Virusi itera SIDA/SIDA

Virusi itera SIDA ni agakoko kambura umubiri ubudahangarwa. Virusi ya SIDA ica umubiri intege ikawambura ubudahangarwa maze igatera ubwandu bw’indwara. Iyo itavuwe hakiri kare Virusi itera SIDA itera indwara zitandukanye bikarangwa no gucika intege k’umubiri ku buryo uba utakibasha guhangana n’indwara ari nabwo umurwayi bivugwa ko arwaye SIDA. Abantu banduye virusi itera SIDA iyo nta miti bafata igabanya ubukana bwayo bashobora kumara imyaka itatu gusa. Iyo umuntu yanduye virusi itera SIDA afashwe n’izindi ndwara z'ibyuririzi kandi nta miti igabanya ubukana anywa, icyizere cy’ubuzima ni umwaka umwe. Abantu banduye virusi itera SIDA baba bagomba gufata imiti kugira ngo bakumire gupfa vuba. Nyuma yo kwandura kwambere umuntu ashobora kutabona ibimenyetso byayo, cyangwa ashobora guhura nigihe gito cyindwara zimeze nk'ibicurane (grippe). Ubusanzwe, ibi bikurikirwa nigihe kirekire nta bimenyetso byigaragaza. Iyo ubwandu bugenda bwiyongera mu mubiri, bubangamira cyane ubudahangarwa bw'umubiri, bikongera ibyago byo kwandura indwara zisanzwe nk'igituntu, kimwe n'izindi ndwara zibasira umubiri mu buryo butunguranye, ndetse n'ibibyimba bitamenyerewe ku bantu basanzwe bafite ubudahangarwa buhagije mu mubiri wabo. Ibi bimenyetso byigaragaza nyuma yaho ari nabyo bikomeye nibyo bituma umurwayi bivugwa ko yanduye SIDA kenshi bigaragazwa cyane no gutakaza ibiro byinshi kuburyo bugaragarira ijisho.

Virusi itera SIDA ikwirakwizwa cyane cyane n'imibonano mpuzabitsina idakingiye (harimo n'ibikorwa byo gutingana bashyira ibitsina mu kibuno nababishyira mu kanwa ku bahuje ibitsina), guterwa amaraso yanduye, inshinge zikoreshwa kwa muganga batera imiti mu mubiri w'umurwayi, umubyeyi utwite akaba yayanduza umwana atwite iyo adafashe imiti ku gihe, iyo umubyeyi abyaye, cyangwa binyuze mu konsa. Amatembabuzi asanzwe nk'amacandwe, ibyuya n'amarira, ntabwo byanduza virusi itera SIDA. Virusi itera sida ni imwe muri za virus zibarizwa mu itsinda ry'amavirusi azwi ku izina rya "retrovirus".

Uburyo bwo kwirinda virusi itera SIDA burimo imibonano mpuzabitsina ikingiye, gahunda zo gukoresha neza inshinge zujuje ubuziranenge, kuvura abanduye, hamwe no gukoresha imiti nka "prophylaxis" mbere na nyuma yo gukora iminonano mpuza bitsina idakingiye. Iyo ari umwana uvutse yanduye virusi itera SIDA we na nyina umubyara bahabwa imiti igabanya ubukana bwa virusi itera SIDA. Nta muti cyangwa urukingo rwa virusi itera SIDA ruhari; ariko, imiti igabanya ubukana bwa virusi itera SIDA ishobora gutuma umuntu abaho igihe kirekire byenda kungana kimwe nk'abantu basanzwe bazima batayanduye. Nibyiza gutangira gufata imiti no kwivuza no kwisuzumisha buri gihe ukimara kumenya ko wanduye. Hatabayeho kuvurwa, impuzandengo yo kubaho nyuma yo kwandura ni imyaka 11.

Muri 2018, abantu bagera kuri miliyoni 37.9 babanaga na virusi itera SIDA bituma hapfa abantu 770.000. Abagera kuri miliyoni 20.6 muri bo baba mu burasirazuba no mu majyepfo ya Afurika. Hagati y'igihe SIDA yamenyekanye (mu ntangiriro ya za 1980) na 2018, iyi ndwara yateje urupfu rw'abantu bagera kuri miliyoni 32 ku isi hose. Virusi itera SIDA ifatwa nk'icyorezo - icyorezo cy’indwara kiboneka ahantu hanini kandi kigenda gikwirakwira.

Virusi itera sida yavuye mu zindi nyamaswa yerekeza ku bantu bo muri Afurika yo mu burengerazuba bwo hagati mu ntangiriro kugeza no hagati mu kinyejana cya 20. Ubwandu bwa SIDA bwamenyekanye bwa mbere n’ikigo cya Leta zunze ubumwe z’Amerika gishinzwe kurwanya no gukumira indwara (CDC) mu 1981 kandi hamenyekana igitera SIDA - ubwandu bwa virusi itera SIDA - byagaragajwe mu ntangiriro y’imyaka icumi ya mbere y'uwo mwaka.

Virusi itera SIDA yagize uruhare runini muri sosiyete, iba indwara ndetse n'isoko y'ivangura. Iyi ndwara kandi igira ingaruka zikomeye mu bukungu. Hariho imyumvire myinshi itavugwaho rumwe ku birebana na Virusi itera SIDA, nko kwizera ko yanduzwa gusa no guhuza ibitsina mu buryo busanzwe. Iyi ndwara yateje impaka nyinshi mu banyamadini, harimo n’umwanya wa Kiliziya Gatolika yo kudashyigikira ikoreshwa ry’agakingirizo mu rwego rwo kuyirinda. Yatumye habaho ubuvuzi budasanzwe ku rwego rwa kiganga, ku rwego mpuza mahanga ndetse igenerwa n'inkunga nyinshi zitandukanye kuva yamenyekana mu myaka ya za 1980.

 

## Ibimenyetso biranga agakoko gatera SIDA
Hariho ibyiciro bitatu by'ingenzi bigaragaza ubwandu bwa virusi itera sida: kuremba bikabije, kuremba bikurikiranye no kurwaragurika kenshi bidakira, no kugera mu cyiciro cyaho umubiri ubura ubudahangwara mu buryo bukabije.  

### kuremba bikabije

Mu ikubitiro kwandura virusi itera sida icyo cyiciro cyitwa "Acute HIV/igihe virusi itera SIDA iba ifite ubukana bwinshi mu mubiri" cq kwandura mu gihe cy'ibanze aho virus iba ifite imbaraga nyinshi mu mubiri irimo gushaka gukwirakwira mu mubiri hose. Abantu benshi barwara ibicurane cyangwa indwara isa na "mononucleose" nyuma y'ibyumweru 2-4 nyuma yo kuyandura, naho abandi nta bimenyetso bifatika bafite. Ibimenyetso bibaho muri 40-90% byabantu bafite ubwandu bwa virusi itera SIDA kandi mubisanzwe harimo umuriro mwinshi ukabije uzamuka buri kanya, ibibyimba mu kanwa, kumuka no kuryana mu muhogo, guhubuka, kubabara umutwe, kunanirwa, cyangwa ibisebe byo mumunwa no mu/ku gitsina. Indwara z'uruhu zizana ibiheri bigaragara muri 20-50% y'abayanduye byigaragaza mu buryo bw'uduheri twinshi turi kumurongo umwe kandi twinshi tubyimbye gakeya kandi tudasanzwe. Abantu bamwe na bamwe barwara indwara zitandukanye muriki cyiciro. Ibimenyetso byo mu gifu, nko kuruka cyangwa impiswi bishobora kubaho. Ibimenyetso nko kurwara imitsi, ingingo zigacika inege. Igihe ibimenyetso byiyerekana biratandukanye, ariko mubusanzwe ni icyumweru kimwe cyangwa bibiri.

Bitewe n'imiterere yabyo idasanzwe, ibi bimenyetso ntibifatwa nkibimenyetso simusiga byabanduye virusi itera SIDA. Ndetse nibibazo bibonwa na muganga cyangwa ibitaro bikunze gusuzumwa nabi nkimwe mundwara zandura zifite ibimenyetso byinshi byenda gusa. Niyo mpamvu, birasabwa ko virusi itera sida yakekerwa cyane mu bantu bagaragaza umuriro mwinshi udasobanutse ushobora kuba ufite isano n'ingaruka zo kwandura. 

### kuremba bikurikiranye no kurwaragurika kenshi bidakira
Ibimenyetso byambere bikurikirwa nicyiciro cyitwa "clinical latency" cyangwa virusi idakira. Hatabayeho kuvurwa, iki cyiciro cya kabiri ku bantu banduye virusi itera sida bisanzwe ariko bativuje habe namba gishobora kumara imyaka igera kuri itatu kugeza ku myaka 20 (ugereranije, imyaka umunani). Mugihe mubisanzwe hari ibimenyetso bike cyangwa bitagaragaye mbere, hafi yiki cyiciro kirangiye abantu benshi bahura numuriro mwinshi udasanzwe, guta ibiro, ibibazo byigifu no kubabara imitsi. Hagati ya 50% na 70% byabantu nabo barwara utubyimba two mu kwaha duhora twizana, ibice by'umubiri byaguka cyangwa bibyimba mu buryo budasobanutse, kwaguka kurenze uburyo busanzwe kw'imyanya ndangagitsina (uretse mu kibuno) mumezi arenga atatu kugeza kuri atandatu.

