一线抗逆转录病毒药物奈韦拉平

　　科学家发现，在帮助患者生存方面，通过临床检查体征评估治疗阶段的艾滋病感染者/患者的状态几乎和实验室血液检测同样可靠。他们说，这一研究表明，缺乏实验室检测不应该成为在发展中国家大规模推广抗艾滋病逆转录病毒药物项目的障碍。

　　Researchers have found that, in terms of survival, assessing the status of a HIV/AIDS patient by clinical examination is almost as reliable as laboratory blood testing during their course of treatment.

　　Poor access to laboratory tests should therefore not be a barrier to rolling out antiretroviral (ARV) drug programmes for HIV in developing countries, they say.

　　他们的发现发表在了上周（4月26日）出版的《柳叶刀》杂志上。

　　The findings were published in The Lancet last week (26 April).

　　在发达国家，医生定期监测服用一线抗逆转录病毒药物的患者血液中的艾滋病病毒数量。当它低于某一水平的时候，治疗就转而采用二线抗逆转录病毒药物。但是由于发展中国家很难获得实验室检测，世界卫生组织推荐发展中国家监测患者的艾滋病病程的临床体征，例如口腔细菌感染和特定类型的癌症。

　　Patients on first-line ARVs in the developed world are monitored regularly for the amount of HIV circulating in their blood. When this falls below a certain level, treatment switches to second-line ARVs.

　　But because of limited access to laboratory tests, the WHO recommends that people in the developing world are monitored for clinical signs of HIV progression, such as bacterial infection in the mouth and certain types of cancer.

　　当可以获得实验室检测的时候，也可以使用监测CD4细胞水平的方法。CD4细胞水平是患者免疫系统健康程度的一个指标。迄今为止，人们对于这种策略的有效性还知之甚少。

　　Monitoring of CD4 cell levels — an indicator of the health of a patient's immune system — is also used when laboratory testing is available. Until now, little was known about the effectiveness of this strategy.

　　这组科学家使用了一个计算机模型模拟了艾滋病病毒感染的进程，并估计了监视病毒载量、CD4细胞计数或者临床观察对患者生存的影响。

　　The researchers used a computer model to simulate the course of HIV infection and estimate the impact on survival of monitoring by viral load, CD4 count or clinical observation.

　　这个模型最初是为了富国开发的，但是通过考虑到诸如药物供应中断等因素，科学家将其改造为适合低收入国家。

　　The model was initially developed for wealthy countries, but was adapted for lower-income countries by taking into account factors such as interruptions in drug supply.

　　它预测在5年之后，83%的监测病毒载量的患者、82%的监测CD4细胞计数的患者以及82%的通过临床检查进行监测的患者将会存活下来。这些数字在20年后分别降至67%、64%和64%。

　　It predicts that after five years, 83 per cent of patients monitored by viral load, 82 per cent of patients monitored by CD4 cell count, and 82 per cent of patients monitored by clinical examination alone, would have survived. This decreases to 67, 64 and 64 per cent, respectively, after 20 years.

　　本研究的第一作者、英国皇家自由大学医学院的流行病学教授Andrew Phillips说，尽管这些研究表明临床观察的效果，但是它们并不应该用于劝阻（有条件的）人们放弃病毒载量监测。

　　Andrew Phillips, professor of epidemiology at the UK-based Royal Free & University College Medical School and lead author of the study, says the findings shouldn't dissuade people from relying on viral-load monitoring.

　　他告诉本网站说：“我肯定不希望看到病毒载量监测的大规模推广受到阻碍；我们也期望开发出不严重依赖于基础设施或者训练有素的实验室人员的廉价可靠的检测方法。”但是他说，这不应该建立在妨碍所有需要抗逆转录病毒药物的人们获得药物的基础之上。

　　"I certainly wouldn't want to inhibit the roll-out of viral-load monitoring and the development of cheap and robust tests that don't rely heavily on infrastructure or highly skilled laboratory staff," he told SciDev.Net.

　　But, he says, that shouldn't be done at the cost of getting ARVs to everyone who needs them.

　　“当你面对能否真正让所有需要抗逆转录病毒药物的人们获得治疗的问题的时候，是否使用病毒载量监测的问题就变得不再重要。服用药物但是没有病毒载量监测远远比没有服用药物更好。”

　　"The issue of whether to use viral-load monitoring or not pales into insignificance when dealing with whether you've actually got everyone who needs ARVs on therapy. Having drugs without viral-load monitoring is a lot better than not having drugs."

　　本文由科学与发展网络(SciDev.Net)独家提供。