingine katika mwili.
Retinitis - virusi zinashambulia nyuma ya jicho.
Pneumocystis carinii (kifupi PCP) - aina ya pneumonia, magonjwa ya kuambukiza ya mapafu. PCP ni maambukizi ya kawaida kwa wagonjwa wa UKIMWI.
Toxoplasmosis - ugonjwa unaosababishwa na vimelea, ambao unaweza kusababisha matatizo katika mifumo ya ubongo na mingine katika mwili.
Kansa ya kizazi - ambayo huwa inaenea.

Utambuzi

Grafu iliyo na mistari miwili. Mstari wa buluu unapanda kuelekea kulia kisha kushuka kuelekea kushoto huku ukipanda kidogo katikati. Mstari wa pili mwekundu unapanda kutoka sufuri hadi juu sana, kisha kushuka hadi chini halafu kupanda pole pole hadi juu tena — Grafu ya ujumla ya uhusiano wa nakala za VVU (wingi wa virusi) na viwango vya seli za CD4⁺ T katika wastani wa kipindi cha maambukizi yasiyotibiwa ya VVU.Kigezo:Legend-line Kigezo:Legend-line

VVU hutambuliwa kupitia uchunguzi wa kimaabara kisha kuainishwa kiawamu kwa msingi wa uwepo wa dalili au ishara fulani.^[4] Watu walio katika hatari kubwa ya kuambukizwa hupendekezwa kupimwa VVU, ikiwa ni pamoja na mtu yeyote aliye na ugonjwa wa zinaa^[7] Katika maeneo mengi ya ulimwengu, 1/3 ya watu wenye VVU hutambua kuwa wameambukizwa katika awamu za mwishoni mwa ugonjwa huu wakati UKIMWI au ukosefu mkuu wa kingamwili umekuwa wazi.^[7]

Uchunguzi wa VVU

Watu wengi walioambukizwa VVU huzalisha zindiko maalum (yaani kuzalisha zindiko mpya) katika wiki 3 hadi 12 tangu maambukizi ya kwanza. ^[6] Utambuzi wa VVU vya kimsingi hufanywa kabla ya kuzalishwa kwa zindiko mpya kwa kupima RNA ya VVU au antijeni ya p24.^[6] Matokeo chanya yanayopatikana kwa kupima MAP au zindiko huthibitishwa kwa zindiko au MAP tofauti.^[4]

Vipimo vya zindiko kwa watoto wa umri wa chini ya miezi 18 kwa kawaida huwa kasoro kwa sababu ya uwepo endelevu wa zindiko za mama.^[91] Kwa hivyo, maambukizi yanaweza kutambulika tu kwa vipimo vya MAP vya VVU, RNA au DNA, au kupitia kupima uwepo wa antijeni ya p24.^[4]Sehemu kubwa ya ulimwengu haina uwezo wa kupata vipimo bora vya MAP huku watu wa sehemu nyingi wakisubiri hadi dalili za watoto wao kuendelea au watoto hao kukua hadi kuwa na uwezo wa kupimwa kikamilifu.^[91] Kufikia mwaka wa 2007-2009 katika eneo la Kusini mwa Jangwa la Sahara, kati ya asilimia 30-70 ya watu walikuwa wakifahamu hali yao ya VVU.^[92] Mnamo mwaka wa 2009, kati ya asilimia 4-42 ya watu hawa walipimwa. ^[92] Takwimu hizi zinaonyesha ongezeko kubwa kutoka miaka ya awali.^[92]

Uainishaji wa maambukizi ya VVU

Mifumo miwili mikuu ya uainishaji hutumika kuainisha VVU na magonjwa husika kwa ajili ya uchunguzi:mfumo wa uainishaji wa mfumo wa uainishaji wa maambukizi na magonjwa wa Shirika la Afya Duniani,^[4] na mfumo wa VKM wa uainishaji wa maambukizi ya VVU.^[93] The VKM hutumika zaidi katika mataifa yaliyostawi. Kwa vile mfumo wa uainishaji waSAD hauhitaji vipimo vya mahabara, mfumo huu ni mwafaka kwa mataifa yanayostawi ambayo kwa kawaida yana upungufu wa vifaa, ambapo unaweza pia kutumika kuongoza udhibiti wa kimatibabu. Ingawa mifumo hii miwili ni tofauti, yote huwezesha ulinganishaji kwa ajili ya malengo ya kitakwimu.^[2]^[4]^[93]

Shirika la Afya Duniani lilipendekeza ufasili wa UKIMWI mara ya kwanza mwaka wa 1986.^[4] Tangu hapo, ufasili wa Shirika hili umedurusiwa na kurefushwa mara kadhaa, toleo la hivi karibuni likiwa la mwaka wa 2007. ^[4] Mfumo wa SAD hutumia vikundi vifuatavyo:

Maambukizi ya kimsingi ya VVU: Yanaweza kuwa bila dalili au yakihusishwa na sindromu kali ya retrovirusi. ^[4]
Awamu ya I: Maambikizi ya VVU huwa bila dalili yakiwa na kiwango cha seli za CD4⁺ T (ambacho pia huitwa kiwango cha CD4) cha zaidi ya 500/uL.^[4] Maambukizi haya yanaweza kujumuisha kuvimba kwa tezi za mwili wote.^[4]
Awamu ya II: Dalili ndogo zinaweza kuhusisha kiwango cha chini cha kudhihirika kwa za tando za ute na maambukizi yanayorejea ya sehemu ya juu ya njia ya pumzi. Kiwango cha seli za CD4 cha chini ya 500/uL..^[4]
Awamu ya III: Dalili kuu zinazoweza kujumuisha hali ya kuharisha ya muda mrefu isiyo na kisababishi maalum kwa zaidi ya mwezi mmoja, maambukizi makali ya bakteria ikiwa ni pamoja na tiibii ya mapafu na pia kiwango cha seli za CD4 cha chini ya 350/uL. ^[4]
Awamu ya IV ya UKIMWI: dalili kali zinazojumuisha toksoplasmosi ya ubongo, ukungu wa umio, trakea, bronkasi au mapafu na sakoma ya Kaposi. Kiwango cha seli za CD4 cha chini ya 500/uL..^[4]

