Weiss S H, Louria D B
Department of Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark.
Clin Perinatol. 1994 Mar;21(1):179-98.
The HIV problem will inexorably increase over the next decade, with an increasing proportionate impact upon women and children over the next decade. HIV will become endemic, essentially worldwide. Some regions in the developed world may be relatively spared if current trends continue. This may reduce the willingness to expend necessary resources, particularly if trends toward increasing isolationism continue. There are already signs of a world becoming "bored" with AIDS and the chronicity of a difficult problem. This engenders an atmosphere ripe for increasing discrimination, with the development of loopholes in protective legislation. Already in the United States, some lawsuits concerning health care access among employees have been decided in the employer's favor, permitting them to restrict access to health insurance, despite other regulations which might have protected such workers. Similarly, some HIV-infected health care workers have been dismissed or lost their privileges in the 1990s, despite passage of the Americans with Disabilities Act as well as preceding legislation. It remains to be seen how society will cope with these complicated issues. The view of AIDS in 2004 presented above is pessimistic. There are some important rays of hope. Recent innovative vaccine work and new theoretical models may put us on the road to success, both with preventive and therapeutic vaccines. In particular, the first success in eliciting protection against vaginal HIV exposure, albeit partial, was reported in mid 1993. In a simian immunodeficiency virus (SIV) in vivo experimental model, cellular immunity to SIV was induced in macaques without their developing any signs of SIV infection. These macaques after rechallenge with low-dose SIV remained free of detectable SIV, so there may be an element of protection associated with specific cellular immune responses to immunodeficiency viruses. However, very high-dose SIV rechallenge experiments in similar macaques still led to acquisition of active SIV infection, suggesting that any such protection was only partial. It is also possible that cellular immune protection may be of varying efficacy against different types of exposure, particularly parenteral versus mucosal (such as sexual) exposures. There is also reason for specific optimism concerning interventions that might directly reduce the risk of perinatal transmission. Data from studies of twins suggest that a substantial proportion of perinatal transmission does not occur until after labor has commenced. Thus, caesarian sections may potentially reduce the risk of transmission to the fetus in some cases.(ABSTRACT TRUNCATED AT 400 WORDS)
在未来十年，艾滋病问题将不可避免地加剧，对妇女和儿童的影响比例也会不断增加。艾滋病将在全球范围内成为地方病。如果当前趋势持续下去，发达国家的一些地区可能相对幸免。这可能会降低投入必要资源的意愿，特别是如果孤立主义抬头的趋势持续下去。已经有迹象表明，世界对艾滋病以及这一难题的长期性开始感到“厌倦”。这营造了一种氛围，使得歧视现象有增无减，保护性立法也出现了漏洞。在美国，一些关于员工医疗保健权益的诉讼已判定雇主胜诉，允许雇主限制员工获得医疗保险，尽管可能有其他法规保护这些员工。同样，在20世纪90年代，一些感染艾滋病病毒的医护人员被解雇或失去了特权，尽管当时已经通过了《美国残疾人法案》以及之前的相关立法。社会将如何应对这些复杂问题还有待观察。上文所呈现的2004年对艾滋病的看法是悲观的。不过，也有一些重要的希望之光。近期创新的疫苗研究工作和新的理论模型可能会引领我们走向成功，无论是预防性疫苗还是治疗性疫苗。特别是在1993年年中，首次报告了在预防阴道接触艾滋病毒方面取得的成功，尽管只是部分成功。在一个猿猴免疫缺陷病毒（SIV）体内实验模型中，猕猴体内诱导出了针对SIV的细胞免疫，且没有出现任何SIV感染迹象。这些猕猴在再次接受低剂量SIV攻击后，仍未检测到SIV，所以针对免疫缺陷病毒的特异性细胞免疫反应可能具有一定的保护作用。然而，在类似猕猴身上进行的高剂量SIV再次攻击实验仍导致了活跃的SIV感染，这表明任何此类保护都只是部分的。细胞免疫保护针对不同类型的接触（特别是肠道外接触与黏膜接触，如性接触）的效果也可能有所不同。对于可能直接降低围产期传播风险的干预措施，也有具体的乐观理由。对双胞胎的研究数据表明，相当一部分围产期传播直到分娩开始后才会发生。因此，在某些情况下，剖腹产可能会降低胎儿感染的风险。（摘要截选至400字）
