Tlhahlobo ea limolek'hule tsa HIV-1 lefatšeng ka bophara le libakeng tse fapaneng nakong ea 1990-2024: tlhahlobo e hlophisitsoeng, phuputso ea lefats'e, le tlhahlobo ea ho ata ha eona

Selelekela

Phuputso ea morao tjena e phatlalalitsoeng hoMafu a tšoaetsanoang a Lancet(2026) e fana ka tlhahlobo e felletseng ka ho fetisisa ea lefats'e ea seoa sa limolek'hule tsa HIV-1 ho fihlela joale, e kopanyang lintlha tsa tlhahlobo e hlophisitsoeng le phuputso ea lefats'e ka bophara ea tlhokomelo ea limolek'hule.

Ka ho kopanya disete tsa data tse neng di fumaneha pele (1990–2021) le data e sa tswa bokellwa ya tatellano, phuputso e kenyeleditse tse fetangLirekoto tsa liphatsa tsa lefutso tsa HIV-1 tse limilione tse 1.39 tse tsoang linaheng tse 154 li bokelletsoe pakeng tsa 1990 le 2024Ba sebelisa lipalo tse hakanyetsoang ke UNAIDS tsa batho ba phelang le HIV e le lintlha tsa bohlokoa, bafuputsi ba hlahisitse limmapa tsa lefats'e le tsa libaka tse hlalosang kabo ea nako le sebaka ea mefuta e fapaneng ea HIV-1, mefuta e potolohang ea recombinant (CRFs), le mefuta e ikhethang ea recombinant (URFs).

Liphuputso li bontša hore leha sebaka sa lefats'e sa mofuta oa HIV-1 se ntse se tsitsitse lilemong tse mashome a mabeli tse fetileng, liphetoho tse kholo tsa libaka lia etsahala, haholo-holo tse susumetsoang ke mefuta e mengata e ntseng e eketseha le katoloso ea mefuta e kopantsoeng.

Semelo sa Thuto

Vaerase ea mofuta oa 1 ea khaello ea 'mele ea ho itšireletsa mafung (HIV-1) e bontša mefuta e mengata ea liphatsa tsa lefutso ka lebaka la sekhahla se phahameng sa phetoho ea 'mele, bokhoni ba ho kopanya lisele tse ncha le matla a phetisetso ea nako e telele.

Ho feto-fetoha hona ha liphatsa tsa lefutso ho na le litlamorao tsa bohlokoa bakeng sa:

• · Tlhokomelo ea limolek'hule,
• · Tlhahlobo ea ts'ebetso ea tlhahlobo,
• · Tlhokomelo ea ho hanyetsa li-antiretroviral,
• · le maano a nts'etsopele ea liente.

Phuputso ena e ne e ikemiseditse ho hlalosa dipaterone tsa kabo ya lefatshe ka bophara le ya lebatowa ya mefuta e fapaneng ya HIV-1 le mefuta e kopaneng ho tloha hoHo tloha ka 1990 ho isa ho 2024, e fanang ka moralo o ntlafalitsoeng oa limolek'hule oa epidemiological bakeng sa thibelo le taolo ea HIV lefatšeng ka bophara.

Moralo le Mekhoa ea ho Ithuta

Bafuputsi ba entse tlhahlobo e hlophisitsoeng ea li-database tsa PubMed, Embase, Global Health, CINAHL, ba akaretsa lithuto tse phatlalalitsoeng pakeng tsa la 1 Pherekhong 2022, le la 22 Pherekhong 2025.

Ho phaella moo, tlhahisoleseding e bokelletsoe ka netweke ya Global HIV Molecular Epidemiology Collaboration.

Disete tsa data tse loketseng di kenyelelitsoe:

• · Tlhahisoleseding ea mofuta oa limolek'hule tsa HIV-1,
• · libaka tse hlalositsoeng ka ho hlaka tsa ho nka sampole,
• · matsatsi a ho bokella,
• · le linomoro tse lekaneng tsa sampole.

Sete ea data ea ho qetela e ne e kenyelletsa:

• · Lirekoto tsa liphatsa tsa lefutso tsa HIV-1 tse 1,395,222 
• · Linaha tse 154 
• · linako tse tšeletseng tsa epidemiological:1990–1999, 2000–2004, 2005–2009, 2010–2014, 2015–2019, 2020–2024.

Ho ata ha mefuta ea liphatsa tsa lefutso tsa HIV-1 lefatšeng ka bophara le libakeng tse ling ho hakantsoe ho sebelisoa mekhoa ea ho lekanya boima e fetotsoeng ke UNAIDS.

Kabo ea Lefatše ka Bophara ea Mefuta e Menyenyane ea HIV-1: Mofuta o Monyenyane oa C o Lula o Laola

Nakong ea2020–2024, mofuta wa C o ntse o le leloko le ka sehloohong la HIV-1 lefatsheng ka bophara, le ikarabellang bakeng sa:

Ka kakaretso, mefuta e kopanyang hape (ho kenyeletsoa le li-CRF le li-URF) e ne e ikarabella bakeng sa hoo e ka bang22.4% ea tšoaetso ea HIV-1 lefatšeng ka bophara, e totobatsang ho rarahana ho ntseng ho eketseha ha mefuta-futa ea liphatsa tsa lefutso tsa HIV-1.

