时间:2019年10月21日 08:17:15

The world has passed a tipping point in the fight against Aids, according to data showing that more people gained access to HIV drugs last year than became infected with the virus.国际社会抗击艾滋病(Aids)的斗争走过了一个转折点。数据显示,去年,接受抗艾滋病病毒(HIV)药物治疗的人数超过了感染这种病毒的人数。This marks the first time since anti#173;retroviral medicines were introduced 27 years ago that treatment of HIV has expanded at a higher rate than the incidence of the virus itself.这是自27年前抗逆转录病毒药物问世以来,接受抗艾滋病病毒治疗的人数首次超过艾滋病病毒感染的人数。“We’re not saying the end of Aids is near but we have reached an important milestone where, for the first time, we are getting ahead of the disease,” said Erin Hohlfelder, health policy director for One, an anti-poverty group that highlights the watershed in a report to mark today’s World Aids Day.扶贫组织One的卫生政策主任埃琳#8226;霍尔菲尔德(Erin Hohlfelder)表示:“我们并不是说艾滋病即将被消灭,但我们已经达到了一个重要的里程碑,我们第一次跑在了艾滋病前面。”今日是世界艾滋病日(World Aids Day),在一份纪念这个日子的报告中,该组织强调了这个转折点。In 2013 – the most recent year for which data are available – 2.3m people were added to treatment programmes compared with 2.1m new infections.2013年,有230万人开始接受抗艾滋病病毒治疗,而新增艾滋病病毒感染者为210万人。目前还拿不到2014年的数据。This marked an improvement from the year before when 1.6m people gained access to medicines for the first time while 2.2m were newly infected.上述数据标志着,去年的情况较前年有所改善。前年,有160万人首次接受药物治疗,而新增感染者为220万人。Antiretroviral drugs now reach 13.6m people around the world, but this still represents less than half the estimated 35m people living with HIV.目前,全球累计有1360万人得到抗逆转录病毒药物治疗,但这个数字仍不到艾滋病病毒携带者人数的一半,后者估计有3500万人。Ms Hohlfelder warned there was a long way to go before victory could be declared. “We’ve passed the tipping point globally but not all countries are there yet, and the gains made can easily stall or unravel,” she said.霍尔菲尔德警告称,现在还远不到宣布胜利的时候。她说:“就全球而言,我们确实走过了这个转折点,但并非对所有国家都是如此。而且,我们取得的进展很容易陷入停滞或付诸东流。”Global funding for anti-HIV programmes reached .1bn last year but this is still below the annual bn-bn the UN says is needed.去年,全球用于抗艾滋病病毒的资金达到191亿美元,但仍低于联合国(UN)认为需要达到的水平,即每年220亿至240亿美元。Ms Hohlfelder said middle-income countries were beginning to contribute more but the three leading donors – the US, France and the UK – were carrying an “unsustainable” share of the #173;burden.霍尔菲尔德表示,中等收入国家开始捐出更多资金,但三个主要捐助国(美国、法国和英国)目前的负担比例是“不可持续”的。“Many donor countries – such as Australia, Japan and some in the Middle East – really haven’t stepped up as much as we’d have liked.”“很多捐助国——例如澳大利亚、日本及中东一些国家——的前进速度的确还赶不上我们的期望。”Activists and health officials warn against the risk of complacency when HIV is becoming seen in the developed world as a manageable chronic disease because of the potential for people to live an almost normal lifespan on the latest antiretroviral drugs.由于最新的抗逆转录病毒药物使得艾滋病病毒感染者的预期寿命有可能逼近正常人的水平,艾滋病在发达国家正慢慢地被视为一种可控的慢性病,但活动人士和卫生官员警告称,要提防可能出现的自满情绪。They say HIV remains one of the #173;gravest health threats across much of the developing world, especially Africa, which has almost 70 per cent of cases.