Nubwo abantu benshi banduye virusi itera SIDA bafite virusi itagaragara kandi mugihe hatabayeho kuvurwa amaherezo bizatera SIDA (kubura burundu ubudahangwarwa bw'umubiri kwirwanaho ku ndwara), umubare muto (hafi 5%) ugumana urugero rwinshi rw'utunyabuzima twubatse ubudahangarwa bw'umubiri w'umuntu twitwa CD4+ T (T Helper Cells) udafite imiti igabanya ubukana bwa virusi itera SIDA irenze imyaka itanu. Abo bantu bashyizwe mu rwego rwa "HIV Controllers" cyangwa "long-term nonprogressors" (LTNP). Irindi tsinda rigizwe nabagumana uko virusi zigaragaza mu mubiri wabo muburyo butajya bumenyekana habe namba cyangwa butigaragaza byihuse kandi badakoresha imiti igabanya ubukana bwa virusi ari nabo bakunze kwitwa "elite controllers" cyangwa udashobora kumenyekana udafite imiti igabanya ubukana bwa virusi itera SIDA bene abo bari ku kigero kiri kuri 1 kugeza kuri 300 y'abanduye.

### Umubiri kubura ubudahangwara mu buryo bukabije

"Acquired immunodeficiency syndrome (AIDS/SIDA)" bisobanuye icyiciro aho umubiri w'uwanduye virusi itera SIDA yaba yageze aho abura ubudahangarwa bw'umubiri mu buryo bukabije kugeza aho abasirikare barinda umubiri we indwara bitwa "CD4+ T" baba bari munsi ya 200 ku gipimo gikoreshwa cya µL cyangwa kuba hari indwara zihariye ziterwa no kwandura virusi itera SIDA zamaze kwigaragaza mu buryo bufatika. Mugihe hatabayeho ubuvuzi bwihariye, ibi nibyo byigaragaza hafi kimwe cya kabiri cyabantu banduye virusi itera sida mu myaka icumi ya mbere. Ibintu byambere bikunze kugaragara byerekana ko umurwayi yageze muri iki cyiciro cyaho umuntu afatwa ko arwaye SIDA harimo "pneumocystis pneumonia" / UMUSONGA (40%), gutakaza ibiro byinshi mu buryo budasanzwe "cachexia" (20%), na "candidiasis esophageal" / indwara nutubyimba no kubabara mu kanwa ndetse no mu muhogo. Ibindi bimenyetso bikunze kugaragara harimo kwandura indwara zifata imyanya y'ubuhumekero.

Ashobora ndetse no kwibasirwa n'indwara zitunguranye ziterwa n'udukoko nka bacteria, virusi, ibihumyo, n'udukoko dutandukanye zisanzwe zikumirwa zikarindwa na bwa budahangarwa bw'umubiri mu bantu bazima. Indwara zandura ziterwa ahanini n’ibinyabuzima bikunze kubaho mu bidukikije by’umuntu. Izi ndwara zirashobora kwanduza umubiri wose zikawibasira zikawuca inege.

Ababana n'ubwandu bwa SIDA bafite ibyago byinshi byo kwandura kanseri zitandukanye ziterwa na virusi, harimo na sarcoma ya Kaposi, lymphoma ya Burkitt, lymphoma y'ibanze yo hagati, na kanseri y'inkondo y'umura. Sarcoma ya Kaposi ni kanseri ikunze kugaragara, iboneka ku 10% kugeza kuri 20% by'ababana na virusi itera SIDA. Kanseri ya kabiri ikunze kwibasirwa cyane ni lymphoma, ikaba ari yo nyirabayazana w'urupfu rw'abantu bagera kuri 16% babana n'ubwandu bwa SIDA kandi ni cyo kimenyetso cya mbere cya SIDA muri 3% kugeza kuri 4%. Izi kanseri zombi zifitanye isano na herpesvirus ya 8 (HHV-8). Kanseri y'inkondo y'umura igaragara cyane ku bafite sida kubera ko ifitanye isano na "papillomavirus" ya muntu (HPV). Kanseri ifata (ya layer/urububi ruhuza igice cy'imbere cy'amaso n'igice cyera cy'ijisho) nayo ikunze kugaragara ku banduye virusi itera SIDA.

Byongeye kandi, ababana n'ubwandu bwa SIDA bakunze kugira ibimenyetso byo kwibasirwa n'umuriro mwinshi udasanzwe uzamuka buri kanya utajya ugabanyuka, ibyuya byinshi (cyane cyane nijoro), kubyimba "lymph node" / utubyimba two mu kwaha n'amabinga, guhorana ubukonje bukabije (imbeho, gutitira), intege nke, no gutakaza ibiro byinshi cyane. Indwara y'impiswi iza buri kanya ni ikindi kimenyetso gikunze kugaragara, kiboneka ku bantu 90% barwaye SIDA. Bashobora kandi kwanduzwa n'ibimenyetso bitandukanye byo mu mutwe ndetse no mu mitsi bidafitanye isano n'ubwandu bwa kanseri.

## Uburyo virusi itera SIDA ikwirakwizwamo
Virusi itera SIDA ikwirakwizwa n'inzira eshatu z'ingenzi: guhuza ibitsina mu buryo budakingiye, ibice by'umubiri w'uwanduye indwara ya SIDA twahungabanye nk'ibisebe bivamo amatembabuzi n'amaraso, ndetse no kuva amaraso ku mubyeyi iyo atwite; ndetse no mu gihe umubyeyi atwite umwana ashobora kumwanduza, mu gihe cyo kubyara umubyeyi wanduye ava amaraso arimo abyara akivanga n'amaraso y'umwana binyuze ku mukonda/ikiriri, cyangwa konsa uruhinja ku mubyeyi wanduye. Nta kaga ko kwandura virusi itera sida binyuze mu mazirantoki, ururenda rw'amazuru/ibimyira, amacandwe, ibyuya, amarira, inkari, cyangwa kuruka keretse iyo byivanzemo n'amaraso yanduye virusi itera SIDA. Birashoboka kandi ko umuntu yakwandura impurirane y'ubwoko bwa virusi itera sida burenze bumwe bikunze kwitwa "HIV superinfection".

### Imibonano mpuza bitsina
Uburyo bukunze kwanduriramo virusi itera SIDA ni uburyo bwo guhuza ibitsina n'umuntu wanduye hakorwa imibonano mpuza bitsina idakingiye. Icyakora, umuntu wanduye virusi itera sida ufite virusi itagaragararira ibyuma biyipima bitewe no kuvurwa igihe kirekire, nta byago afite byo kwanduza abandi virusi itera SIDA binyuze mu gukorana nabo imibonano mpuza bitsina idakingiye. Kuba hari abantu banduye virusi itera SIDA itagaragarira ibyuma biyipima byamenyekanye cyane mu itangazo ry’Ubusuwisi ryo mu 2008 biteza impaka no kutabivugaho rumwe, kuva icyo gihe byaje gukorerwa ubushakashatsi bwimbitse biremezwa ko bibari ndetse bishoboka.

Ku isi hose, uburyo bukunze kwanduriramo virusi itera SIDA ni uburyo bwo guhuza ibitsina n'umuntu wanduye hakorwa imibonano mpuza bitsina idakingiye hagati y’abadahuje igitsina; ariko, uburyo bwo kwandura buratandukanye mu bihugu. Kugeza mu 2017, abantu benshi banduye virusi itera SIDA muri Amerika babaye mu bagabo baryamanye n'abagabo (82% by'abanduye virusi itera SIDA ku bagabo bafite imyaka 13 n'abayirengeje na 70% by'indwara nshya). Muri Amerika, abagabo bahuje ibitsina bafite imyaka 13 kugeza kuri 24 bangana na 92% by'abanduye virusi itera SIDA mu bagabo bose bari mu kigero cyabo na 27% by'indwara nshya mu bagabo bose bahuje ibitsina ndetse n'ibitsina byombi. Abagabo bagera ku 15% b’abagabo bahuje ibitsina banduye virusi itera SIDA, mu gihe 28% by’abagore bahindura ibitsina "transgender" banduye muri Amerika.

Ku bijyanye n’imibonano mpuzabitsina idakingiye, ibigereranyo by’ingaruka zo kwandura virusi itera sida ku gikorwa cy’imibonano mpuzabitsina bigaragara ko byikubye inshuro enye kugeza ku icumi mu bihugu byinjiza amafaranga make ugereranyije no mu bihugu byinjiza amafaranga menshi. Mu bihugu byinjiza amafaranga make, ibyago byo kwandura abagore ku bagabo bingana na 0.38% kuri buri gikorwa, naho kwanduza abagabo ku bagore ni 0,30% kuri buri gikorwa; ibigereranyo bihwanye n'ibihugu byinjiza amafaranga menshi ni 0,04% ku gikorwa cyo kwanduza abagore ku bagabo, na 0.08% kuri buri gikorwa cyo kwanduza abagabo n'abagore. Ibyago byo kwandura bivuye mu mibonano mpuzabitsina ni byinshi cyane, bivugwa ko 1,4-1.7% kuri buri gikorwa haba mu mibonano mpuzabitsina idahuje igitsina ndetse n'abaryamana bahuje igitsina. Nubwo ibyago byo kwandura biva mu mibonano mpuzabitsina ku bahuje ibitsina ari bike, biracyahari. Ibyago byo kwakira imibonano mpuzabitsina mu kanwa byavuzwe ko ari "hafi NTABYO"; ariko, byagaragaye ko hari abantu bake banduye binyuze muri ubwo buryo. Ibyago kuri buri gikorwa byagereranijwe kuri 0-0.04% ku bakira imibonano mpuza bitsina mu kanwa "oral sex". Mu bihe birimo uburaya mu bihugu bikennye cyane, ibyago byo kwandura abagore ku bagabo byagereranijwe ko ari 2,4% kuri buri gikorwa, naho kwanduza abagabo ku bagore ni 0,05% kuri buri gikorwa.

