Siriimu

Buno bulwadde obuleetebwa akawuka ka vayiraasi akakosa obutoffaali mu mubiri gw’omuntu obukola ku kulwanyisa endwadde ne gusigala nga gunafuye. Olw’ensonga eno, kye kava kayitibwa HIV (Human immunodeficiency virus infection. Mu mbeera eno, Siriimu bulwadde obukosa enkola n’obuttoffaali bw’omubiri obulwanyisa endwadde. Omuntu nga yakakwatibwa akawuka kano, asobola okufunamu olubu lw’ endwadde ezeekuusa ku yegu oba ssenyiga. Kino kisobola okuddirirwa ekiseera ekiwanvuko okuyitawo kyokka nga tewali kabonero konna muntu kaalaga. Obulwadde bwe bugenda bukulu mu mubiri, bw’ongera okutabangula entegeka y’omubiri ekola ku kulwanyisa endwadde ezigulumba ekireetera omuntu okuba ng’alumbibwalumbibwa endwadderwadde omuba n’ebizimba ebitatera kukwata muntu mulamu bulungi ng’obutoffaali bwe mu mubiri n’entegeka erwanyisa obulumbaganyi mu mubiri ekola bulungi.

Akawuka ka HIV okusinga kayita mu kikolwa ky’abantu eky’okwegatta ( kino kitwaliramu abeegatta mu ntegeera emanyiddwa ey’omukazi n’omusajja n’ey’ebisiyaga okugeza omusajja ne musajja munne), okufuna omusaayi mwe kaali, okuyita mu mpiso n’okuva ku maama ne kakwata omwana mu biseera omukazi w’abeerera olubuto, mu kuzaala aba mu kuyonsa. Amazzi g’omubiri gw’omuntu agamu nga amalusu n’amaziga tegasiiga HIV. Ekubbo erisooka okwekuuma akawuka ka Siriimu kuba kwekuuma mu kwettanira ebikolwa by’okwegatta mu mukwano n’okwengendereza enkozesa y’ebintu byonna ebifumita ng’empiso. Teri ddagala liwonya wadde erigema obulwadde buno, naye, waliwo enzijanjaba esobola okwettanirwa okukendeeza ku misinde akawuka gye kaddukirako mu kukosa omubiri gw’omuntu. Enzijanjaba eno esobola okuleetera ddala omuntu alina akawuka kano okubeerera ddala mu bulamu kumpi nga atakalina era n’awangaalira ddala. Newankubadde ezijanjaba y’eddagala eriweeweeza lino ku kawuka ekendeeza ku misinde akawuka kano gye keeyongerera mu musaayi gw’omuntu mu mubiri ne kitangira akalina okulumbibwalumbibwa ennyo endwadde, enzijanjaba eyinza okuba ey’obuwanana n’oluusi okutuusa obuzibu obulala kw’agyettanidde ennyo.

Abakola ku kunoonyereza ku Ndagabutonde, bagamba nti ensibuko ya siriimu/HIV ewanuuzibwa kuba mu mawanga ga Masekkati- n’Obugwanjuba ga Afrika ku nkomerero y’ekyasa ekye 19 oba entandikwa y’ekyasa ekya 20. Siriimu yasooka kwetegerezebwa kitongole kya Amerika ekikola ku kukugira n’okutangira ensaasaana y’endwadde ekya Center for Disease Control and Prevention (CDC) mu 1981 ng’aleetebwa akawuka ka HIV. Okuva Siriimu lwe yavumbulwa, asse abantu abateeberezebwa okuba mu bukadde 36 (ng’otunuuliridde omwaka 2012). Mu mwaka gwe gumu guno we gwatuukira, 2012, kiwanuuzibwa nti abantu abakunukiriza mu bukadde 35 n’emitwalo 30 be baalina akawuka kano mu nsi yonna. Siriimu assibwa mu ttuluba ly’endwadde eziyitibwa ‘’Nnabe oba Nawokeera’’ oba endwadde ezisaasaanira ettunduttundu eddene ate ng’era zisigala zikyasaasaana.

Siriimu alina engeri nkumu gy’akosezaamu ensi, okusooka ng’endwadde n’ensibuko y’okusosolebwa. Obulwadde bulina n’engeri gye bukosezzaamu ebyenfuna naddala okujojobya abantu ababa mu myaka emikozi. Wabula obulwadde bufuuse mitwe egivuddeko okusika omuguwa mu nzikiriza z’amadiini. Mu ngeri y’emu, obulwadde bussiddwaako nnyo essira naddala mu kisaawe ky’ebikisawo n’ebyobufuzi era ng’emirimu egy’ekuusa ku kunoonyereza ku bulwadde buno gissiddwaamu n’okuvujirirwa omusimbi omusuffu okuva 1981 lwe bwazuulibwa okulaba obo basobola okubowonya oba si kyo okufuna vakisini ya siriimu.

Obubonero kw’olabira

Akawuka ka HIV kalina emitendera esatu mwe keeyebululira nga katuuse mu mubiri gw’omuntu okutuuka lwagwa ddala ku ndiri n’ayogerwako ng’alina Siriimu. Emitendera gino gye gino wammanga: acute infection, clinical latency ne AIDS.

Obubonero obukulu obw’omuntu ali mu acute infection

Ekiseera ekiddirira ng’omuntu akwatiddwa akawuka ka HIV okuyita mu limu ku makubo ge twalabye waggulu ky’ekiyitibwa acute HIV. Mu kiseera kino abantu abasinga bateeganyizibwa ssenyiga n’endwadde ezimwefaanaanyiriza okumala ebbanga eriri wakati wa wiiki 2-4 kyokka nga waliwo abatabaako kintu kyonna kibabaako. Mu bantu ababa bakwatiddwa akawuka kano, ebitundu ebiri wakati wa 40 – 90 bafuna obubonero buno; omusujja, esanjabavu, omutwe ogubobba, okubutuka olususu ng’obutulututtu bulimu olusirasira, n’amabwa mu bulago n’olumu mu bitundu eby’ekyama.Abantu abamu mu kiseera kino batera n’okulumbibwalumbibwa endwadde enneegwanyize ezijja olw’okuba mu musaayi muba muyingiddemu akawuka akagwira akatali kaamu. Endwadde endala ezeekuusa ku lubuto ng’okusesema, okusinduukirirwa emmeeme n’okufuna ekiddukano. Olumu omuntu ali mu kaseera kano asobola okufuna embeera y’okusannyalalasannyalala okutonotono oluusi mu bigere n’ebitundu ebirala embeera eyitibwa Guillain – Barre Syndrome Olw’okuba obubonero obwogeddwaako waggulu tebujja mu ngeri esengekeddwa, obumu olumu tebwetegerezebwa nti bwa kawuka ka HIV. Ne mu mbeera ezimu ezirabibwa abasawo oba eddwaaliro, ziteera okuwubisibwa endwadde endala nazo olumu eziraga obubonero obwefaananyirizaako. Olw’ensonga eno, kye kiva kisembebwa eri omulwadde yenna aba atawaanyizibwa omusujja ogutasobola kunnyonnyolwa bulungi okwekengerwa olw’akawuka ka HIV.

