Ubhubhane we-molecular epidemiology we-HIV-1 kwihlabathi liphela nakwingingqi ngexesha le-1990-2024: uphononongo olucwangcisiweyo, uphando lwehlabathi, kunye nohlalutyo lokuxhaphaka

Intshayelelo

Uphononongo lwakutshanje olupapashwe kwiIzifo Ezisulelayo zeLancet(2026) ibonelela ngohlalutyo olupheleleyo lwehlabathi lwe-HIV-1 molecular epidemiology ukuza kuthi ga ngoku, idibanisa idatha yophononongo olucwangcisiweyo kunye nophando lwe-molecular surveillance lwehlabathi.

Ngokudibanisa iiseti zedatha ezazikho ngaphambili (1990–2021) kunye nedatha yolandelelwano eqokelelweyo entsha, olu phononongo lubandakanye okungaphezuluIirekhodi ze-HIV-1 zezigidi ezili-1.39 ezivela kumazwe ali-154 eziqokelelweyo phakathi kowe-1990 nowe-2024Besebenzisa inani labantu abaphila ne-HIV eliqikelelweyo yi-UNAIDS njengezinto ezibangela ubunzima, abaphandi bavelise iimephu zehlabathi nezengingqi ezichaza ukusasazwa kwexesha kunye nendawo kweentlobo ze-HIV-1, iifom ze-recombinant ezijikelezayo (ii-CRF), kunye neefom ze-recombinant ezizodwa (ii-URF).

Iziphumo zibonisa ukuba nangona imeko-bume yehlabathi ye-HIV-1 ihlale izinzile kwiminyaka engamashumi amabini edlulileyo, utshintsho olukhulu lwengingqi luyenzeka, ingakumbi ngenxa yokwanda kokwahluka kunye nokwanda kweentlobo ze-recombinant.

Imvelaphi yoFundo

Uhlobo 1 lwentsholongwane yokungakwazi ukuzikhusela komzimba womntu (i-HIV-1) lubonisa ulwahlulo olukhulu lwemfuza ngenxa yesantya sayo esiphezulu sokuguquka, amandla okuphinda ahlangane, kunye namandla okudlulisela ixesha elide.

Olu tshintsho lwemfuza lunempembelelo ebalulekileyo kwezi zinto zilandelayo:

• · ukujonga iimolekyuli,
• · uvavanyo lokusebenza kokuxilonga,
• · Ukubeka esweni ukumelana ne-antiretroviral,
• · kunye namaqhinga okuphuhlisa imijovo.

Olu phononongo lujolise ekuchazeni iipatheni zokusasazwa kwe-HIV-1 subtypes kwihlabathi liphela nakwingingqi kunye neentlobo ze-recombinant ezivelaUkususela ngo-1990 ukuya ku-2024, ebonelela ngesakhelo esihlaziyiweyo se-molecular epidemiological sokuthintela nokulawula i-HIV kwihlabathi liphela.

Uyilo loFundo kunye neendlela

Abaphandi benze uphononongo olucwangcisiweyo lweedathabheyisi zePubMed, Embase, Global Health, CINAHL, begubungela izifundo ezipapashwe phakathi koJanuwari 1, 2022, kunye noJanuwari 22, 2025.

Ukongeza, idatha iqokelelwe ngenethiwekhi yeGlobal HIV Molecular Epidemiology Collaboration.

Iiseti zedatha ezifanelekileyo ziquka:

• · Ulwazi lwe-HIV-1 molecular subtype,
• · iindawo ezichazwe ngokucacileyo zeesampuli,
• · imihla yokuqokelelwa,
• · kunye namanani eesampuli aneleyo.

Idatha yokugqibela yayiquka:

• · Iirekhodi ze-genotyping ze-HIV-1 eziyi-1,395,222 
• · Amazwe ali-154 
• · amaxesha amathandathu e-epidemiological:1990–1999, 2000–2004, 2005–2009, 2010–2014, 2015–2019, 2020–2024.

Ukuxhaphaka kweentlobo zemfuza ze-HIV-1 kwihlabathi liphela nakwingingqi kuqikelelwe kusetyenziswa iindlela zokulinganisa ubunzima ezilungisiweyo yi-UNAIDS.

Ukusasazwa kweentlobo ze-HIV-1 kwihlabathi liphela: Uhlobo lwe-C luhlala lulawula

Ngexesha2020–2024uhlobo C luhlala luloluhlu oluphambili lwe-HIV-1 kwihlabathi liphela, lubangela oku kulandelayo:

Ngokubanzi, iifom eziphinda zisetyenziswe (kuquka ii-CRF kunye nee-URF) zimalunga ne-22.4% yosulelo lwe-HIV-1 kwihlabathi liphela, egxininisa ubunzima obandayo bokwahlukahluka kwezakhi zofuzo ze-HIV-1.

