Ubhubhane lwe-HIV-1 emhlabeni wonke kanye nowesifunda phakathi kuka-1990-2024: ukubuyekezwa okuhlelekile, ucwaningo lomhlaba wonke, kanye nokuhlaziywa kokusabalala

Isingeniso

Ucwaningo lwamuva nje olushicilelwe ku-Izifo Ezithelelanayo ze-Lancet(2026) ihlinzeka ngokuhlaziywa okuphelele komhlaba wonke kwe-HIV-1 molecular epidemiology kuze kube manje, okuhlanganisa idatha yokubuyekezwa okuhlelekile kanye nocwaningo lokuqapha ama-molecule emhlabeni jikelele.

Ngokuhlanganisa amasethi edatha atholakala ngaphambilini (1990–2021) nedatha yokulandelana esanda kuqoqwa, ucwaningo luhlanganise okungaphezu kwalokhoAmarekhodi ofuzo lwe-HIV-1 ayizigidi ezingu-1.39 avela emazweni angu-154 aqoqwe phakathi kuka-1990 no-2024Besebenzisa inani labantu abaphila ne-HIV elilinganiswe yi-UNAIDS njengezici zokulinganisa, abacwaningi bakhiqize amamephu omhlaba wonke nawesifunda achaza ukusatshalaliswa kwe-HIV-1 subtypes ngokwesikhathi kanye nendawo, amafomu e-recombinant ajikelezayo (ama-CRF), kanye namafomu e-recombinant ahlukile (ama-URF).

Okutholakele kubonisa ukuthi yize isimo somhlaba wonke se-HIV-1 sihlala sizinzile eminyakeni engamashumi amabili edlule, izinguquko ezinkulu zesifunda ziyenzeka, ikakhulukazi ngenxa yokwanda kokwehlukahlukana nokwanda kwezinhlobo ze-recombinant.

Isizinda Sokufunda

Uhlobo 1 lwegciwane le-human immunodeficiency virus (HIV-1) lubonisa ukuhlukahluka okukhulu kwezakhi zofuzo ngenxa yesilinganiso salo sokuguquka okuphezulu, ikhono lokuphinda lihlangane, kanye nokuguquguquka kokudlulisela isikhathi eside.

Lokhu kuhlukahluka kwezakhi zofuzo kunemiphumela ebalulekile ku:

• · ukuqapha kwama-molecule,
• · ukuhlolwa kokusebenza kokuxilonga,
• · Ukuqapha ukumelana nemithi yokulwa namagciwane,
• · kanye namasu okuthuthukisa imijovo.

Ucwaningo luhlose ukuchaza amaphethini okusatshalaliswa komhlaba wonke kanye nawesifunda kwama-subtype e-HIV-1 kanye nezinhlobo eziphinde zahlanganiswa ezivelaKusukela ngo-1990 kuya ku-2024, enikeza uhlaka olusha lwe-molecular epidemiological lokuvimbela nokulawula i-HIV emhlabeni jikelele.

Umklamo Wokufunda Nezindlela

Abacwaningi benze isibuyekezo esihlelekile sedathabheyisi ye-PubMed, i-Embase, i-Global Health, i-CINAHL, behlanganisa izifundo ezanyatheliswa phakathi kukaJanuwari 1, 2022, kanye noJanuwari 22, 2025.

Ngaphezu kwalokho, idatha yaqoqwa ngenethiwekhi ye-Global HIV Molecular Epidemiology Collaboration.

Amasethi edatha afanelekile afakiwe:

• · Ulwazi lwe-HIV-1 molecular subtype,
• · izindawo ezichazwe ngokucacile zokuthatha amasampula,
• · izinsuku zokuqoqa,
• · kanye nezinombolo zesampula ezanele.

Isethi yedatha yokugcina yayihlanganisa:

• · Amarekhodi ofuzo lwe-HIV-1 angu-1,395,222 
• · Amazwe angu-154 
• · izikhathi eziyisithupha ze-epidemiological:1990–1999, 2000–2004, 2005–2009, 2010–2014, 2015–2019, 2020–2024.

Ukusabalala kwezinhlobo zofuzo ze-HIV-1 emhlabeni wonke kanye nakwesifunda kulinganiswe kusetshenziswa izindlela zokulinganisa isisindo ezilungisiwe yi-UNAIDS.

Ukusatshalaliswa Komhlaba Wonke Kwezinhlobo Ezingaphansi Ze-HIV-1: Uhlobo Olungaphansi C Luhlala Ludumile

Ngesikhathi2020–2024uhlobo C lulokhu luwuhlobo oluvelele lwe-HIV-1 emhlabeni jikelele, okubangela lokhu okulandelayo:

Sekukonke, amafomu ahlanganisiwe (kufaka phakathi ama-CRF nama-URF) abalelwa cishe ku-Ama-22.4% okutheleleka kwe-HIV-1 emhlabeni jikelele, okugqamisa ubunzima obandayo bokwehlukahlukana kwezakhi zofuzo ze-HIV-1.

