But doing so will take patience and money
不過，這麼做將需要耐心及金錢。
It is a tribute to human ingenuity and determination that AIDS no longer makes headlines. That is because HIV, the virus which causes it, is on the run. According to the latest update by UNAIDS, the UN programme that keeps tabs on such matters, deaths from AIDS-related illnesses have been falling since 2004 and new infections since 1996.
後天性免疫缺陷症候群(AIDS：Acquired Immune Deficiency Syndrome)不再成為頭條新聞，這是對人類聰明才智及決心的一種禮讚。那是因為，導致它的病毒，人類免疫缺陷病毒(HIV：Human Immunodeficiency Virus)消退中。根據由聯合國HIV/AIDS聯合規劃署(UNAIDS：Joint United Nations Programme on HIV/AIDS)，密切關注此類問題之聯合國計劃的最新更新，自2004年以來，AIDS相關疾病的死亡人數，及1996年以來的新感染人數，一直下降中。
Indeed, the fact that the number of people living with the virus (currently about 38m) continues to rise is actually good news. It means they are being kept alive by antiretroviral drug therapy (art), rather than dropping out of the statistics by dying.
事實上，攜帶該種病毒的人數(目前大約3800萬)持續上升的事實，實際上是個好消息。這意味著，他們是藉由，抗逆轉錄病毒藥物治療(人為方式)保持活命，而不是因為死亡而退出此些統計數字。
But HIV still kills in numbers that would never be off the front pages if a war, rather than a virus, were the cause. So far, it has ended the lives of some 40m people, with 650,000 of those deaths having happened in 2021.
不過，倘若原因是戰爭而不是病毒，則在人數上，HIV仍然會奪走，絕不會脫離頭版新聞的人命數量。迄今，它已經奪走大約4千萬條人命，其中有65萬人發生於2021年。
There is, moreover, a feeling of nervousness among doctors and activists alike. Funding directed at the problem in poor and middle-income countries has shrunk since 2018. And the year-on-year fall in new infections in 2021 was the smallest since 2016.
此外，在醫生及行動主義者們中，一樣有種緊張感。打從2018 年以來，導向於貧困及中等收入國家中之此一問題的資助，已經縮減。不過，2021年在新感染上，比去年同期的下降，是打從2016年以來最小的。
This may be a blip. Covid-19 has changed immediate medical priorities in many countries, to the detriment of HIV control. But if blip turns to slide, things could go wrong quite fast in some places, particularly in Africa.
這或許是一個記錄。在許多國家中，2019冠狀病毒症(COVID-19：Coronavirus Disease-19)已經改變當前的醫療重點，這不利於HIV控制。不過，倘若記錄轉為下滑，在某些地方，特別是非洲，事情可能會很快出問題。
Balanced against that, though, the scientific news about AIDS is positive. New treatments—and particularly new preventions—are being developed and deployed, and an unexpected side-effect of covid has been a novel approach to vaccination that seems well-suited to tackling HIV as well.
不過，與此平衡的是，有關AIDS的科學新聞是正面的。新的治療法，特別是新的預防藥物，正被開發及利用中。而一種冠狀病毒症(covid：coronavirus disease)意想不到的副作用，已經是種似乎也非常適合應付HIV之疫苗接種的新處理方法。
To discuss these matters, exchange intelligence and make battle plans, a crowd of researchers, clinicians, activists and patients recently gathered under the auspices of the International AIDS Society (IAS).
為了討論此些問題、交換訊息及制定搏鬥計劃。一群研究人員、臨床醫生、行動主義者及患者們，最近在國際AIDS協會(IAS)主辦下，聚集在一起。
This latest meeting, the 24th, was held in Montreal—a venue legendary in the field of AIDS. This was the place where, in 1989, activists and patients gatecrashed what had, until then, been a purely scientific gathering, and created the productive hybrid that these meetings have now become.
