临床试验证明艾滋病早期治疗效果明显

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.

联邦卫生官员周三表示，艾滋病毒(HIV)携带者在得知自己被感染后，应尽快服用抗逆转录病毒药物。他们同时宣布，将很快结束一项迄今为止规模最大的艾滋病早期治疗临床试验，因为该疗法的益处已经十分明显。

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.

这项研究的结束时间比预期提前了一年多，因为初步数据已经证明，在感染后立即接受治疗的感染者在试验期间死亡、发展成艾滋病或者严重疾病的概率，比推迟治疗的感染者低了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.

这些官员称，这项研究有力地证明了，尽早治疗可以挽救更多生命。根据联合国艾滋病规划署(UNAIDS)的数据，全世界约有3500万HIV携带者，其中有不到1400万人正在接受治疗。根据疾病控制与预防中心（Centers for Disease Control and Prevention，简称CDC）的数据，美国约有120万HIV携带者，只有大约45万人在接受治疗。

“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.”

“这是早检测和早治疗的另一个理由，因为你会从中受益，”国家过敏及传染性疾病研究所(National Institute of Allergy and Infectious Diseases)所长安东尼·S·福奇(Anthony S. Fauci)博士说。“越早越好。”该机构是这项试验的赞助方。

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.

尽管CDC推荐HIV感染者确诊后立即接受治疗，该机构去年11月表示，在美国只有37%的感染者有药物处方。该机构将其归因于多种因素，比如HIV携带者没有进行检测，或者没有医保并因此不看医生或买不起药，还有一些病人的医生对治疗的指导原则不熟悉。

“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.”

“这是社会公正的一个决定性时刻，”联合国艾滋病规划署的执行主任米歇尔·西迪贝(Michel Sidibé)说。“人们会被吓到，说，‘噢，这会是很大一笔钱。’但这就终结了是否应该花钱治疗的错误争论。”

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.

长期以来，许多艾滋病研究人员和倡导者一直强调——根据他们自己的观察和较小规模的研究——治疗应该尽早开始。周三结束的这项实验是第一个证明了感染者在接受治疗之后可以活得更长、更健康的大型临床试验。

“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.”

“这太棒了，”旧金山公共卫生局艾滋病病毒预防研究主任苏珊·P·布赫宾德(Susan P. Buchbinder)博士说。她的机构在2010年开始建议感染者在确诊后立即接受治疗，此后这座城市的新感染病例大幅减少。“相当长时间以来，支持这种做法的证据一直在积累，但现在已经是明确无疑了，那就是应该立刻为人们提供治疗，并告诉他们这样做的好处。”

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.

纽约市从2011年开始推荐艾滋病病毒携带者尽早治疗，但尚未取得旧金山那样的成功，部分原因是旧金山城市规模更小，许多艾滋病专家都是一起当住院医生的，因此所学习的治疗方案也一样。

“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.”

“纽约市的许多医生正在开始为新诊断出来的患者提供药物治疗，”该市卫生局艾滋病毒/艾滋病预防和控制助理局长季米特里·C·扎斯卡拉基斯(Demetre C. Daskalakis)博士说。“凭借这项研究，我们明确回答了这个问题：治疗艾滋病病毒——对个人和公共卫生都有好处。这样一个权威来源发布的数据应该可以消除所有疑虑。”

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.”

前国际艾滋病学会(International AIDS Society)会长朱利奥·S·G·蒙塔内尔(Julio S. G. Montaner)2006年在《柳叶刀》(Lancet)杂志上发表了一篇开创性的论文，称广泛使用抗逆转录病毒治疗是遏制艾滋病的最好办法。蒙塔内尔表示，上述研究“证实了多年来的说法”。

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.

尽早治疗不仅对患者有利，还可以防止他们把病毒传播出去。另外的几项研究显示，定期服用药物的人把病毒传染给其他人——包括经常与他们有无保护性行为的配偶——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.

在美国，许多患者在没有感觉不适的情况下不愿意服药，原因是他们听说过关于药物的严重副作用的报道。上世纪90年代中期的早期抗逆转录病毒处方药通常会引发疹子、腹部脂肪堆积，手指和脚失去知觉。不过，现代的疗法——许多疗法主要依靠替诺福韦(Tenofovir)，该药品2001年被通过，但几年后才普及起来——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.

这项名为抗逆转录病毒治疗战略时机(Strategic Timing of Antiretroviral Treatment)的实验，于2009年招募了第一批患者，但直到2011年才对外公开。实验结束的时候，它已经追踪了35个国家的4685名男性和女性艾滋病病毒感染者。