How close are we to eradicating HIV? - Philip A. Chan

譯者: Lilian Chiu 審譯者: Helen Chang

The world is getting closer

世界已經越來越接近達成

to achieving one of the most important public health goals of our time:

我們這個時代最重要的 公共健康目標之一：

eradicating HIV.

根絕愛滋病。

And to do this, we won’t even have to cure the disease.

要達到這個目標，我們甚至 不需要治好這種疾病。

We simply have to stop HIV from being transmitted

我們只需要阻止愛滋病病毒傳播，

until eventually it fizzles out.

直到它完全消失。

Once, this goal would have seemed impossible.

這個目標曾被視為不可能達成的。

HIV has caused millions of deaths

愛滋病已經造成了數百萬人死亡，

and is one of the most devastating diseases that humanity has ever known.

是人類已知最具破壞性的疾病之一。

But we’re now at a point where new advances

但現在，新的發展，

such as one-pill, once-a-day medications

如一天吃一顆的藥物，

are helping us tackle HIV in effective ways.

能協助我們有效處理愛滋病。

HIV is a retrovirus–

愛滋病病毒是逆轉濾過性病毒——

meaning it integrates copies of itself into an infected cell’s DNA,

意思是，它會將自己複製， 結合到受感染的細胞的 DNA 中，

allowing it to replicate and infect other cells.

讓它可以複製並感染其他細胞。

HIV has evolved numerous ways to evade the human immune system,

愛滋病病毒已在多方面進化， 得以避開人類的免疫系統，

which makes it difficult to cure.

因此愛滋病很難治癒。

But by developing ways to block HIV replication,

但我們可以發展阻擋 愛滋病病毒複製的方法，

we can stop the spread of HIV itself.

來阻止愛滋病病毒本身散播。

That’s where antiretrovirals– a.k.a. ARVs– come in.

這就是抗逆轉錄病毒藥物—— 即 ARV——出場的時候了。

ARVs are a group of drugs which work in different ways to combat HIV.

ARV 是一組藥物，會以不同的 方式來對抗愛滋病病毒。

Some block HIV’s access into immune cells,

有些會阻擋愛滋病病毒， 讓它碰不到免疫細胞，

and others work by stopping the virus itself from replicating.

還有些則會阻止病毒本身複製。

ARVs also work preventatively in people who don’t have HIV.

ARV 也可以用在非愛滋 患者身上，做預防用。

This type of approach is called pre-exposure prophylaxis, or PrEP.

這種方法叫做暴露前 預防，簡稱 PrEP。

PrEP works by accumulating in a person’s body

PrEP 的運作方式， 是在人體內累積，

and preventing HIV from establishing itself.

讓愛滋病病毒無法立足。

That means an HIV-negative person who may be at risk of contracting the disease

那就表示，愛滋病檢驗結果呈陰性 反應，有可能會得到愛滋病的人，

can take certain ARVs to protect themselves,

可以在暴露前就用 ARV

before they become exposed.

來保護他們自己。

Here’s where it gets especially interesting:

這就是特別有趣的地方：

In people with HIV, ARVs can also dramatically reduce HIV transmission.

ARV 也能大大降低 愛滋病病毒帶原者的傳染。

This is called “Treatment as Prevention.”

這叫做「用治療來做預防」。

On a global scale, this has the potential to end the HIV epidemic.

在全球的層面上，它具有 終止愛滋病流行的潛力。

It’s based on the idea that someone with HIV who takes ARV’s

想法的基礎是 愛滋病病毒帶原者服用 ARV

can lower the virus level in their bodies until it becomes undetectable.

就可以降低體內病毒量， 直到無法偵測到。

That doesn’t mean the virus is gone;

這並不表示就沒有病毒了；

it could still be lurking within cells, ready to reactivate if treatment stops.

病毒仍然有可能潛伏在細胞中， 等治療停止再開始活動。

But so long as it’s kept dormant with drugs,

但只要藥物讓它 一直保持在潛伏狀態，

HIV remains undetectable.

就會一直偵測不到愛滋病病毒。

And when HIV is undetectable, it’s untransmittable, too.

愛滋病病毒在偵測不到的 狀態時，也不會傳染。

In theory this means that by testing everyone who’s at risk of HIV

理論上，這就表示針對所有 可能有愛滋病風險的人做檢驗，

and treating those who test positive,

再治療那些檢驗結果陽性的人，

we could stop transmission and eventually eradicate HIV.

我們可以阻止傳播， 最終根絕愛滋病。

In the real world, however, things are more complex.

然而，在真實世界沒那麼簡單。

Many at-risk HIV negative people across the world

全世界許多有風險 而檢驗結果是陰性的人

do not have access to PrEP or ARVs,

無法取得 PrEP 或 ARV，

and those who are HIV positive may experience challenges to taking ARVs.

而檢驗結果陽性的人 想服用 ARV 卻會遇到困難。

These problems are often greatest in countries

這些問題最嚴重的國家，

where the burden of HIV is highest.

通常也是愛滋病負擔最重的國家。

Getting these medications depends on access to a functioning healthcare system–

要拿到這些藥物，要看是否 能取得在運作的健康照顧體制，

and this isn’t something everyone has.

這並不是每個人都有的。

That’s part of the reason why stopping the spread of HIV for good

這就是為什麼要終結愛滋病的散播

will require a significant investment of resources to improve those systems.

會需要投入大量資源 以改善那些系統的理由之一。

One study carried out by the UNAIDS

聯合國愛滋病聯合 規劃署的一項研究

estimated that between 20-30 billion dollars per year

估計每年會需要 200~300 億美元

would be needed to achieve a nearly 90% reduction

才能達成在 2030 年時

將新的愛滋病感染案例 減少近 90%。

in new HIV infections by 2030.

This investment would ensure more people would get tested in the first place,

這項投資會先確保最初的檢驗 就能納入更多對象，

and more would be able to access and maintain treatment.

也讓更多人能取得、維持治療。

Achieving this goal and improving healthcare in general

達成這個目標， 並改善整體健康照護，

is in everyone’s best interest,

對大家都是最有利的，

from individual people to society as a whole.

從個人到整個社會能都受惠。

We have roadmaps that could allow us

我們有藍圖，讓我們可以

to bring the HIV epidemic to an end in the near future,

在近期終止愛滋病的傳播，

with the possibility of eradicating the disease altogether

還有機會可以在幾個世代之後

several generations in the future.

完全根絕愛滋病。

In the period from 1996 to 2017

在 1996 年到 2017 年這段期間，

we almost halved the number of new HIV infections,

我們幾乎讓新愛滋病 感染案例數目減半，

and for the millions of people who still live with the virus,

至於仍然和愛滋病病毒 共存的數百萬人，

ARV treatments enable most to lead long and healthy lives.

ARV 治療能讓大多數 延長健康的生命。

With continued and increased investments,

只要能持續投資、增加投資，

we can get transmission rates low enough to end HIV once and for all.

我們就能讓傳播率降低到 足以一勞永逸終結愛滋病。

A world without HIV is no longer inconceivable:

沒有愛滋病的世界不再難以想像：

it’s closer than ever.

它比以往都更接近實現。