Uhlobo olungaphantsi C luyaqhubeka nokukhokela ikakhulu kwi:

• · eMzantsi Afrika,
• · UMzantsi Asia,
• · kunye namazwe aliqela aseMpuma Afrika.

Ngenxa yokuba ezi ndawo ziqulathe inxalenye enkulu yomthwalo we-HIV kwihlabathi liphela, ukongama kwe-subtype C kunefuthe elikhulu kwindlela yokusasazeka kwihlabathi liphela.

Umahluko Wengingqi: Iipateni Ezihlukileyo Zokuguquka Kwezinto Kumazwekazi

Nangona ulwakhiwo lwe-HIV-1 lwehlabathi lubonakala luzinzile, iipatheni zengingqi ziyatshintsha kakhulu.

UMzantsi Afrika kunye noMzantsi Asia: Ulawulo oluqhubekayo lweSubtype C

UMzantsi Afrika kunye noMzantsi Asia usaziwa kakhulu ngokusasazeka kwe-subtype C.

Kwezi ndawo zinomthwalo omkhulu, uhlobo C lumele uninzi lweentsholongwane ezijikelezayo, nto leyo eyenza ukuba lube lolona negalelo elikhulu ekuxhaphakeni kohlobo C kwihlabathi liphela.

Nangona kunjalo, olu phononongo lukwagxininisa ukuba ukufunyaniswa kweesampuli zeemolekyuli kwezinye iindawo ezixineneyo kusasikelwe umda, nto leyo ebonisa ukuba kufuneka imizamo eyongezelelweyo yokujonga ukuze kubanjwe ngcono ukwahlukahlukana kweentsholongwane zasekuhlaleni.

UMntla Melika kunye neLatin America: Ukuqhubeka koBukhosi beSubtype B

Uhlobo olungaphantsi B luhlala luloluhlu oluphambili olujikelezayo kwi:

• · Amantla Emelika,
• · Ilatin America.

Ezi ndawo zibonisa iipateni ze-epidemiological ze-molecular ezizinzileyo xa kuthelekiswa neendawo ezidlula kwiinguqu ezincinci ezikhawulezayo.

INtshona neYurophu eseMbindini: Ukwanda kokwahluka kwezakhi zofuzo

INtshona neYurophu eseMbindini zijongene notshintsho oluhamba kancinci ukusuka kubhubhane oluyi-subtype B olujolise kakhulu kwindawo eneentsholongwane ezahlukeneyo.

Iindlela eziphambili ziquka:

• · ukwehla kwenani le-subtype B,
• · igalelo elongezelelekileyo leefom eziphinda-phindayo,
• · ukwanda kobukho beentsatshana ezingezizo eze-B.

Olu tshintsho lubonisa ukuba ukwahlukahlukana kweemolekyuli ze-HIV-1 kuya kuba yinto ebaluleke ngakumbi nakwiindawo ezixhaphakileyo ngokwembali ze-B.

EMpuma Asia: Ukwanda Okukhawulezileyo KweeFomu Eziphinda Zibe YiRecombinant

IMpuma Asia ibonise enye yezona nguqu zibalulekileyo kwizifo ezibangelwa yintsholongwane.

Olu phononongo lufumanise ukuba:

• · I-CRF07_BC inyuke kakhulu ngokuhamba kwexesha,
• · uhlobo B lwehle kakhulu.

I-CRF07_BC inyukile ukusuka malungaI-13.1% phakathi kowama-2000–2004 ukuya kuma-48.1% phakathi kowama-2020–2024, ebonisa utshintsho olukhulu kwi-HIV-1 molecular epidemiology yengingqi.

Olu tshintsho lugxininisa ukubaluleka kokuhlolwa okuqhubekayo kweemolekyuli kwiindawo apho iifom eziphinda zibunjwe ziqala ukuba namandla khona.

Iifom zeRecombinant: Icandelo elikhulayo loBuntu be-HIV-1 kwihlabathi liphela

Umlinganiselo weefom ze-recombinant unyuke kwihlabathi liphela kwiminyaka edlulileyo:

• · 2000–2004: malunga ne-20.8%
• · 2010–2014: malunga ne-24.2%
• · 2020–2024: malunga ne-22.4%

Nangona inani lehlabathi liye lehla kancinci kwixesha lakutshanje, iifom ze-recombinant ziyaqhubeka nokwanda kwiindawo ezahlukeneyo, ingakumbi:

• · EMpuma Asia,
• · ENtshona naseYurophu eseMbindini.

Olu phononongo lubonisa ukuba iifom ze-recombinant zisenokungathathelwa ngqalelo kwezinye iindawo kuba iinkqubo ezininzi zokujonga zixhomekeke kakhulu kwiindawo ze-genomic ezingaphelelanga, ezisenokungazichongi ngokupheleleyo iipatheni ze-recombination ezintsonkothileyo.