Kituo cha Kukinga na Kudhibiti Magonjwa cha Marekani pia kilianzisha mfumo wa uainishaji wa VVU, kilichoudurusu mwaka wa 2008.^[93] Katika mfumo huu, maambukizi ya VVU yameainishwa kulingana na kiwango cha CD4 na dalili za kiutambuzi, ^[93] nayo hueleza maambukizi kwa awamu tatu:

Awamu ya 1: Kiwango cha CD4 cha seli ≥ 500 /uL na hakuna hali zinazoashiria UKIMWI
Awamu ya 2: Kiwango cha seli za CD4 200 hadi 500 /uL na hakuna hali zinazoashiria UKIMWI
Awamu ya 3: Kiwango cha seli za CD4≤ 200 cells/uL au hali zinazoashiria UKIMWI.
Tashwishi: iwapo habari iliyopo haitoshi kufanya uainishaji uliopo juu

Kwa sababu za kiuchunguzi, utambuzi wa UKIMWI hubakia iwapo baada ya matibabu kiwango cha seli za CD4⁺ T kitapanda zaidi ya 200 kwa kila µL ya damu au iwapo maradhi mengine yanayoashiria UKIMWI yataponywa.^[2]

Matibabu

Hakuna tiba au chanjo; hata hivyo, matibabu ya kudhibiti virusi yanaweza kupunguza mwendo wa ugonjwa huu na huenda yakapelekea urefu wa maisha kuwa karibu na kawaida. Ingawa matibabu ya kupunguza makali hupunguza hatari ya kifo na matatizo yanayotokana na ugonjwa huu, matibabu haya ni ya bei ghali, hivyo yanaweza kuhusishwa na madhara mbadala.

Kuna dawa za kusaidia watu wenye UKIMWI. Hizi zinaitwa dawa za kurefusha maisha. Dawa za kurefusha maisha haziwezi kutibu UKIMWI. Hii ina maana kwamba haziwezi kufanya virusi vyote kuondoka mwili wa mtu. Lakini zinaweza kuwasaidia watu kupambana na virusi vya UKIMWI kwa mifumo yao ya kinga kufanya kazi vizuri zaidi. Hivyo dawa za kurefusha maisha si tiba kabili kwa virusi ya UKIMWI.

Watu wenye VVU / UKIMWI ambao huchukua dawa za kurefusha maisha wanaweza kuishi muda mrefu, bila kupata maradhi yanayothibitisha UKIMWI.

Lakini baada ya muda mrefu, virusi za HIV zisizouawa na dawa hizo hujifunza jinsi ya kupambana nazo na hivyo zinakuwa sugu kwa dawa hizo.

Wakati mwingine HIV ni sugu kwa dawa moja, lakini dawa nyingine inaweza kutumika. Ili kupunguza uwezekano wa upinzani kutokea, watu wenye UKIMWI huchukua dawa zaidi ya moja kwa wakati mmoja. Wanaweza kuchukua madawa 2-4 kwa mara moja. Hii wakati mwingine inaitwa cocktail ya UKIMWI. Lakini baada ya muda mrefu, HIV kujifunza kuwa sugu kwa dawa nyingi. Hapo hakuna zaidi ya kuwatibu. Hivyo wanasayansi kuendelea kujaribu kupata dawa mpya ya kupambana na VVU.

Dawa tano muhimu za wenye VVU ni:

D4T (stavudine)
3TC (Lamivudine)
NVP (nevirapine)
AZT (zidovudine)
EFZ (efavirenz)

Bila dawa hizo, kwa kawaida mtu mwenye VVU anaweza akaishi miaka 9-11.

Njia za kujikinga na UKIMWI

Kuna njia nyingi za watu kupambana na janga hilo.

Mgusano wa kingono

Matumizi ya kondomu kila mara hupunguza hatari ya kusambaziwa UKIMWI kwa takriban 80% katika muda mrefu wa usoni. ^[94] Iwapo mwezi mmoja ameambukizwa, matumizi ya kondomu kila mara hupelekea viwango vya chini ya 1% kwa mwaka vya huyo mwingine kuambukizwa. ^[95] Kuna ushahidi mdogo unaoonyesha kuwa kondomu za wanawake huwa na kiwango sawa cha kinga. ^[96] Kutumia mafuta ya ukeni yanaliyo na tenofovir (kizuia kugeuzwa kwa nakala]]) muda mfupi kabla ya ngono hukisiwa kupunguza viwango vya maambukizi kwa takriban 40% miongoni mwa wanawake wa Kiafrika. ^[97] Kinyume na hili, matumizi ya spemisidi nonoxynol-9 yanaweza kuongeza hatari ya kuambukizwa kwa sababu ya uwezo wake wa kusababisha muwasho wa uke na rektamu.^[98] Tohara katika eneo la Kusini mwa Sahara "hupunguza uambukizaji wa VVU katika wanaume wanaohusiana na wanawake kimapenzi kwa kati ya 38% na 66% kwa muda wa miezi 24". ^[99] Kwa msingi wa tafiti hizi, mashirika ya SAD na UNAIDS yalipendekeza tohara kama mbinu ya kuzuia uambukizaji VVU kutoka kwa mke hadi mume mwaka wa 2007. ^[100] Haijabainika wazi iwapo njia hii huzuia uambukizaji kutoka kwa mume hadi mke ^[101]^[102] na iwapo mbinu hii ina manufaa katika mataifa yaliyostawi na haijabainika miongoni mwa wanaume wanaofanya ngono na wanaume. ^[103]^[104]^[105] Baadhi ya wataalam wanahofia kuwa dhana ya kiwango cha chini cha uhatarisho miongoni mwa wanaume waliotahiri inaweza kupelekea mienendo hatari zaidi, hivyo wanapinga faida ya mbinu hii katika kukinga.^[106] Wanawake waliofanyiwa tohara ya wanawake wana hatari zaidi ya kuambukizwa.^[107]

Miradi inayohimiza kujinyima ngono haijatambulika kuathiri hatari ya baadaye ya kupata VVU.^[108] Ushahidi wa manufaa ya elimu ya rika pia hautoshi.^[109] Elimu ya kina kuhusu ngono inayotolewa shuleni inaweza kupunguza mitindo hatari.^[110] Idadi ndogo ya vijana wangali wanajihusisha katika vitendo hatari licha ya kufahamu kuhusu VVU/UKIMWI, huku wakipuuza hatari ya kuambukizwa.^[111] Haijulikani iwapo kutibu magonjwa mengine ya zinaa ni mwafaka katika kuzuia VVU.^[58]