Ibyago byo kwandura byiyongera iyo umuntu yanduye indwara zisanzwe zandurira mu mibonano mpuzabitsina hamwe n’ibisebe byo mu gitsina. Ibisebe byo mu gitsina bigaragara ko byongera ibyago inshuro zigera kuri eshanu. Izindi ndwara zandurira mu mibonano mpuzabitsina, nka mburugu, kilamidiya, tirikomunasi, na vaginose ya bagiteri, zifitanye isano no kwiyongera gake mu byago byo kwandura.

Ubwiyongere bw'ubukana bwa virusi itera SIDA mu mubiri w'uwayanduye  "viral load" ni ikintu cy’ingaruka zikomeye mu kwanduza virusi itera SIDA binyuze mu mibonano mpuzabitsina ndetse biciye mu kwandura hagati y'umwana na nyin/umubyeyi we. Mu mezi 2.5 y'ibanze mu ikubitiro ryo kwandura virusi itera SIDA ubwandu bw'umuntu bwikubye inshuro cumi n'ibiri bitewe (n'ubwiyongere bw'ubukana bwiyo virusi itera SIDA afite mu mubiri we) - "VIRAL LOAD". Niba umuntu ari mu cyiciro cye cyanyuma yaho yanduriye virusi itera SIDA, ibipimo byanduza bikubye inshuro umunani.

Abakora imibonano mpuzabitsina bicuruza mu bikorwa by'uburaya (harimo n'abacuruza imibiri yabo by'umwuga byemewe "pornography") bafite ibyago byinsho byo kwandura virusi itera SIDA. Imibonano mpuzabitsina ikabije mu buryo bwo gukubana kw'ibitsina nta bunyerere cyangwa ububobere buhagije mu gitsina "rough sex" irashobora guteza kwiyongera kw'ibyago byo kwandura virusi itera SIDA. Ihohoterwa rishingiye ku gitsina rikubiyemo ibikorwa byo gufata kungufu/gusambanya undi ku gahato no gusambanya abana bakiri bato "sexual assualt" naryo rishobora guteza ibyago byinshi byo kwandura virusi itera SIDA kubera ko udukingirizo tudakunze kwambarwa muri ibyo bikorwa by'ubugome bigatera gukomereka mu gitsina ku bagore n'abakobwa no ku gitsina ku bagabo n'abahungu cyangwa gukomereka mu kibuno kubakorerwa ibikorwa byo gufatwa ku ngufu n'abatinganyi bikongera ibyago byinshi byo kwandura virusi itera SIDA ndetse bikaba byanatera ibyuririzi by'indwara zindi zandurira mu gukora imibonano mpuza bitsina akabirwarira hamwe n'ubwandu bwa virusi itera SIDA.

### Amatembabuzi

Uburyo bwa kabiri bukunze kwanduriramo virusi itera sida ni uburyo bunyuze mu maraso yanduye n'amatembabuzi yivanzemo ayo maraso yanduye. Kwandura biciye muri ubu buryo birashobora guterwa no gusangira inshinge mugihe cyo gukoresha ibiyobyabwenge bacisha mu kwitera inshinge mu mitsi, gukomeretswa n'inshinge mu gihe ruri guterwa ufite ubwandu bwa virusi itera SIDA, guterwa amaraso yanduye cyangwa ibikomoka ku maraso yanduye, cyangwa inshinge zikoreshwa mu buvuzi ariko zitujuje ubuzira nenge hamwe n’ibikoresho bidafite ubuziranenge "bidafite umutekano uhagije wo kubibika mu buryo bwiza mu byuma bibihanaguraho imyanda "sterilizers". Ibyago byo kwandura virusi itera SIDA hakoreshejwe uburyo bwo gusangira urushinge mugihe cyo gutera ibiyobyabwenge mu mitsi hagati y'abakoresha ibyobya bwenge ubwabo biri hagati ya 0,63% na 2,4% kuri buri gikorwa, ugereranije ku gipimo cyo hagati "average" ni 0.8%. Ibyago byo kwandura virusi itera sida ku binyuze k'urushinge rwatewe umuntu wanduye virusi itera sida bivugwa ko ari 0.3% (hafi 1 kuri 333) kuri buri gikorwa kandi ibyago byo kwandura virusi itera SIDA binyuze ku rurenda rw'amatembabuzi ruvanzemo amaraso yanduye virusi itera SIDA ni 0.09% (hafi 1 kuri 1000) kuri buri gikorwa. Izi ngaruka zirashobora ariko kugera kuri 5% mugihe ayo maraso ari muri urwo rurenda rw'amatembabuzi yaturutse kumuntu ufite ubwikorezi bwinshi bwa virusi itera SIDA n'umwenge cyangwa igisebe ari kinini mu mubiri kuri wawundi wandujwe. Muri Leta zunze ubumwe za Amerika abakoresha ibiyobyabwenge bagejeje kuri 12% by'abanduye virusi itera SIDA mu 2009, ndetse no mu turere tumwe na tumwe abantu barenga 80% bitera ibiyobyabwenge banduye virusi itera SIDA.

Virusi itera SIDA yanduza hafi 90% binyuze mu guterwa amaraso yanduye "blood transfusion". Mu bihugu byateye imbere ibyago byo kwandura virusi itera SIDA ni bike cyane (munsi ya kimwe cya kabiri cya miliyoni) aho hakorwa uburyo bwo gutoranya abaterankunga no gusuzuma virusi itera sida mu maraso atangwa "blood donations"; urugero, mu Bwongereza ibyago bivugwa ko ari umwe muri miliyoni eshanu naho muri Amerika yari imwe muri miliyoni 1.5 muri 2008. Mu bihugu bikennye cyane, kimwe cya kabiri cy’amaraso ni yo yonyine ishobora gupimwa mu buryo bukwiye (guhera mu 2008), kandi bikaba bivugwa ko abagera kuri 15% banduye virusi itera SIDA muri utwo turere baturuka ku guterwa amaraso yanduye n'amatembabuzi avanze nayo maraso yanduye, bigereranywa kuri 5% na 10% byanduye kwisi. Birashoboka kwandura virusi itera sida mu guhinduranya ingingo z'umuburi zitangwa kwa muganga "implants", nubwo ibi bidasanzwe kubera kwipimisha mbere ko bikorwa.

Gutera imiti hifashishijwe inshinge zidafite umutekano bigira uruhare muri virusi itera SIDA muri Afurika yo munsi y'Ubutayu bwa Sahara. Mu 2007, hagati ya 12% na 17% byanduye muri kano karere byatewe no gukoresha inshinge zidafite umutekano zo kwa muganga. Ishami ry'Umuryango w'Abibumbye ryita ku Buzima rivuga ko ibyago byo kwandura biturutse ku gutera inshinge muri Afurika ni 1,2%. Hari n'ingaruka zo kwandura virusi itera SIDA zikomoka ku kubaga indembe, kubyaza, no kuvura no kubaga amenyo muri kano karere.

Abantu baterwaho ibishushanyo ku mibiri yabo "tattooing", gutobora ibice by'umubiri bitandukanye, no gukomeretsa ibice by'umubiri wabo binyuze mu ndasago "scarification" bafite ibyago byo kwandura nubwo nta bushakashatsi buhari bufatika bubyemeza. Imibu ndetse nutundi dukoko ntibishobora kuba impamvu yo gukwirakwiza ubwandu bwa virusi itera SIDA.

### Umubyeyi kwanduza umwana
Virusi itera SIDA irashobora kwanduza umwana mu gihe umubyeyi amutwite, igihe cyo kubyara, cyangwa binyuze mu mashereka amwonsa, bigatuma umwana na we yandura virusi itera SIDA. Kugeza mu mwaka wa 2008, kwandura virusi itera SIDA mu buryo bwiswe "verticle transmission" binyuze mu dukoko twa bagitiriya na virusi mu gihe umubyeyi atwite umwana cyangwa arimo kubyara ni 90% by'abana bayandura. Mugihe hatabayeho kuvurwa virusi itera SIDA ku mubyeyi wanduye, ibyago byo kwanduza umwana mbere cyangwa mugihe cyo kuvuka ni 20%, naho kubonsa amashereka ni 35%. Ubuvuzi butangwa ku mubyeyi ukimenya ko yanduye ariko atwite bugabanya ibyago byo kwanduza umwana we akimutwite no mu gihe cyo kumubyara kugeza munsi ya 5%.

