ການສຶກສາໃຫມ່ສະແດງໃຫ້ເຫັນກໍລະນີທີສອງຂອງການກໍາຈັດເຊື້ອໂລກເອດສສົບຜົນສໍາເລັດຫຼັງຈາກການຜ່າຕັດກະດູກ
ຢ່າງໜ້ອຍມີຄົນເສຍຊີວິດຢ່າງໜ້ອຍໜຶ່ງລ້ານຄົນຍ້ອນສາຍເຫດທີ່ກ່ຽວຂ້ອງກັບເຊື້ອ HIV ໃນແຕ່ລະປີ ແລະເກືອບ 35 ລ້ານຄົນແມ່ນມີຊີວິດຢູ່ ເຊື້ອໂລກເອດສ. HIV-1 (Human Immunodeficiency Virus) ແມ່ນຮັບຜິດຊອບຕໍ່ການຕິດເຊື້ອ HIV ສ່ວນໃຫຍ່ໃນທົ່ວໂລກ ແລະຖືກສົ່ງຜ່ານການສຳພັດໂດຍກົງກັບທາດແຫຼວໃນຮ່າງກາຍທີ່ຕິດເຊື້ອ HIV. ເຊື້ອໄວຣັສໂຈມຕີແລະຂ້າຈຸລັງຕໍ່ສູ້ກັບການຕິດເຊື້ອທີ່ສໍາຄັນຂອງລະບົບພູມຕ້ານທານຂອງພວກເຮົາ. ບໍ່ມີການປິ່ນປົວສໍາລັບ HIV. ປະຈຸບັນ, HIV ສາມາດປິ່ນປົວໄດ້ໂດຍໃຊ້ຢາທີ່ມີຄວາມສາມາດຕ້ານເຊື້ອ HIV ໄດ້ ເຊື້ອໄວຣັສ. These drugs have to be taken life long and it is challenging plus a cost burden on the health system especially in low-and-middle-income countries. Only 59 percent of patients of HIV worldwide are receiving Antiretroviral therapy (ARV) and ເຊື້ອໂລກເອດສ virus is fast becoming resistant from many known drugs which itself is a major concern.
ການຜ່າຕັດໄຂກະດູກ (ສະຫະປະຊາຊາດ) is a treatment used for leukemia, myeloma, lymphoma etc. Bone marrow, the soft tissue inside bones, makes blood-forming cells including the infection fighting white blood cells. A bone marrow transplant replaces unhealthy marrow with a healthy one. In the first case of successful ເຊື້ອໂລກເອດສ remission, an ເຊື້ອໂລກເອດສ-infected individual called ‘Berlin Patient’ who later revealed his name received a bone marrow transplant a decade ago when he was targeted to treat acute leukemia. He received two transplants along with total body irradiation which led to long-term ເຊື້ອໂລກເອດສ ການໃຫ້ອະໄພ.
ໃນການສຶກສາ ໃໝ່ ທີ່ເຜີຍແຜ່ໃນ ລັກສະນະ led by UCL and Imperial College London, the only second person has been shown to experience sustained remission from HIV-1 after a bone marrow transplant and stoppage of treatment. The anonymous adult male patient from UK was diagnosed with HIV infection in 2003 and was on antiretroviral therapy treatment since 2012. He was subsequently diagnosed with Hodgkin’s Lymphoma in the same year and he underwent chemotherapy. In 2016, he was given stem cell transplant from a donor who carried a genetic mutation which prevents expression of a most commonly used ເຊື້ອໂລກເອດສ receptor protein called CCR5. Such a donor is resistant to HIV-1 strain of the virus which specifically uses CCR5 receptor and thus the virus now cannot enter host cells. Since chemotherapy kills cells which are dividing, ເຊື້ອໂລກເອດສ could be targeted. From this understanding if one’s immune cells are replaced by cells which do not have CCR5 receptor, ເຊື້ອໂລກເອດສ can be prevented from rebounding after the treatment.
