Anderson R M, Gupta S, May R M
Biology Department, Imperial College, University of London, UK.
Nature. 1991 Mar 28;350(6316):356-9. doi: 10.1038/350356a0.
Whether zidovudine (3'-azido-3'-deoxythymidine, AZT) should be offered to symptomless individuals infected with human immunodeficiency virus type-1 (HIV-1), in the hope of delaying or even preventing progression to AIDS, has been much debated. The discussion has focused on the efficacy of the drug in delaying progression to disease, the severity of its side-effects, and the likelihood of its prolonged and widespread use resulting in zidovudine-resistant strains of the virus. Little attention has been given to the degree to which treatment reduces the infectiousness of symptomless patients, and to the concomitant implications for the overall transmission rate of HIV-1 in the community. Here we use simple mathematical models to show that community treatment with antiviral drugs or immunotherapies that lengthen the incubation period of AIDS without significantly reducing the infectiousness of treated individuals, can increase the rate at which HIV-1 infection spreads (which is fairly obvious) and can even, under certain circumstances, increase the AIDS-related death rate in the community (which is less obvious).
是否应该给感染了1型人类免疫缺陷病毒（HIV-1）的无症状个体提供齐多夫定（3'-叠氮-3'-脱氧胸苷，AZT），以期延缓甚至预防病情发展为艾滋病，这一问题一直备受争议。讨论主要集中在该药物延缓病情发展的疗效、副作用的严重程度，以及长期广泛使用该药物导致病毒产生齐多夫定耐药菌株的可能性。对于治疗能在多大程度上降低无症状患者的传染性，以及这对社区中HIV-1总体传播率的连带影响，人们关注甚少。在此，我们使用简单的数学模型表明，使用抗病毒药物或免疫疗法进行社区治疗，若能延长艾滋病的潜伏期而又不显著降低接受治疗者的传染性，可能会提高HIV-1感染的传播速度（这相当明显），甚至在某些情况下，还可能提高社区中与艾滋病相关的死亡率（这就不那么明显了）。
