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今读到最新一期出版的“经济学家”Economist 杂志刊登了一篇题目为“展望未来” 的文章,本人认为非常有看点,全文阐述了第19届国际艾滋病会议的宗旨,同时也探讨了治疗艾滋病的最新发展动向。本人试着将全文分段做了翻译,目的是想引起人们对艾滋病治疗的关注同时也想同广大爱好翻译的朋友们进行学习交流。如果您对本人的翻译内容有异议或有更好的翻译方法请直接提供上来,相信对我本人也是一次学习的机会。由于我个人水平有限,其中会有错译、漏译或理解上的错误出现,希望诸位高手谅解且多多指教!

Looking into the future 展望未来

Jul 28th 2012 | WASHINGTON, DC | from the print edition (原自经济学家杂志)

Now that the means exist to bring AIDS under control, attention is turning towards a cure

既然找到了控制艾滋病的方法,就应该把注意力转向如何彻底治愈这种可怕的疾病。

“CAN AIDS be cured?” That was the question being whispered in the back rooms and satellite meetings of the 19th International AIDS Conference, held in Washington, DC, this week. The conference’s formal business was to keep up the momentum behind the most successful public-health campaign of the past 30 years: the taming, at the cost of a few pills a day, of an infection that was once an inevitable killer. It still kills. About 1.7m people succumbed last year. But that figure is down from 2.3m in 2005 (see chart 1), and is expected to continue falling. Now, therefore, some people are starting to look beyond the antiretroviral (ARV) drugs which have brought this success. They are asking if something else could do even better.

本周在华盛顿地区举行了第19届国际爱滋病大会,在其中几次的卫星电话会议中坐在室内后排的与会者们在嘘声念叨着这样一个问题那就是“艾滋病能否被彻底治愈”本次大会的真正目的是为人类过去30年征服爱滋病所作的最成功的公共卫生运动鼓劲。这里所说的对爱滋病的征服是指感染者过去不可避免的会死去,而如今每天只需要吃几粒药就可以将艾滋病控制住,当然现今艾滋病仍然夺去很多人的生命。不过,死亡的数字从2005年的23百万人下降到了去年的17百万人,人们期待未来死亡数字会继续下降。为此,有人开始研究抗病毒逆转类药物以外的方法,尽管抗病毒逆转类药物获得了巨大成功,但人们还是想探讨是否能找到更好的方法来治疗艾滋病。

The drugs work, and are getting cheaper by the year: a report released during the conference by the Clinton Foundation, an American global-health charity, put the annual cost of treatment at $200; it used to be $10,000. But once on them, you are on them for life. Stop, and the virus crawls out of cellular hidey-holes that ARVs cannot reach and rapidly reinfects you. This has implications both for patients, whose lives are constrained by the need for constant medication, and taxpayers, who bear most of the cost of this indefinite treatment.

推出各种治疗药物且价格逐年变得更便宜。与会期间一份由美国全球健康慈善机构-克林顿基金会提供的报告显示,过去治疗费用一年要花费1万美元,而如今一年才要200美元,不过问题是一旦开始用药就不能停,要终身服用。令人纠结的是艾滋病病毒是从细胞隐藏洞里爬出来的,而抗病毒逆转药类物无法进入,所以,当病毒一旦出现病患者会又一次被感染 。这就意味着病患者要想活命就必须不终断的进行治疗,而对于纳税者们来说要承担这些患者永久治疗的大部分费用。

Many of those taxpayers do not live in the rich world but in the worst-afflicted countries. A new estimate by UNAIDS, the United Nations agency charged with combating the disease, suggests that more than half of the cost of treating and preventing AIDS is now borne by these countries, rather than paid for by international agencies (see chart 2). As many of these countries have high economic growth rates, that is only right and proper. But it does mean that they, too, have a strong interest in a cure. And researchers would like to provide them with one.

在这些纳税者中有很多人都不是生活在富有国度而是生活在饥寒交迫的国家。一个来自联合国抗艾滋病机构的消息估计大约有一半的治疗和抗艾滋病的药物要由这些国家负担,而不是像先前了解到是由国际组织来承担的,虽然这些国家中有很多其经济增长率很高,那只是客观条件具备而已,按并不意味着这些国家会对治愈艾滋病有很大兴趣。而今天与会的这些研究人员们会为这些国家提供一线希望。

The road to Berlin

通往柏林之路

A race is therefore on to work out how to flush the virus from its hiding places and get rid of it completely. Several clues suggest a cure may be possible. But no one knows which route will lead to it.