ການປູກຖ່າຍໄດ້ຖືກປະຕິບັດໂດຍມີຜົນຂ້າງຄຽງເລັກນ້ອຍເຊັ່ນ: ອາການແຊກຊ້ອນເລັກນ້ອຍທີ່ພົບເລື້ອຍໃນການປູກຖ່າຍທີ່ຈຸລັງພູມຕ້ານທານຂອງຜູ້ຮັບຖືກໂຈມຕີໂດຍຈຸລັງພູມຕ້ານທານຂອງຜູ້ໃຫ້ທຶນ. ການປິ່ນປົວດ້ວຍຢາຕ້ານໄວຣັສແມ່ນສືບຕໍ່ເປັນເວລາ 16 ເດືອນຫຼັງຈາກການຜ່າຕັດປ່ຽນ ກ່ອນທີ່ຈະຕັດສິນໃຈຢຸດການປິ່ນປົວເພື່ອປະເມີນການກໍາຈັດເຊື້ອ HIV-1. ປະກາດນີ້, ການໂຫຼດໄວຣັດຂອງຄົນເຈັບຍັງສືບຕໍ່ບໍ່ສາມາດກວດພົບໄດ້. ຄົນເຈັບຢູ່ໃນການໃຫ້ອະໄພຫຼັງຈາກ 18 ເດືອນຫຼັງຈາກການປິ່ນປົວດ້ວຍຢາຕ້ານໄວຣັສຖືກຂັດຂວາງຍ້ອນວ່າຈຸລັງພູມຕ້ານທານຂອງຄົນເຈັບບໍ່ສາມາດຜະລິດ receptor CCR5 ທີ່ສໍາຄັນ. ໄລຍະເວລາທັງຫມົດນີ້ເທົ່າກັບ 35 ເດືອນຫຼັງຈາກການປູກຖ່າຍ.
This is a second case of a patient exhibiting sustained remission of ເຊື້ອໂລກເອດສ-1 following a bone marrow transplant. One important difference in this second patient being that ‘Berlin Patient’ had received two transplants along with total body irradiation while this UK patient received only a single transplant and underwent less aggressive and lesser toxic approach of chemotherapy. Mild complications of similar nature were seen in both patients i.e. graft versus host disease. Achieving success in two different patients points towards developing strategies based on preventing CCR5 expression which might even cure ເຊື້ອໂລກເອດສ.
Authors state that they are monitoring the patient’s condition and cannot say with affirmation yet if he has been cured of HIV. This may not be a generalized appropriate treatment for ເຊື້ອໂລກເອດສ because of adverse effects and toxicity of chemotherapy. Also, bone-marrow transplants are expensive and carry risks. Nevertheless, it is a better approach with reduced intensity conditioning and no irradiation. Research could also focus on knocking out the CCR5 receptor using gene therapy in people with ເຊື້ອໂລກເອດສ.
***
{ທ່ານສາມາດອ່ານເອກະສານການຄົ້ນຄວ້າຕົ້ນສະບັບໄດ້ໂດຍການຄລິກທີ່ລິ້ງ DOI ທີ່ໃຫ້ໄວ້ຂ້າງລຸ່ມນີ້ໃນລາຍຊື່ແຫຼ່ງທີ່ອ້າງອີງ}
ແຫຼ່ງຂໍ້ມູນ (s)
1. Gupta RK et al. 2019. ການປົດປ່ອຍເຊື້ອ HIV-1 ປະຕິບັດຕາມ CCR5Δ32/Δ32 haematopoietic stem-cell transplantation. ທໍາມະຊາດ. http://dx.doi.org/10.1038/s41586-019-1027-4
2. Hütter G. et al. 2009. ການຄວບຄຸມໄລຍະຍາວຂອງເຊື້ອ HIV ໂດຍ CCR5 Delta32/Delta32 Stem-Cell Transplantation. N Engl J Med. 360. https://doi.org/10.1056/NEJMoa0802905
3. Brown TR 2015. I Am the Berlin Patient: A Personal Reflection', AIDS Research and Human Retroviruses. 31(1). https://doi.org/10.1089/aid.2014.0224
