臨牀試驗證明艾滋病早期治療效果明顯

People with H.I.V. should be put on antiretroviral drugs as soon as they learn they are infected, federal health officials said Wednesday as they announced that they were halting the largest ever clinical trial of early treatment because its benefits were already so clear.

聯邦衛生官員週三表示，艾滋病毒(HIV)攜帶者在得知自己被感染後，應儘快服用抗逆轉錄病毒藥物。他們同時宣佈，將很快結束一項迄今爲止規模最大的艾滋病早期治療臨牀試驗，因爲該療法的益處已經十分明顯。

The study was stopped more than a year early because preliminary data already showed that those who got treatment immediately were 53 percent less likely to die during the trial, develop AIDS or a serious illness than those who waited.

這項研究的結束時間比預期提前了一年多，因爲初步數據已經證明，在感染後立即接受治療的感染者在試驗期間死亡、發展成艾滋病或者嚴重疾病的概率，比推遲治療的感染者低了53%。

The study is strong evidence that early treatment saves more lives, the officials said. Fewer than 14 million of the estimated 35 million people infected with H.I.V. around the world are on treatment now, according to , the United Nations AIDS-fighting agency. In the United States, only about 450,000 of the estimated 1.2 million with H.I.V. are on treatment, according to the Centers for Disease Control and Prevention.

這些官員稱，這項研究有力地證明了，儘早治療可以挽救更多生命。根據聯合國艾滋病規劃署(UNAIDS)的數據，全世界約有3500萬HIV攜帶者，其中有不到1400萬人正在接受治療。根據疾病控制與預防中心（Centers for Disease Control and Prevention，簡稱CDC）的數據，美國約有120萬HIV攜帶者，只有大約45萬人在接受治療。

“This is another incentive to seek out testing and start therapy early, because you will benefit,” said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Disease, which sponsored the trial. “The sooner, the better.”

“這是早檢測和早治療的另一個理由，因爲你會從中受益，”國家過敏及傳染性疾病研究所(National Institute of Allergy and Infectious Diseases)所長安東尼·S·福奇(Anthony S. Fauci)博士說。“越早越好。”該機構是這項試驗的贊助方。

Although the C.D.C. recommends immediate treatment, it said in November that only 37 percent of infected Americans had prescriptions for the drugs. The agency blamed a mix of factors, including H.I.V.-positive people missed by testing, those who had no health insurance and therefore did not see doctors or could not afford the drugs, and those whose doctors were unfamiliar with treatment guidelines.

儘管CDC推薦HIV感染者確診後立即接受治療，該機構去年11月表示，在美國只有37%的感染者有藥物處方。該機構將其歸因於多種因素，比如HIV攜帶者沒有進行檢測，或者沒有醫保並因此不看醫生或買不起藥，還有一些病人的醫生對治療的指導原則不熟悉。

“This is a defining moment for social justice,” said Michel Sidibé, executive director of . “People will be scared, saying, ‘Oh, it will be a big number.’ But this puts an end to the false debate about whether to pay for treatment.”

“這是社會公正的一個決定性時刻，”聯合國艾滋病規劃署的執行主任米歇爾·西迪貝(Michel Sidibé)說。“人們會被嚇到，說，‘噢，這會是很大一筆錢。’但這就終結了是否應該花錢治療的錯誤爭論。”

Many AIDS researchers and advocates have long argued — based on their own observations and smaller studies — that treatment should start immediately. The trial stopped Wednesday is the first major clinical trial to produce evidence that patients would live longer and be healthier if they did so.

長期以來，許多艾滋病研究人員和倡導者一直強調——根據他們自己的觀察和較小規模的研究——治療應該儘早開始。週三結束的這項實驗是第一個證明了感染者在接受治療之後可以活得更長、更健康的大型臨牀試驗。

“This is fantastic,” said Dr. Susan P. Buchbinder, director of H.I.V. prevention research for the San Francisco Department of Public Health. Her department began recommending immediate treatment in 2010 and new infections in that city have dropped substantially since then. “The evidence for this has been building for quite some time, but now it’s clear that people should be offered treatment right away and told why it’s beneficial.”