Obubunero bw’omuntu ali mu mutendera gwa Clinical latency

Obubonero obusooka buddirirwa omutendera guno. N’awatali bujjanjabi bwonna, omutendera guno ogw’omuntu eyakwatibwa akawuka ka HIV gusobola okumala ebbanga eriri wakati w’emyaka 3 n’okusukka 20 ( naye ng’okusinga kitera kuba myaka nga 8). Newankubadde ku ntandikwa y’omutendera guno omuntu ayinza obutaba na kabonero konna, bwe guba gufundikira, omuntu atandika okutaataganyizibwa omusujja, okukogga, endwadde ezeekusa ku lubuto n’okulumizibwa ebinywa. Wakati w’ebitundu 50 ne 70 abantu ku mutendera guno bafuna okuzimba kw’esanjabavu , okuba kutwaliramu okuzimba kw’esanjabavu ezisukka mw’emu (mu bitundu ebitali mbalakaso) okumala ebbanga eriri wakati w’emyezi 3 – 6.

Wadde abantu abasinga abalina ekika ky’akawuka HIV-1 basobola okuzuulibwa ng’awatali bujjanjabi katuusa omuntu oyo mu mbeera y’okweyubula n’alabikira ddala nti mulwadde wa siriimu, akatundu akatono ak’abantu abamu (ebitundu 5 ku 100) basigala ng’omuwendo gw’obutaffooli bw’omusaayi obulwanyisa obulumbaganyi mu gwo (CD4 T cells) nga guli waggulu newankubadde baba tebali ku bujjanjabi bwa Antiretroviral okumala emyaka egisukka 5. Abantu abagwa mu ttuluba lino be bayitibwa ba HIV controllers oba long-term nonprogressors (LTNP). Ettuluba eddala lye ly’abantu , ababeera n’akawuka akatasobola kulabibwa oba akatono mu musaayi wadde baba tebali ku nzijanjaba ya ARVs. Bano bayitibwa elite controllers oba elite suppressors. Bano mu bantu ababa n’akawuka 300, musobola okubaamu 1 yekka.

Obubonero bw’omuntu akawuka gwe katuusizza ku ddala lya Siriimu(AIDS)

Omuntu agambibwa nti wa Siriimu, akawuka HIV kaba katuusizza omubiri gwe okuba nga gunafuyisiddwa ddala . Mu mbeera eno, omuntu kati aba alina ekiyitibwa Acquired Immune Deficiency Syndrome (AIDS). Eno esobola okunnyonnyolwa ng’embeera ng’obutoffaali obulwanyisa obulumbaganyi mu masaayi (CD4+ Tcells) nga zisse wansi we 200 oba okubalukawo kw’endwadde ezeekuusa ku kawuka ka HIV. Awatali bujjanjabi butuukiridde, kumpi ekitundu ky’abantu ababa n’akawuka ka HIV batuuka mu mbeera y’okuba ne Siriimu mu bbanga lya myaka 10.

Embeera eziraga omuntu atuuse mu mbeera eno ziri nga 3

1 Embeera esooka pneumocystis pneumonia , omuntu afuna obubonero omuli omusujjasujja, ekifuba – oluusi ekiba ekikalu, okufuna obuzibu mu kussa, okutuuyanirira ekiro n’ebirala.

2 Embeera endala ye Cachexia - Wasting Syndrome. Muno omuntu atandika okufuna obukoowukoowu, ebinywa okusereba ssaako okukogga akagenderere. Okukogga kuno kuba mu ngeri nti oli ne bw’alya atya emmere ezimba omubiri taddamu kufuna mubiri.

3 Embeera endala ye ya Esophageal Candidiasis. Muno omuntu atandika okufuna engeri y’amabwa mu mimiro. Obubonero obulala buba endwadde ezeekuusa ku mukutu ogussizibwa empeewo.

Omuntu asobola n’okutaganyizibwa eddwande enneegwanyize (opportunistic infections) eziba zireetebwa obuwuka bwa bakitiriya, vayiraasi, fungi ne parasites nga zino ziba zirwanyisibwa baserikale b’omubiri. Endwadde ezikwata omuntu ebiseera ebisinga ziba zeekuusa ku mbeera gy’aba abeeramu. Endwadde zino zisobola okukosa ekitundu ky’omubiri.

Abantu abalina Siriimu ebiseera ebisinga baba basabola okufuna kookolo eyeekuusa ku viyiraasi, nga Kaposi’s Sarcoma, Burkitt’s lymphoma, Primary Central nervous system lymphoma ne kookola wa nnabaana (cervical cancer).

Kookolo wa Kaposi’s Sarcoma y’asinga okwegiriisiza mu bantu ababa ne HIV era ng’ebitundu ebiri wakati we 10 na 20 ku 100 gwe baba naye. Ekika ekyokubiri ekya kookolo ye lymphoma, ng’ono kigambibwa yatta kumpi ebitundu 16 ku 100 ku by’abantu ababa ne HIV so ng’era ke kamu ku bubonero obusooka mu bantu ebitundu ebiri wakati we 3 ne 4 ku bazuulibwa nti balina siriimu. Ebika bya kookolo bino ebibiri birina akakwate n’ekisipi (Human herpes virus). Kookolo wa nnabaana asinga kuba mu baba ne Siriimu olw’akakwate ne viyiraasi ya Human papillomavirus. Okwongereza kw’ebyo, abantu abalina Siriimu babeera n’obubonero bw’omusujja gw’oluteentezi, okutuuyanirira (naddala ekiro), esanjabavu ezizimba, okutiitima, obunafu n’okukogga. Ekiddukano nako kabonero akeeyolekera mu bitundu 90 ku 100 eby’abantu ababeera ne Siriimu.

Ensaasaana y’akawuka ka siriimu

Akawuka HIV kayita mu makubo amakulu asatu: 1. Okwegatta mu by’omukwano 2. Okugatikka musaayi aba amazzi g’omubiri ng’enkwaso, 3. N’okuva ku maama ne kakwata omwana mu biseera by’olubuto, okuzaala, oba okuyonsa (Vertical transmission)

Tewali kakwate kukwatibwa kawuka kano singa omuntu akwata mu bubi bw’omuntu alina akawuka kano, eminyira, amalusu, ebikolondolwa, amaziga, entuuyo, omusulo oba ebisesemye okujjako, ng’ebintu bino bibaddemu omusaayi. Kisoboka omuntu okukwatibwa ebika bya HIV eby’enjawulo ekimanyiddwa nga superinfection.