Kabla ya kuhatarishwa

Asilimia 96 ya watu walikingwa dhidi ya maambukizi iwapo wenzi wao walioambukizwa walitibiwa mapema kwa dawa za kudhibiti VVU ^[112]^[113] Proflaksisi ya kabla ya kuhatarishwa pamoja na kipimo cha kila siku cha dawa ya tenofovir ikiwa na au bila emtricitabine ni mwafaka kwa vikundi Fulani, ikijumuisha: wanaume wanaoshiriki ngono na wanaume wenzao, mchumba wa mtu aliye na VVU na vijana wa Afrika wanaovutiwa na watu wa jinsia tofauti. ref name=VagGel2012/>

Hadhari za kijumla katika mandhari ya utunzaji wa afya zinaaminika kufaulu kupunguza hatari ya VVU.^[114] Matumizi ya dawa zinazodungwa mishipani ni kipengele muhimu cha hatari, hivyo mikakati ya kupunguza madhara kama vile miradi ya kubadilisha sindano na matibabu ya kubadilisha opioidi yanaonekana kufaulu kupunguza hatari.^[115]

Baada ya kuhatarishwa

Vipimo vya dawa za kudhibiti VVU zinazotolewa kati ya saa 48 hadi 72 baada ya kuhatarishwa kwa damu yenye VVU au viowevu vya uzazi hujulikana kama proflaksisi ya baada ya kuhatarishwa.^[116] Matumizi ya dawa moja ya zidovudine hupunguza kwa mara tano, hatari ya kupata VVU baadaye kutokana na jeraha la sindano.^[116] Matibabu hupendekezwa baada ya dhuluma za kimapenzi iwapo mshukiwa anatambulika kuwa na VVU lakini yanakumbwa na utata iwapo hali yake haijulikani.^[117] Taratibu za matibabu ya sasa hutumia lopinavir/ritonavir na lamivudine/zidovudine au emtricitabine/tenofovir na yanaweza kupunguza hatari zaidi.^[116] Kwa kawaida, muda wa matibabu huwa wiki nne ^[118]na mara nyingi huhusishwa na athari kali (zidovudine ikiwa na takriban 70% ya visa, ikijumuisha 24% kichefuchefu, 22% uchovu, 13% mafadhaiko na 9% maumivu ya kichwa.^[63]

Mama hadi mtoto

Hatua za kuzuia kusambaza VVU kutoka kwa mama hadi mtoto zinaweza kupunguza kiwango cha maambukizi kwa asilimia 92-99.^[71]^[115] Kimsingi, hatua hizi hujumuisha kutumia mwungano wa dawa za kudhibiti VVU katika ujauzito na baada ya kuzaa, na pia kunywesha kwa chupa badala ya kunyonyesha.^[71]^[119]Ikiwa itakubaliwa kulisha, inafaidi, inawezekana kumudugharama yake, na ni salama, kina mama hawapaswi kuwanyonyesha watoto wao. Hata hivyo, iwapo haiwezekani, kina mama hushauriwa kunyonyesha pekee katika miezi ya kwanza ya maisha.^[120] Ikiwa kunyonyesha pekee kutatekelezwa, kumpa mtoto proflaksisi ya kudhibiti VVU kwa muda mrefu zaidi hupunguza hatari ya kuambukizwa.^[121]

Chanjo

Kufikia mwaka wa 2012, hakuna chanjo mwafaka dhidi ya VVU/UKIMWI.^[122]Jaribio moja la chanjo ya RV 144 iliyotolewa mwaka wa 2009 lilipelekea upungufu mdogo wa hatari ya kuambukiza kwa takriban 30%, hivyo kuchochea matarajio ya jamii ya utafiti ya kutengeneza chanjo mwafaka zaidi.^[123] Majaribio zaidi ya chanjo ya RV 144 yanaendelea.^[124]^[125]

Udhibiti

Kwa sasa hakuna tiba au chanjo ya VVU mwafaka. Matibabu hujumuisha dawa tendi za kudhibiti VVU za kiwango cha juu zinazopunguza mwendo wa ugonjwa huu.^[126] Kufikia 2010, zaidi ya watu milioni 6.6 wa nchi za mapato ya chini na kati walikuwa wakitumia dawa hizi.^[20] Matibabu pia huhusisha hatua za kuzuia na kutibu Maambukizi nyemelezi.

Matibabu ya dawa za kudhibiti virusi

Chaguo za kisasa za KNKN ni michanganyiko ya angalau dawa tatu za angalau aina au "vikundi" viwili vya ajenti za dawa za kudhibiti VVU.^[127] Mwanzoni, matibabu kwa kawaida huhusisha kizuizi kisicho cha nukliosidi kinachozuia kugeuzwa kwa nakala (KKNKN) pamoja na vidonge viwili vya kifanani cha nukliosidi kinachozuia kugeuzwa kwa nakala (KNKN).^[127] KNKN kwa kawaida hujumuisha: zidovudine (AZT) au tenofovir (TDF) na lamivudine (3TC) au emtricitabine (FTC).^[127] Mwungano wa ajenti zinazojumuisha kizuizi cha protisi (KP) hutumika utaratibu huu ukipoteza utendakazi.^[127]

Wakati wa kuanzisha matibabu kwa kutumia dawa za kudhibiti VVU ni mada ambayo ingali inajadiliwa.^[7]^[128] Shirika la Afya Duniani, miongozo ya Ulaya na pia Marekani hupendekeza dawa za kudhibiti VVU kwa vijana baleghe, watu wazima na kina mama wajawazito walio na kiwango cha CD4 cha chini ya 350/uL au walio na dalili, bila kuzingatia kiwango chao cha CD4.^[7]^[127]Hali hii huwezeshwa na ukweli kwamba kuanzisha matibabu katika wakati huu hupunguza hatari ya kifo.^[129] Isitoshe, Marekani imependekeza matibabu haya kwa watu wote wenye VVU bila kuzingatia kiwango cha CD4 au dalili, ingawa inatoa pendekezo hili ikiwahofia watu wenye kiwango cha juu cha CD4.^[130] Shirika la Afya Duniani pia linapendekeza matibabu kwa watu wenye maambukizi nyongeza ya kifua kikuu na wenye hepatitisi B tendi ya muda mrefu.^[127] Matibabu yanapoanzishwa, inapendekezwa yaendelezwe bila kusita au "kupumzika".^[7] Watu wengi hutambuliwa punde tu baada ya wakati ambao matibabu yalipaswa kuanzishwa.^[7] Katika matibabu, matokeo yanayotarajiwa ni kiwango cha HIV-RNA ya plasma ya muda mrefu cha chini ya nakala 50 /mL.^[7]Viwango vya kudhibitisha ikiwa matibabu ni mwafaka hupendekezwa kwanza baada ya wiki nne na punde viwango hivi vinaposhuka chini ya nakala 50 /mL. Vipimo vya kila baada ya miezi 3-6 kwa kawaida huwa mwafaka.^[7] Udhibiti usio mwafaka huchukuliwa kuwa zaidi ya nakala 400 /mL.^[7] Kulingana na kigezo hiki, matibabu huwa mwafaka kwa zaidi ya 95% ya watu katika mwaka wa kwanza.^[7]