“這太棒了，”舊金山公共衛生局艾滋病病毒預防研究主任蘇珊·P·布赫賓德(Susan P. Buchbinder)博士說。她的機構在2010年開始建議感染者在確診後立即接受治療，此後這座城市的新感染病例大幅減少。“相當長時間以來，支持這種做法的證據一直在積累，但現在已經是明確無疑了，那就是應該立刻爲人們提供治療，並告訴他們這樣做的好處。”

New York City has recommended immediate treatment since 2011, but has not yet achieved San Francisco’s success, partly because the latter is a smaller city in which many AIDS specialists have done their residencies together and learned the same treatment protocols.

紐約市從2011年開始推薦艾滋病病毒攜帶者儘早治療，但尚未取得舊金山那樣的成功，部分原因是舊金山城市規模更小，許多艾滋病專家都是一起當住院醫生的，因此所學習的治療方案也一樣。

“Most doctors in NYC are starting HIV medications quickly for newly diagnosed patients,” said Dr. Demetre C. Daskalakis, the city health department’s assistant commissioner for H.I.V./AIDS prevention and control. “With this study, we’ve answered the question definitively: Treat HIV — it’s good for both personal and public health. The release of data from such a powerful source should erase any doubt.”

“紐約市的許多醫生正在開始爲新診斷出來的患者提供藥物治療，”該市衛生局艾滋病毒/艾滋病預防和控制助理局長季米特里·C·扎斯卡拉基斯(Demetre C. Daskalakis)博士說。“憑藉這項研究，我們明確回答了這個問題：治療艾滋病病毒——對個人和公共衛生都有好處。這樣一個權威來源發佈的數據應該可以消除所有疑慮。”

Dr. Julio S. G. Montaner, a former president of the International AIDS Society who wrote a seminal 2006 paper in the Lancet arguing that universal antiretroviral treatment was the best way to curb the AIDS epidemic, said the study “confirms what we have been saying for years.”

前國際艾滋病學會(International AIDS Society)會長朱利奧·S·G·蒙塔內爾(Julio S. G. Montaner)2006年在《柳葉刀》(Lancet)雜誌上發表了一篇開創性的論文，稱廣泛使用抗逆轉錄病毒治療是遏制艾滋病的最好辦法。蒙塔內爾表示，上述研究“證實了多年來的說法”。

Immediate treatment not only benefits patients but prevents them from passing the disease on. Several other studies have shown that people taking their drugs regularly are more than 90 percent less likely to infect others, including spouses with whom they have regular unprotected sex.

儘早治療不僅對患者有利，還可以防止他們把病毒傳播出去。另外的幾項研究顯示，定期服用藥物的人把病毒傳染給其他人——包括經常與他們有無保護性行爲的配偶——的可能性降低了90%。

In the United States, many patients hesitate to start taking drugs while they feel healthy because they have heard reports of harsh side effects. The early antiretroviral drugs prescribed in the mid-1990s often caused rashes, accumulation of belly fat and loss of feeling in the fingers and feet. But modern regimens — many based on tenofovir, which was approved in 2001 but took some years to be widely used — have far fewer side effects.

在美國，許多患者在沒有感覺不適的情況下不願意服藥，原因是他們聽說過關於藥物的嚴重副作用的報道。上世紀90年代中期的早期抗逆轉錄病毒處方藥通常會引發疹子、腹部脂肪堆積，手指和腳失去知覺。不過，現代的療法——許多療法主要依靠替諾福韋(Tenofovir)，該藥品2001年被通過，但幾年後才普及起來——副作用要少得多。

The Start trial — short for Strategic Timing of Antiretroviral Treatment — enrolled its first patients in 2009 but was publicly announced in 2011. When it was stopped, it had followed 4,685 H.I.V.-infected men and women in 35 countries.

這項名爲抗逆轉錄病毒治療戰略時機(Strategic Timing of Antiretroviral Treatment)的實驗，於2009年招募了第一批患者，但直到2011年纔對外公開。實驗結束的時候，它已經追蹤了35個國家的4685名男性和女性艾滋病病毒感染者。