最近這次集會，24日，於加拿大蒙特婁舉行。這是一處，在AIDS領域具傳奇性的地點。這是於1989年，行動主義者及患者未受邀請而進入，在此之前，一直純粹是科學的聚會，並創造了此些集會目前已經發生之有成果的聚合體。
The AIDS establishment, activists and scientists alike, love a slogan. One of the first, “3 by 5”, captured the aspiration, promulgated by the World Health Organization (who) in 2003, to put 3m people on art by 2005.
AIDS機構、行動主義者及科學家們一樣，喜好口號。最早之一，“3 by 5”導入了，於2003年，由世界衛生組織(WHO)所頒布，到2005年，將300萬人導向藉由人為方式的憧憬。
This was followed in 2014 by the UNAIDS target of 90-90-90: the intention that, by 2020, 90% of those living with HIV would know their status, that 90% of that 90% would be taking advantage of treatment, and that 90% of those thus on treatment would have the virus suppressed within their bodies.
緊隨其後的是，於2014年由聯合國HIV/AIDS聯合規劃署(UNAIDS)頒布的90-90-90目標：意圖，到2020年，那些感染HIV者，90%能知道自己的狀況，那90%的人將利用治療法，而那些接受治療的人，90%在其體內能有此病毒受抑制。
The slogan du jour, though, is “u=u”, dreamed up by the Prevention Access Campaign, a group of activists. This is not a mathematical identity. The two us stand for different things: “undetectable” and “untransmittable”, respectively.
不過，當日的口號是“u=u”，由一群行動主義者們的“預防訪問活動”想出來。這不是一個數學恆等式。這兩個u代表不同的事：分別是“無法檢測”及“無法傳播”。
But it is this equation, above all, which makes attempts to stop HIV spreading realistic—for the idea it encapsulates is that someone for whom art has suppressed viral load to the point that it is undetectable cannot then pass the virus on.
不過，最重要的是，正是這個等式，使阻止HIV散播的嘗試，成為實際可行。因為，其概括的構想是，對人為方式已經抑制病毒載量，達無法檢測點的人來說，則不會傳播病毒。
This may not sound surprising, but it was, until quite recently, hotly contested. Only with publication in the 2010s of well-controlled studies which proved the point has u=u, known more formally as “treatment as prevention”, been universally acknowledged.
這聽起來可能並不令人驚訝，不過直到最近，一直備受爭議。只有在獲得於2010 年代，證實有u=u這論點之諸多良好對照研究的發表情況下，更正式地被通稱為“治療作為預防”，才普遍被認可。
The point, though, is obvious. Find, identify and treat every case of HIV infection on the planet and that would be the end of the pandemic. The latest UN aspiration, announced in 2021, is not quite that ambitious. It is to achieve 95-95-95 (and a whole lot of other targets, many of them social, rather than strictly medical) by 2025. That, though, is ambition enough.
不過，此論點很明顯。發現、確認及治療，地球上每一HIV感染病例，結果那會是此種大流行病的結束。於2021年宣布的最新聯合國憧憬，並非全然雄心勃勃。它是到2025年，達成95-95-95(及諸多其他目標，其中許多是社會的，而不是嚴謹的醫療目標)目標。(也就是，HIV的檢測、治療及病毒抑制率達到95%-95%-95%)不過，那是夠雄心的目標。
As Paul DeLay, who helped make the relevant calculations, explained, modelling shows that reaching those various targets will be needed to achieve the wider UN goal of ending AIDS as “a public-health threat” by 2030. The UN defines this as a reduction in new incidences of, and mortality from, HIV by 90%, compared with 2010.
如同協助進行相關計算之Paul DeLay的解釋，製作模型顯示，到2030 年，達成結束AIDS作為“一種公共衛生威脅”之更廣泛的聯合國目標，將需要達到那些不同的目標。聯合國將此界定義為，與2010年相較下，在HIV的新發病率及死亡率，減少達90%。
More specifically, the idea is to drive countries below an incidence-to-prevalence ratio (IPR) of 0.03. The IPR is defined as the number of new infections occurring per year, divided by the number of people living with HIV in a given population. If this value is below 0.03, the epidemic will start contracting of its own accord. At the moment, according to UNAIDS, of 117 countries with a published estimate, 31 have an IPR below that value.