Manufaa ya matibabu hujumuisha upungufu wa hatari ya kuendelezwa kwa VVU na kupunguka kwa hatari ya kifo.^[131]Katika mataifa yaliyostawi matibabu pia huboresha afya ya kimwili na kiakili.^[132] Matibabu hupelekea upungufu wa 70% wa hatari ya kupata kifua kikuu.^[127] Manufaa nyongeza hujumuisha upungufu wa hatari ya kusambazwa kwa ugonjwa huu hadi kwa wenzi kingono, na upungufu wa kusambazwa kwa maambukizi kutoka kwa mama hadi mtoto. ^[127]

Ubora wa matibabu hutegemea uafikiano pakubwa.^[7] Sababu za kutoafikiana hujumuisha: ufikiaji duni wa huduma za kimatibabu,^[133]huduma duni za kijamii, ugonjwa wa akili na uraibu wa madawa.^[134] Isitoshe, utata wa utaratibu wa matibabu (kufuatia idadi ya tembe na idadi ya marudio ya kumeza tembe) na athari kali zinaweza kusababisha kutoafikiana kwa kimakusudi.^[135]Hata hivyo, viwango vya uafikiano ni sawa katika nchi zinazostawi na zilizostawi^[136]

Matukio makuu huhusishwa na ajenti inayotumika.^[137] Baadhi ya visa vinavyotokea mara nyingi hujumuisha:sindromu ya lipodistofi, dislipidemia na kisukari tamu hasa pamoja na vizuizi vya protisi.^[2] Dalili zingine zinazotokea mara nyingi hujumuisha: kuhara,^[137]^[138] na ongezeko la hatari ya ugonjwa wa moyo na mishipa.^[139] Hata hivyo, athari kali huwa katika matibabu mapya yaliyopendekezwa.^[7] Gharama huenda ikawa tatizo kwani baadhi ya dawa huwa ghali ^[140]. Hata hivyo, hadi mwaka wa 2010, 47% ya watu waliohitaji dawa hizi walikuwa wakizitumia katika nchi zinazostawi na za mapato ya wastani^[20] Dawa fulani zinaweza kuhusishwa na ulemavu wa kuzaliwa hivyo hazifai kutumiwa na wanawake wanaopangia kupata watoto.^[7]

Matibabu yanayopendekezewa watoto hutofautiana kidogo na ya watu wazima. Katika nchi zinazoendelea, kufikia mwaka wa 2010, 23% ya watoto waliohitaji dawa hizi walikuwa wakizitumia.^[141] Shirika la Afya Duniani na Marekani inapendekeza matibabu kwa watoto wote wa umri wa chini ya miezi 12.^[142]^[143]Marekani hupendekeza matibabu kwa watoto wa umri wa mwaka 1-5 walio na kiwango cha VVU-RNA cha zaidi ya nakala 100,000 /mL na kwa walio zaidi ya miaka mitano watibiwe iwapo kiwango cha CD4 ni chini ya 500/ul.^[142]

Maambukizi nyemelezi

Mikakati ya kuzuia Maambukizi nyemelezi hufaa watu wengi wenye VVU/UKIMWI. Matibabu ya dawa za kudhibiti virusi huboresha na kupunguza hatari ya kupata Maambukizi nyemelezi kwa wakati huo na baadaye.^[137]Chanjo dhidi ya hepatitisi A na B hupendekezwa kwa watu walio katika hatari ya VVU kabla ya maambukizi, ingawa yanaweza kutolewa baada ya kuambukizwa.^[144] Proflaksisi ya Trimethoprim/sulfamethoxazole kati ya wiki 4-6 na kukoma kunyonyesha watoto waliozaliwa na mama mwenye VVU hupendekezwa katika sehemu zenye upungufu wa raslimali.^[141] Pia inapendekezwa kuzuia PCP kiwango cha CD4 kikiwa chini ya 200 /uL na kwa wenye PCP au waliokuwa nayo awali.^[145] Watu wenye ugandamizaji wa kingamwili pia hushauriwa kupata matibabu ya profilaksisi ya toksoplasmosisi na Meninjitisi ya kriptokokasi. ^[146] Mikakati mwafaka ya kinga imepunguza kiwango cha maambukizi kwa 50% mwaka wa 1992-1997.^[147]

Matibabu mbadala

Takriban 60% ya watu wenye VVU nchini Marekani hutumia mbinu mbalimbali za matibabu saidizi au mbadala.^[148] Ubora wa matibabu haya hata hivyo haujadhibitishwa.^[149] Kwa kuzingatia ushauri wa kilishe na UKIMWI, kuna ushahidi unaoonyesha manufaa ya nyongeza za virutubishi vidogo.^[150] Ushahidi wa manufaa ya nyongeza za seleniamu unaonyesha kuwa manufaa yake si mengi sana.^[151] Kuna ushahidi mdogo kuwa nyongeza ya vitamini A kwa watoto hupunguza vifo na kuboresha ukuaji.^[150] Nyongeza ya vitamini nyingi kwa kina mama wajawazito wenye lishe duni na wanaonyonyesha imeboresha afya ya kina mama na watoto barani Afrika^[150] Kutumia virutubishi vidogo ndani ya lishe katika viwango vya KMS kwa watu wazima wenye VVU kumependekezwa na Shirika la Afya Duniani. ^[152]^[153] SAD linasema kuwa takwimu kadhaa zimeonyesha nyongeza ya vitamini A, zinki na ayoni inaweza kuwaathiri pakubwa watu wazima walio na VVU.^[153] Hakuna ushahidi wa kutosha kuonyesha manufaa ya miti shamba.^[154]

Elimu

Njia muhimu ya kuzuia VVU / UKIMWI ni elimu kwa kuwa hiyo inawezesha kukwepa sababu za maambukizi yake. Ni kwamba watu wanaweza kupata VVU kutokana na ngono na kutokana na damu. Watoto wanaweza pia kupata VVU kutoka kwa mama zao (wakati wa kukua ndani ya akina mama wajawazito na wakati wa kunyonya maziwa ya mama.)