Imiti igabanya ubwandu bwa virusi itera SIDA iyo ifashwe na nyina cyangwa umwana bigabanya ibyago byo kwandura ku bonsa. Ibiryo bigaburirwa umwana iyo byivanzemo n'amaraso yanduye virusi itera SIDA mbere yo kubihekenya birashobora guteza ibyago byo kwandura virusi kuri uwo mwana. Niba umugore atavuwe virusi itera SIDA akamara imyaka ibiri yonsa uruhinja nabyo bitera ibyago byo kwanduza umwana we bigera kuri 17%. Bitewe n’ubwiyongere bw’urupfu rw'impinja bukomoka ku kutonsa mu bice byinshi byo mu bihugu biri mu nzira y'amajyambere, Ishami ry'Umuryango w'Abibumbye ryita ku Buzima rirasaba ko konsa byihariye hagati y'umubyeyi n'uwo mwana we umwe gusa cyangwa gutanga kwifashisha amata yo mu bikombe nk'imfashabere. Abagore bose bazwiho kuba banduye virusi itera SIDA bagomba gufata imiti igabanya ubukana ubuzima bwabo bwose.

## Ubumenyi n'ubucukumbuzi bujyanye na Virusi

Virusi itera SIDA niyo nyirabayazana w'indwara zitera umuburi kubura ubudahangarwa ari nabyo byitwa "SIDA". Virusi itera SIDA ni ubwoko bwa "retrovirus" yibanda cyane mu kwangiza abasirikare barinda umubiri w'umuntu bitwa "CD4 + T Cells", "macrophage" na "dendritic cells" . Yangiriza byimazeyo mu buryo buziguye ndetse n'ubutaziguye abo basirikare batuma umubiri ugira ubudahangarwa bitwa "CD4 + T". 

Iyo virusi itera SIDA ibarizwa mu bwoko bwa "*Lentivirus"*,  nabwo bubarizwa mu cyiciro cyitwa "*Retroviridae"* .  Virusi zo muri ubu bwoko bwa "Lentivirus" zisangiye ibintu byinshi biziranga imiterere yabyo ndetse n'ibijyanye n'ubutabire bw'ibinyabuzima bubiranga. Ibinyabuzima byinshi biri mu cyiciro cy'inyamaswa zonsa zikunze gufatwa no kwandura nama virusi ari muri ubu bwoko bwa "Lentiviruses" ari nabyo bikunze gutera indwara z'igihe kirekire ndetse zimara igihe mu mubiri zirimo gukura.  Ubu bwoko bwa virusi zibarizwa muri "Lentiviruses" zigira ububasha bwo kwandura bwinjira mu mubiri ari imbumbe kandi bwiteguye kwanduza bwiyambitse urububi ruzirinda rwa "RNA GENOME". Iyo zinjiye mu mubiri ako kanya, rwa rububi ruzirinda rwa "RNA GENOME" ruhita ruhindagura imiterere yarwo "reverse transcribed" rugahinduka ADN ifite kopi ebyiri ya virusi nyayo itera uburwayi byitwa "reverse transciptase" bizanana na ya "GENOME" virusi mu bigize virusi. Nyuma yo kwihindagura yisanisha na ADN ziri mu mubiri mu buryo bwo gukora kopi zisa neza ihita yinjira mu dutafari twubatse umubiri twitwa "nucleus cells" tugahita twisanisha neza nkatwo mu rwego rwo kwiyorobeka no kwihisha mu mubiri binyuze mu buryo bwitwa "integrase" nibigize umubiri yinjiyemo. Virusi iyo imaze kwinjira neza muri twa dutafari tugize umubiri "cells" ihita yirinda kugira ibitero igaba ku mubiri ako kanya kugirango abasirikare baha ubudahangarwa mu mubiri batayivumbura bagatangira kuyirwanya. Hari nubwo virusi iyo imaze kwinjira mu mubiri ihita ikoresha ubundi buryo bwitwa "transcribed" ari nabwo bwo kubasha kwiyubura ikikoramo kopi nyinshi z'amavirusi bisa kimwe ya "RNA GENOMES" afite naza poroteyine z'ama virusi byishyize hamwe bikirema mu imbere muri za "cells" zigakomeza gutubuka gutyo zikaba nyinshi mu mubiri "VIRAL LOAD". 

Virusi itera SIDA ubu yamenyekanye ko ikwirakwira iciye mu basirikare barinda umubiri bawuha ubudahangarwa ba "CD4 + T" biciye mu nzira ebyiri zibangikanye: gukwirakwiza mu imbere muri "cells" ubwayo aribyo byitwa "cell-free spread" cyangwa gukwirakwizwa yanduza za "cells" zitandukanye ku bwinshi ari nabyo byitwa "cell-to-cell spread". Mu gukwirakwiza biciye mu buryo bwa "cell-free spread" virusi ziva mu ngirabuzimafatizo "virus particles bud" zituruka mu basirikare banduye ba  "T cells", zinjira mu maraso/nandi matembabuzi avanze namaraso hanyuma zikanduza utundi dusirikare turinda umubiri kwandura twa "T cells" uko zijyenda zihura nazo gutyo gutyo kugeza zikwirakwiye mu mubiri hose.  Iri kwirakwizwa rya virusi mu mubiri uko rigenda ryikoramo kopi nyinshi biri mu bintu birwanya bigaca inege imiti n'ubuvuzi bujyanye no kuvura amavirusi 

Ubwoko bubiri bwa virusi itera sida bwaranzwe na virusi y'ubwoko bwitwa "VIH-1" na "VIH-2". Virusi ya "VIH-1" ni virusi yavumbuwe bwa mbere (kandi yabanje kwitwa "LAV" cyangwa "HTLV-III"). Ni virusi ifite ubukana kandi yandura cyane,  kandi niyo nyirabayazana w'ubwandu bwa virusi itera SIDA ku isi yose ugereranije na virusi yo mu bwoko bwa "VIH-2" izwiho kwandurwa n'abantu bake. Kubera ubushobozi buke ugereranije bwo kwandura, ubwoko bwa virusi ya "VIH-2" igarukira muri Afurika y'Iburengerazuba .

## Indwara ya Pathophysiology

Iyo virusi imaze kwinjira mu mubiri habaho igihe cyo gutubuka kwayo zikaba nyinshi mu buryo bwo kujyenda zikoramo kopi nyinshi byihuse, biganisha kuri virusi nyinshi mumaraso "VIRAL LOAD". Mu ikubitiro ryo kwandura virusi, urwego rwa virusi itera sida rushobora kugera kuri miliyoni nyinshi za virusi kuri mililitiro yamaraso mu mubiri.  Iki gisubizo kijyana nigabanuka ryagaragaye mumibare y'abasirikare barinda umuburi indwara bitwa "CD4 T". Virusi ikomeza kugira ubukana kubera imiterere yayo yo gutuma havuka utundi dusirikare "cells" twitwa "CD8 T" tuza twica burundu twa dusirikare turinda umubiri kutandura indwara tukabyara za "antibody" zirwanya umubiri ziwuca intege, cyangwa "seroconversion" . Igisubizo gifatika mu isuzuma ryutwo dusirikare twa "CD8 + T" nicyo cyerekana uko ubwandu bw'indwara bujyenda bugabanyuka cyangwa bwiyongera mu mubiri nubwo bitarinda burundu virusi itera SIDA.

Amaherezo, virusi itera SIDA irwanya ba basirikare barinda umubiri indwara ikajyenda ibica ibagabanya ubwinshi bakaba bakeya mu mubiri "CD4 + T" kugeza ubwo umubiri ubura ubudahangarwa bigatera indwara z'ibyuririzi kwibasira umubiri muburyo buzorohereye. Abasirikare ba "T Cells" ni ingirakamaro mubisubizo byubudahangarwa bw'umubiri kandi bitabaye ibyo, umubiri ntushobora kurwanya indwara cyangwa kwica udusirikare twamaze kuba kanseri mu mubiri. Uburyo abasirikare ba "CD4 + T cells" bagenda bashira mu mubiri bugiye butandukanye yaba mu ikubitiro umubiri ukinjiramo virusi itera SIDA ikikoramo kopi nyinshi ndetse no mu bihe bwo kurwaragurika cyane mu byiciro bitandukanye.  Mu cyiciro cy'ibanze cyo kwandura virusi itera SIDA, hifashishwa udusirikare twanduye twabaye kanseri mu mubiri twa "CD8 + T" ari natwo tugira uruhare mu kugabanuka k'udusirikare turinda umubiri twa "CD4 + T", nubwo umubiri ubwawo wabigiramo uruhare mu gihe wirwanaho wica udukoko turi mu mubiri mu buryo bwitwa "apoptose" nayo ishobora kubitera. Iyo virusi ziyongereye mu mubiri; umurwayi akagera mu cyiciro cyo kuremba bikabije no kurwaragurika indwara z'ibyuririzi zitandukanye bituma habaho gutakaza buhoro buhoro ubushobozi bwimikorere yubudahangarwa bwo kubyara abasirikare bashya ba "T cells" ari nabyo bituma bagabanyuka cyane"CD4 + T". 