更具體地說，此構想是，驅使各國家之發病對流行程度的比率(IPR)低於0.03。此IPR被界定為，每年發生的新感染人數，除以特定人群中，感染HIV的人數。倘若該值低於0.03，則此流行病將開始自然而然地縮減。目前，根據聯合國HIV/AIDS聯合規劃署的數據，在117個公佈之估計值的國家中，有31個國家的IPR低於那值。
None of this comes cheap, though. It is the additional targets beyond 95-95-95, including such things as more-granular data collection and more effort to reach particularly vulnerable populations, rather than a simple desire for extra “business as usual” money, that has so massively put up the amount of cash UNAIDS reckons will be needed in three years’ time (see chart 1).
不過，這些都不低廉。這是包括，諸如更精細的數據收集，及更多的努力來及於特別脆弱的人群等，超出95-95-95的諸多其他目標，而不是對額外“一切照舊”資金的單純渴望。那已經大大增加了，聯合國HIV/AIDS聯合規劃署估計，於三年時間內，將需要的現金數量(見圖1)。
At the moment, there is some way to go to reach even the headline goal of 95-95-95. According to a UNAIDS update the numbers last year were 85-88-92. But even if the deadline slips, as it did for both 3 by 5 and 90-90-90, provided the political will to get there is maintained and the money continues to flow there is no obvious reason why this goal should not eventually be met.
目前，要全然達到95-95-95的主要目標，尚有一段路要走。根據聯合國HIV/AIDS聯合規劃署的一項更新，去年的數字是85-88-92。不過，即使此界線下滑，如同3 by 5及90-90-90一樣，只要保持實現目標的政治意願，及資金持續流動，沒有最終不會達到此目標的明顯理由。
Moreover, other pharmaceutical tools than art are now available to assist. The most promising is pre-exposure prophylaxis (PREP), which involves giving drugs that ward off infection to those who feel they may need them. PREP is an idea that has long been discussed, and the best established version, a daily oral preparation called Truvada, has been available for a decade.
此外，目前除了人為方式之外，有其他製藥工具可資使用，來提供協助。最有指望的是，涉及將避免感染的藥物，施予那些感覺可能需要此些藥物之人暴露前的預防法(PREP)。PREP是一種，早已被討論的構想，而最成熟的版本是，一種被稱為Truvada的每日口服製劑，已經可資使用達十年。
But in the past two years prescriptions for Truvada and its generic equivalents have taken off, with 1m new recipients in 2020 and 800,000 in 2021, according to UNAIDS. Admittedly, as Anthony Fauci, President Joe Biden’s chief medical adviser and a doyen of the field of AIDS, pointed out in his pep talk to the meeting, those figures are still far short of the tens of millions of people who could benefit.
不過，根據聯合國HIV/AIDS聯合規劃署的數據，在過去兩年裡，Truvada及其仿製藥的處方已經攀升。於2020年有1百萬新接受者，於2021年有80萬新接受者。毫無疑問的是，如同美國喬·拜登總統的首席醫療顧問兼AIDS領域泰斗，Anthony Fauci在他對此集會，鼓舞人心的講話中所指出的，那些數字仍然遠低於可能受益的數千萬人。
But even tens of millions might seem small beer compared with the world’s population. For the truth is that AIDS is not an equal-opportunity killer. Some people are at vastly greater risk than others.
不過，與世界人口相較下，即使是數千萬人也可能顯得微不足道。因為事實是，AIDS並非機會均等的殺手。有些人比其他人冒有更大風險。
This was highlighted in the UNAIDS report (see chart 2). Even in sub-Saharan Africa, the part of the world where HIV is most widespread, about half of new cases are in recognized risk groups (sex workers and their clients, gay and bisexual men, transgender women, injecting drug users, and the partners of all of these groups). In the rest of the world that figure is 94%.