Vitendo vya kijinsia ni njia kuu ya kupata VVU. Kama watu wanatumia kondomu wanapofanya mapenzi, kuna nafasi ndogo zaidi ya kuambukizana VVU, lakini ukweli kamili ni kwamba hakuna ngono salama kwa hakika.

Mtu anaweza pia kupata VVU kwa kuchanga sindano na wenzake. Hii ina maana ya kutumia sindano ambayo haijawahi kusafishwa baada ya mtu mwingine kuitumia. Baadhi ya watu ambao, kinyume cha sheria, huchukua madawa ya kulevya kama heroin na cocaine huchukua dawa hizo kwa sindano. Baadhi yao wanachanga sindano moja. Kama mmojawao ana virusi ya UKIMWI na anashirikisha sindano yake, anaweza kuambukiza HIV kwa watu wengine.

Kuna baadhi ya watu ambao hawataki watu wajue kuhusu kondomu na sindano safi, au hawataki wawe na kondomu au sindano safi. Hao wanaamini kuwa watu wakijua kuhusu kondomu na kuwa na kondomu watafanya ngono zaidi na hivyo kuzidisha maambukizi badala ya kuyapunguza kwa sababu kinga hiyo si madhubuti. Vilevile wanaamini kuwa watu wakiwa na sindano safi watatumia dawa za kulevya zaidi. Wengi wa wanaodhani hivyo ni pia kwa sababu ya dini zao zinazokataza uzinifu na ulevi.

Chanjo dhidi ya HIV

Njia bora ya kuzuia VVU ni wazo la kuwa na chanjo, lakini hakuna chanjo kwa HIV bado. Wanasayansi wengi wanatafuta chanjo ya VVU ili kuokoa uhai wa mamilioni ya watu.

Matarajio ya kuishi

Prognosi

VVU vimekuwa wa muda mrefu wala sio ugonjwa mkali katika sehemu nyingi ulimwenguni.^[155] Prognosi ni tofauti katika watu mbalimbali, na kiwango cha CD4 pamoja na wingi wa virusi huwa muhimu katika kutabiri matokeo.^[6] Wastani wa muda wa kuishi baada ya kuambukizwa unakadiriwa kuwa kati ya miaka 9-1 bila matibabu, ikitegemea aina ndogo ya VVU.^[156] Baada ya utambuzi wa UKIMWI, iwapo matibabu hayapo, uwezo wa kuishi huwa kati ya miezi 6-19 .^[157]^[158] KKNKN na uzuiaji mwafaka wa Maambukizi nyemelezi hupunguza kima cha vifo kwa 80% na kuongeza matarajio ya urefu wa maisha hadi miaka 20-50 kwa mtu mzima wa kimo aliyetambuliwa na maambukizi karibuni.^[155]^[159]^[160] Hii ni kati ya 2/3^[159] na karibu na kiwango cha umma.^[7]^[161] Matibabu huwa hayafaulu yanapoanzishwa yakiwa yamechelewa katika prognosi,^[7] kwa mfano, matibabu yakianzishwa kufuatia utambuzi katika kiwango cha UKIMWI, matarajio ya urefu wa maisha huwa miaka~10–40 . ^[7]^[155] Wasipotibiwa, nusu ya watoto wachanga wanaozaliwa na VVU hufa kabla ya miaka miwili.^[141]

Sababu kuu ya vifo vinavyotokana na VVU/UKIMWI ni Maambukizi nyemelezi na saratani ambayo mara nyingi hutokana na matatizo endelevu ya mfumo wa kingamwili.^[147]^[162] Hatari ya saratani huonekana kuongezeka ikiwa kiwango cha CD4 kitashuka chini ya 500/uL.^[7] Kiwango cha kuendelea kwa ugonjwa wa kiutambuzi hutofautiana pakubwa katika watu mbalimbali na kimedhihirika kuathiriwa na vipengele kadhaa, kama vile uhatarisho na utendaji wa kingamwili;^[163] uwezo wa kufikia huduma ya afya na uwepo wa maambukizi pacha;^[157]^[164] pamoja na aina ya (au za) virusi husika.^[165]^[166]

Maambukizi pacha ya kifua kikuu ni mojawapo ya visababishi vikuu vya ugonjwa na vifo vya watu wenye VVU/UKIMWI, huku yakipatikana katika 1/3 ya watu walioambukizwa VVU na husababisha 25% ya vifo vinavyohusiana na VVU.^[167] VVU pia ni kipengele kikuu zaidi cha hatari ya kifua kikuu.^[168] Hepatitisi C ni maambukizi mengine pacha yanayotokea mara nyingi, ambapo kila ugonjwa huongeza uendeleaji wa ugonjwa mwingine^[169] Saratani zinazotokea mara nyingi zaidi ambazo huhusishwa na VVU ni sakoma ya Kaposi na limfoma isiyo ya Hodgkin.^[162]

Hata wakitibiwa kwa dawa za kudhibiti VVU, watu walio na VVU huenda wakakumbwa na matatizo ya kiniuroni ya ufahamu,^[170] osteoporosi,^[171] nuropathia,^[172] saratani,^[173]^[174] nefropathi,^[175] na ugonjwa wa moyo na mishipa baada ya muda mrefu.^[138] Haijulikani ikiwa hali hizi hutokana na kuambukizwa kwa VVU kwenyewe au ni athari kali za matibabu yake.

Watu wangapi wana UKIMWI?

Mwaka 2015 walau watu wapatao 36,700,000 walikuwa wakiishi na VVU. Watu wengi wenye VVU hawajui kuwa nayo. Kwa sababu hiyo, idadi halisi ya watu wanaoishi na VVU haijulikani.

Wengi kati ya watu wenye VVU huishi katika Afrika. Wengi kati ya watoto ambao hufariki dunia kutokana na UKIMWI pia wanaishi barani Afrika.