一场前所未有的竞技开始了,人们在研究如何将病毒从其藏匿处驱赶出来然后将其彻底杀死。有几种线索揭示出治愈艾滋病还是有可能的,不过,目前还没人知道到底什么方法可以实现这一目标。

One of those routes passes through Timothy Brown. Mr Brown, pictured above, is known as the Berlin patient. He was living in that city in 2007 when he underwent radical treatment for leukaemia. This required the destruction of his immune system—the source of the cancer—and its replacement using stem cells transplanted from the bone marrow of a donor, which allowed him to grow a new (but alien) immune system.

其中有一个方法对生活在柏林的病人布朗先生是有作用的。布朗2007年住在柏林当时他是在接受血癌的放射治疗,也就是说放射线将其原有的免疫系统破坏掉,因为原来的免疫系统是导致血癌的根源。而后,他将接受从一位骨髓捐赠者移植过来的干细胞取代其原有的免疫系统,从而长出新的免疫系统。

Mr Brown did not just have leukaemia. He was also infected with HIV. So his doctor, with his permission, tried an experiment. The doctor searched for and found a donor who had a rare genetic mutation which confers immunity to HIV infection by disabling a protein on cell surfaces to which the virus attaches itself in order to gain entry to a cell.

布朗先生不仅得了血癌,同时他还感染了艾滋病病毒(HIV是人类免疫缺损综合症的缩写也被称为艾滋病病毒)。于是在的到他允许的情况下,他的医生做了一个试验。搜寻并找到了一位捐赠者,该捐赠者拥有一种非常罕见的转移基因,这种转移基因可以通过阻断细胞表面上的一种艾滋病病毒想进入到细胞中去本身必带有的蛋白质从而将免疫力转给艾滋病感染者。

After the transplant, the virus seemed to disappear from Mr Brown’s body. Traces of viral genes were found recently, but these may have been contamination, and in any case they did not amount to entire, working viruses. There is no disputing, however, that Mr Brown no longer needs drugs to stay healthy, and has not needed them for five years.

移植后布朗先生身体中的艾滋病病毒似乎消失了,最近找到了病毒基因,可这些病毒基因或许是早已被污染。不管怎么说,不能以点带面认为这种方法对所有的艾滋病病毒都起作用。不过,布朗先生从此不再需要药物维持其健康且至少5年都不再需要药物了,这是毋庸争辩的事实。

No one is suggesting immune-system transplants as a treatment for AIDS. They are far too dangerous and costly. The intriguing point about Mr Brown’s procedure is that it would have been expected to destroy directly only one of the hiding places of the virus: immune-system cells squirrelled away in a quiescent state as the system’s memory. (These allow it to recognise and respond to infections experienced in the past.) Other reservoirs, particularly certain brain cells, would not have been affected directly—and in Mr Brown’s case checking his brain to find out what is going on would be grossly unethical.

这个例子并不是建议为艾滋病患者进行免疫系统移植治疗,这样做会非常危险且成本很高。布朗先生的案例中最为扑朔迷离的是新移植的免疫系统直接捣毁了病毒藏匿地的一处,即:新的免疫系统细胞作为系统的记忆以静态的方式存储起来(这些存储起来的免疫系统的细胞可以识别和对过去受感染的病毒进行反应)其他的藏匿处,特别是他的大脑细胞并没有受到直接的影响。不过,去检查布朗先生的大脑来确定到底发生了什么那或许是非常有背职业道德的。

Clearly, it is dangerous to draw conclusions from a single example. But if quiescent memory cells are the main source of viral rebound, that would simplify the task of finding a cure. And many groups of researchers are trying to do just that, by waking up the memory cells so that ARVs can get at the virus within them.

有一点是很清楚的那就是从一个单纯的案例来做结论是很危险的。如果静态记忆细胞是病毒卷土重来的根源,那将为我们寻找治疗办法变得简单多了。很多团体的研究人员们都在试图做这项试验,即:通过唤醒记忆细胞好让抗病毒逆转类药物就可以在细胞里面将病毒杀死。

Once such group, led by David Margolis of the University of North Carolina, uses an established anticancer drug called vorinostat as the wake-up call. This drug activates quiescent cells by tweaking the proteins that wrap their DNA. Dr Margolis’s latest results, announced to the conference and published simultaneously in Nature, suggest vorinostat does indeed awaken dormant memory cells, though the experiment did not ask whether that can in turn lead to the elimination of the virus.

