In 2008, something incredible happened: a man was cured of HIV. In over 70 million HIV cases, that was a first and, so far, a last. We don't yet understand exactly how he was cured. We can cure people of various diseases, such as malaria and hepatitis C, so why can't we cure HIV? Well, first let's examine how HIV infects people and progresses into AIDS.
在 2008 年發生了神奇的事情:一個男人 被治好了「人類免疫缺陷病毒」 (HIV) 在超過 7,000 萬筆 HIV 病例中 這是首件,至今也是最後一件 我們尚未瞭解他到底是如何被治癒的 我們可以治好很多種疾病 像是瘧疾或是 C 型肝炎 那麼我們無法治癒 HIV 是什麼原因呢? 首先讓我們來檢視 HIV 對人體的影響 以及如何進化成愛滋病 (AIDS)
HIV spreads through exchanges of bodily fluids. Unprotected sex and contaminated needles are the leading cause of transmission. It, fortunately, cannot spread through air, water, or casual contact. Individuals of any age, sexual orientation, gender and race can contract HIV.
HIV 會透過體液散播出去 沒有防護措施的性愛、受感染的針頭 是染病的首要原因 幸運的是它不能透過空氣 水分、或是一般接觸來散播 任何年齡層、性傾向、性別 或是種族的單一個體 都可能會感染到 HIV
Once inside the body, HIV infects cells that are part of the immune system. It particularly targets helper T cells, which help defend the body against bacterial and fungal infections. HIV is a retrovirus, which means it can write its genetic code into the genome of infected cells, co-opting them into making more copies of itself.
一但進入了體內 HIV 會影響免疫系統的部分細胞 它又特別針對輔助 T 細胞 這種細胞保護身體 對抗細菌和黴菌感染 HIV 是一種「反轉錄病毒」 意即它可以將它的基因碼 寫進受感染細胞的基因組 拉攏這些細胞來複製更多病毒
During the first stage of HIV infection, the virus replicates within helper T cells, destroying many of them in the process. During this stage, patients often experience flu-like symptoms, but are typically not yet in mortal danger. However, for a period ranging from a few months to several years, during which time the patient may look and feel completely healthy, the virus continues to replicate and destroy T cells. When T cell counts drop too low, patients are in serious danger of contracting deadly infections that healthy immune systems can normally handle. This stage of HIV infection is known as AIDS.
在第一階段的 HIV 感染期間 病毒在輔助 T 細胞裡面做複製 在過程裡摧毀掉大量的輔助 T 細胞 在這個階段病患經常 遭受到類似流行感冒的症狀 但是通常還不會有致命的危險 然而在幾個月到數年的期間裡 病患也許看起來 或感覺上是完全健康的 病毒繼續在複製本身 並摧毀輔助 T 細胞 當輔助 T 細胞的數量下降到太低時 病患就會有受到感染 而喪命的極度危險 那是健康的免疫系統通常可以解決的 這階段的 HIV 感染 就是你我熟知的愛滋病
The good news is there are drugs that are highly effective at managing levels of HIV and preventing T cell counts from getting low enough for the disease to progress to AIDS. With antiretroviral therapy, most HIV-positive people can expect to live long and healthy lives, and are much less likely to infect others.
好消息是有一些藥 在控制 HIV 的程度有高度成效 並防止輔助 T 細胞的數量 降低到足以讓病情演變成愛滋病 有了抗反轉錄病毒療法 大部分的 HIV 陽性反應者 能預期活得長久又健康 而且不太會感染給他人 不過有兩個大問題
However, there are two major catches. One is that HIV-positive patients must keep taking their drugs for the rest of their lives. Without them, the virus can make a deadly comeback.
第一、 HIV 陽性反應患者 在往後的日子裡一定要持續服藥 少了這些藥,病毒就會回復而且致命 這些藥如何發生作用呢
So, how do these drugs work? The most commonly prescribed ones prevent the viral genome from being copied and incorporated into a host cell's DNA. Other drugs prevent the virus from maturing or assembling, causing HIV to be unable to infect new cells in the body.
最常開出的藥能避免 病毒的基因組複製 及被整合進宿主細胞的 DNA 裡頭 其他的藥則不讓病毒成熟或是組合 造成 HIV 無法感染身體的新細胞 但是 HIV 深藏於 最新藥方仍無法碰觸的某處
But HIV hides out somewhere our current drugs cannot reach it: inside the DNA of healthy T cells. Most T cells die shortly after being infected with HIV. But in a tiny percentage, the instructions for building more HIV viruses lies dormant, sometimes for years. So even if we could wipe out every HIV virus from an infected person's body, one of those T cells could activate and start spreading the virus again.
健康的輔助 T 細胞的 DNA 裡面 大部分的輔助 T 細胞 感染到 HIV 很快就會死亡 不過在極少百分比的情形下 製造更多 HIV 病毒的指令會潛伏 有時候還會長達數年 因此即便我們可以將所有的 HIV 病毒趕出受感染者的身體 潛伏指令的輔助 T 細胞 能激活並再次開始傳播病毒 另一個問題就是並非世界上的 所有人都能拿到可能救其一命的療法
The other major catch is that not everyone in the world has access to the therapies that could save their lives. In Sub-Saharan Africa, which accounts for over 70% of HIV patients worldwide, antiretrovirals reached only about one in three HIV-positive patients in 2012. There is no easy answer to this problem. A mix of political, economic and cultural barriers makes effective prevention and treatment difficult. And even in the U.S., HIV still claims more than 10,000 lives per year.
在亞薩哈拉非洲 有著世界上超過 70% 的 HIV 病患 2012 年抗反轉錄病毒療法只能及於 大約1/3 的 HIV 陽性反應病患 這個問題並不容易解決 夾雜了政治和經濟還有文化的隔閡 使得有效的防護以及治療很難做到 即便在美國 每年 HIV 照樣奪走一萬多條人命 然而還是有足夠的理由可以盼望
However, there is ample cause for hope. Researchers may be closer than ever to developing a true cure. One research approach involves using a drug to activate all cells harboring the HIV genetic information. This would both destroy those cells and flush the virus out into the open, where our current drugs are effective. Another is looking to use genetic tools to cut the HIV DNA out of cells genomes altogether.
研究人員比以前更有可能 做出真正的解藥 有一個研究方法涉及 利用藥物活化所有藏著 HIV 基因資訊的細胞 這將會一併摧毀這些細胞 以及讓病毒趕出細胞外 在那裡最新的藥物是起的了作用的 另一個則是打算利用基因工具 把 HIV 的 DNA 全部 趕出細胞的基因組 7,000 萬個案例裡才一個被治癒 可能看起來是非常糟糕的機率
And while one cure out of 70 million cases may seem like terrible odds, one is immeasurably better than zero. We now know that a cure is possible, and that may give us what we need to beat HIV for good.
一個還是遠遠勝過零個 現在我們知道了治癒是有可能的 這就可能帶給我們想永遠解決掉 HIV 所需要的東西