Epidemolojia

VVU/UKIMWI ni janga la kimataifa]].^[177] Kufikia mwaka wa 2010, takriban watu milioni 34 wana VVU kote ulimwenguni.^[20] Kati ya hawa, takriban milioni 16.8 ni wanawake nao milioni 3.4 wako chini ya miaka 15 .^[20] Hali hii ilisababisha karibu vifo milioni 1.8 mwaka wa 2010 ikilinganishwa na milioni 3.1 katika mwaka wa 2001.^[20]

Kusini mwa Sahara ni eneo lililoathirika zaidi. Katika mwaka wa 2010, kadirio la 68% (milioni 22.9 ) la visa vyote vya VVU na 66% ya vifo (milioni 1.2 ) vilitokea katika eneo hili.^[178] Hii inamaanisha kuwa karibu 5% ya watu wazima wana virusi hivi^[179] na vinaaminika kuwa kisababishi cha 10% ya vifo vyote vya watoto.^[180] Wanawake wa eneo hili huchangia karibu 60% ya visa vyote tofauti na maeneo mengine.^[178] Afrika Kusini ina idadi kubwa zaidi ya watu wenye VVU ulimwenguni kote, ikiwa ni watu milioni 5.9 .^[178] Kiwango cha matarajio ya urefu wa maisha kimepungua katika nchi zilizoathirika zaidi kutokana na VVU; kwa mfano, mwaka wa 2006, ilikadiriwa kuwa kiwango hiki kilipungua kutoka miaka 65 hadi 35 nchini Botswana.^[21]

Kusini & Kusini Mashariki mwa Asia ni eneo la pili lililoathirika zaidi; mwaka wa 2010, eneo hili lilikuwa na kadirio la visa milioni 4 au 12% ya watu wote wanaoishi na VVU, hivyo kupelekea vifo vya takriban watu 250,000.^[179] Takriban milioni 2.4 ya visa hivi viko India^[178] Ukithiri wa VVU uko chini katika maeneo ya Uropa Magharibi na Kati ikifikia 0.2% na Mashariki mwa Asia ikiwa na 0.1%.^[179]

Mwaka wa 2008 nchini Marekani, takriban watu milioni 1.2 walikuwa wakiishi na VVU, hivyo kupelekea takriban vifo 17,500. Kituo cha Kudhibiti na Kuzuia Magonjwa kilikadiria kuwa, mw aka wa 2008, 20% ya Wamarekani waliokuwa na VVU hawakujua hali yao. ^[181] Nchini Uingereza, kufikia 2009 kulikuwa na takriban visa 86,500 vilivyopelekea vifo 516.^[182] Nchini Kanada, kufikia 2008 kulikuwa na visa 65,000 vilivyopelekea vifo 53.^[183] Kuanzia kubainika kwa VVU mnamo mwaka wa 1981 hadi 2009, vifo karibu milioni 30 vimetokea.^[19]

Jamii na Utamaduni

Unyanyapaa

Mvulana baleghe akitabasamu akipigwa picha huku mkono wa mwingine ukiwa uemeegemeshwa begani mwake — Ryan White alipelekea kuwa mtoto wa uhamasisho wa VVU baada ya kufukuzwa shuleni kwa sababu alikuwa ameambukizwa.

Unyanyapaa dhidi ya watu walio na UKIMWI zipo kote ulimwenguni kwa namna mbalimbali, zikiwemo kutengwa, kukataliwa, ubaguzi na kuepuka watu walioambukizwa VVU, kulazimishwa kupimwa VVU bila idhini au ulinzi wa usiri, vurugu dhidi ya watu walioambukizwa au waliodhaniwa kuambukizwa VVU; na karantini ya watu waliombukizwa VVU.^[184] Vurugu zinazohusiana na unyanyapaa au hofu ya vurugu huzuia watu wengi kupimwa VVU, kurudia matokeo ya vipimo na kutotafuta matibabu. Hali hizi hugeuza ugonjwa wa muda mrefu unaoweza kudhibitiwa kuwa hukumu ya kifo na kuendeleza ueneaji wa VVU.^[185]

Unyanyapaa dhidi ya watu wanaoishi na UKIMWI, umegawanywa zaidi katika vikundi vitatu kama ifuatavyo:

Unyanyapaa Mkuu wa UKIMWI -mawazo ya woga na wasiwasi unaoweza kuhusishwa na ugonjwa wowote aunaoua au kuambukiza.^[186]
Unyanyapaa wa kiishara wa UKIMWI -kutumia VVU/UKIMWI kuonyesha mitazamo fulani dhidi ya vikundi vya jamii au mitindo ya maisha inayohusishwa na ugonjwa huu.^[186]
Unyanyapaa wa kihisani wa UKIMWI- Unyanyapaa dhidi ya watu wanaohusishwa na suala la VVU/UKIMWI au watu walio na VVU.^[187]

Mara nyingi, unyanyapaa wa UKIMWI huonyeshwa pamoja na unyanyapaa wa aina moja au nyingine, hasa unyanyapaa unaohusiana na ushoga, uhuntha, uasherati ukahaba na kutumia dawa za kudunga mishipani.^[188]

Katika nchi nyingi mataifa yaliyostawi, kuna uhusiano kati ya UKIMWI na ushoga au uhuntha na uhusiano huu huhusishwa na kiasi kikubwa cha ubaguzi wa kingono kama vile mitazamo ya kupinga ushoga/huntha.^[189] Pia kuna uhusiano kati ya UKIMWI na mitindo yote ya mwanaume kwa mwanaume, ikiwa ni pamoja na ngono kati ya wanaume ambao hawajaambukizwa. ^[186]Hata hivyo, njia kuu ya kuenea kwa UKIMWI ulimwenguni kote inabakia kuwa maambukizi kati ya waume na wake. ^[190]

Athari za kiuchumi

VVU/UKIMWI huathiri uchumi wa watu na nchi.^[180] Pato la ndani la uzalishaji la nchi zilizoathiriwa zaidi limepungua kufuatia ukosefu wa rasilimali ya kibinadamu.^[180]^[191]Bila lishe mwafaka, huduma za afya na dawa, watu wengi hufariki kutokana na matatizo yanayohusiana na UKIMWI. Kando na kutoweza kufanya kazi, watu hawa pia huhitaji kiwango kikubwa cha huduma za afya. Inakadiriwa kuwa kufikia mwaka wa 2007, diadi ya watoto yatima kutokana na UKIMWI milioni 12.^[180] Wengi wao hutunzwa na nyanya na babu wazee. ^[192]