Okwegatta

Ekkubo erisinga okuyitwamu okusiigibwa akawuka ka HIV, lya kwegatta mu kikolwa ky’omukwano n’omuntu aba akalina. Omuwendo gw’abasinga okufuna akawuka kano bayita mu kika ky’okwegatta ekimanyiddwa wakati w’omusajja n’omukazi (hetero sex). Wabula mu Amerika, nga tunuulidde omwaka 2009, okusaasaana kw’akawuka okuyita mu kwegatta kwali mu bantu abeenyigira mu bisiyaga era nga bano baali bakola ebitundu 64 ku 100 ku banntu bonna abaali bakwatibwa akawuka. Bw’oba otutte okwegatta kw’abantu nga tebeekuumye, kiteeberezebwa nti obulabe okukwatibwa buli lwegatta wakati w’abantu guli waggulu ebitundu 4 ku buli 10 okusinga mu mawanga agaakula mu byenfuna.

Mu mawanga amaavu, obulabe bw’okusaasanya akawuka okuva ku bakazi okudda mu basajja kiteeberezebwa kuba ebitundu 0.38% buli kikolwa ky’okwegatta lwe kibaawo bw’ogeraageranya ku kusaasanyizibwa okuva ku basajja okudda mu bakazi okuli ebitundu 0.30%.

Obulabe bw’okusaasaanya akawuka kano mu bali b’ebisiyaga kuli waggulu nga kiteeberezebwa kuba wakati w’ebitundu 1.4% - 1.7% buli kikolwa buli lw’ekibaawo (ka kibe ku musajja ku musajja (homo sexual) oba musajja ku mukazi (heterosexual). Newankubadde obulabe bw’okusaasaanya akawuka okuyita mu bikolwa by’okwenywegera (omuli n’ebitundu eby’ekyama) (oral sex), guli wansi, naye era akawuka kasobola okuyitamu okusaasaanyizibwa era nga waaliwo n’abalwadde abaali bazuuliddwa. Obulabe akawuka okusaasaanira mu kkubo lino bussibwa ku butundu wakati wa 0 -0.04%. Mu mawanga amaavu, obulabe bw’okusaasaanya akawuka kano mu kukuba obwamalaaya okuva ku bakazi okudda mu basajja guli ebitundu 2.4% buli kikolwa so nga okuva ku basajja okudda ku bakazi obulabe buli obutundu 0.05% Obulabe bw’okukwatibwa akawuka ka HIV gweyongera mu mbeera ono ng’abadde n’endwadde z’ekikaba endala (Sexually Transmitted Infections (STI)). Amabwa mu bitundu by’ekyama (Genital ulcers) ng’ongera obulabe bw’okukwatibwa akawuka kano emirundi 5. Endwadde z’ekikaba endala nga enziku, kabootongo, chlamydia, trichomoniasis ne bacterial vaginosis nazo zisobola okwongera ku bulabe bw’okukwatibwa akawuka kano newankubadde ku ssa entonotono.

Obungi bw’akawuka kano mu musaayi gw’omuntu (viral load) nakyo kikola kinene mu kusaasaanya akawuka kano mu bikolwa by’okwegatta by’ekika kyonna n’okuva ku maama okudda ku mwana. Mu bbanga ery’emyezi 2 n’ekitundu egisooka omuntu ng’akwatiddwa akawuka kano, obusobozi bwe okukasaasaanya buba emirundi emirundi 12 olw’obungi bw’akawuka akaba mu musaayi gwe. Omuntu bw’aba ali mu biseera bye ebisembayo ng’akawuka kamuli mu musaayi, obusobozi bwe okukasaasaanya buba bukubisaamu kumpi ate emirundi munaana okusingawo.

Obulabe bw’okusaasaanya akawuka mu bakuba obwamalaaya bunene, okwegatta okuli okukuluusaanyizibwa nakwo kwongera ku bulabe bw’okusaasaanya akawuka. Obuliisamaayi nabwo bw’ogera ku bulabe bw’okusaasaanya akawuka olw’ensonga nti mu mbeera eno kondomu ebiseera ebisinga tezirowoozebwako. So nga n’obulabe bw’okukwatibwa akawuka buba bw’amaanyi eri abakwatibwakwatibwa endwadde z’ekikaba olutetenzi.

Amazzi g’omubiri

Ekkubo ery’okubiri erisinga okuyitibwamu okusaasaanya akawuka ka HIV lya musaayi n’ebikozesebwa mu musaayi. Okusaasaanyizibwa okuyita mu musaayi kusobola kuba mu kugatta bikozesebwa ng’empiso, okufumitibwa ekintu ekisongovu wakati w’alina akawuka n’atalina, mu kugaba omusaayi n’okukozesa ebintu ebifumita ebitali bifumbe bulungi.

Obulabe okukwatibwa akawuka mu kugatta ebintu ng’empiso mu kwekuba ebiragala buli ebitundu 0.63 ne 2.4% buli kikolwa lwe kibaawo, ate obulabe oli okukwatibwa akawuka ng’afumitiddwa kintu kisongovu guli 0.3% (omuntu ng’omu mu 333) buli kikolwa lwe kibaawo, ate obulabe oli okukwatibwa akawuka ng’amusaayi gwe gutabaganye n’alina akawuka mu butanwa ne biba ebitundu 0.09% (oba omuntu 1 mu bantu 1000) buli lwe kiba kibaddewo.

Mu Amerika abeekuba ebiragala mu 2009, baali bakola ebitundu 12% ku bantu bonna abaalina akawuka era ng’ebitundu kumpi 80 ku 100 mw’abo abakozesa ebiragala balina akawuka ka HIV.

Akawuka kasaasaanyizibwa kumpi ebitundu 93 ku 100 mu musaayi mwe kaba kabadde. Mu mawanga agaakulu, obulabe bw’okusiigibwa akawuka okuyita mu kussibwaako omusaayi guli wansi nnyo (wansi w’ekitundu kimu ku kitundu ky’akakadde) olw’okwekkeenneenya omusaayi okw’ekika ekya waggulu gye kikolebwa. Ekyokulabirako, e Bungereza, obulabe buloopebwa mu muntu omu bantu obukadde 5!

Mu mawanga amaavu, ekitundu kya musaayi ogugambibwa gwe guyinza okuba nga gw’ekebejebwa obulungi (2008 we yatuukira) era kiteeberezebwa nti ebitundu 15 ku 100 ku muwendo gw’abakwatibwa akawuka kano bakafunira mu kussibwako musaayi mwe kaba n’ebintu ebyekuusa ku musaayi, nga kino kitegeeza nti ebitundu ebiri wakati w’e 5 ne 10 mu nsi yonna ey’abalina akawuka kano bakafunira mu musaayi okugagibwa.

Abantu abettanira okusalwa enjola mu bigambo kigambibwa nabo bali mu bulabe bw’okukwatibwa akawuka kano newankubadde tewali mulwadde yali afunise kuyita mu kkubo lino ali ku likodi. Ensiri n’ebiwuka ebirala kizibu okusaasaanya akawuka ka HIV.