Uhlobo olungaphansi C luyaqhubeka nokubusa ikakhulukazi ku:

• INingizimu Afrika,
• INingizimu Asia,
• · kanye namazwe amaningana aseMpumalanga Afrika.

Ngenxa yokuthi lezi zifunda ziqukethe ingxenye enkulu yomthwalo we-HIV womhlaba wonke, ukubusa kwe-subtype C kuthonya kakhulu iphethini yokusatshalaliswa komhlaba wonke.

Umehluko Wesifunda: Amaphethini Okuziphendukela Kwemvelo Ahlukile Kuwo Wonke Amazwekazi

Nakuba isakhiwo se-HIV-1 somhlaba wonke sibonakala sizinzile, amaphethini esifunda ashintsha kakhulu.

INingizimu Afrika kanye neNingizimu Asia: Ukubusa Okuqhubekayo Kohlobo C

INingizimu Afrika kanye neNingizimu Asia zisalokhu ziphawuleka kakhulu ngokusakazwa kwezinhlobo ezincane ze-C.

Kulezi zindawo ezithwele kakhulu, uhlobo C lumelela iningi elikhulu lamagciwane ajikelezayo, okwenza kube nomthelela omkhulu ekusabalaleni kohlobo C emhlabeni jikelele.

Kodwa-ke, ucwaningo luphinde luqokomise ukuthi ukumbozwa kwamasampula ama-molecule kwezinye izindawo ezithwele kakhulu kusalokhu kulinganiselwe, okuphakamisa ukuthi kudingeka imizamo eyengeziwe yokuqapha ukuze kubanjwe kangcono ukuhlukahluka kwamagciwane endawo.

INyakatho Melika kanye neLatin America: Ukuqhubeka Kokubusa Kohlobo Oluncane B

Uhlobo olungaphansi B luhlala luwuhlu oluhamba phambili ku:

• · I-America esenyakatho,
• · I-Latin America.

Lezi zifunda zibonisa amaphethini e-epidemiological azinzile ngokwezinga elithile uma kuqhathaniswa nezifunda ezidlula ezinguqukweni ezincane ezisheshayo.

IYurophu YaseNtshonalanga Nephakathi: Ukwanda Kokuhlukahluka Kwezakhi Zofuzo

INtshonalanga neYurophu Ephakathi zibhekene noshintsho oluhamba kancane kancane kusukela obhubhaneni oluyi-subtype B oluvame kakhulu ukuya endaweni ehlukahlukene kakhulu yegciwane.

Izitayela ezibalulekile zifaka:

• · ukwehla kwesilinganiso se-subtype B,
• · Ukwanda komnikelo wezinhlobo ze-recombinant,
• · Ukuba khona okukhulayo kwezizukulwane ezingezona eze-B.

Lezi zinguquko zibonisa ukuthi ukuhlukahluka kwama-molecule e-HIV-1 kuya ngokuya kubaluleka ngisho nasezindaweni eziyinhloko zohlobo lwe-B ngokomlando.

I-East Asia: Ukwanda Okusheshayo Kwezinhlobo Ze-Recombinant

I-East Asia ibonise olunye lwezinguquko ezibaluleke kakhulu kwezifo eziwumshayabhuqe.

Ucwaningo luthole ukuthi:

• · I-CRF07_BC yanda kakhulu ngokuhamba kwesikhathi,
• · uhlobo B lwehle kakhulu.

I-CRF07_BC inyukile kusukela cishe ku-13.1% phakathi kuka-2000–2004 kuya ku-48.1% phakathi kuka-2020–2024, okubonisa ushintsho olukhulu ku-HIV-1 molecular epidemiology yesifunda.

Lolu shintsho luqokomisa ukubaluleka kokubhekwa okuqhubekayo kwama-molecule ezindaweni lapho izinhlobo eziphindaphindayo ziba khona kakhulu.

Amafomu Okuhlanganisa: Ingxenye Ekhulayo Yokuhlukahluka Kwe-HIV-1 Yomhlaba Wonke

Inani lezinhlobo ze-recombinant landa emhlabeni jikelele eminyakeni edlule:

• · 2000–2004: cishe 20.8%
• · 2010–2014: cishe 24.2%
• · 2020–2024: cishe 22.4%

Nakuba isilinganiso somhlaba wonke sehle kancane esikhathini sakamuva, izinhlobo ze-recombinant ziyaqhubeka nokukhula ezindaweni eziningana, ikakhulukazi:

• · EMpumalanga Asia,
• · INtshonalanga neYurophu Ephakathi.

Ucwaningo lusikisela ukuthi izinhlobo ze-recombinant zisengabhekwa njengezingabalulekile kwezinye izindawo ngoba izinhlelo eziningi zokuqapha zithembele kakhulu ezindaweni ze-genomic ezingaphelele, ezingase zingaziboni ngokugcwele amaphethini e-recombination ayinkimbinkimbi.