UKIMWI hupunguza idadi ya watu wanaoweza kulipa ushuru Kwa kuwaathiri hasa vijana, hivyo kupunguza raslimali zilizopo za matumizi ya umma kama vile huduma za elimu na afya ambazo hazihusiki na UKIMWI. Hali hii husababisha ongezeko la upungufu wa pesa za nchi na kupunguza ukuaji wa uchumi. Hali hii kisha hupelekea upungufu wa ukuaji wa msingi wa ushuru, athari ambayo huongezeka iwapo kuna matumizi zaidi katika matibabu, mafunzo (ili kuchukua nafasi ya wafanyakazi wanaougua), kuwalipa wafanyakazi wagonjwa na kuwatunza mayatima wa UKIMWI. Hali hii hutokea hasa iwapo ongezeko kubwa la vifo vya watu wazima litapelekea kubadilika kwa wajibu na lawama ya kuwatunza mayatima hawa kutoka kwa familia hadi kwa serikali.^[192]

Katika kiwango cha familia, UKIMWI husababisha upungufu wa mapato na pia ongezeko la matumizi katika huduma za afya. Utafiti katika inchi ya Côte d'Ivoire ulionyesha kuwa familia zilizo na mgonjwa aliye na VVU/UKIMWI zilitumia pesa mara mbili zaidi ya familia zingine. Matumizi haya ya ziada pia hupelekea kiwango kidogo zaidi cha mapato ya kutumia katika elimu au uwekezaji wa kibnafsi au kifamilia.^[193]

Mayatima

Asilimia ya watu waliokuwa wanaishi na VVU katika Afrika miaka 1999-2001

Watu wengi ambao wanakufa kutokana na UKIMWI, hasa katika Afrika, huacha watoto ambao bado ni hai, na ambao wanaweza wanahitaji msaada na huduma.

Dini na UKIMWI

Mada kuhusu dini na UKIMWI imekuwa ikikumbwa na utata mwingi katika miaka ishirini iliyopita, hasa kwa sababu baadhi ya viongozi wa kidini wametangaza hadharani kwamba wanapinga utumiaji kondomu.^[194]Hitilafu ya kutaja: Invalid parameter in <ref> tag Synagogue Church Of All Nations walitangaza maji ya upako ili kuwezesha uponyaji kutoka kwa Mungu, ingawa walikana kuwa waliwashauri watu kukoma kutumia matibabu.^[195]

Uonyeshaji katika vyombo vya habari

Mojawapo ya visa maarufu zaidi vya UKIMWI kilikuwa cha Mmarekani Rock Hudson, muigizaji shoga aliyekuwa ameoa kisha kutalaki hapo awali. Hudson alifariki tarehe 2 Oktoba mwaka wa 1985 baada ya kutangaza kuwa alikuwa na VVU tarehe 25 Julai mwaka uo huo. Yeye alikuwa ametambuliwa kuwa na ugonjwa huo mwaka wa 1984.^[196] Mgonjwa mashuhuri kutoka Uingereza mwaka huo alikuwa Nicholas Eden mwanasiasa shoga na mwana wa Waziri Mkuu, marehemu Anthony Eden.^[197]Tarehe 24 Novemba, 1991, virusi hivi vilipelekea kifo cha mwanamziki wa aina ya mziki wa rock, Mwingereza Freddie Mercury. Mercury, aliyeongoza bendi iliyojulikana kama Queen alifariki kutokana na magonjwa yanayohusiana na UKIMWI baada ya kutambuliwa kuwa na ugonjwa huo siku iliyopita tu.^[198] Hata hivyo, Mercury alikuwa ametambuliwa kuwa na ugonjwa huo mwaka wa 1987.^[199] Mojawapo ya visa maarufu zaidi vilivyotokana na ngono kati ya watu wa jinsia tofauti ni kisa cha Arthur Ashe, mchezaji tenisi Mmarekani. Ashe alitambuliwa kuwa na VVU mnamo tarehe 31 Agosti,1988; baada ya kuambukizwa alipokuwa akiongezwa damu akifanyiwa upasuaji wa moyo awali miaka ya 1980. Vipimo zaidi katika saa 24 baada ya utambuzi wa kwanza vilionyesha kuwa Ashe alikuwa na UKIMWI, lakini hakuwambia watu kuhusu utambuzi huu hadi Aprili 1992.^[200] Ashe alifariki kutokana na UKIMWI akiwa na umri wa miaka 49 tarehe 6 Februari, 1993.^[201]

Picha ya Therese Frare ikionyesha mwanaharakati wa ushoga David Kirby akifariki kutokana na UKIMWI huku akizungukwa na familia yake, ilipigwa Aprili mwaka wa 1990.LIFE magazine ilisema kuwa picha hiyo ilikuja kufahamika kama picha maarufu zaidi kuwahi kuhusishwa na janga la UKIMWI/VVU. Picha hiyo iliyochapishwa katika LIFE magazine, ilishinda tuzo la World Press Photo, kisha kupata umaarufu ulimwenguni kote baada ya kutumiwa na United Colors of Benetton katika kampeni yao ya utangazaji ya 1992.^[202]

Ukanaji, njama na ila

Kikundi kidogo cha watu kingali kinakana uhusiano wa VVU na UKIMWI, ^[203] uwepo wa VVU au ubora wa vipimo vya VVU na njia za matibabu.^[204]^[205]Madai haya, yanayojulikana kama ukanaji UKIMWI, yamechunguzwa na kukataliwa na jamii ya kisayansi.^[206]Hata hivyo, madai haya yana athari kuu kisiasa, hasa nchini Afrika Kusini. Hatua ya serikali ya nchi hii kukubali kirasmi ukanaji wa UKIMWI ilipelekea mwitikio usiofaa wa janga hili, na imelaumiwa kupelekea visa vingi vya maambukizi ya VVU na mamia ya maefu ya vifo ambavyo vingeepukwa.^[207]^[208]^[209] Muungano wa mataifa ya Urusi ulianzisha Operesheni INFEKTION, uhamasisho wa ulimwengu mzima hatua za kimikakati wa kueneza habari kuwa VVU/UKIMWI ulitengenezwa na Marekani. Takwimu zinaonyesha kuwa idadi kubwa ya watu wanaamini na wanaendelea kuamini madai hayo.^[210]