Subtype C e ntse e tsoela pele ho busa haholo-holo ho:

• Afrika Boroa,
• · Asia Boroa,
• · le linaha tse 'maloa tsa Afrika Bochabela.

Kaha libaka tsena li na le karolo e kholo ea moroalo oa lefats'e oa HIV, puso ea mofuta oa C e susumetsa haholo mokhoa oa kabo lefatšeng ka bophara.

Liphapang tsa Libaka: Mekhoa e Ikhethang ea ho Iphetola ha Lintho ho pholletsa le Lik'honthinente

Leha sebopeho sa lefats'e sa HIV-1 se bonahala se tsitsitse, mekhoa ea libaka e ntse e fetoha haholo.

Afrika Borwa le Asia Borwa: Taolo e sa Feleng ya Mofuta o Monyenyane wa C

Afrika Borwa le Asia Borwa di ntse di tsebahala haholo ka ho potoloha ha mofuta wa C.

Libakeng tsena tse imetsoeng haholo, mofuta oa C o emela boholo bo boholo ba likokoana-hloko tse potolohang, e leng se etsang hore e be sesosa se seholo sa ho ata ha mofuta oa C lefatšeng ka bophara.

Leha ho le jwalo, phuputso ena e boetse e totobatsa hore ho angwa ha di-sampuli tsa dimolek'hule dibakeng tse ding tse imetsweng haholo ho ntse ho lekanyeditswe, e leng se bontshang hore ho hlokahala boiteko bo eketsehileng ba ho lekola ho hapa mefuta e fapaneng ya dikokwana-hloko tsa lehae hamolemo.

Amerika Leboea le Latin America: Puso e Tsoelang Pele ea Subtype B

Subtype B e ntse e le leloko le leholo le potolohang ho:

• · Amerika e leboea,
• · Amerika boroa.

Libaka tsena li bontša mekhoa e tsitsitseng ea epidemiological ea limolek'hule ha e bapisoa le libaka tse fetang liphetohong tse potlakileng tsa subtype.

Europe Bophirima le Bohareng: Ho Eketseha ha Mefuta-futa ea Liphatsa tsa Lefutso

Europe Bophirima le Bohareng li ntse li feta butle-butle ho tloha seoa sa mofuta oa B se seholo ho ea sebakeng se nang le vaerase e fapaneng haholoanyane.

Mekhoa ea bohlokoa e kenyelletsa:

• · ho fokotseha ha karolo ea mofuta oa B,
• · monehelo o eketsehileng oa mefuta e kopantsoeng,
• · ho ba teng ho ntseng ho hola ha meloko e seng ea B.

Liphetoho tsena li bontša hore mefuta-futa ea limolek'hule tsa HIV-1 e ntse e e-ba ea bohlokoa haholo esita le libakeng tse nang le mofuta oa B o atileng historing.

Asia Bochabela: Katoloso e Potlakileng ea Mefuta ea Recombinant

Asia Bochabela e bontšitse e 'ngoe ea liphetoho tsa bohlokoa ka ho fetisisa tsa seoa.

Phuputso e fumane hore:

• · CRF07_BC e eketsehile haholo ha nako e ntse e ea,
• · mofuta oa B o fokotsehile haholo.

CRF07_BC e eketsehile ho tloha ho hoo e ka bang13.1% nakong ea 2000-2004 ho isa ho 48.1% nakong ea 2020-2024, e bonts'ang phetoho e kholo thutong ea limolek'hule tsa HIV-1 sebakeng seo.

Phetoho ena e totobatsa bohlokoa ba tlhokomelo e tsoelang pele ea limolek'hule libakeng tseo mefuta e kopantsoeng e ntseng e ata ho tsona.

Mefuta e Kopantsoeng: Karolo e Holang ea Mefuta-futa ea HIV-1 Lefatšeng ka Bophara

Karolo ea mefuta e kopantsoeng e eketsehile lefatšeng ka bophara lilemong tse mashome tse fetileng:

• · 2000–2004: hoo e ka bang 20.8%
• · 2010–2014: hoo e ka bang 24.2%
• · 2020–2024: hoo e ka bang 22.4%

Leha karolo ea lefats'e ka bophara e fokotsehile hanyane nakong ea morao tjena, mefuta ea li-recombinant e ntse e tsoela pele ho atoloha libakeng tse 'maloa, haholo-holo:

• · Asia Bochabela,
• · Europe Bophirima le Bohareng.