他们说,在许多发展中国家,艾滋病病毒依然是对人类健康的最严重威胁之一,特别是在非洲,那里的感染者占全球的近70%。More rapid gains may be hard to achieve as the virus becomes concentrated among hard-to-reach groups, such as sex workers and drug users, as well as gay people and youths who may shun testing and treatment.随着某些难以触及的群体成为这种病毒的主要感染者,比如性工作者和吸毒者、以及可能躲避检测和治疗的同性恋人群和青年,可能很难取得更多的快速进展。Michel Sidibé, executive director of UNAids, which leads the global response to HIV, says a push is needed to meet a target to end the epidemic by 2030. “We have bent the trajectory of the epidemic. Now we have five years to break it for good or risk the epidemic rebounding out of control.”领导全球抗击艾滋病的联合国艾滋病规划署(UNAids)的执行主任米歇尔#8226;西迪贝(Michel Sidibé)说,要实现到2030年时结束艾滋病疫情的目标,需要发动一场大规模攻势。“我们已经改变了这一疫情的发展轨迹。现在,我们有五年的时间来永久性地挫败它,否则疫情可能会反弹至失控的程度。”Pharmaceutical companies, once #173;pilloried for keeping HIV drugs out of reach of the poor, have lent support to the effort by licensing their medicines for generic manufacturers to make at a low cost in the developing world.某些制药公司曾因把穷人挡在抗艾滋病病毒药物治疗的大门之外而受到公众的嘲笑。现在,它们已通过授权发展中国家的仿制药厂商以较低成本生产它们的药物,来持抗击艾滋病的努力。AbbVie today became the fifth big company to grant a licence for generic production to the UN-backed Medicines Patent Pool, following Bristol-Myers Squibb, Gilead Sciences, Roche and ViiV Healthcare, a joint venture between GlaxoSmithKline and Pfizer.今日,艾伯维(AbbVie)成为第五家授予联合国资助的药品专利池组织(MPP)仿制药生产许可的大公司。此前已签署许可协议的企业包括百时美施贵宝(Bristol-Myers Squibb)、吉利德科学公司(Gilead Sciences)、罗氏(Roche),以及葛兰素史克(GSK)和辉瑞(Pfizer)的合资公司ViiV Healthcare。The agreement with AbbVie involves two antiretrovirals formulated for paediatric use and helps address a shortage of treatments suitable for the 3.2m children with HIV in the world.艾伯维与药品专利池组织签署的协议包括两种为儿科使用配制的抗逆转录病毒药物,可帮助缓解儿童适用药物短缺的问题。全球有320万儿童感染了艾滋病病毒。AbbVie’s lopinavir and ritonavir drugs will be available to generic producers in the 102 countries where almost all children with HIV live.102个国家的仿制药厂商将可生产艾伯维的洛匹那韦(lopinavir)和利托那韦(ritonavir)药物。几乎所有感染了艾滋病病毒的儿童都生活在这102个国家。“This is a crucial licence for paediatric programmes in resource-limited countries,” said Greg Perry, executive director of the Medicines Patent Pool.药品专利池组织执行主任格雷格#8226;佩里(Greg Perry)说:“这对资源有限国家的儿科治疗计划而言是一项关键的授权。” /201412/346217

It#39;s one thing to want to get fit, but it#39;s a whole other thing to actually do it. Going from couch potato to enthusiastic exerciser takes some serious motivation and a fitness plan that#39;s easy to follow。想要减肥是一回事,可真正采取行动又是另一回事。从懒惰的沙发土豆一族变成充满热情的运动达人,需要强大的动力以及一套简单易行的减肥计划。We went to celebrity fitness guru David Kirsch--the man behind the bodies of Heidi Klum and Anne Hathaway--to get his tips for getting your butt off the couch and working out. His simple plan will help you get toned, without having to morph into a total gym rat。我们拜访了明星减肥专家大卫·克尔士(他可是名模海蒂·克拉姆和甜蜜公主安妮·海瑟薇美妙身材的背后功臣),看看他有什么建议能让你从沙发里爬起来,开始锻炼。他简单的减肥计划能帮助你完成蜕变,而且不需要变成一个健身狂人。