Okuva ku maama okudda ku mwana

Akawuka ka HIV kasobola okusaasaanyizibwa okuva ku maama okudda ku mwana mu kiseera ky’olubuto, mu kuzaala ne mu kuyonsa. Lino ly'ekkubo ery'okusatu erisinga okusaasaaniramu akawuka mu nsi yonna. Awatali bujjanjabi, obulabe bw’okufuna akawuka ng’omukyala tannasumulukuka ne mu kusumulukuka guli ebitundu 20 ku 100 so nga mu kuyonsa obulabe buli ebitundu 35 ku 100. 2008 we yatuukira, ekkubo lino (vertical transmission) lyali livunaanyizibwa ku bitundu 90 ku 100 ku muwendo gw’abaana abaali abalina akawuka. Okuyita mu nzijjanjab ey’omulembe, obulabe bwa maama okusiiga omwana bussiddwa nnyo okutuuka ku kitundu 1 ku 100. Obujjanjabi obutangira mulimu; maama okukozesa ARVS ng’ali lubuto ne mu kuzaala, abakyala okuzaala nga balongooseddwa, maama okwewala okuyonsa n’okussa bbebi ku ddagala lya ARVs. Ebimu ku bimenyeddwa waggulu ebyembi mu mawanga agamu agakyakula tebiriiyo. Singa omusaayi gw’etabika mu mmere mu kiseera ky’okugaaya, kisobola okuleetawo obulabe bw’okusaasaanya akawuka.

Enkula ya kawuka ka HIV (virology)

Akawuka HIV ke kavaako embeera etuusa omuntu okulwala Siriimu. HIV kika kya viyiraasi mu butonde ekyekolako olukomera retrovirus nga mu nkula yaakyo kirumba ntegeka y’omubiri eguyamba okulwanyisa obulumbaganyi naddala obutoffaali bwa CD4+ T Cells, Macrophages ne [[dendritic cells. Mu bugenderevu ne mu butali, akawuka ka HIV kasaanyawo obutoffaali bwa CD4+ T cells.

Akawaka HIV kagwa mu ttuluba ly’ensibuko genus Lentivirus eririna akakwate ku kika Retroviridae. Vayiraasi ezimanyiddwa nga Lentivirus zifaanaganya enkula n’obutonde. Ebika by’ebisolo bikosebwa lentivirus ezivaako endwadde okumala ekiseera ekiwanvu mu mubiri okweyerula. Zisaasaanyizibwa ga lulandira olw’ekozeeko olukomera. Nga ziyingidde mu katoffaali ke buluubirira, enkula yaako yeekyusa ne yeegabanyamu. Kino nga kiwedde, kayingira ntabiro ya katoffaali k’omubiri (cell nucleus) ne katandika okukola olubembe ku katoffaali akalumbiddwa okwewala okwetegerezebwa abaserikale oba entegeka z’omubiri ezikola ku kulwanyisa obulumbaganyi mu gwo. Mu ngeri endala, akawuka katandika okweyubula okuva mu katoffaali akaalumbiddwa ne muvaamu obuwuka obulala.

Ebika bya kawuka ka HIV byawuziddwamu emirundi ebiri: HIV-1 ne HIV-2. HIV- 1 ke kawuka akaasooka okuzuulibwa (mu kusooka kaali kaayitibwa LAV oba HTLV-III]]). Kano ke kasinga okuba mu bantu era ke kavunaanyizibwa ku kufa kw’abantu abasinga mu nsi. HIV-2 kasinga kuba mu Bugwanjuba bwa Afrika.

Ensaasaana y’akawuka mu musaayi (Pathophysiology)

Akawuka ka HIV nga kamaze okuyingira omubiri gw’omuntu, ekiseera ekiddirira kiba kya kweyubula oba okweyalula ku misinde emiyitirivu (viral replication) ekikaleetera okuba akangi mu musaayi gw’oku ngulu. Mu biseera by’okukwatibwa akawuka kano ebisooka, obungi bw’akawuka kano butuuka mu bukadde n’obukadde mu buli (milliliter) y’omusaayi. Kino kiddirirwa okusereba kw’obungi bw’obutoffaali bwa CD4+ T Cells. Akawuka okweyalula mu bungi okuva nga kaakayingira omubiri (viremia) kirina akakwate ku kukuzuukusibwa kw’obutoffaali bwa CD8+ T Cells, ezitta obutoffaali obuba bulumbiddwa akawuka ka HIV, okweyalula kw’obutoffaali obulumbiddwa HIV ne bukyusibwakyusibwa obutonde bwabwo n'enkula (seroconversion).

Okuzuukusibwa kw’obutoffaali bwa CD8+T Cell kirowoozebwa nti kukulu mu kukuuma omuwenda gw’akawuka (HIV) mu musaayi nga gulinnya n’okukka nga bunaabwo obwa CD4+ T Cell bwe bugenda mu maaso n’okweyaluza.

Enneeyisa oba enziramu y’obutoffaali bwa CD8+T Cell mu kiseera ky’obulumbaganyi kirina akakwate ku kukendeeza emisinde akawuka ka HIV mwe keeyalulira mu musaayi newankubadde tekasaanyizibwawo (HIV).

Ku nkomerero, akawuka ka HIV kaleeta Siriimu bwe kamalawo obutoffaali bwa CD4+ T cell mu musaayi. Kino kinafuya entegeka y’omubiri erwanyisa obulumbaganyi era obutoffaali obwo we butali, omubiri tegusobola kulwanyisa bulumbaganyi bukolebwa ndwadde oba okutta obutoffaali obulala obuba bumaze okufuulibwa obw’obulabe olwa HIV okubwesogga.

Embeera obutoffaali bwa CD4+ T Cell gye busaanyizibwawo, ekyuka okusinziira ku mutendera akawuka gye kabaamu mu mubiri (kwe kugamba; we kaba kaakaguyingirira ne we kabeerera nga kamazeemu ku kiseera (acute and chronic phases)). Mu kiseera ekimanyiddwa nga (Acute phase), okulwanagana okubaawo ku butoffaali obusenseddwa akawuka ka HIV okubutta okuba kuwadaawandibwako obutoffooli obukola ogw’okutta bunnaabwo obuba bufunye obuzibu ((cytotoxic T cells)) kuleetera obutoffaali bwa CD4+ T Cell okusereba newankubadde embeera ya (apotosis) esobola okuvaako kino. Mu kiseera ekimanyiddwa nga (chronic phase) embeera y’omubiri okuba nga buli kadde guli ku bwerende nga n’okutondawo T cells kutono, kivaako omuwendo gwa CD4+ T Cells okusereba.

Newankubadde obubonero bwa Siriimu tebweraga okumala emyaka ng’omuntu amaze okukwatibwa akawuka ka HIV, omuwendo gwa CD4+ T Cells ogusinga gusaanyizibwawo mu wiiki ezisooka ng’akawuka kaakayingira mu mubiri gw’omuntu naddala mu lunyiranyira lw’ebyenda omusinga okuba obutoffaali obulwanyisa obulabe (lymphocytes).

Ensonga lwaki obutoffaali bwa CD4+ T Cell obw’olunyiranyira (Mucosal CD4+ T cells) bwe businga okwettanirwa akawuka kwe kuba nti bulaga ekiriisa CCR5 akawuka ka HIV kye kakozesa ng’omukutu (co- receptor) okwesogga obutoffaali so ng'akatundu katono nnyo aka CD4+ T Cells mu musaayi akasobola okubaako embeera y’ekiriisa ekyo.