Nubwo ibimenyetso byo kubura ubudahangarwa biranga SIDA bitagaragara imyaka myinshi nyuma yuko umuntu yanduye, igice kinini cyo gutakaza abasirikare ba CD4 + T kibaho mugihe cyicyumweru cya mbere cy'ubwandu, cyane cyane mumitsi yo munda, kibamo uturemangingo turwanya indwara zo mu mubiri twita "lymphocytes" mu mubiri.  Impamvu virusi itera SIDA yibanda cyane kuri ako gace ko munda "intestinal mucosa" ni ukubera ko virusi itera SIDA ikora za poroteyine z'ubwoko bwa "CCR5" ikoresha mu kwibasira yinjira ihungabanya abasirikare barinda umubiri indwara ba "CD4 + T" kandi ako gace k'imitsi yo munda kagizwe cyane nizo poroteyine kuruta za poroteyine ziba mu maraso. Imihindagurikire yihariye ihindura imiterere ya za poroteyine za "CCR5" iyo ziboneka mu buryo bwombi bwa "chromosomes" birinda cyane kwandura virusi y'ubwoko bwa VIH-1. 

Virusi itera SIDA ishakisha kandi ikarandura byimazeyo  CCR5 zigaragaza mudusirikare turinda umubiri twa CD4 + T mu ikubitiro ryo kwandura iyo virusi kuko nibwo iba ifite ubukana bwinshi.  Abasirikare barinda umubiri ba CD4 + T ni nako batangira kurwanya iyo virusi itera SIDA ari nako irushaho kubica bikihutisha kujya mu cyiciro cya kabiri cyo kuremba no kurwaragurika buri kanya bidakira "clinical latent phase". Uko virusi itera SIDA irushaho kwikoramo kopi nyinshi ikibasira umubiri wose ni nako umubiri ubura ubudahangarwa kurushaho. Ibyo byose bigateza uruvangitirane rw'ibibazo byo mu mubiri bituma habaho gusohoka kwa "pro-inflammatory cytokines". Ni nabyo ndetse bifitanye isano mu guteza indwara zo munda nk'igifu kubera urububi/igisenge kigize amara gikomeza kujyenda cyangirika cyane iyo habayeho kuremba cyane.

## Gusuzuma

Virusi itera SIDA isuzumwa hifashishijwe ibizamini bya laboratoire hanyuma bigakorwa hashingiwe ku bimenyetso cyangwa ibimenyetso bimwe na bimwe. Ikigo cya Leta zunzwe ubumwe z'Amerika cya "Preventive Services Task Force" gishishikariza abantu bose kuva ku myaka 15 kugeza ku myaka 65 kwisuzumisha virusi itera SIDA, harimo n'abagore bose batwite. Byongeye kandi, kwipimisha bishishikarizwa cyane abantu bafite ibyago byinsho byo kuyandura, cyane abasuzumwa bagasanga baranduye izindi ndwara zandurira mu mibonano mpuza bitsina. Mu bice byinshi byisi, kimwe cya gatatu cyabanduye virusi itera SIDA babimenya ari uko igihe cyamaze kurenga bamaze gutaka ubudahangarwa bw'umubiri kuburyo bwigaragaza bukabije.

### Kwipimisha virusi itera SIDA

Abantu benshi banduye virusi itera SIDA bakunze kurangwa n'imisemburo mu mubiri yabo irwanya ibice by'umubiri "antibodies" (ni ukuvuga seroconvert) bibaho mu byumweru bitatu kugeza kuri cumi na bibiri nyuma yo kwandura bwa mbere. Gupima virusi itera sida mbere ya seroconversion bikorwa mugupima HIV-RNA cyangwa p24 antigen. Ibisubizo bigaragaza ubwandu (positive) byabonetse nyuma yo gupima za "antibodies" cyangwa ibizamini bya PCR byemezwa na "antibody" itandukanye cyangwa na PCR.

Gusuzuma no gupima "antibody" ku bana bari munsi y'amezi 18 bikunze gutanga ibisubizo bitari bya nyabyo kubera za "antibodies" bakomora ku babyeyi babo ziba zikiri mu mibiri yabo bana. Kubw'izo mpamvu, ubwandu bwa virusi itera SIDA bishobora gupimwa gusa hifashishije gupima PCR za HIV-RNA cyangwa ADN, cyangwa binyuze mu gupima antigen p24. Henshi ku isi hari icyuho n'ibura ry'ibikoresho bihagije byo gupima ubwandu bwa virusi itera SIDA hifashishijwe agakoresho ka PCR yizewe, kandi abantu mu bihugu byinshi bitishoboye bategereza kugeza ibimenyetso byigaragaje cyangwa umwana akuze bihagije kugirango bapimwe neza za "antibody". Muri Afurika yo munsi y'Ubutayu bwa Sahara hagati ya 2007 na 2009, abaturage bari hagati ya 30% na 70% bari bafite amakuru ahagije kuri virusi itera SIDA. Muri 2009, hagati ya 3,6% na 42% by'abagabo n'abagore bo mu bihugu byo munsi y'ubutayu bwa Sahara nibo babashije kwisuzumisha; ibi byagaragaje ubwiyongere bugaragara ugereranije nimyaka yashize.

### Ibyiciro
Uburyo bubiri bw'ingenzi bwo kuvura bukoreshwa mu gushyira mu byiciro indwara zanduye virusi itera SIDA n'indwara zifitanye isano na virusi itera SIDA hagamijwe gukurikirana abanduye: gahunda y'ikigo mpuza mahanga gikurikirana ubuzima "WHO" gikurikirana umunsi kuwundi imiterere ya virusi itera SIDA n'indwara zigashamikiyeho, n'ikigo gikurikirana kinakakumira indwara zandura cya "CDC" uburyo gishyira mu byiciro ibirebana na virusi itera SIDA. Kubera ko gahunda y'ikigo cya "WHO"  idasaba ibizamini bya laboratoire, ikwiranye n’imiterere y’imikoreshereze ihura n’ibihugu biri mu nzira y'amajyambere, aho ishobora no gukoreshwa mu gufasha kuyobora imiyoborere y’amavuriro. Nubwo zi gahunda zitandukanye, sisitemu zombi zemerera kugereranya intego zimibare.

Ishami ry'Umuryango w'Abibumbye ryita ku Buzima ryatanze icyifuzo cya mbere ku gisobanuro kirebana na SIDA mu 1986. Kuva icyo gihe, OMS yakomeje gahunda yo kuvugurura ibyiciro bitandukanye inshuro nyinshi, igisobanuro giheruka cyemeranyijweho ku isi hose ubu OMS ikaba iheruka kugisohora mu 2007. Sisitemu ya OMS ikoresha ibyiciro bikurikira:

* Icyiciro cy'ibanze cy'ubwandu bwa virusi itera sida: Birashobora kuba bidafite ibimenyetso cyangwa bifitanye isano no kuremba bikabije (kwandura mu gihe cy'ibanze aho virus iba ifite ingufu nyinshi mu mubiri irimo gushaka gukwirakwira mu mubiri hose).
* Icyiciro cya I: Kwandura virusi itera sida bifitanye isano n'ibimenyetso byigaragaza bijyanye numubare w'abasirikare baha umubiri ubudahangarwa bitwa CD4 + T (uzwi kandi nka "CD4 count") urenga 500 kuri microlitre (µl cyangwa cubic mm) yamaraso. Bikunze kugirana isano no kubyimba k'utunyabuzima twa "lymph" turinda umuburi indwara (tuba mu kwaha, aho amaguru yombi ahera uturutse ku gice igihimba kirangiriraho ndetse no mu bice bitandukanya amatama ijosi)
* Icyiciro cya II: Ibimenyetso byoroheje, bishobora kuba birimo uduheri twinshi duto duto kandi twegeranye twibanda ku bice bimwe by'uruhu hamwe n'indwara zandurira mu myanya y'ubuhumekero. CD4 ibara munsi ya 500 / µl
* Icyiciro cya III: Ibimenyetso biri kurwego runini, bishobora kuba birimo impiswi idakira idasobanutse mugihe kirenze ukwezi, indwara ziterwa na n'agakoko ka bagiteri zirimo igituntu cyibihaha, hamwe na CD4 ibara munsi ya 350 / µl
* Icyiciro cya IV ari nacyo SIDA: ibimenyetso bikomeye, birimo indwara cyangwa gufatwa n'ibimenyetso bya "toxoplasmosis " yo mu bwonko, indwara ya kandida "candidiasis" ifata mu muhogo, mu buhumekero cyangwa ibihaha, na "sarcoma" ya Kaposi. CD4 ibara munsi ya 200 / µl

Ikigo cyo muri Leta zunze ubumwe z’Amerika gishinzwe kurwanya no gukumira indwara (CDC) nacyo cyashyizeho uburyo bwo gushyira mu byiciro virusi itera SIDA, kandi byavuguruwe mu 2008 na 2014. Ubu buryo bushyira mu byiciro virusi itera SIDA hakurikijwe kubara abasirikare baha umubiri ubudahangarwa "CD4 count" no kugenzura ibimenyetso byigaragaza, kandi busobanura ubwandu mu matsinda atanu. Mu barengeje imyaka itandatu ni:

* Icyiciro cya 0: igihe kiri hagati yo gufata ikizamini gipima ubwandu bwa virusi itera SIDA ntikiyigaragaze (negative) cyangwa kitamenyekanye cyakurikiranye n'ikizamini cyaje kugaragaza ubwandu bwa virusi itera SIDA (positive) kiri munsi yiminsi 180.
* Icyiciro cya 1: CD4 ibara abasirikare bari hejuru ya 500 / µl kandi nta bimenyetso bya SIDA byigaragaza
* Icyiciro cya 2: CD4 ibara abasirikare bari hagati ya 200 na 500 / µl kandi nta bimenyetso bya SIDA byigaragaza
* Icyiciro cya 3: CD4 ibara abasirikare bangana cq bari munsi ya 200 / µl kandi hari ibimenyetso bya SIDA byigaragaza
* Icyiciro kitazwi: Kuba nta makuru ahagije ahari yo kuba hari ibyatuma habaho gushyirwa mu byiciro bivuzwe haruguru.