Set Reasonable Goals制定合理的目标The easiest way to discourage yourself is to set an unreasonable goal--there will be no way for you to hit it and you#39;ll wind up getting frustrated and giving up. Kirsch recommends setting an obtainable goal, such as ;I want to lose five pounds,; or ;I want to fit into my skinny jeans.;制定一个不切实际的目标是最容易让自己泄气的——你根本没有办法实现它,而且只会让自己越来越沮丧,最后放弃。克尔士建议大家制定一个可以实现的目标,比如 “我想减掉5磅” 或者“我想穿上这条紧身牛仔裤”。It#39;s also important to be realistic about your time frame and the amount of exercise you do each day. Don#39;t start off at two hours a day--you#39;ll burn out. If you are not sure what you#39;re doing, find a good trainer or training material to guide you。为每天的运动时间和运动量做出一个合适的安排也非常重要。不要刚开始就每天锻炼两小时,你很快就会累垮的。如果你不确定应该怎么做,可以找一位好的教练或者看一些锻炼教程,以此来指导自己。Movement Exercise活动锻炼;You don#39;t need to go to the gym to exercise,; says Kirsch. The easiest way to start your new fitness routine is to incorporate exercise into your daily routine. When you get out of bed in the morning, before heading to the shower, do 15 knee bends, 15 lunges and 15 crunches. When you#39;re making breakfast, do some isometric contractions: squeeze and release your abs, your butt, your thighs。“你没有必要去健身房锻炼,”克尔士说。要启动一项新的减肥计划,最简单的办法就是把它融入到你的日常生活中去。早上起床后别急着冲澡,先做15个屈膝运动,15个弓步训练和15个仰卧起坐。可以一边做早餐一边做一些肌肉收缩训练:收紧并放松你的腹肌、臀部和大腿。Get your body moving with a 10 minute express workout--be it yoga or stretching or cardio--every day before work. If you start that way and build from that, you#39;re more likely to stick with a program。每天工作之前都让你的身体做10分钟的快速锻炼,可以是瑜伽也可以是伸展运动或者有氧运动。如果你按照这样的方法开始锻炼,并且有所收获,那么你坚持下去的可能性会更大。Find Time For Fitness利用零碎时间减肥Feel like there#39;s no time in the day to squeeze in exercise? Kirsch says that any exercise is beneficial, no matter how little. The reality is that our lifestyles are conflicting and everyone has different physical needs for exercise. Ideally, you should be doing an hour of exercise a day, but if you can only find time for 10 minutes, then 10 minutes of focused training beats doing nothing。感觉挤不出时间来锻炼?克尔士说任何的运动都是有益的,不管时间长短。事实上我们的生活方式各不相同,每个人对于锻炼的生理需求也不一样。理想情况下,你应该每天锻炼1小时,但如果你只能锻炼10分钟,那这10分钟专心锻炼也比什么都不做要好得多。Stay Focused保持专注According to Kirsch, the number one biggest mistake women make while exercising is not focusing on what they are doing. That means no more cell phone, no more magazines and no more TV while you are working out. You need to make the most of your time at the gym while you are there. Sitting on the tmill and talking on the phone doesn#39;t give you the exercise you really need. Whatever you are doing, focus. Connect your brain and your body so you can really focus on what you are trying to accomplish。克尔士认为,女性在锻炼时犯的最大的错误在于不够专注。专注意味着在你锻炼时不打手机,不看杂志也不看电视。你要最大化利用自己运动的时间。坐在跑步机上讲电话可不会带给你所需要的运动强度。不论你做哪种运动,保持专注。让你的身心统一起来,这样你才能真正专注于你想要实现的目标。 /201507/386998