Ukuqinisa iindlela zokujonga i-genomic kuya kuba yinto ebalulekileyo, ingakumbi kwimimandla enomthwalo ophezulu wosulelo lwe-HIV kunye nokwanda kokwahluka kwentsholongwane.

Impilo Yoluntu Neziphumo Zeklinikhi

1. Iinkqubo zokuxilonga zifuna uVavanyo oluQhubekekayo lweNtlobo eNcinci

Ukwanda kokwahluka kwemfuza ye-HIV-1 kubonisa ukubaluleka kovavanyo oluqhubekayo lwetekhnoloji yokuxilonga kwiimvelaphi ezahlukeneyo zentsholongwane.

Nangona amaqonga angoku okuvavanya i-HIV kunye novavanyo lomthwalo wentsholongwane ebonakalise ukusebenza ngokubanzi, ukuqinisekiswa okuqhubekayo ngokuchasene neentlobo ezincinci ezisakhulayo kunye neefom ezidibeneyo kusabalulekile.

Uhlolo lwexesha elizayo kufuneka ludibanise:

• · i-molecular epidemiology,
• · Ukubeka esweni ukusebenza kokuxilonga,
• · kunye nohlalutyo lokuguquka kwentsholongwane.

2. Ukuhlolwa kokumelana namayeza kufuna ukhuseleko olubanzi kwimfuza

Ukwanda kweentsatshana ezahlukeneyo ze-HIV-1 kunokuphembelela ukuvela, ukufunyanwa, kunye nokutolikwa kotshintsho oluhambelana nokuxhathisa.

Ezinye izifundo zibonise ukuba imiqolo ethile ye-HIV-1, kuquka neentlobo ezinxulumene ne-A6/A1, inokunxulunyaniswa nomngcipheko ophezulu wokungaphumeleli kwe-virological phantsi kweenkqubo ezithile zonyango lwe-cabotegravir/rilpivirine olusebenza ixesha elide.

Nangona kunjalo, iziphumo zokuxhathisa ziphenjelelwa zizinto ezininzi, kuquka:

• · utshintsho olusisiseko lokuxhathisa,
• · imbali yonyango,
• · ukunamathela,
• · kunye nemvelaphi yemfuza ebangelwa yintsholongwane.

Ke ngoko, ukujonga ukumelana neentlobo ngeentlobo kusabaluleke ngakumbi.

3. Uphuhliso lweMithi yokugonya kufuneka luqwalasele ukwahlukahlukana kweentsholongwane zengingqi

Ukwahlukahlukana okukhulu kwemfuza ye-HIV-1 kusengomnye wemingeni emikhulu ekuphuhlisweni kwegonyo.

Ukusasazwa okuguqukayo kweentlobo ezincinci kunye neefom ezidibeneyo kubonisa imfuneko yezicwangciso zokugonya eziqwalasela oku kulandelayo:

• · iintlobo ezijikeleza ngokwengingqi,
• · iindlela zokuzivelela kwezinto ezisasazeka ngentsholongwane,
• · kunye nokugubungela ngokubanzi amajoni omzimba.

Indlela efanayo kwihlabathi liphela isenokungajongani ngokupheleleyo nokwahlukahlukana kwe-HIV-1 esasazeka kwihlabathi liphela.

Isiphelo

Olu hlalutyo lubalulekileyo lwehlabathi lonke lwe-HIV-1 molecular epidemiology lubonisa ukuba imeko yentsholongwane kwihlabathi liphela ibonakaliswa kukuqhubela phambili notshintsho.

Nangona uhlobo C luqhubeka nokubala phantse isiqingatha sosulelo lwe-HIV-1 kwihlabathi liphela, iipateni zeemolekyuli zengingqi ziyatshintsha ngokukhawuleza, kwaye iintlobo eziphinda zibuyele kwi-recombinant ziya zitshintsha ngakumbi izifo ezibulalayo kwiindawo ezifana neMpuma Asia neYurophu.

Ezi ziphumo zigxininisa ukubaluleka kokubekwa kweliso eliqhubekayo kweemolekyuli, ukuqinisekiswa kokuxilongwa kweentlobo ezahlukeneyo, kunye neendlela ezidibeneyo ze-genomic ukuxhasa uthintelo olusebenzayo lwe-HIV, ukubeka iliso kunyango, kunye nophuhliso lwexesha elizayo lwe-vaccine.

Isalathiso

1. I-epidemiology ye-molecular epidemiology yehlabathi neyengingqi ye-HIV-1 ngexesha lika-1990–2024: uphononongo olucwangcisiweyo, uphando lwehlabathi, kunye nohlalutyo lokuxhaphaka. Izifo Ezisulelayo zeLancet, 2026.