Mu rwego rwo kugenzura, isuzuma rya SIDA rikomeje gukorwa nubwo nyuma yo kuvurwa, umubare wa wabasirikare barinda umubiri ba "CD4 + T" wazamutse ukagera kuri 200 kuri µL yamaraso cyangwa izindi ndwara zishamikiye ku bimenyetso bigaragaza SIDA ziba zamaze gukira

## Kwirinda

### uhuza ibitsina

Gukoresha agakingirizo mu buryo buhoraho kandi igihe kirekire bigabanya amahirwe yo kwandura virusi itera SIDA ku kigereranyo kingana na 80%. Iyo agakingirizo gakoreshwa buri gihe n’abashakanye muri bombi umwe ariwe wanduye undi ari atanduye bigabanya amahirwe yo kwandura virusi itera SIDA ku kigereranyo kiri kuri 1% ku mwaka. Hariho ubushakashatsi bushimangira ko agakingirizo k'abagore gashobora gutanga urwego rumwe rwo kurinda. Gukoresha imiti yifashishwa mu gutuma mu gitsina hazamo ububobere yitwa "gel" nka "tenofovir"(yifashishwa mu kuvura indwara ya SIDA rimwe na rimwe indwara y'umwijima ya hepatitis B) igakoreshwa mbere yo gukora imibonano mpuza bitsina bijya bigabanya amahirwe yo kwandura virusi itera SIDA kugera ku kigereranyo kingana na 40% mubagore bo muri Afrika. Binyuranye no gukoresha imiti yica intanga ngabo nka "nonoxynol-9" kuko iyo izwiho kongera ibyago byo kwandura virusi itera SIDA bitewe nuko ituma mu gitsina no mu nnyo hazamo udusebe.

Gusilamura (abagabo) muri Afurika yo munsi y'Ubutayu bwa Sahara "bigabanya kwandura virusi itera sida ku bagabo badahuje igitsina hagati ya 38% na 66% mu gihe cy'amezi 24". Kubera ubwo bushakashatsi, Ishami ry’Umuryango w’abibumbye ryita ku buzima ndetse na UNAIDS bashishikarije abagabo kwisiramuza muri 2007 mu rwego rwo gukumira virusi itera SIDA binyuze ku bwandu buturuka ku mugore wanduye yanduza umugabo utanduye mu turere twa Afurika twiganjemo umubare munini wabanduye virusi itera SIDA. Icyakora, ntibivugwaho rumwe ku bijyanye nimba kwisilamuza birinda umugore utanduye virusi itera SIDA iyo aryamanye n'umugabo wanduye virusi itera SIDA usilamuye, ndetse nta mibare izwi cyangwa ifatika ivuga ko byarinda abahuje ibitsina b'abagabo bakora imibonano kwandura virusi itera SIDA mu bihugu byateye imbere. Umuryango mpuzamahanga urwanya virusi, urasaba ukanashishikariza ko abagabo bose bakora imibonano nabo badahuje igitsina bagomba kwisilamuza ndetse nabakora imibonano mpuzabitsina nabo bahuje igitsina ko byaganirwaho nkuburyo bwo guhitamo kwirinda virusi itera SIDA. Abahanga bamwe batinya ko hashobora kuvuka imyumvire ituma umubare munini wabantu wakwitabira ibikorwa byo gukora imibonano mpuza bitsina idakingiye bitwaje ko gusilamurwa ari urukingo rubarinda ubwandu bwa virusi itera SIDA.

Porogaramu zishishikariza kwifata no kurinda ubusugi n'ubumanzi ku bakobwa n'abahungu ntabwo bigaragara ko zigira umusaruro mwiza uhagije kandi ufatika mu kwirinda virusi itera SIDA. Hari ibimenyetso bigaragaza ko umusaruro wizo nyigisho udahagije habe namba. Inyigisho zihagije zitangwa ku bumenyi bw'imyororokere mu mashuri zishobora kugabanya imyitwarire ishobora guteza ibyago byinshi byo kwijandika no kwiyandarika mu bikorwa by'ubusambanyi. Umubare munini wurubyiruko rukomeje kwishora mubikorwa byinshi bishobora guteza ibyago byo kwandura virusi itera SIDA nubwo bahabwa inyigisho zihagije kuberana n'ubwandu bwiyo virusi, kuko babitesha agaciro ko kumva ko nabo bashobora kwandura. Ubujyanama butangwa no gupima kubizana kubihabwa ku bushake ntabwo bigabanya ibikorwa byo kwijandika no kwiyandarika mu busambanye kubamaze gupimwa bagasanga batanduye ahubwo bituma abapimwe bagasanga banduye bakunda gukoresha udukingirizo n'imibare ikazamuka mu buryo bwigaragaza. Serivisi zinoze zo kuboneza urubyaro bigaragara ko byongera umubare wo gukoresha imiti yo kuboneza urubyaro mu bagore bamaze kumenya ko bafite ubwandu bwa virusi itera SIDA. Nta makuru agahije azwi niba kuvura izindi ndwara zandurira mu mibonano mpuzabitsina bifite akamaro mu gukumira virusi itera SIDA.

### Kwirinda mbere yo kwandura virusi itera SIDA
Gufata imiti igabanya ubukana bwa virusi itera SIDA mu bantu babana n'ubwandu bafite abasirikare barinda umubiri "CD4 count" bagejeje kuri 550 / µL ni uburyo bwiza cyane bwo kurinda kwanduza abo baryamana nabo (ingamba zizwi nko kuvura bisa nko kwirinda, cyangwa TASP). TASP ifitanye isano no kugabanuka inshuro 10 kugeza kuri 20 ibyago byo kwandura. Imiti irinda kwandura virusi itera sida yitwa "profhylaxis (PrEP)" ikoreshwa mbere yo gukora imibonano mpuza bitsina hamwe numuti ukoreshwa buri munsi wa "tenofovir", hakoreshejwe cq hatanakoreshejwe umuti wa "emtricitabine", bigabanya ibyago byinshi byo kwandura virusi itera SIDA hagati y'abantu bafite amahirwe menshi yo kwandura nk'abagabo bakora imibonano nabo bahuje igitsina ndetse n'abaryamana umwe abizi ko yanduye undi abizi ko atanduye ndetse no murubyiruko rwo muri Afurika. Bene ubu buryo bushobora kurinda nabakoresha inshinge bitera imiti/ibiyobyabwenge babicishije mu mitsi, nyuma y'ubushakashatsi bwakoze bukagaragaza ko habayeho kugabanyuka ku kigereranyo kivuye kuri 0.7 kugeza kuri 0.4 ku gipimo cy'imyaka 100 y'abantu "100 person years". Ikigo cy'Amerika gishinzwe gahunda zo kwirinda indwara gishishikariza ko abantu bafite ibyago byinsho byo kwandura virusi itera SIDA ko bakwiye gukoresha imiti ya PrEP.

Uburyo rusange bwo kwirinda muri gahunda z'ubuzima no kubwitaho bifite ingaruka nziza mu kugabanya ibyago byo kwandura virusi itera SIDA. Gahunda zishyirwaho mu gukumira kwitera ibiyobyabwenge biciye mu mitsi hakoreshejwe inshinge no kuzisangira no gahunda zo gufasha kuvura abakoresha ibiyobyabwenge bagahabwa ingurane nziza zo kubavura "rehabilitation therapy" biri mu bintu bihambaye bigabanya ibyago by'ubwandu bwa virusi itera SIDA.

### Kwirinda nyuma yo gukeka ko wandujwe virusi itera SIDA
Imiti irinda ubwandu bwa virusi itera SIDA ifatwa mu masaha ari hagati ya 48 na 72 ku muntu ukeka ko cyangwa wahuye n'amaraso arimo ubwandu bwa virusi itera SIDA cq amavangiro yo mu gitsina yanduye; iyo miti yitwa "prophylaxis (PEP)". Gukoresha umuti ufata rimwe wa "zidovudine" bigabanya ibyago byo kwandura virusi itera sida inshuro eshanu nyuma yo gukomeretswa n'urushinge. Kugeza mu 2013, gahunda yo gukoresha imiti irinda kwandura virusi itera SIDA muri Leta z'unze ubumwe z'Amerika yashyizeho imiti y'ubwoko butatu bwo kwifashisha ari bwo - "tenofovir, emtricitabine na raltegravir" - kuko ibyo bishobora kugabanya ingaruka kurushaho.