由北卡罗来纳大学的大卫马尔格李斯领导的团体采用已出产的一种名为vorinostat治疗皮肤T细胞淋巴瘤组蛋白去乙酰酶抑制剂类)的抗癌药作为唤醒细胞的引子。这种药物是通过调整包裹在DNA上的蛋白量来激活静态的细胞。马尔格李斯博士的这项最新研究成果在此次大会上做了宣读,同时也发表在“自然”杂志上。他提出尽管目前还只是在试验阶段还不能确定其是否可以逆转且彻底消灭艾滋病病毒,但这种抗癌药物确实可以唤醒起主导作用的记忆细胞。

Dr Margolis’s approach looks interesting. But it is not the only one on offer. A second, the so-called Visconti trial undertaken by France’s National Agency for Research on AIDS, studied people who had been put on ARVs immediately after they became infected. Some of these, the study found, become what are known as elite controllers.

马尔格李斯博士所研究的方法看起来很有趣。这不只是唯一的提议,另外还有所谓法国国家艾滋病研究机构进行的所谓杰出的试验。就是人们在感染了艾滋病后立即进行抗病毒逆转治疗,研究表明控制病毒效果显著。

An elite controller is an individual who is infected, but whose immune system seems able to suppress viral replication by itself. Elite controllers thus never develop the symptoms of AIDS. Natural cases of elite control are rare, but the Visconti trial (the name is a contraction of “Virological and immunological studies in controllers after treatment interruption”) seems to have found a way to create them artificially. Its dozen participants have lived without ARVs for an average of six years, having previously used them for an average of three. And the latest results from the study suggest the pattern of infection of their immune system closely resembles that seen in natural elite controllers.

所谓效果显著控制体是指被感染病毒的个体,其免疫系统可以抑制病毒本身的复制,从而不会发展成艾滋病。靠全天然控制病毒突出的案例非常罕见,不过,这项杰出试验其实是病毒学和免疫学在研究治疗干扰后寻找有效的控制体的一个名词缩写,似乎是找到了认为创造成功的机会。参与这项研究的一共12人在没有进行抗病毒逆转治疗的情况下平均存活率为6年,而以前用常规的抗病毒逆转法存活率只有3年。通过对他们的免疫系统解析所得出的最新结果表明已经很接近自然控制体的效果了。

Reasons to be cheerful

值得高兴的原因:

Amid all this scientific interest, however, the conference did not neglect the more immediate question of how the tools now available can be deployed. The watchword, borrowed from the jargon of drug delivery, is combination prevention.

然而,在所有的这些科学成就中,与会者并没有忽略问得最多的一个问题那就是如何运用这些研究成果去根治艾滋病。也就借用从药典中得来的一个专有术语:即:综合防治。

The crucial trick with ARVs is to use several different treatments simultaneously, an approach known as combination therapy. Attacked from many directions, the virus cannot escape. A similar method is now being applied to preventing transmission. Three techniques, beyond the traditional (and successful) one of exhorting couples to use condoms, have now been demonstrated to work. Researchers are busy crunching data that will allow them to suggest what emphasis should be placed on which techniques in different parts of the world.

抗病毒逆转法关键是同时采用多种不同的治疗方法,也可以称为综合疗法。全方位消灭病毒,让其无法藏身。最简单的方法就是想办法阻断病毒的传播。除了传统且是成功预防艾滋病病毒传播的方法即劝告夫妻用避孕套外的另外3个方法都已经得到证明是桌有成效。目前研究人员们在致力于剖析那些数据以便能让他们了解在这个领域中不同的方面采用哪种方法会更行之有效。

One technique, treatment-as-prevention, relies on the fact that ARVs themselves suppress transmission. A cross-continental study published last year showed that, when given to infected individuals whose sexual partners are uninfected, ARVs reduce by 96% the rate of transmission of the virus to the uninfected partner. Another study, published this July, showed that giving ARVs to the uninfected partner reduces their chances of becoming infected by 75%. These studies prove what might reasonably be suspected: that the smaller the amount of virus in someone’s body, the harder it is to pass it on; and that organising a hostile reception makes it hard for the virus to take hold.

方法一就是抑制疗法依赖由不同的抗病毒逆转类药物本身所起的作用能抑制艾滋病病毒的传播. 去年发表的跨洲研究表明当给一个其性伴侣没有感染艾滋病病毒的感染者使用多种抗病毒逆转类药物可以降低病毒传染给这个没有感染病毒的性伴侣,其有效率高达96%。而于今年7月发表的另一项研究表明采用给没有感染病毒者使用多种抗病毒逆转类药物会降低他们被感染病毒的机会,有效率高达75%。这些研究虽说可能还有理由表示怀疑不过却证明了某些人体内病毒量越少,病毒传播也就越难。刻意地去组合一个强有力的治疗方案会使病毒无法立足。

Treatment-as-prevention raises questions about how ARVs should be used in the future. At the moment, 8m people in poor and middle-income countries take them and the aim is to increase that to 15m. At that point, all those sick enough to warrant being treated would be under treatment. But a further 19m are infected. Prevailing opinion is that they need not be treated because their disease has not progressed to a point where it threatens their health. Yet if ARVs were used as preventatives, these people, too, would need to take them. Many would, to avoid infecting their lovers. But some might not want to. And for those who did the ARVs would have to be paid for. So the drug bill would go up.