New drugs that boost the immune system’s ability to fight tumors may be one of the greatest medical advances in years, cancer doctors say, pulling some patients from death’s door and keeping them in remission for years.增强免疫系统对抗癌细胞能力的新型药物有可能是近年来最大的医学进步之一,癌症医生说,它能将病人从鬼门关上拉回来,延长数年的寿命。But the truth is that this happens for only a minority of patients. Now, doctors say, there is a new imperative to develop a test that will identify in advance which patients will benefit, sparing others the cost and possible side effects.但事实是,这种情况只会发生在一小部分病人身上。现在,医生说,开发一项能提前鉴定出哪些病人能受益的检测是当务之急,它能省去其他病人大笔的费用和可能出现的副作用。The drugs currently cost about 0,000 a year per patient — even more for higher doses used in some cases — and the health system is eventually expected to spend billions or even tens of billions of dollars on the drugs each year.目前,这种药物每个病人每年要花费约15万美元——在一些需要更大剂量的病例中甚至更多——预计医疗体系最终每年将在这种药物上投入数十亿、甚至是上百亿美元资金。“We don’t want to give these to 100 percent of the patients if only 59 percent or 20 percent will benefit,” said Dr. David R. Gandara, a professor and lung cancer specialist at the University of California, Davis. Being able to test for a biomarker that could predict the drugs’ efficacy “would make this new class of drugs easier on the wallet, the national health wallet,” he said.“如果只有59%或者20%的病人能从中受益,我们不希望将这种药物开给100%的病人,”加州大学戴维斯分校的教授、肺癌专家大卫·R·甘德拉医生(Dr. David R. Gandara)说。如果有一项技术可以通过检测生物标志物来展示药物有效与否,“将使这种新型药物对钱包造成的压力减小,我说的是国家医疗体系的钱包。”他说。But developing such a test has proved tricky so far, for ethical as well as scientific reasons. Some doctors said it would be unfair to withhold the new drugs from patients based on a test if there was still even a slight chance that the drugs would help.但迄今为止,出于道德伦理和科学技术的原因,对这样一种检测手段的开发一直步履维艰。一些医生认为,哪怕只存在一丝这种药物发挥作用的机会,仅因为一项检测就不把药物给予病人都是不公平的。“We don’t want to be wrong, because these medicines have an effect that, in some cases, is durable for years,” said Dr. Jedd D. Wolchok, chief of the melanoma and immunotherapeutics service at the Memorial Sloan Kettering Cancer Center. “We don’t want to have an imperfect biomarker.”“我们不想犯错,因为这些药物在某些病例中,药效会持续数年,”纪念斯隆-凯特琳癌症中心(Memorial Sloan Kettering Cancer Center)黑色素瘤和免疫疗法务部(melanoma and immunotherapeutics service)负责人杰德·D·沃夏克士(Dr.Jedd D. Wolchok)说。“我们不希望有一个不完美的生物标志物。”The need for such biomarkers is illustrated in a study led by Dr. Wolchok that is to be presented on Sunday in Chicago at the annual meeting of the American Society of Clinical Oncology. The study is being published online by the New England Journal of Medicine.沃夏克领导的一项研究说明了对于这样的生物标志物的需求,研究将在芝加哥周日的美国临床肿瘤学会(American Society of Clinical Oncology)年度会议上获得展示。《新英格兰医学期刊》(New England Journal of Medicine)也将在其网站上发表这项研究。The 945-patient study shows that the combination of two immune-boosting drugs from Bristol-Myers Squibb — Opdivo and Yervoy — is more effective than either drug alone in treating advanced melanoma. Patients treated with both drugs went a median of 11.5 months before their disease worsened, a longer reprieve than the 6.9 months for those who received only Opdivo and 2.9 months for those who took Yervoy.