Enkyukakyuka ezimu ku CCR5 naddala ekika kya CCR5 - ^32 zisobola okutangira okulumbibwa kw’akawuka ka HIV (HIV -1 infection).

Akawuka ka HIV kanoonya ne kasaanyawo CCR5 eziba ziraga embeera ya CD4+ T Cells mu kiseera kya (Acute infection). Obwangu entegeka y’omubiri erwanyisa endwadde gy’eyanukulamu obulumbaganyi bw'akawuka nga kamaze okuyingira omubiri kukendeeza ku bukosefu obwandikoleddwa akawuka olwo ne kireetera omubiri okuyingira ekitundu ekimanyiddwa nga (clinically latent phase).

Obutoffaali bwa CD4+ T Cells mu lunyiranyira lw’ebyenda lusigalira ddala nga lwo lumeteddwa akawuka. Akawuka okusigala nga keeyubula kireetera entegeka y’omubiri erwanyisa obulumbaganyi okusigalira ddala ng’ekola butaweera ogwayo okuyitira ddala mu kiseera ekya chronic phase.

Omubiri okubeera ku bwerende olw’okuba entegeka erwanyisa obulumbaganyi eba ezuukusiddwa ekiriisa (protein) ekitonotono ekizuukusa obutoffaali (cytokines) kiva ku kawuka okwongera okutabangula omubiri nga kagenda keeyubula.

Embeera y’obwerende eno era yeekuusa ne ku ntegeka y’omubiri eketta embeera y’olunyiranyira mu byenda okuba ng’efudde (Break down of immune surveillance system of the gastrointestinal mucosal barrier) nga kino kiba kivudde ku kusereba kwa CD4+ T cell ez’olunyirira mu kiseera kya (acute phase).

Okukebera akawuka

Akawuka ka HIV kazuulibwa mu kukeberebwa olwo ne kamanyibwa n’omutendera kwe kaba kalimu mu mubiri. Abakakiiko akakola ku kutangira endwadde aka United States Preventive Services Task Force kasemba abantu bonna aba wakati w’emyaka 15 – 65 ng’abakyala ab’embuto bonna kya buwaze. Okukeberebwa oba akawuka ka HIV keesozze omubiri gw’omuntu ng’embeera ya seroconversion tennabaawo kikolebwa nga bapima HIV –RNA oba p24. Ribonucleic acid (RNA) kika kya molekyu (molecule) ekikola emirimu egy’egyawulo n’okuwa ebirairo ku nneeyisa y’obutoffaali z’endagabutonde (genes). Okukebera p24 kugenderera kuzuula oba ekika ky’ekiriisa kya protein eky’akawuka ka HIV ekimanyiddwa olumu nga CA, obutoffaali bwa Monoclonol ezeekuusa ku kiriisa kya p24 byegatta mu musaayi gw’omuntu. Buli kiriisa kya p24 mu musaayi kyebeembeka ku katoffaali ka monoclonal era obutoffaali bw’ekiriisa p24 bwe kyegatta ku butoffaali monoclonal, kireetawo enkyukakyuka ya langi singa ekiriisa kiba nga kyabadd mu musaayi okukeberebwa.

Ebiva mu kukebera akawuka mu butoffaali bw’abaana abato wansi w’emyaka 18 ebiseera ebisinga ebivaamu biba bifu olw’ensonga nti baba bakyalina obutoffaali obuyamba ku mubiri obwa bamaama baabwe maternal antibodie. Mu mbeera eno okusiigibwa akawuka ka siriimu kusobola kuzuulibwa nga bakozesa PCR okuzuula RNA oba endagabutonde {DNA]] oba okuyita mu kiriisa kya p24.. Ebitundu by’ensi bingi tebirina busobozi bwa nkebera ya PRC yeesigika era nga mu bifo bingi balinda okutuusa omwana ng’akuze ekimala okukeberwa obutoffaali . Mu mawanga agali w’eddungu Sahara wakati wa 2007 – 2009 abantu abali wakati w’ebitundu 30 – 70 baali bamanyi nga bwe bayimiridde ku nsonga y’akawuka ka Sirriimu. Mu 2009, abantu wakati wa 3.6 ne 42 ku 100 mu basajja bali bakebereddwa ekyoleka nti waaliwo okweyongera mu maaso bw’ogeraageranya n’emyaka egyasooka.

Ebiti omugwa abakwatiddwa akawuka ka HIV

Enkola bbiri ez’ekisawo ze zeesigamizibwako okusengeka akawuka ka HIV n’endwadde ezeekuusa ku kawuka olw’okusobola okubwekenenya. Enkola esooka y’ensengeka y’ekitongole ky’Amawanga Amagatte mu nsi ekivunaanyizibwa ku byobula World Health Organisation WHO n’ensengeka y’ekitongole ky’Amerika ekivunaanyizibwa ku kutangira endwadde ekya Center for Disease Control (CDC).

Ensengeka ya CDC’s esinga kwettanirwa mu mawanga agaakula. Engeri ensengeka y’ekitongole kya WHO gy’eteetaza nnyo bizuuliddwa kuva mu labalatore, esinga kwettanirwa mu mawanga agakyakula agalina ebikozesebwa ebitono. Newankubadde ensengeka eyawukana, enkola zombi ziyamba mu kukung’aanya bwiino ku ndwadd eno.

WHO ennyinnyola ya Siriimu yasooka kugiwa mu 1986. Okuva olwo, ensengeka ezze esuumusibwa n’okugaziyizibwa, era ng’ennyinnyola ekyasembyeyo yali mu 2007. Enkola ya WHO ekozesa emitendera gino mu nseneka yaayo.

1. Primary HIV infection: Omutendera guno omuntu asobola okuba nga talaga bubonero kyokka ng’alina akawuka asymptomic oba ng’ali mu mbeera y’okufuunira lusenyigasenyiga acute retroviral syndrome

2. Siteegi 1: Tewali bubonero bulagibwa akwatiddwa era ng’obutoffaali bwe obwa CD4+ T Cell busukka 500 mu musaayi cubic mm. Ku mutendera omuntu asobola okufuna esanjabavu ezisukkiridde.

3. Siteegi 2: Obubonero obutonotono busobola okweyoleka omuba okubutukabutuka omubiri olutulututtu nga lulimu olusirasira. Wano omuwendo gwa CD4+ T Cell gukka okuva ku 500 mu buli cubic liita y’omusaayi.

4. Siteegi 3: Omutendera guno, omuntu afuna ekiddukano ekitannyonnyolekeka kwe kivudde okumala ebbanga erisukka omwezi, omuntu asobola n’okutandika okulumbibwa endwadde ezireetebwa obuwuka bwa bakitiriya omuli n’akafuba. Obutoffaali bwa CD4+ T Cell bukka wansi wa 350.