Imiti ya "PEP" ishishikarizwa gufatwa byihutirwa cyane iyo habayeho igikorwa cyo gufatwa ku ngufu cq gusambanya umwana cyane iyo ukekwaho icyo cyaha akekwaho kuba yanduye virusi itera SIDA, ariko bikunze gutera impagarara no kutavugwaho rumwe cyane ukekwaho icyaha ubuzima bwe busanzwe butazwi nimba yaranduye cyangwa se ari muzima. Igihe cyo kwivuza gikunze kuba ibyumweru bine kandi bikunze kuba bifitanye isano n'ingaruka zizahaza uyikoresheje aho imiti ya "zidovudine" ikoreshwa, hafi 70% bagirwaho ingaruka yo kugira isesemi (24%), umunaniro (22%), guhangayika kumutima (13%) no kubabara umutwe (9%).

### Kurinda umubyeyi kwanduza umwana
Gahunda yo kurinda umubyeyi kwanduza umwana virusi itera SIDA zishobora kugabanya ibyaho byo kwandura ku kigereranyayo kiri hagati ya 92-99%. Ibi ahanini bikubiyemo gukoresha imiti igabanya ubukana bwa virusi itera SIDA mugihe umubyeyi atwite na nyuma yo kuvuka k'umwana no gushyiraho gahunda yo gusimbura ibere umwana akagaburirwa hakoreshejwe insimbura bere nka bebelo aho kumwonsa. Iyo gahunda yo kwifashisha insimbura bere ishoboka, byoroshye kubigeraho, hari ingurane ndetse ari nta mabura kindi abikumira kandi kubigeraho bikaba byoroshye, umubyeyi usanganywe ubwandu bwa virusi itera SIDA agomba kwirinda byimazeyo konsa umwana we; ariko konsa umwana ni ibintu byingenzi muri ya mezi y'ibanze kugirango umwana abashe gukura neza iyo biri ngombwa. Iyo bibaye ngombwa ko umwana yonswa muri ayo mezi y'ibanze ni ngombwa ko umwana akomeza gufata imiti ya "prophylaxis" kugirango arindwe kwandura virusi itera SIDA ayanduzwa na nyina binyuze mu kumwonsa. Mu mwaka wa 2015, igihugu cya Cuba cyabaye icya mbere mu gukumira no kurinda umubyeyi kwanduza umwana virusi itera SIDA.

### Urukingo
Kugeza ubu nta rukingo ruraboneka rwa virusi itera SIDA. Kugeza amagingo aya; urukingo rukiri mu igeragezwa ruhari rukoreshwa kandi rugaragaza ko rufite uburyo rugabanya ubukana bwa virusi itera SIDA ni urwitwa "RV 144", rwavumbuwe mu mwaka wa 2009 ndetse rugaragaza ko rugabanya ubukana bwa virusi itera SIDA kugeza ku kigereranyo kingana na 30%, ibi bikaba bitera ibyiringiro byejo hazaza mu muryango wubushakashatsi bwo gukora urukingo rukora neza kurushaho. Haracyakorwa izindi nkingo zigerageza zishingiye ku rukingo rwa "RV 144" ndetse birakomeje.

## Umuti/Ubuvuzi
Kugeza ubu nta muti uhari, nta rukingo rurinda virusi itera SIDA. Umuti uyivura uhari ni ugizwe n'imiti ikomeye yizewe ku kigero kinini igabanya ubukana bwa virusi itera SIDA yitwa (HAART - highly active antiretroviral therapy) ufasha kurinda ko indwara ya SIDA yihuta gukura no gukomera cyane ikwirakwiza ubukana buzahaza umuburi/ubuzima. Kugeza mu mwaka wa 2010 abantu barenga miliyoni 6,6 bakiriye bene iyi miti mu bihugu bikennye n'ibiciriritse. Uyu muti ukubiyemo imiti ikumira ikanavura indwara z'ibyuririzi bya SIDA. Kugeza mu mwaka wa 2020 mu kwezi kwa Werurwe, abarwayi babiri bari banduye virusi itera SIDA niba bamaze kuyikira burundu. Kwihutira gukoresha imiti igabanya ubukana bwa virusi itera SIDA mu cyumweru cya mbere nyuma yo kwisuzumisha bigaragaza ko bitanga amahirwe menshi n'icyizere cyiza mu kuyivura yaba mu bantu barangwa n'ubukene nabafite ubuzima buciriritse.

### Imiti igabanya ubukana bwa virusi itera SIDA

Imiti ikomeye yizewe ku kigero kinini igabanya ubukana bwa virusi itera SIDA yitwa (HAART) ifatwa mu buryo bwo kuyivanga/gukomatanya bikunze kwitwa "cocktails" bukubiyemo imiti igera ku moko atatu iri mu byiciro bibiri by'imiti igabanya ubukana bwa virusi "antiretroviral agents". Mu ikubitir ryo kuvura habanza gukoreshwa uburyo bwa "non-nucleoside revers transcriptase inhibitor (NNRTI)" hiyongereyeho ubundi buryo bubiri bwa "nucleoside analog analog reverse transcriptase inhibitor (NRTIs)". NRTI zisanzwe zirimo: imiti ya zidovudine (AZT) cyangwa tenofovir (TDF) na lamivudine (3TC) cyangwa emtricitabine (FTC). Uhereye muri 2019, dolutegravir / lamivudine / tenofovir yashyizwe ku rutonde n’umuryango w’ubuzima ku isi nk’umurongo wa mbere uvura abantu bakuru, hamwe na tenofovir / lamivudine / efavirenz mu bundi buryo bwakwifashisha kuvura abantu bakuru. Gukomatanya imiti igabanya ubukana bwa virusi nka "protease inhibitor (PI)" bikoreshwa mu gihe imiti ifatwa mu buryo buvuzwe haruguru bitarimo gutanga umusaruro mwiza ufatika ku murwayi wanduye.

Ishami ry'Umuryango w'Abibumbye ryita ku Buzima na Leta zunze ubumwe z’Amerika batanga amabwiriza ashishikariza abantu gufata imiti igabanya ubukana bwa virusi itera SIDA (harimo n'abagore batwite) bakayitangira kuyifata byihuse bakimara gupimwa, hatitawe ku mubare wabasirikare barinda umubiri "CD4 count". Iyo uwanduye atangiye gufata imiti ni byiza ko yirinda kuyihagarika cyangwa kurambirwa kuyifata. Abantu benshi bapimwa bagasanga baranduye bikunze kubaho byaratinze gutangira imiti kubera kwipimisha bakererewe. Uburyo bwiza bwo kwivuza ni uburyo bw'igihe kirekire bukoresha "Plasma HIV-RNA count" ibara munsi ya kopi 50 kuri buri mL. Ikigero gifatirwaho kumenya nimba ubuvuzi bwa virusi itera SIDA burimo gukora neza bupimwa mu gihe cy'ibyumweru bigera kuri bine (4) igisubizo cyaza kiri munsi ya kopi 50 kuri buri mL hakurikiraho gufata ibizamini buri mezi atatu cyangwa atandatu kandi ibyo biba bihagije. Igenzura ridahagije rifatwa ko za "plasma HIV-RNA count" rirenze kopi 400 kuri buri mL. Ukurikije ibi bipimo mu kuvura virusi itera SIDA bitanga icyizere mu kurwanya ubukana bwa bwayo mubantu barenga 95% mumwaka wambere wo kwisuzumisha no kwivuza.

Inyungu zo kwivuza zirimo kugabanuka kw'ubukana bwa virusi itera SIDA mu mubiri kuburyo bitagera aho bizahaza ubuzima ku kigero cyo kubura ubudahangarwa mu mubiri ari nacyo cyiciro byitwa ko umuntu arwaye SIDA ndetse no kugabanya ibyaho byo gupfa vuba. Mu bihugu bikiri mu nzira y'amajyambere, abantu bavurwa mu buryo bwiza kandi hakiri kare bibatera kugira ubuzima buhagaze neza bw'umubiri no mu mitekerereze. Muzindi nyungu ziri mu kwivuza hakiri kare; bigabanya 70% by'ibyago byo kwandura igituntu ku banduye virusi itera SIDA. Izindi nyungu ziri mu kwivuza no gutangira imiti kare; bigabanya ibyaho byo kwanduza abaryamana n'uwanduye n'ibyago by'uko umubyeyi yakwanduza umwana atwite cyangwa mu gihe cyo kubyara cyangwa ku mwonsa. Kugirango umurwayi arusheho kumererwa neza biterwa n'uburyo yiha gahunda yo gufata imiti bijyanye n'imyifatire ye agomba guhindura mu mabwiriza ahabwa na muganga. Zimwe mu  mpamvu zituma hatubahirizwa gahunda zo gufata imiti neza kandi ku gihe harimo; kubura uburyo bwo guhabwa imiti n'ibigo by'ubuvuzi/ubuzima, kubura gahunda zirimo gufasha abarwayi kwiyakira no kubaganiriza, uburwayi bw'imitekerereze no gukoresha ibiyobyabwenge. Amoko atandukanye y'ubuvuzi n'umubare mwinshi w'imiti ifatwa igabanya ubukana bwa virusi itera SIDA n'ingaruka zo kubikoresha nabyo biri mu bintu bituma abanduye bacika intege zo kubahiriza no gukomeza gufata imiti ku gihe. Hamwe n'uko igiciro cy'iyo miti igabanya ubukana bwa virusi itera SIDA byabigiramo uruhare, 47% byabari bakeneye iyo miti bayibonaga kandi baturuka mu bantu babayeho mu bihugu bikennye n'ibiri mu buzima buciriritse mu mwaka wa 2010 ndetse ubwitabire bwo gufata imiti usanga bungana yaba mu bihugu bikennye ndetse n'ibihugu byateye imbere.