在聯合國HIV/AIDS聯合規劃署的報告中，這被突顯出。(見圖表2)。即使在世界上HIV最廣佈之撒哈拉沙漠以的南非洲地區，大約半數新病例屬於公認的風險群體(性工作者與其客戶、男同性戀與雙性戀男性、跨性別女性、注射吸毒者及那些群體的所有伴侶)。在世界其他地區，那個數字是 94%。
A consequence of this is that those most at risk often know who they are and so will come forward for prep—or, if they do not, can be sought out and offered it. And since some of those most at risk are also in a position to infect many others, breaking the chain of transmission here is a winning strategy.
上述的結果是，那些冒有最大風險的人，通常知道他們是誰，因此會挺身出進行準備。否則，倘若他們不這樣做，會被搜出並提供藥物。而且，由於那些冒有最大風險的人，也處於感染許多其他人的狀況。因此，在這裡打破傳播鍊，是個獲勝的策略。
Moreover, as technologies tend to, prep is getting better. Besides Truvada and its generic equivalents, and a closely related product called Descovy, two other approaches are now available.
此外，由於技術傾向，準備工作正變得更佳。除了Truvada與其仿製藥，及一種被稱為Descovy的密切相關產品之外，目前另有其他兩種方法可資使用。
Remembering to take a pill every day is a nuisance, so there is considerable interest in an injectable form of prep called cabotegravir. This approach, approved by America’s Food and Drug Administration (FDA) December 2021, requires a jab only once every two months.
記得每天吃藥是件麻煩事。因此，對一種被稱為cabotegravir之可注射的準備形式，有相當大的興趣。這種於2021年12月獲得美國食品暨藥物管理局(FDA)批准的藥物，僅需每兩個月皮下注射一次。
The third prep offering, recommended in 2021 by the WHO, is also long-lasting. It is the dapivirine vaginal ring (DVR), a flexible device made of silicone impregnated with a powerful antiviral agent. This needs replacement but once a month.
於2021年，由世界衛生組織推薦的第三種準備形式，也是持久的。這是dapivirine陰道環(DVR)，一種由浸漬有強力抗病毒劑之矽膠製成的柔韌裝置。這需要更換，不過是一個月一次。
Unlike Truvada and Descovy, and cabotegravir, all of which have drug companies behind them (Gilead Sciences for the first two and ViiV Healthcare for the third), the DVR is the product of a charity, the International Partnership for Microbicides, founded in 2002 by Zeda Rosenberg and still run by her.
不像Truvada與Descovy及cabotegravir，其所有背後皆有製藥公司(前兩個是Gilead Sciences，第三個是ViiV Healthcare)。DVR是一家由Zeda Rosenberg，於2002年創立，目前仍由她經營之慈善團體─國際殺微生物劑合夥公司的產品。
art, too, now offers an alternative to daily pill-popping. Cabenuva, a combination of cabotegravir and a second drug, rilpivirine, was approved by the FDA for use as a monthly injection in January 2021, and in some circumstances that approved interval has been raised to two months.
目前，人工方式也提供一種，替代日常吃藥的方法。Cabenuva是cabotegravir與第二種藥物rilpivirine的組合，於2021年1月，被美國食品暨藥物管理局批准，供作為一種每月注射劑使用。且在某些情況下，經批准的間隔已經被提高到兩個月。
And then there is that idea borrowed from the response to covid: deploying mRNA vaccines against HIV.
此外，有引用對冠狀病毒症(Covid：Coronavirus Disease)之反應的構想：也就是，利用對抗HIV的信使RNA(mRNA)疫苗。
The search for an HIV vaccine goes back almost as far as the identification of the virus itself. The result has been diddly squat. An important reason is that, unlike viruses that have been successfully vaccinated against in the past, HIV plays cat-and-mouse with the body’s immune response, as each tries to out-evolve the other. Mimicking this process with a vaccine is difficult. But mRNA offers a way to do so.