5. Siteegi 5 oba Siriimu: Embeera enzibu omuba n’okufuna obuzibu ku bwongo toxoplasmosis, okufuna Kaposi’s Sarcoma, emimiro okufuna amabwa candidiasis of the esophagus, trachea n’ebirala. Obutoffaali bwa CD4+ T Cell buba wansi 200.

Ate okusinziira ku nsengeka y’ekitongole kya CDC, emitendera gy’akawuka ka HIV gy’asemba okukyusibwa mu 2008. Enkola eno ensengeka emitendera akawuka ka siriimu gye kayisaamu omuntu nga batunuulira omuwendo gw’obutoffaali bwa CD4+ T Cell n’obubonera obweyoleka ku muntu.

Siteegi 1: CD4+ T Cell ziba zenkana 500 oba okusingawo era tewaba kabonero kooleka Siriimu.

Siteegi 2: Omuwendo gwa CD4 nga guli wakati wa 200 – 500 era tewali bubonero bulaga Siriimu.

Siteegi 3: Omuwendo gwa CD4 gwenkana 200 oba okuba wansi wagwo.

Newankubadde omuwendo gwa CD4 gulinnya okuva ku 200, okujjanjaba embeera n’obubonero bwa Siriimu kulina okusigala.

Eby’okwegatta

Okukozesa obupiira kukendeeza ku bulabe bw’okusaasaanya akawuka ka HIV ebitundu 80 ku 100. Singa kondomu zikosebwa abafumbo, ng’omu ku bo alina akawuka, embeera y’akawuka okusaasaanyizibwa eri ekitundu 1 ku 100. Waliwo obukakafu nti ne kondomu y’ekikyala nayo esobola okuwa obukuumi bwe bumu nga kondomu y’abasajja. Omukazi okwesiga ebizigo ebirimu eddagala lya tenofovir Reverse transcriptase inhibitor nga tanneegatta, kikeendeeza ku bulabe bw’okukwatibwa ebitundu 40 ku 100 mu bakyala mu Afrika.

Okwawukanako, okukozesa ekika ky’ebizigo ebyesiigibwa mu bitundu by’ekyama ebya spermicide nonoxyno 1-9 bino bisobola okwongera obulabe bw’okukwatibwa akawuka kano olw’ensonga nti bireetera abikozesezza okufuna okusiiyibwa mu mbugo n’okwetakulatakula. Okukomola abasajja mu kitundu ky’Afrika eky’obukiikaddyo bw’eddungu Sahara kiyambye okukkakkanya ku bulabe bw’abasajja abeenyigira mu bikolwa by’okwegatta ebimanyiddwa (hetero sexual men) okukwatibwa akawuka ka HIV, ebitundu ebiri wakati wa 38- 68 ku 100. Okusinziira okukunoonyereza okukoleddwa, ekitongole kya WHO ne UNAIDS, byonna bisemba abasajja okukomolwa ng’ekkubo ly’okukeendeza okusaasaana kw’akawuka wakati wa basajja n’abakazi mu 2007.

Eky’okukomola oba kikendeeza ku kusaasaanya kw’akawuka mu basajja n’abakazi kikoontanibwako. Mu ngeri y’emu, n’omugaso gw’okukomola mu mawanga agaakula kuliko akabuuza oba kulina ne kye kuyinza okuyamba kutangira obulabe bw’okusaasaanya akawuka mu basiyazi.

Wabula abakungu abo, balina okutya nti entaputa embi ku nsonga y’okukomola eyinza okuleetera abantu abamu okuwubisibwa ne beeyongera kwettanira bikolwa bisobola kubateeka mu bulabe bwa kukwatibwa kawuka. Omuwendo gw’abavubuka bangi bongera okwenyigira mu bikolwa ebibateeka mu bulabe bw’okukwatibwa akawuka ka HIV. Tekimanyiddwa oba okujjanjaba endwadde z’ekikaba kiyamba mu kutangira akawuka ka HIV okusaasaana.

Pre – exposure

Abantu abalina akawuka ka HIV nga balina CD4 ezeenkana oba eziri waggulu wa 350 okumira eddagala eriweweeza ku kawuka ka HIV antiretrovirals bwe balikozesa nga tennanneegatta na baagalwa baabwe kikendeeza ku bulabe bw’okukwatibwa akawuka ebitundu 96 ku 100. Kino kikola ebitundu ebiri wakati wa 10 – 20 ku kukeendeeza ensaasaana kw’akawuka. Okubeera ku nzijanjaba ya Pre – exposure Prophylaxis (PrEP) ne doozi y’eddagala lya tenofovir ne bwe kutabaako emtricitabine kiyamba okutangira ensaasaana y’akawuka mu basiyazi, abaagalana okuba omu ng’alina akawuka omulala nga talina, n’abavubuka abeettanira enkola y’okwegatta ennambulukufu (hetero sexual). Enzinjajaba eno esobola okuba ey’omugaso ne ku beekuba ebiragala kuba okunoonyereza kino kikulaze. Okwettanira obuyonjo mu mbeera abantu ze babeeramu ekiteeberezebwa nti kikola kinene mu kussa ensaasaanya y’akawuka ka HIV. N’okwewala okugatta ebifumita ng’empiso nakyo kikendeeza ku bulabe bw’okusaasaanya akawuka ka HIV.

Post – exposure (PEP)

Buno bwe bujjanjabi omuba okumira eddagala mu bbanga eriri wakati w’essaawa 48 – 72 ng’omuntu yaakamala okwesanga mu limu ku makubo agayitamu akawuka ng’ate teyeekankasa mbeera ya muntu okugeza gw’abadde yeegasse naye oba okwesanga nga yeesaze oba okwefumita omusaayi ne gwegatta ku gw’omulala mu butanwa.

Okukozesa eddagala lyokka erya Zidovudine kikeendeeza obulabe bw’okukwatibwa akawuka ka siriimu singa omuntu aba mu butanwa yeefumise empiso eyinza okubaamu akawuka ( abasawo abafumitibwa empiso mu butanwa nga bali ku mirimu enkola eno bagyettanira.)

Omwaka 2013 we gwatuukira, enzijanjaba entuufu ekkaanyiziddwaako okuyamba mu mbeera eno mu USA eba yakukozesa eddagala omuli: tenofovir, emtricitabine ne raltegravir nga lino likendeereza ddala obulabe bw’okukwatibwa akawuka.

Enzijanjaba ya PEP esembebwa eri abo ababa basobezeddwaako naddala mu mbeera ng’akoze ekikolwa amanyiddwa nti alina akawuka ka HIV kyokka nga lya ngeri singa oli aba tamanyiddwa mbeera ye ku kawuka oba akalina oba nedda. Enzijanjaba ku ddagala lino emala wiiki 4 era ng’ereetawo embeera ezitali za bulijjo eri oyo aba alikozesa ekiseera ekyo. Mu mbeera eddagala Zidovudine we likozesebwa ebitundu 70 ku 100 ku balyettanira bafuna kamunguluze, obukoowukowu, okulumwa omutwe n’ebirala.