这项覆盖945名病人的研究表明,两种来自百时美施贵宝(Bristol-Myers Squibb)的提高免疫力的药物——纳武单抗(Opdivo)和伊匹单抗(Yervoy)——搭配在一起,在治疗晚期黑色素瘤中比任意一种更有效。同时使用这两种药物的病人在病情恶化前有平均11.5个月的时间,相较只使用纳武单抗的6.9个月和只使用伊匹单抗的2.9个月,病人获得了更长的寿命。But the combination also caused serious side effects like diarrhea and colitis in 55 percent of patients, compared with only 16.3 percent for Opdivo alone and 27.3 percent for Yervoy alone.但药物搭配在一起也导致了严重的副作用,如55%的病人出现腹泻和结肠炎,而只使用纳武单抗的病人中这一比例只有16.3%,只使用伊匹单抗的病人中这一比例只有27.3%。Dr. Antoni Ribas, a melanoma specialist at the University of California, Los Angeles, who was not involved in the study, said Opdivo alone might be just as good as the combination for many patients, with far fewer side effects, but that a biomarker test was needed.加州大学洛杉矶分校的黑色素瘤专家安东尼·瑞巴斯医生(Dr. Antoni Ribas)没有参与到这项研究当中,他说,对于许多病人来说,只使用纳武单抗的疗效也许和药物组合一样好,它远没有那么多副作用,只是需要一项生物标志物检测。“The combination is outstanding, but we have to figure out who needs the combination as opposed to the single agent,” he said.“药物组合很出色,但我们必须搞清楚哪些病人需要它们,而不是只需要某一种药物。”他说。The main test being explored is for PD-L1, a protein produced by cancer cells that, in effect, orders the immune system to stand down and not attack.现在正在研发的主要检测针对的是PD-L1,一种由癌细胞产生的蛋白质,它能使免疫系统“解除戒备”、不攻击癌细胞。The Merck drug Keytruda, Opdivo and other similar treatments work by keeping this “stand down” order from being received by the immune cells. So it makes sense that the drugs work best against tumors that are issuing such an order and that they may not work at all against tumors that are not issuing the order.纳武单抗和默克(Merck)的Keytruda等类似药物,通过阻止免疫细胞接收到“解除戒备”的命令来发挥作用。因此一种合情合理的想法是,这类药品最擅长对抗发布这类指令的肿瘤,而不是那些不会发出相关指令的肿瘤。Studies by Bristol-Myers and Merck as well as Roche, which is also developing such a drug, have shown that there was a much greater success rate using the drugs to treat tumors that were positive for PD-L1.百时美施贵宝、默克与罗氏(Roche)等研发此类药物的公司的研究显示,此类药物在治疗PD-L1呈阳性的肿瘤时有着大得多的成功率。Still, at least a small number of patients whose tumors do not produce meaningful amounts of PD-L1 also seem to benefit from these drugs. So some doctors say it is wrong to withhold the drugs from patients whose tumors test negative for PD-L1.然而,仍有少数体内肿瘤甚少释放PD-L1的患者可以受益于此类药物,因此一些医生表示,不应拒绝给出这些药物,不让PD-L1呈阴性反应的患者用药。In the melanoma study, patients whose tumors were positive for PD-L1 did as well on Opdivo alone as with the combination, as measured by the delay before their cancer worsened. One implication might be that those patients should get only Opdivo, while others should get the combination.针对黑色素瘤的研究中,就延迟癌症恶化时间这个标准而言,PD-L1呈阳性反应的病患在只用纳武单抗时,与用药物组合效果相同。这可能显示这些病患应当单独使用纳武单抗治疗,其他病患则用药物组合。But Dr. Michael B. Atkins, deputy director of the Georgetown Lombardi Comprehensive Cancer Center in Washington, said that even for PD-L1-positive tumors, the combination was better at shrinking the abnormalities.但乔治城大学隆巴底综合癌症中心(Georgetown Lombardi Comprehensive Cancer Center)的副主任迈可#8231;B#8231;埃特金斯士(Dr. Michael B. Atkins)表示,即便是PD-L1呈阳性反应的肿瘤,药物组合在缩小肿瘤上的表现仍然更佳。