抑制治疗法对如何在未来使用抗病毒逆转类药物产生了疑问。届时在贫困和中产收入为主的国度里有百万人要服用这类药,而目标是想增加到15百万人。基于这一点,凡是够条件的患者都会得到治疗。可问题是现在有19百万人受到了感染。普遍认为他们不需要医治因为他们的病情还没有发展到危及到他们自身健康的地步。然而,如果抗病毒逆转类药物能作为阻断病毒的药物使用,这些人也可以服用。人们都会力避免将病毒传染给他们的爱人。但是有些人或许不愿意为那些需要服用抗病毒逆转类药物的人买单,为此,药费开销自然就会上去。

The second approach uses ARVs to stop one very specific form of transmission: that between an infected mother and her child at birth, or during suckling. Using the latest drugs this is more than 95% effective, and it is easy to do because most pregnant women go to a doctor or a clinic before they give birth and can thus (with their permission) be tested for HIV.

第二种方法是利用抗病毒逆转类药物具有的阻断传播特性可以使用在被感染母亲和出生孩子两者之间,或者用在哺乳期。最新研制的药物总有效率高达95%以上,且很容易做到因为大多数怀有身孕的妇女在他们产前都会去看医生,在得到对方允许的前提下就能给她们做艾滋病病毒测试。

The third technique is circumcision. Men’s foreskins are rich in immune-system cells, which are there to prevent the entry via the penis of infectious agents. Unfortunately, some of these cells are particularly susceptible to HIV infection. Removing the foreskin thus has a huge effect. It reduces, by about two-thirds, the risk of a man becoming infected. And follow-up studies suggest that with time this figure may rise to three-quarters.

第三种方法是做包皮切割术。本来男人阴茎前端过长的皮肤内含有非常丰富的免疫细胞,用来防御外来感染体的入侵,可不幸的是在这些细胞中有些被怀疑同艾滋病病毒感染有关。割掉阴茎前端过长的包皮会产生巨大的效果。可以减少2/3成年男子感染艾滋病病毒的危险。随后的研究还表明这个比率随着时间的推移可能会提升到3/4

In Africa, circumcision has, as it were, gone viral. The definitive studies showing it worked were published in 2006. After a slow start, hundreds of thousands of men have now had the snip. In 13 countries of eastern and southern Africa that are regarded by the World Health Organisation as being priority areas for the procedure, over half a million men were circumcised explicitly for AIDS protection between 2008 and 2010. The clinics can barely keep up, and several devices designed to simplify the process are now being tested.

在非洲,包皮环切术相当普遍,最终的研究成果发表在2006年。随后慢慢开始做的人多了起来,目前已有成千上万的男性割掉了包皮。世界卫生组织把13个东非和南非的国家列为优先行使该措施的区域,在20082009年期间有超过50万男人为了防止艾滋病果断地做了环切术。有些诊所很难继续下去,有数台简化这一程序的设备正在检测当中。

The upshot of all this activity is a marked reduction in the rate of new infections, though sceptics point out that the fall began before ARV use and circumcision became widespread, and that the role of behavioural changes (including a greater willingness to use condoms) should thus not be underestimated.

尽管有人怀疑指出感染率的下降在使用抗病毒逆转类药物以及包皮环切术前就已经出现了,但所有这些行动的结果都标志着新感染率的降低。这一举措不应该受到低估。

Regardless of the cause, the graphs are all pointing in the right directions: ARV use is up; deaths and new infections are down. Soon, more people will be put on ARVs each year than die of the disease. That will be cause for celebration. AIDS is not yet beaten, and may be a long time in the beating. But if the will is there, then the means exist to do it.

无论是什么原因,所有这一切都在朝着正确的方向迈进:抗病毒逆转类药物使用的上升使死亡率和新增感染者的比率下降。不久,人们发现有更多的人会使用抗病毒逆转类药物,而这个数字远远超过死亡人数。那将是值得庆祝的。彻底治愈艾滋病尚未被攻破,或许还要经历一个漫长的时期。不过如果人类战胜它的意志尚存,终有一天会找到彻底治愈它的方法。

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