研究：HIV治疗可作为预防手段所存在的限制 [美国媒体]

-------------译者：布拉格鸽子蛋-审核者：龙腾翻译总管------------



One of the great unknowns in HIV/AIDS research is how much prevention bang you get for your treatment buck. Yes antiretroviral (ARV) drugs make individuals less infectious but how many people have to be on treatment to slow spread in a community and even bring epidemics to an end? A giant new study in South Africa failed to show any reduction in HIV transmission in communities even when nearly 50% of infected people received the drugs.

对于艾滋病研究者来说最大的盲区就是在治疗中需要多少药量来防止感染爆发。是的，逆转录病毒药物可降低个体的感染率，但为了减缓病毒的社区传播，甚至彻底消灭艾滋，多少人需要接受治疗？南非一项针对艾滋病社区传播的大样本新研究显示，当几乎50%的感染者接受药物治疗后，感染率并没有降低。

-------------译者：ysmorange-审核者：ysmorange------------

When HIV-infected people take ARV drugs it can stop viral growth so effectively that levels in the blood drop below detectable on standard tests. Several studies have shown that HIV-infected people on treatment who have fully suppressed the virus rarely transmit it to their sexual partners. In theory as more infected people in a community start treatment new infection rates should drop. Four big studies were launched to test this idea in different sub-Saharan African countries; a presentation in Durban South Africa at the International AIDS Conference last week revealed data from the first of these to reach completion.

艾滋病感染者服用抗逆转录病毒药物可以有效阻止病毒的增长，由此，在标准检验中血液病毒水平亦会下降。一些研究表明，接受治疗并已经完全抑制病毒的艾滋病感染者很少会把病毒传播给他们的性伴侣。理论上，随着社区内越来越多的感染者开始接受治疗，新的感染率应该会有所下降。现已在撒哈拉以南的不同非洲国家开展了四项大的研究来论证这个观点。上周，南非德班国际艾滋病大会上的一个报告显示了其中一项研究的数据即将全部完成。

-------------译者：ysmorange-审核者：龙腾翻译总管------------

The study called treatment as prevention (TasP) began in 2012 and enrolled 28000 people in KwaZulu-Natal the hardest hit province in South Africa. Sponsored by the French national research agency known as ANRS TasP tested participants in 22 separate communities which each had an HIV prence of about 30% every 6 months. In one arm of the study that involved 11 communities infected people were offered the chance to visit a study clinic near their homes and receive ARVs. Infected people in the 11 communities in the control arm similarly had easy access to a clinic but they were offered the drugs only if their immune systems had evidence of damage from the virus as defined by government recommendations.

被称为预防性治疗（TASP)的研究始于2012年，招收了来自南非受灾最严重的省份夸祖鲁纳塔尔省的28000人。法国国家研究机构赞助的ANRS TASP测试了来自22个不同的社区的参与者，这些社区普遍每半年有大概30%的机率会产生一个艾滋病患者。研究为其中11个社区中受感染的人提供附近的临床门诊以及接受抗逆转录病毒药物治疗的机会。另外对照组的11个社区的感染者同样可以容易地到达门诊部，但是根据物政府给定的建议，只有当他们的免疫系统有被病毒损害的迹象时才会为他们提供药物。

-------------译者：ysmorange-审核者：龙腾翻译总管------------

As François Dabis from ANRS explained less than one-third of the people who were eligible for treatment in both groups visited a clinic within 3 months and less than half had at 1 year. Another 9% of the eligible people in the immediate treatment arm who went to the clinic opted not to start ARVs meaning only 43% went on treatment in the communities that researchers had hoped would have every infected person taking the drugs. The 22 communities all had roughly the same rate of new HIV infections about 2% per year. “lixage to care was far from optimal and when it did occur it occurred slowly”  Dabis said.

François Dabis根据ANRS表示，三个月内两组中只有不到三分之一有资格获得治疗的人去到诊所接受治疗，整一年也不够一半。去诊所接受即时治疗的另外9%符合条件的人没有选择使用抗逆转录病毒药物。这意味着在研究者希望所有患者都服用药物的社区里只有43%的人继续接受治疗。22个社区每年都有约2%的大体相同的新增艾滋病毒感染率。Dabis说道：当它缓慢发生的时，联动（应该是 L i n k a g e 原文 l i x a g e 应该有误）护理远不是最佳的选择。

-------------译者：lovexq-审核者：龙腾翻译总管------------

One possible reason the trial failed to see a difference between the groups is that too many people in the immediate treatment arm did not take ARVs. In effect these untreated people transmitted the virus so frequently that it overwhelmed any prevention effect from those on the drugs. It could also be that a key assumption in the trial design did not hold true. Previous studies suggested that people in the study area primarily had sex with people who lived within a few kilometers of their homes meaning that communities in effect were closed sexual networks. This is why researchers expected that massively treating HIV-infected people in a community would have a discernible “population effect” on that group. But it could be that the assumption was wrong and that sexual networks were far more intermingled between different communities. “Things may have changed” Dabis said. “This is one of the precise missing lixs we need to explore.”

试验未能观察到不同试验组的差别，可能是因为在立即治疗组中，太多的人没有服用过抗逆转录病毒的药物。事实上，这些未经治疗的人频繁地传播病毒，掩盖了任何的来自服用药物人群的预防效果。也可能是因为试验设计中的关键假设并不是有效的。先前的研究提示了在研究区域的人主要与其距离几公里范围的人发生性关系，暗示了社区实际上接近于性网络。这就是为什么研究者期望在社区中大规模治疗HIV感染病人需要在那组人群中有一个可辩别的“群体效应”。但这个设想可能是错误的，而且性网络在不同的社区中会有许多的混杂。“情况已经变了。”戴比斯说到，“这是一个我们需要探索的确切的漏掉的问题。”

-------------译者：q984q994-审核者：龙腾翻译总管------------

The TasP results were “one of the most important” presentations at the weeklong meeting says Myron Cohen of the University of North Carolina Chapel Hill who led a landmark study that showed treating HIV-infected people in long-term relationships all but eliminated the risk of transmission to their partners.

来自北卡大学的Myron Cohen说预防性治疗（TASP)结果是这次长达一周会议的“最重要的展示之一”，他所领导的一个重大意义的研究表明对处于长期关系中的HIV感染者的治疗几乎可以消灭将病毒传染给配偶的风险。

“We really have immutable evidence that drugs when given in a reasonable way have the power to prevent onward transmission” he says. “We went from this observation to hopes that scaling up that finding would allow us treat our way out of the epidemic.”

他说：“我们有确凿的证据表明适当的给药方式可以防止艾滋病毒的传播。所以我们据此认为只要继续往这条路走下去，我们就一定可以战胜这个疾病。”

-------------译者：q984q994-审核者：龙腾翻译总管------------

Cohen says the TasP study was a carefully done randomly controlled trial and shows that the real world has lots of complicated variables—like people learning their status and for whatever reasons not taking advantage of treatment. The study yielded an important insight he says because TasP “sets a bar”: Leaving aside the question of ending AIDS treating 43% of the people in a community likely won’t have any impact on new infection rates. “We need to do a lot better than  they did” Cohen says.

他说预防性治疗（TASP)研究是一个精心制定并随机控制的试验，表明了现实世界有很多复杂的变量——比如人们在知道自己的处境后还不好好接受治疗。他说这个试验产生了一个深刻的见解：先不谈终结艾滋病，对一个社区里的43%的人口进行治疗不可能阻止人们感染艾滋病。



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