Ngakho-ke ukuqinisa izindlela zokuqapha izakhi zofuzo kuzobaluleka, ikakhulukazi ezindaweni ezinomthwalo omkhulu wokudluliswa kwe-HIV kanye nokwanda kokuhlukahluka kwegciwane.

Impilo Yomphakathi kanye Nemiphumela Yezokwelapha

1. Izinhlelo Zokuxilonga Zidinga Ukuhlolwa Okuqhubekayo Kwezinhlobo Ezingaphansi Kwezinhlobo

Ukwanda kokwehlukahlukana kwezakhi zofuzo ze-HIV-1 kugcizelela ukubaluleka kokuhlolwa okuqhubekayo kobuchwepheshe bokuxilonga kuzo zonke izizinda ezahlukahlukene zegciwane.

Nakuba amapulatifomu okuhlola i-HIV kanye nokuhlolwa kwenani legciwane egazini amanje abonise ukusebenza okubanzi, ukuqinisekiswa okuqhubekayo ngokumelene nezinhlobo ezincane ezisafufusa kanye nezinhlobo eziphinde zahlanganiswa kusabalulekile.

Ukuqapha kwesikhathi esizayo kufanele kuhlanganise:

• · i-molecular epidemiology,
• · Ukuqapha ukusebenza kokuxilonga,
• · kanye nokuhlaziywa kokuvela kwegciwane.

2. Ukubhekwa Kokumelana Nemithi Kudinga Ukumbozwa Okubanzi Kwezakhi Zofuzo

Ukwanda kwezinhlobo ezahlukene ze-HIV-1 kungathinta ukuvela, ukutholakala, kanye nokuchazwa kwezinguquko ezihlobene nokumelana.

Ezinye izifundo ziphakamise ukuthi izinhlobo ezithile ze-HIV-1, okuhlanganisa izinhlobo ezihlobene ne-A6/A1, zingase zihlotshaniswe nengozi eyengeziwe yokwehluleka kwe-virological ngaphansi kwezilungiselelo ezithile zokwelapha i-cabotegravir/rilpivirine ezisebenza isikhathi eside.

Noma kunjalo, imiphumela yokumelana ithonywa yizici eziningi, okuhlanganisa:

• · izinguquko zokumelana okuyisisekelo,
• · umlando wokwelashwa,
• · ukunamathela,
• · kanye nesizinda sezakhi zofuzo ezibangelwa yigciwane.

Ngakho-ke, ukuqapha ukumelana okuqaphela izinhlobo ezincane kusalokhu kubaluleke kakhulu.

3. Ukuthuthukiswa Kwemithi Yokugoma Kumelwe Kucabangele Ukuhlukahluka Kwamagciwane Esifunda

Ukuhlukahluka okukhulu kwezakhi zofuzo ze-HIV-1 kusalokhu kungenye yezinselelo ezinkulu zokuthuthukiswa kwemithi yokugomela.

Ukusatshalaliswa okuguqukayo kwezinhlobo ezincane kanye nezinhlobo eziphinde zahlanganiswa kugqamisa isidingo samasu okugoma acabangela:

• · izinhlobo ezijikelezayo zesifunda,
• · izitayela zokuziphendukela kwemvelo ezisakazekile,
• · kanye nokumbozwa okubanzi kwamasosha omzimba.

Indlela efanayo yomhlaba wonke ingase ingaxazululi ngokugcwele ukuhlukahluka kwe-HIV-1 okusakazeka emhlabeni wonke.

Isiphetho

Lokhu kuhlaziywa okuphawulekayo komhlaba wonke kwe-HIV-1 molecular epidemiology kubonisa ukuthi isimo segciwane emhlabeni wonke sibonakala ngokuqhubeka kanye noshintsho.

Nakuba uhlobo C luqhubeka nokubala cishe ingxenye yokutheleleka kwe-HIV-1 emhlabeni jikelele, amaphethini ama-molecule esifunda ashintsha ngokushesha, kanti izinhlobo eziphindaphindayo ziya ngokuya zibumba ubhubhane ezindaweni ezifana ne-East Asia kanye ne-Europe.

Okutholakele kugcizelela ukubaluleka kokubhekwa okuqhubekayo kwama-molecule, ukuqinisekiswa kokuxilonga izinhlobo ezahlukene, kanye nezindlela ezihlanganisiwe zofuzo zokusekela ukuvimbela i-HIV okuphumelelayo, ukuqapha ukwelashwa, kanye nokuthuthukiswa kwemithi yokugomela esikhathini esizayo.

Ireferensi

1. I-epidemiology yama-molecule yomhlaba wonke neyesifunda ye-HIV-1 phakathi kuka-1990–2024: ukubuyekezwa okuhlelekile, inhlolovo yomhlaba wonke, kanye nokuhlaziywa kokusabalala. Izifo Ezithelelanayo ze-Lancet, 2026.