尋找HIV疫苗幾乎回溯遠至病毒本身的確認。此結果一直是完全蜷伏。一個重要的原因是，不像過去成功接種疫苗的病毒。當每次試圖超越演化另一次時，HIV與人體的免疫反應玩貓捉老鼠。用疫苗，來模仿此過程是困難的。不過，mRNA提供了一種，做到這一點的方法。
Molecules of mRNA carry the plans of proteins, or fragments thereof. In the case of those used in an AIDS vaccine, these are bits of the viral envelope. These plans are then read by body cells and turned into envelope fragments which go on to stimulate an immune response.
mRNA分子具有蛋白質的概要，也就是關於蛋白質的片段。在那些被用於AIDS疫苗的實例中，此些是病毒包膜的小部分。然後，此些概要被體細胞讀取，並轉化為持續刺激免疫反應的包膜片段。
Crucially, mRNA is easily tweaked to generate novel versions of these envelope fragments. That, researchers hope, will allow a series of vaccinations to mimic the process of co-evolution and thus coax the immune system towards producing the desideratum of an HIV vaccine: so-called neutralizing antibodies which disable the virus.
至關重要的是，mRNA很容易被調整，來產生這些包膜片段的新形式。研究人員們期盼，那將使一系列疫苗接種得以模擬共同演化的過程，從而誘導免疫系統朝向產生HIV疫苗的所需之物：也就是，所謂使病毒失能的中和抗體。
There are, then, plenty of tools both around already and in the pipeline. But they need to be deployed correctly. Here, Dr Fauci had some troubling news. These were data on art compliance, and they showed that in America people adhere properly to their regimes only about 40% of the time, suboptimally about 20% and poorly about 40%.
因此，有很多已經存在及處於開發中的工具。不過，它們需要正確地被利用。在此，Fauci博士有一些令人不安的消息。這些是有關人工方式依從性的數據，及它們展現了，在美國此期間，人們僅大約40%，正確遵循他們的生活規則，次優的大約20%，而較差的大約40%。
That emphasises that however good a drug is, it is no good if people don’t take it or take it badly. People, as well as immune systems, often need to be coaxed into doing the right thing.
那強調了，藥物無論多好，倘若人們不服用或不當服用，就是不好。除了免疫系統之外，人們通常也需要被勸誘，去做正確的事。
As barriers to compliance, or seeking treatment in the first place, Dr Fauci mentioned things ranging from simple forgetfulness, via housing and food insecurity, to stigma (always a problem with HIV, given prejudiced social attitudes towards the ways it is spread), misuse of alcohol and illegal recreational drugs, and even “pill fatigue”.
由於對依從性或首先尋求治療的諸多障礙，Fauci博士提到了，範圍從簡單的健忘，經由住家與糧食不安全，到污名(總是有HIV的問題，鑑於對HIV傳播方式的偏見社會態度)、濫用酒精及非法的消遣性藥物，甚至“藥丸疲勞”(一種服用大量藥丸的習慣變得筋疲力盡的現象)。
On top of these, in countries less favoured than America, one might add poor education—particularly, in many places, of girls—criminalisation of (as opposed to prejudiced attitudes towards) homosexual behaviour, criminalisation of sex work, and poor medical infrastructure.
除此之外，在比美國較少受照顧的國家中，會增加教育水平低下一項(在許多地方，特別是女孩的教育水平)，將同性戀行為定為犯罪(而不是朝向偏見態度)、將性工作定為犯罪及貧乏的醫療基礎設施。
Such things are, indeed, among the cost-raising non-medical targets of the UN’s 2025 goals. But many of them will require either political action that is unlikely soon, or behavioural changes in people beyond those infected or in imminent risk of infection.
事實上，此類事情是聯合國2025年目標中，提高經費的非醫療目標。不過，其中諸多將需要，不是短期內不太可能的政治行動，就是在那些感染者以外或即將有感染風險之人中的行為改變。
That is a tall order and, it might be argued, one which risks detracting from focused and measurable targets for pill-popping. In the end, though, closing the gap between those on treatment (some 29m) and those who would benefit from being so (a further 10m) depends on it.