Kuna aina nyingi za dhana potovu kuhusu VVU na UKIMWI. Dhana tatu kuu ni kwamba UKIMWI unaweza kusambazwa kwa kumgusa mtu, kuwa ngono na bikira itatibu UKIMWI na kuwa VVU vinaweza tu kuambukizwa wanaume shoga na watumiaji wa madawa. Dhana zingine potovu ni kuwa tendo lolote la ngono ya kinyeo kati ya wanaume wawili shoga wasioambukizwa linaweza kupelekea maambukizi, na kuwa majadiliano wazi kuhusu ushoga na VVU katika mashule yatasababisha ongezeko la ushoga na UKIMWI.^[211]^[212]

Utafiti

Utafiti wa kuboresha matibabu ya kisasa unajumuisha kupunguza madhara ya ziada ya dawa zilizopo, kurahisisha kanuni za kutumia dawa na kuboresha ubora na kuamua utaratibu bora wa kanuni ili kudhibiti ukinzani wa dawa. Hata hivyo, chanjo pekee ndiyo inayodhaniwa kuweza kusitisha janga hili. Hii ni kwa sababu chanjo ni ya bei nafuu, hivyo mataifa yanayostawi yanaweza kuimudu, na haitahitaji matibabu ya kila siku.^[213] Hata hivyo, baada ya miaka 20 ya utafiti, imekuwa vigumu kupata chanjo dhidi ya VVU-1,^[213]^[214] hivyo tiba bado haijapatikana.

Upandikizaji seli kuu

Mwaka wa 2007, Timothy Ray Brown,^[215] mwanaume wa umri wa miaka 40 aliyekuwa na VVU, pia anayejulikana kama "the Berlin Patient" alipewa huduma ya pandikizo la seli kuu kama mojawapo ya matibabu ya lukemia sugu ya mieloidi (LSM).^[216]Pandikizo la pili lilifanyika mwaka uliofuata baada ya kuugua tena. Mfadhili alichanguliwa sio tu kwa kuwa ana upatanifu wa kijeni lakini pia kwa kuwa alikuwa na utangamano wa kubadilika kwa CCR5-Δ32 ambayo huwezesha ukinzani dhidi ya maambukizi ya VVU.^[217]^[218] Baada ya miezi 20 bila matibabu ya dawa za kudhibiti VVU, iliripotiwa kuwa viwango vya VVU kwenye damu ya Brown uboho na matumbo vilikuwa chini ya kiwango cha kutambulika.^[218]Virusi hivi vilibakia katika kiwango hicho kwa miaka mitatu baada ya upandikizo wa kwanza.^[216]Ingawa watafiti na baadhi ya wachambuzi wanasema kuwa matokeo haya ni tiba, wengine wao wanadokeza kuwa virusi hivi vinaweza kuwa vimejificha ndani ya tishu^[219]kama vile ubongo (unaotumika kama hifadhi).^[220] Matibabu ya seli kuu yamebakia chini ya kuchunguzwa kwa sababu ya asili yake ya kinadharia, ugonjwa wenywe na hatari ya kufa inayohusishwa na upandikizaji wa seli kuu na ugumu wa kupata wafadhili mwafaka.^[219]^[221]

Matibabu ya kuboresha kingamwili

Matibabu saidizi za kudhibiti uigaji wa virusi, matibabu ya kingamwili zinazoweza kusaidia kuboresha mfumo wa kingamwili zilizochunguzwa awali, na juhudi zinazoendelea ni pamoja na IL-2 na IL-7.^[222]

Kutofaulu kwa chanjo kadhaa kukinga dhidi ya maambukizi ya VVU na kuendelea kwa UKIMWI kumepelekea mwelekeo mpya wa kuzingatia taratibu za kibayolojia zinazosababisha ufiche wa VVU. Kipindi kifupi cha matibabu ya kuunganisha dawa za kudhibiti VVU na dawa zinazolenga hifadhi fiche siku moja kinaweza kutokomeza maambukizi ya VVU.^[223]Watafiti wamegundua abusaimu inayoweza kuharibu eneo la kufungia protini ya gp120 CD4. Protini hii hupatikana katika aina zote za VVU kwa sababu ndiyo ncha ambapo limfosaiti za B hujishikisha kisha kuafikiana kwa mfumo wa kingamwili.^[224]

Tanbihi

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↑ Tincati, C; d'Arminio Monforte, A; Marchetti, G (2009 Jan). "Immunological mechanisms of interleukin-2 (IL-2) treatment in HIV/AIDS disease". Current molecular pharmacology 2 (1): 40–5. PMID 20021444. doi:10.2174/1874467210902010040. Check date values in: |date= (help)
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Marejeo

Mandell, Gerald L.; Bennett, John E.; Dolin, Raphael, wahariri (2010). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (toleo la 7th). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
Joint United Nations Programme on HIV/AIDS (UNAIDS) (2011). Global HIV/AIDS Response, Epidemic update and health sector progress towards universal access. Joint United Nations Programme on HIV/AIDS.

Viungo vya nje

HIV/AIDS katika Open Directory Project
Joint United Nations Program on HIV/AIDS
AIDSinfo – HIV/AIDS Treatment Information, U.S. Department of Health and Human Services
Shirika la Afya Duniani Mashirika 3 na 5 Initiative
Médecins Sans Frontières: Kampeni ya upatikanaji wa madawa muhimu
WHO Mpango wa VVU / UKIMWI
Elimu UKIMWI Mfumo wa Taarifa za Global
Kutoka Taasisi ya Taifa ya Marekani ya Afya
New England Journal of Medicine Ibara "Ruhusu dhidi ya Wagonjwa? Kurefusha maisha Tiba katika India"
AIDSPortal maarifa mtandao
Piedmont Care
UKIMWI portal
Tovuti ya Shirika la Umoja wa Mataifa la Masuala ya Ukimwi, UNAIDS
HIV InSite
sida.fr • un centre pour les malades du SIDA • infos • tèmoignages • actualités

Makala hii kuhusu mambo ya tiba bado ni mbegu.
Je, unajua kitu kuhusu Ukimwi kama sababu yake au mahusiano yake na mada nyingine?
Labda unaona habari katika Wikipedia ya Kiingereza au lugha nyingine zinazofaa kutafsiriwa?
Basi unaweza kuisaidia Wikipedia kwa kuihariri na kuongeza habari.

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