Maama okusiiga omwana

Pulogulaamu z’okutangira maama okusiiga omwana we akawuka vertical transmission zikeendeeza ensaasaana y’akawuka ebitundu ebiri wakati wa 92- 99 ku 100. Kino kikolebwa mu kwettanira ezinjajaba y’eddagala ez’enjawulo omuba ekiseera maama w’abeerera olubuto ne mu kuzaala. Oluvannyuma lw’okuzaala omwana ayinza n’okuyonsebwa ku ccupa.

Singa okuliikiriza omwana kuba kwe kusaliddwaawo okukolebwa, era nga kujja kusoboka okutuukirizibwa, maama alina okuva ku by’okuyonseza ddala bbebi we. (Lwaki? Emmere n’amata agatali g’amabeere gayinza okuleetera bbebi amabwa ku lulimi oba mu lubuto ate bw’addamu okuyonka wayinza okubaawo obulabe bw’okusiigibwa akawuka) Kyokka bbebi bw’aba taliikiriziddwa, kisembebwa n’ayonkera ddala emyezi mukaaga. Singa bbebi ayonka emyezi 6 mu butuufu byagyo, n’okweyongera okwettanira enzinjajaba ya antiretroviral prophylaxis eri bbebi, kikendeeza obulabe gy’ali okusiigibwa akawuka.

Okugemesebwa

Mu kiseera kino, kisoboka okugambibwa nti tewali ddagala ligema siriimu oba vakisini ya siriimu. Okugezesebwa kwa vakisini ya RV 144 ebyafulumizibwa mu 2009 byazuula nti kyali kisoboka okukendeeza ku bulabe bw’ensasaana y’akawuka ebitundu 30 ku 100. Kino kyayongera okuleetawo essuubi eri bannasaayansi abakola ku kunoonyereza kwa vakisini nti osanga bannaatuuka ku buwanguzi. Okugezesa okulala ku RV 144 kukyagenda mu maaso.

Okubeerawo n’akawuka

Okubeerawo n’akawuka kano kyetaagisa omuntu okukozesa ebika bya ARVs okukendeeza okusaasaanyizibwa kwako. Waliwo ebika bya ARVs eby’enjawulo byonna nga bikola ku kiseera oba mutendera gwa njawula mu bulamu bw’akawuka ka HIV. (life cycle). Enzijjanjaba eyettanira okukozesa eddagala ery’enjawulo eriruubirira emitendera egy’enjawulo egy’akawuka ka HIV kwe kaba kye kimanyiddwa nga Highly Active Anti Retroviral Therapy (HAART) Obujjanjabi bwa HAART obuliwo bukola mu mulengo (cocktails) omuba waakiri eddagala lya mirundi ng’esatu ebigwa mu ttuluba lya bika (class/types) bya ARVs. Obujjanjabi bwa HAART bukendeeza ku bungi bw’akawuka mu musaayi, bukuuma omubiri n’obusobozi okulwanyisa obulumbaganyi bw’endwadde n’okutangira endwadde enneegwanize ezitera okutuusa abantu okufa.

Ebitongole bya Amerika eby’obulamu American Institutes of Health n’ebirala bisemba okuwa obujjanjabi bwa ARVs eri buli mulwadde wa siriimu. Olw’okuba waliwo obuzibu mu kulonda enzijjanjaba n’okugituukiriza mu bulambulukufu, obulabe bw’ebiyinza okuva mu butagondera mateeka okutangira ate okumerusaawo ekika ky’akawuka akagumira eddagala oba okulyebalama, ebitongole ebyo byagala nnyo n’abalwadde okwenyigira mu bujjanjabi buno era nga bissa ensira ku kwetegereza obulabe n’ebirungi eri omulwadde alina omuwendo gw’akawuka omutono mu mubiri.

Ebyafaayo by’enzijjanjaba

Ensibuko y’abasawo okutandika okwettanira enzijjanjaba eyeesigamiziddwa ku HAART erina emirandira oba ensibuko kuva mu lukung’ana olw’atuula wakati wa July 7 – 16, 1966 e Vancouver (Canada) olwayitibwa 11th International Conference on AIDS. Mu lukung’aana luno, David Ho, okuva mu kitongole ekinoonyereza ku siriimu ekya Aaron Diamond AIDS Research Center e New York ne George Shaw owa University of Alabama mu ttendekero ly’obusawo, baggyayo bwiino ku mbeera y’akawuka ka HIV bwe baategeeza nti omuntu akwatiddwa akawuka ka HIV, olunaku keeyaluza emirindu obuwumbi 10, ekyali kitegeeza nti eno yali ddwadde egwa mu ttuluba lya vayiro yifekisoni ekyali kitegeeza nti kaali kalian kufuna nzinjajaba ya antiviral.

Olukung’aana luno lwaddirirwa amawulire ku nsonga eno ag’omuddiringanwa okufulumizibwa mu katabo ‘The New England Journal of Medicine’ nga biwandiikibwa Hammer, Gulick ne bannaabwe abalala abakola ku mawulire g’okunoonyereza bwe baalaga omugaso ogwali mu kukozesa indinavi mu bujjanjabi bw’enkola ya HAART. Enkola y’okwettanira obujjanjabi obulimu ebika by’eddagala bisatu 3-drug therapy yettanirwa abali ku bujjanjabi bw’abakola ku balwadde abalina akawuka era ebyavaamu gwali omuwendo gw’abantu abaali batandise okufa olwa Siriimu okukka okukka okuva ku bitundu ebiri wakati we 60 - 80.

Ensengeka y’ebika(classes) by’eddagala

Waliwo ebika by’eddagala ebiwera kyokka byonna nga bikozesebwa mu mirengo okujjanjaba akawuka ka HIV. Enkozesa y’eddagala lino mu mulengo okutwalira awamu ky’ekiyitibwa Anti- Retroviral Therapy Eddagala lya Anti retroviral (ARV) okutwaliza awamu lisengekebwa okusinziira ku mutendera ggw’akawuka lye gutangira. Omulengo ogusookerwako gubaamu ebiti by’eddagala 2 okuli; Nucleoside Reverse Transcriptase Inhibitors (NRTIs) + Protease Inhibitors (PI) oba ebika 2, [[Nucleoside Reverse Transcriptase Inibhibitors (NRTIs) + Non – Nucleoside Reverse Transcriptase Inhibitor NNRT).

Eddagala eritangira (Entry Inihibitors/Fusion Inihibitors

Lino lyettanira kukalubya mbeera y’akawuka kano mwe keerippira ku butoffaali bw’omubiri gw’omuntu. Maraviroc ne Enfuvirtide bye bika ebibiri ebikyakakasiddwa ku mulimu guno. Maraviroc eruubirira kiriisa kyanirizi CCR5 ekisangibwa ku butoffaali obuyambi (human helper T Cells).

Wabula obwegendereza bulina okubaawo mu kweyambisa eddagala lino olw’obusobozi bwe liyinza okuleetawo mu nkyukakyuka y’enneeyisa y’obutoffaali bw’omubiri tropism eyinza okuvaako ate akawuka ka HIV okukyusa ne kettanira kiriisa kirala ekya CXCR4.