Hari ingaruka ziterwa no gufata imiti igabanya ubukana bwa virusi itera SIDA. Zimwe muri izo ngaruka harimo: umubiri kunanirwa gukora uturema ngingo dutuma umubiri ugira amavuta ahagije "lipodystrophy Syndrome", dyslipidemia, na diabete ifata urwagashya, cyane kubakoresha "protease inhibitor". Ibindi bimenyetso bikunze kugaragara harimo impiswi, hamwe n’ubwiyongere bw’indwara zifata umutima. Ubuvuzi bushya bugezweho buzwiho ingaruka nke kubafata imiti igabanya ubukana bwa virusi itera SIDA. Imiti imwe n'imwe irashobora kuba ifitanye isano no gutera ubumuga buvukanwa bityo bikaba bidakwiriye abagore bateganya kubyara kuba bayikoresha.

Imiti igabanya ubukana bwa virusi itera SIDA ihabwa abana bakiri bato itandukanye nihabwa abantu bakuze. Ishami ry'Umuryango w'Abibumbye ryita ku Buzima rishishikariza kuvura abana bose bari munsi y’imyaka itanu; abana bari hejuru yimyaka itanu bavurwa kimwe nkabantu bakuru. Amabwiriza ya Leta zunze ubumwe z'Amerika ashishikariza kuvura abana bose bari munsi y’amezi 12 na buri wese ufite ibipimo bya "HIV RNA" bingana na 100.000 / mL ufite imyaka iri hagati y’umwaka umwe n’imyaka itanu.

Ikigo cy’ubuvuzi cy’ibihugu by’Uburayi (EMA) cyasabye ko habaho uruhushya rwo kwamamaza ku miti ibiri mishya igabanya ubukana bwa virusi itera SIDA (ARV), rilpivirine (Rekambys) na cabotegravir (Vocabria), kugira ngo ikoreshwe hamwe mu kuvura abantu bafite virusi itera SIDA yo mu bwoko bwa (HIV -1). Ubu bwoko bw'iyi iti igabanya ubukana bwa virusi itera SIDA nibwo bwa mbere buje mu buvuzi bwigihe kirekire hifashishwa gutera inshinge. Ibi bivuze ko aho kuba ibinini bya buri munsi, abantu batera inshinge wezi cyangwa buri mezi abiri.

Gukomatanya inshinge za Rekambys na Vocabria bigamije kubungabunga ubuvuzi ku babantu bakuru bafite virusi itera SIDA itagaragara mumaraso (ubwinshi bwa virusi itera SIDA bugaragara ku gipimo cya kopi 50 / ml) babifatanyije hamwe nubuvuzi bwabo bwa ARV, kandi mugihe virusi itigeze itera imbaraga zo kurwanya icyiciro runaka cy'imiti igabanya ubukana bwa virusi itera SIDA yitwa "non-nucleoside reverse transcriptase inhibitor (NNRTIs) na integrase strand transfer inhibitors (INI).

### Indwara z'ibyuririzi
Ingamba zo gukumira indwara z'ibyuririzi ziratanga icyizere mu bantu benshi banduye virusi itera SIDA. Usibye kunoza indwara zubu, ubuvuzi hifashishijwe gufata imiti igabanya ubukana bwa virusi itera SIDA biri mubigabanya ibyago byo kwandura indwara z'ibyuririzi. Abakuze ndetse n'urubyiruko babana na virusi itera SIDA (ndetse no kubafata imiti igabanya ubukana bwa virusi itera SIDA) kabone no ku batagaragara ko banduye igituntu cyangwa a ashobora kuba bafite umutwaro wo kuba baranduye igituntu bagomba gufata ubuvuzi bwa "isoniazid preventive therapy (IPT); bagakorerwa ikizamini cyuruhu gipima igituntu kugirango harebwe nimba hakenewe guhabwa ubuvuzi bwa IPT. Inkingo z'indwara z'umwijima za hepatitis A na B zishishikarizwa guhabwa abanduye virusi itera SIDA mbere ko bagira ibyago byo kwandura bene izo ndwara z'umwijima. Gukoresha imiti y'ubwoko bwa Trimethoprim / sulfamethoxazole prophylaxis bana bakivuka bari hagati yibyumweru bine na bitandatu byamavuko, no guhagarika konsa abana bavutse kubabyeyi banduye virusi itera SIDA, birashishikarizwa cyane ku badafite amikoro ahagije. Birashishikarijwe gukumira PCP mugihe abasirikare barinda umubiri ba CD4 babarwa ku gipimo kiri munsi ya 200 / uL no mubasanganywe PCP cyangwa abigeze kuyirwara. Abantu bafite ubudahangarwa mu mubiri "immunosuppression" buhagije bashishikarizwa gufata imiti ya toxoplasmose na MAC. Ingamba zikwiye zo gukumira zagabanije umuvuduko w’izi ndwara ku kigero cya 50% hagati ya 1992 na 1997. Urukingo rw’ibicurane n’urukingo rwa pneumococcal polysaccharide rukunze gusabwa ku bantu banduye virusi itera SIDA kandi bifite ingaruka nziza zigaragaza ku buzima bwabo iyo bayifashe.

### Indyo
Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS) ryatanze ibyifuzo bijyanye n'intungamubiri zikenewe ku bamaze kwandura virusi itera SIDA. Muri rusange indyo yuzuye ni nayo ishishikarizwa abanduye virusi itera SIDA. Gufata indyo yuzuye ifite intunga mubiri zihagije kurwego rwa RDA ku bantu bakuru banduye virusi itera SIDA ni inama nziza itangwa n'ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS); gufata cyane vitamine A, zinc, na iron bigira ingaruka zitari nziza ku buzima bwabamaze kwandura virusi itera SIDA kubantu bakuze nta nubwo ari byiza keretse niba hari ibigaragaza ko byagabanutse mu mubiri. Gufata indyo z'inyongera "diatary supplmentation" yuzuye kubantu banduye virusi itera SIDA kandi bafite imirire idahagije cyangwa indyo idahagije bifasha gushimangira ubudahangarwa bw'umubiri cyangwa kubafasha gukira indwara zimwe na zimwe; icyakora, ibimenyetso byerekana inyungu rusange muburwayi cyangwa kugabanya impfu zabazira indwara ya SIDA ntabwo bifitiwe ubushakashatsi kuri byo.

Hari ibimenyetso bigaragaza inyungu k'ubuzima bwamaze kwandura visuri itera SIDA iyo bafashe indyo y'inyongera irimo intungamubiri ya "selenium". Ku bagore batwite n'abonsa banduye virusi itera SIDA, indyo z'inyongera zirimo amoko atandukanye ya za vitamine byongera umusaruro ku buzima bwiza ku babyeyi ndetse n'abana. Niba umubyeyi utwite cyangwa wonsa yagiriwe inama yo gufata imiti igabanya ubukana bwa virusi itera SIDA kugira ngo yirinde kwanduza virusi itera SIDA umwana atwite/yonsa, gufata amoko atandukanye ya za vitamine ntizigomba gusimbuzwa ubwo buvuzi. Hariho ibimenyetso bimwe byerekana ko abana bato banduye virusi itera SIDA bafata indyo y'inyongera irimo vitamine A igabanya impfu ndetse ikongerera gukura neza.

Muri Leta z'unze ubumwe z'Amerika, abagera kuri 60% banduye virusi itera SIDA bakoresha uburyo butandukanye bw’ubuvuzi bwuzuzanya cyangwa ubundi buryo bw'inyongera, imikoreshereze yayo ntabwo ifitiwe ubushakashatsi bw'imbitse bwemeza imikorere yayo neza. Nta bimenyetso bihagije byemeza ikoreshwa ry'imiti gakondo cyangwa imiti ikomoka ku bimera. Nta bimenyetso bihagije bihari bishyigikira ikoreshwa ry'urumogi mu gutera ubushake bwo kurya no kubyibuha k'umubiri.

Virusi itera SIDA yamaze kuba indwara karande idakira aho kuba indwara ikomeye mu bice byinshi mu Isi. Kumenyekanisha biratandukanye hagati yabantu, kandi CD4 ibara hamwe numutwaro wa virusi ni ingirakamaro kubisubizo byavuzwe. Hatabayeho kuvurwa, impuzandengo yo kubaho nyuma yo kwandura virusi itera sida bivugwa ko iri hagati yimyaka 9 na 11, bitewe na virusi ya sida. Nyuma yo gusuzuma sida, niba ubuvuzi budahari, kubaho kubaho hagati y'amezi 6 na 19. HAART no kwirinda indwara zanduye zigabanya umuvuduko w'urupfu ku kigero cya 80%, kandi bizamura igihe cyo kubaho ku musore ukiri muto umaze gupimwa kugeza ku myaka 20-50. Ibi biri hagati ya bibiri bya gatatu kandi hafi yabaturage muri rusange. Niba kuvura byatangiye bitinze kwandura, prognoz ntabwo ari nziza: kurugero, niba ubuvuzi bwatangiye nyuma yo gusuzuma sida, icyizere cyo kubaho ni imyaka 10-40. Kimwe cya kabiri cy'abana bavutse banduye virusi itera sida bapfa mbere yimyaka ibiri batavuwe.

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