那是一項艱巨任務(可能有爭議)，且是一種冒有偏離著重及可衡量有關服用藥丸(尤其是當這是一種習慣或藥丸是非法藥物時)之諸目標的風險。不過，最終，縮小接受治療者(約2千9百萬)與那些會從中受益者(另外的的1千萬)之間的差距，取決於它。
All of the art in the world is not, however, the same as a cure—even though a compliant user of art has almost the same life expectancy as an uninfected individual. Others are working on trying to cure those already infected.
然而，於世界上所有的人為方式，並非與治愈相同。即使一個人為方式的依從使用者具有，幾乎與未感染者一樣的預期壽命。其他人正致力於治愈那些已經感染的人。
There is no lack of ideas, but the problem is that HIV’s life cycle, a part of which involves copying its genes into the nuclear DNA of cells it infects, means it can lie dormant in those cells indefinitely. Antiretroviral drugs can deal with it when such a cell awakens. But they can neither cleanse DNA so hijacked nor recognize and kill cells so afflicted.
不乏構想。不過，問題是HIV的生命週期，其中一部分涉及，將其基因複製到其感染的細胞核DNA中。這意味著，於那些細胞中，它能無限期休眠。當這種細胞甦醒時，抗逆轉錄病毒藥物可以應付。不過，它們既不能淨化如此被劫持的DNA，也不能識別及殺死如此受折磨的細胞。
In a session held before the main meeting began, Sharon Lewin of the University of Melbourne, who is the incoming president of the IAS, outlined the options.
在該主要集會開始前舉行的一次會議上，即將上任之國際AIDS協會主席，澳洲墨爾本大學的Sharon Lewin，概述了這些選項。
These include “shock and kill”, which would activate dormant carrier cells, exposing them to attack by drugs; recruiting the immune system in novel ways to attack dormant cells as they wake up; gene therapy that modifies immune-system cells collected from a patient to introduce a genetic change that protects them from HIV infection and then re-transfuses them back again; and similar therapy that works directly on cells in the body to excise HIV DNA from their chromosomes.
此些包括，會激活休眠載體細胞的“衝擊與破壞”，使它們受到藥物的攻擊；以新方式徵招免疫系統，當休眠細胞醒來時，攻擊它們；基因療法，修改從患者身上收集的免疫系統細胞，來導入一種保護它們免於HIV感染，然後再將它們重新移回的基因改變；及直接針對體內細胞起作用，來從其染色體中，切除HIV DNA的類似療法。
All of these approaches have their drawbacks. Progress is slow. Unlike antiretrovirals, which are small, easily synthesized molecules that can be stored without difficulty, any practical therapy that might result from them is likely to be fiddlesome and expensive, at least to start with.
所有此些方法皆有進展緩慢的缺點。不像易於合成、能輕易儲存之小分子的抗逆轉錄病毒藥物。任何能從此些方法產生的實際治療，皆可能是繁瑣且昂貴，至少在開始時。
But maybe not for ever. art itself started life as regimens which required multiple doses a day and cost thousands of dollars a year. Now, a single, daily pill costing 25 cents will do the job. Technology, once invented, always gets better. You just have to come up with it in the first place.
不過，或許不會永遠如此。人為方式本身以每天需要多劑，且每年花費數千美元之養生法的生活開始。目前，每天只需25美分的藥丸，就能達成此工作。一旦發明，技術總會變得更佳。僅需首先想出解決之道。
網址：https://www.economist.com/science-and-technology/2022/08/02/despite-setbacks-hiv-can-be-beaten?utm_content=article-link-6&etear=nl_today_6&utm_campaign=a.the-economist-today&utm_medium=email.internal-newsletter.np&utm_source=salesforce-marketing-cloud&utm_term=8/4/2022&utm_id=1278872
翻譯：許東榮
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