Mu mbeera entono, abantu abamu basobola okufuna enkukakyuka y’enneeyisa y’obutoffaali mu kiriisa CCR5 ekivaako embeera yaakyo enyanirizi okuba nga tekola, ekintu ekisobola okuleetawo obugubaasivu oba okukendeeza ku misinde ye nneeyubula y’akawuka.

Naye nga bwe kyalagiddwaako waggulu embeera eno esobola okwebalamwa akawuka ka HIV singa ate kagubira eddagala obwanga ne kabwolekeza ekiriisa CXCR4.

Okusobola okutangira akawuka ka HIV okwerippa ku lususu lw’akatoffaali (host membrane) eddagala Enfuvirtide likozesebwa.

Enfuvirtide kika kya ddagala eririna enneeyisa ya peptide eririna okumiribwa ne likola nga likolagana ne N –terminal heptad ez’ekiriisa gp41 olwo ne lisannyalaza obusimu bw’akawuka ne katasobola kukola lujegere ku butoffaali bw’omubiri ( form an inactive hetero six-helix bundle).

Nucleoside reverse transcriptase Inhibitors (NRTI)ne Nucleotide reverse transcriptase inhibitors (NtRTI)

Lino ddagala eririna enneeyisa ya nucleoside ne nucleotide ezitangira ekiriisa ekiyamba akawuka ka HIV okukyusa entondeka yaako RNA n’efuuka DNA.

Kwekugamba eddagala ly’ekika kya NRTIs likutula lujegere akawuka ka HIV mwe kayita okusobola okufuna embeera mwe kasobola okutandikira okweyaluliza. Eddagala litangira nucleosides endala okugenda mu maaso nga zigattang’ana okukola olujegere lumu. Kino kisoboka olw’ensonga nti mbeera nnyunzi eya 3’OH.

Ebika bino byombi bikola mu ngeri ya kuvuganya competitive substrate inhibitors. Mu bufunze kwe kugamba nti eddagala likola mu ngeri zombi, okutangira akawuka okusikirizibwa okwerippa ku katoffaali host cell n’akatoffaali obutasikirizibwa kwegatta ku kawuka.

Ebyokulabirako bya NRTIs kuliko: deoxythymidine, zidovudine, stavudine, didanosine, zalcitabine, abacavir, lamivudine, emtictabine ne tenofovir.

Non- Nucleoside reverse transcriptase inhibitors (NNRT)

Lino ddagala eriba n’obusobozi okuziiza ekyukakyuka y’akawuka( reverse transcriptase) nga lyekwata ku kitundu ky’ekiriisa ekiyamba ku kawuka nga keekyusa (binding to an allosteric site of the enzyme).

NNRTIs zikosa ekifo ekiriisa ky’akawuka ekikayamba okwegatta ku k’atoffaali k’omubiri (host cell) nga kaleetawo embeera y’obutabangufu (molecular arthritis).

Eddagala lya NNRTIs zisobola era okugwa mu matuluba abiri. Ettuluba erisooka (first generation) n’ettuluba ery’okubiri (second generation).

NNRTIs mu ttuluba erisooka ziruubirira ekifo kimu eky’eriisa ky’akawuka ka HIV era kyangu akawuka okufuna obugubu ne kalyebalama. Olw’okuba NNRTs mu ttuluba ery’okubiri nnyangu okukyusakyusa ebifo, lisobola okusoma enkyukakyuka y’akawuka ne likola ku mbeera mwe kaba keekyusizakyusiza.

Ebyokulabirako by’eddagala lino mulimu; nevirapine, delavirdine, efavirenz, ne rilpivirine.

Integrase inhibitors

Eddagala lino liziiza ekiriisa ekikolebwa akawuka ka HIV kikasobozese okwerippa ku katoffaali k’omubiri host cell. Mu mbeera eno litangira endagabutonde y’akawuka ka HIV (RA) okwesogga endagabutonde ya katoffooli k’omubiri host cell kwe kaba keerippye (ka HIV).

Mu kiseera kino eddagala eritangira ekiriisa ky'akawuka okwerippa ku mubiri gw'akatoffaaki akawuka mwe kaba kaagala okwesogga(host cell) lingi liri mu kugezesebwa clinical trial era ng’eddagala raltegravir mu ttuluba lino lye lyasooka okukakasibwa ekitongole kya FDA mu October 2007.

Eddagala eddala erimaze okuyita okugezesebwa lye, Elvitegravir.

Protease inhibitors

Eddagala lino litangira akatoffaali k’omubiri host cell akamaze okwesoggebwa akawuka ka HIV ne kakansesera obuteeyalula. Mu mbeera eddagala litangira obuwuka obweyalula okuba obw’omutawaana nga liremesa embeera vayiraasi yonna mwe yeetondekera n’eba ey’obulabe ng’efuna ekiriisa. Kino kiba kityo nga liremesa embeera ya cleavage of gag and gag/pol precursor proteins. Obuwuka bwonna obweyalula ng’eddagala lya Protease inhibitor liri mu mubiri buba bulemaziddwa nga tebukyali bwa bulabe. Ebyokulabirako by’eddagala lino kuliko; lopinavir, Indinavir, Nelfinavir, Amprenavir and Ritonavir.

Waliwo n’eddagala Maturation inhibitors eritangira vayiraasi ya HIV okuyita mu mitendera gy’obulamu bwayo okutuuka lw’ekula n’eba ya bulabe ng’efunye ekirungo ky’ekiriisa kya protein. Kyokka okugezesa n’okukola ebika by’eddagala lino bibiri Bevirimat ne Vivecon byayimirizibwa mu 2010.

Wabula nn’akawuka okugubira ebika ebimu eby’eddagala weeguli nnyo. Mu mbeera eno ettuluba ly’ebika by’eddagala eritangira akawuka akagubira eddagala likoleddwa.

References

Bisimbuddwa mu wikipidea y'Olungereza

Notes

  Jump up ^ Sepkowitz KA (June 2001). "AIDS—the first 20 years". N. Engl. J. Med. 344 (23): 1764–72. doi:10.1056/NEJM200106073442306. PMID 11396444.
  ^ Jump up to: a b c d e f g h i j Markowitz, edited by William N. Rom ; associate editor, Steven B. (2007). Environmental and occupational medicine (4th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 745. ISBN 978-0-7817-6299-1.
  Jump up ^ "HIV and Its Transmission". Centers for Disease Control and Prevention. 2003. Archived from the original on February 4, 2005. Retrieved May 23, 2006.
  ^ Jump up to: a b Sharp, PM; Hahn, BH (September 2011). "Origins of HIV and the AIDS Pandemic". Cold Spring Harbor perspectives in medicine 1 (1): a006841. doi:10.1101/cshperspect.a006841. PMC 3234451. PMID 22229120.
  Jump up ^ Gallo RC (2006). "A reflection on HIV/AIDS research after 25 years". Retrovirology 3: 72. doi:10.1186/1742-4690-3-72. PMC 1629027. PMID 17054781.