何时开始抗逆转录病毒治疗？一场科学争论的历史与分析。
When to start antiretroviral treatment? A history and analysis of a scientific controversy.
作者信息
Geffen Nathan, Low Marcus O
机构信息
Department of Computer Science and Centre for Social Science Research, University of Cape Town, South Africa.
Spotlight Magazine, Cape Town, South Africa.
出版信息
South Afr J HIV Med. 2017 Dec 5;18(1):734. doi: 10.4102/sajhivmed.v18i1.734. eCollection 2017.
BACKGROUND
Since 1987 HIV scientists and activists have debated the optimal point to start antiretroviral treatment. Positions have varied between treating people with HIV as soon as they are diagnosed, based on biological, modelling and observational evidence, versus delaying treatment until points in disease progression at which clinical trial evidence has shown unequivocally that treatment is beneficial.
OBJECTIVES
Examining the conduct and resolution of this debate may provide insight into how science works in practice. It also documents an important part of the history of the HIV epidemic.
METHOD
We describe clinical trials, observational studies, models and various documents that have advanced the debate from 1987 to 2015.
RESULTS AND CONCLUSION
Evidence accumulated over the past decade, especially from randomised controlled clinical trials, has shown that immediate treatment both reduces the mortality and the risk of HIV transmission; it benefits both public health and the individual patient. By mid-2015, the debate was resolved in favour of immediate treatment.
背景
自1987年以来，艾滋病病毒科学家和活动家一直在争论开始抗逆转录病毒治疗的最佳时机。基于生物学、模型和观察证据，一种观点主张一旦确诊感染艾滋病病毒就对患者进行治疗；另一种观点则主张推迟治疗，直到疾病进展到临床试验证据明确显示治疗有益的阶段。
目的
审视这场争论的过程和结果，或许能让我们了解科学在实际中的运作方式。它还记录了艾滋病流行历史的一个重要部分。
方法
我们描述了从1987年到2015年推动这场争论的临床试验、观察性研究、模型以及各种文件。
结果与结论
过去十年积累的证据，尤其是来自随机对照临床试验的证据表明，立即治疗既能降低死亡率，又能降低艾滋病病毒传播风险；它对公共卫生和个体患者都有益。到2015年年中，这场争论以支持立即治疗而告终。
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