“The biomarker isn’t good enough to make any decisions on it,” said Dr. Atkins, who was not involved in the study.“这个生物标志物不足以成为治疗决策的根据,”未参与研究的埃特金斯士表示。PD-L1 is not the only possible biomarker. Scientists are finding that the drugs work best against tumors with lots of mutations. Researchers reported on Friday that a genetic signature could identify a small subset of patients with colorectal and other types of cancer who would be likely to benefit from Keytruda.PD-L1不是唯一可能带来帮助的生物标志物。科学家发现,这些药物在对抗有着多种突变的肿瘤时效果最好。研究者周五公布,一种标记基因可以指认出一小部分结肠癌及可能会受益于药物Keytruda的其他癌症类型。Dr. Ribas and colleagues suggest examining tumor samples to see if immune cells are present. The drugs appear to work best when immune cells are aly in or near the tumor, y to attack when the “stand down” order is lifted by a drug. If the immune cells are not present, then merely lifting the order may not be enough.瑞巴斯士及同僚指出,需要检验肿瘤样本中是否存有免疫细胞。如果免疫细胞已经位于肿瘤内或邻近部位,可以在“解除戒备”的指令被移除时进行攻击,这些药物就能达到最佳效果。倘若免疫细胞不存在,那移除指令也很难产生效果。Merck is working with a diagnostic company, NanoString Technologies, to develop a test that measures activity levels in genes associated with immune response.默克正在与诊断技术公司“奈米序列科技(NanoString Technologies)合作,研发一种测试,用以测量与免疫反应相关的基因的活跃程度。A downside for drug companies is that a test can narrow the market for a drug.对制药公司不利的是,测试会缩减一种药物的市场。Shares of Bristol-Myers fell nearly 7 percent on Friday based on what would seem to be positive clinical trial results showing that Opdivo could prolong the lives of patients with the most common form of lung cancer.百时美施贵宝的股票在周五下跌了近百分之七,尽管一项临床实验结果似乎带来了好消息,显示纳武单抗可以延长罹患主要类型肺癌的病患的生命。But there was a big survival difference in patients with PD-L1-positive tumors and patients whose tumors test negative for the protein. For those with PD-L1-negative tumors, there was no real difference between Opdivo and the generic chemotherapy drug docetaxel. This information dashed investors’ hopes that Opdivo might be used by all patients with that form of lung cancer.但PD-L1这种蛋白质呈阳性与否意味着患者存活时间上的很大差异。对于PD-L1呈阴性的肿瘤患者而言,纳武单抗与化疗仿制药多西他赛(docetaxel)的效果无异。投资者曾希望此类肺癌的所有病患都会使用纳武单抗,但这个消息让他们希望破灭。Opdivo did cause fewer side effects than docetaxel, but insurers might not be willing to pay so much more for that reason alone.纳武单抗的副作用仍比多西他赛要少,但保险业者并不愿意仅为这个理由付其高额费用。Docetaxel costs ,000 for six cycles of treatment; Opdivo used for the same length of time costs about ,000, said Dr. Patrick W. Cobb, an oncologist in Billings, Mont.蒙大拿州比灵斯的肿瘤科医生派崔克#8231;W#8231;柯布(Partrick W. Cobb)表示,多西他赛六次疗程要价6千美元(约合3万7千人民币),同样时长疗程的纳武单抗则需6万美元。“The cost of treating these patients will be far higher than in the past,” Dr. Cobb said on a webinar sponsored by Kantar Health, a consulting firm. “We really need a way of determining which patients are likely to benefit from these agents.”“治疗这些病患的出会远超以往,”柯布医生在由咨询公司坎达健康(Kantar Health)赞助的网络研讨会中表示。“我们真的需要找到一个方法,来分辨哪些病患可能从这些药物获得益处。” /201506/378942

文章编辑: 问医新闻