Phuputso e fana ka maikutlo a hore mefuta e kopanyang e ntse e ka 'na ea nyenyefatsoa maemong a mang hobane mananeo a mangata a tlhokomelo a itšetlehile haholo-holo libakeng tsa genomic tse sa fellang, tse ka 'nang tsa se ke tsa khetholla ka botlalo mekhoa e rarahaneng ea ho kopanya.

Ka hona, ho matlafatsa mekhoa ea ho lekola liphatsa tsa lefutso ho tla ba bohlokoa, haholo-holo libakeng tse nang le moroalo o phahameng oa phetiso ea HIV le mefuta e mengata ea vaerase e ntseng e eketseha.

Bophelo bo Botle ba Sechaba le Litlamorao tsa Bongaka

1. Mekhoa ea Tlhahlobo e Hloka Tlhahlobo e Tsoelang Pele ea Mefuta e Menyenyane

Ho eketseha ha mefuta-futa ea liphatsa tsa lefutso tsa HIV-1 ho totobatsa bohlokoa ba tlhahlobo e tsoelang pele ea mahlale a tlhahlobo ho pholletsa le maemo a fapaneng a vaerase.

Leha liforomo tsa hajoale tsa tlhahlobo ea HIV le liteko tsa bongata ba vaerase li bontšitse ho sebetsa ka bophara, netefatso e tsoelang pele khahlanong le mefuta e mecha e hlahang le mefuta e kopaneng e ntse e le ea bohlokoa.

Tlhokomelo ea nakong e tlang e lokela ho kenyelletsa:

• · Epidemiology ea limolek'hule,
• · Tlhokomelo ea ts'ebetso ea tlhahlobo,
• · le tlhahlobo ea phetoho ea vaerase.

2. Tlhokomelo ea ho Hanela Lithethefatsi e Hloka Tšireletso e Batsi ea Liphatsa tsa Lefutso

Katoloso ea meloko e fapaneng ea HIV-1 e ka susumetsa ho hlaha, ho fumanoa le ho hlalosoa ha liphetoho tse amanang le khanyetso.

Lithuto tse ling li bontšitse hore mefuta e itseng ea HIV-1, ho kenyeletsoa le mefuta e amanang le A6/A1, e ka amahanngoa le kotsi e eketsehileng ea ho hloleha ha vaerase tlas'a maemo a itseng a kalafo ea cabotegravir/rilpivirine e sebetsang nako e telele.

Leha ho le jwalo, diphetho tsa kganyetso di susumetswa ke mabaka a mangata, ho kenyeletswa:

• · liphetoho tsa khanyetso ea mantlha,
• · nalane ea kalafo,
• · ho khomarela,
• · le semelo sa lefutso la vaerase.

Ka hona, tlhokomelo ea khanyetso e hlokomelang mefuta e fapaneng e ntse e le ea bohlokoa le ho feta.

3. Ntlafatso ea Liente e Lokela ho Nahana ka Mefuta-futa ea Likokoana-hloko tsa Libaka

Mefuta e mengata ea liphatsa tsa lefutso tsa HIV-1 e ntse e le e 'ngoe ea liphephetso tse kholo bakeng sa nts'etsopele ea ente.

Kabo e ntseng e fetoha ea mefuta e fapaneng le mefuta e kopantsoeng e totobatsa tlhoko ea maano a ente a nahanang ka:

• · mefuta e potolohang libakeng tse ling,
• · mekhoa ea ho iphetola ha lintho ka bongata,
• · le tšireletso e pharaletseng ea 'mele ea ho itšireletsa mafung.

Mokhoa o ts'oanang oa lefats'e ka bophara o kanna oa se ke oa sebetsana ka botlalo le mefuta-futa ea HIV-1 e potolohang lefats'e ka bophara.

Qetello

Tlhahlobo ena ea bohlokoa ea lefats'e ka bophara ea seoa sa limolek'hule tsa HIV-1 e bontša hore sebaka sa vaerase lefatšeng ka bophara se khetholloa ka ho tsoela pele le phetoho.

Leha mofuta wa C o ntse o tswela pele ho ikarabella bakeng sa hoo e ka bang halofo ya ditshwaetso tsa HIV-1 lefatsheng ka bophara, dipaterone tsa dimolekhule tsa dibaka di ntse di fetoha ka potlako, mme dibopeho tse kopaneng di ntse di bopa mafu a seoa haholo dibakeng tse kang Asia Bochabela le Yuropa.

Liphuputso li tiisa bohlokoa ba tlhokomelo e tsitsitseng ea limolek'hule, netefatso ea tlhahlobo ea mefuta e fapaneng, le mekhoa e kopaneng ea genomic ho tšehetsa thibelo e sebetsang ea HIV, tlhokomelo ea kalafo le nts'etsopele ea ente ea nakong e tlang.

Referense

1. Thuto ea lefats'e le ea libaka ea limolek'hule tsa HIV-1 nakong ea 1990-2024: tlhahlobo e hlophisitsoeng, phuputso ea lefats'e, le tlhahlobo ea ho ata ha eona. Mafu a tšoaetsanoang a Lancet, 2026.