May R M, Anderson R M
Department of Biology, Princeton University, N.J. 08544.
Philos Trans R Soc Lond B Biol Sci. 1988 Oct 31;321(1207):565-607. doi: 10.1098/rstb.1988.0108.
The paper first reviews data on HIV infections and AIDS disease among homosexual men, heterosexuals, intravenous (IV) drug abusers and children born to infected mothers, in both developed and developing countries. We survey such information as is currently available about the distribution of incubation times that elapse between HIV infection and the appearance of AIDS, about the fraction of those infected with HIV who eventually go on to develop AIDS, about time-dependent patterns of infectiousness and about distributions of rates of acquiring new sexual or needle-sharing partners. With this information, models for the transmission dynamics of HIV are developed, beginning with deliberately oversimplified models and progressing--on the basis of the understanding thus gained--to more complex ones. Where possible, estimates of the model's parameters are derived from the epidemiological data, and predictions are compared with observed trends. We also combine these epidemiological models with demographic considerations to assess the effects that heterosexually-transmitted HIV/AIDS may eventually have on rates of population growth, on age profiles and on associated economic and social indicators, in African and other countries. The degree to which sexual or other habits must change to bring the 'basic reproductive rate', R0, of HIV infections below unity is discussed. We conclude by outlining some research needs, both in the refinement and development of models and in the collection of epidemiological data.
本文首先回顾了发达国家和发展中国家同性恋男性、异性恋者、静脉注射吸毒者以及感染母亲所生子女中艾滋病毒感染和艾滋病发病的数据。我们调查了目前可获得的此类信息，包括艾滋病毒感染与艾滋病出现之间的潜伏期分布、最终发展为艾滋病的艾滋病毒感染者比例、传染性随时间变化的模式以及获得新的性伴侣或共用针头伙伴的速率分布。利用这些信息，开发了艾滋病毒传播动力学模型，从故意过度简化的模型开始，并在此基础上逐步发展为更复杂的模型。在可能的情况下，模型参数的估计值来自流行病学数据，并将预测结果与观察到的趋势进行比较。我们还将这些流行病学模型与人口统计学因素相结合，以评估异性传播的艾滋病毒/艾滋病最终可能对非洲和其他国家的人口增长率、年龄分布以及相关经济和社会指标产生的影响。讨论了性行为或其他习惯必须改变到何种程度才能使艾滋病毒感染的“基本繁殖率”R0降至1以下。我们最后概述了一些研究需求，包括模型的完善和开发以及流行病学数据的收集。
