min'cellanea

這篇是講一位美國女生，因為媽媽在不知道自己有愛滋的情況下懷孕，導致她一出生就有愛滋病，必須從小就與愛滋對抗的心路歷程。

Friday, Dec. 01, 2006

[TIME] Learning from the Living

How HIV-positive teens in the US are teaching doctors how to treat AIDS among the disease's youngest patients

By ALICE PARK

On paper, they are the lucky ones, the 10,000 or so children and and adolescents living with HIV in the United States. They have access to the latest anti-HIV drugs, powerful medications that can keep the virus at bay and, for all intents and purposes, keep them alive long enough for them to date, attend college, marry, and start families of their own. They are indeed fortunate — although living with HIV, even in the U.S., remains a challenge. But these young pioneers — many of them among the first to test antiretroviral (ARV) medications against HIV — are teaching doctors valuable lessons about how best to treat young patients affected by the disease. Their lessons, learned the hard way through painful trial and error, will spare millions of children in the developing world from treading the same difficult path.

理論上，在美國的一萬個有愛滋病的兒童和青少年是幸運的，因為他們有最新的藥和最強的醫療，能夠使他們對抗病毒，使他們能到活到現在，能夠上課、結婚和建立自己的家庭。他們真的是幸運的，即使在美國對抗愛滋仍是個難題。但是這些年輕的先驅者 -- 他們很多都是第一批去測試對抗HIV的ARV藥物的人 -- 教導醫生怎麼才是治療這些年輕病患最好方法的寶貴經驗。他們的經驗將能使第三世界的百萬孩童避免走過同樣困難的路。

AIDS: Acquired Immune Deficiency Syndrome
HIV: Human Immunodeficiency Virus

◆ on paper (idiom): theoretically, in theory. (理論上)

◆ have access to the latest drugs and powerful medications

這裡提出來是因為他用了access 這個動詞，平常寫文章的時候可能想不出來是用這個字吧。

at bay (idiom): forced to turn and face attackers.

◆ keep ... at bay = hold ... at bay (阻止…；不使…接近)

be at bay = stand at bay (走投無路；絕望)

◆ for all intents and purposes (idiom): in every practical sense, virtually.

◆ to date (idiom): up to now, until the present time.

◆ remain a challenge

這裡提出來是因為普通我們可能只會想到用：is still a challenge
但是他用remain，意思一樣，卻有較高級的感覺。

◆ antiretroviral (ARV) medications

"anti-" 有對抗的意思，常用的有antibody(抗體)，antigen(抗原)和antibiotics(抗生素)。

這裡的 retroviral 是 retrovirus 的形容詞，retrovirus 中文為反轉錄病毒，"retro-" 有「反」(reversal)的意思。所謂反轉錄(reverse transcription)是說它的基因體(genome)是RNA，而不是DNA，所以它傳染(infection)的時候，需要先把RNA轉錄(transcription)成DNA。正常生物的 genome 是DNA，然後要製造蛋白質的時候才轉錄成RNA，再從RNA轉譯(translation)成胺基酸(amino acid)，即蛋白質(protein)，這整個過程統稱 Central Dogma。

Central Dogma: DNA → RNA → amino acid

病毒傳染是用infection [n], infect [v]，傳染病則是infectious diseases。

病毒有好幾種，依不同特性分別，有的是單股DNA(ssDNA)病毒，有的是單股RNA(ssRNA)病毒，有的則是雙股RNA(dsRNA)病毒。

【註】ss 為single strand 的縮寫，ds 則是 double strand 的意思。我們通常稱DNA的結構為double helix(如下圖)，helix 有螺旋狀的意思，但是在一股的情況下，不會稱之為 single helix，因為DNA只有在兩股的情況下，即正常的情況下，才是helix 結構，當它要複製或製造胺基酸的時候，螺旋結構會解開成直線狀，這時便叫strand，所以通常一股的時候都是直線狀，即 single strand。(下圖紫色部份為一股。)



另外，有的病毒有脂質封套(lipid envelope)，有的沒有，而 retrovius 是屬於有 envelope 的dsRNA病毒，造成AIDS的HIV便是屬於 retrovirus。之前造成恐慌的SARS病毒屬於coronavirus(冠狀病毒)，"corona-" 有皇冠的意思，冠狀病毒則是有 envelope 的ssRNA病毒。

◆ the hard way (idiom): by bad or difficult experiences; also, by one's own efforts.
例：No one can teach you how--you'll just have to learn it the hard way.

◆ tread：踩、走。

與on或upon連用的時候，有踐踏、傷害的意思。
例：tread on one's feelings (傷害某人的感情)

◆ treading the same difficult path

◆ spare from：免於、避免

spare 常用的意思有「空閒的」，如：spare time (空閒時間)
另外還有「撥出」、「提供」的意思，如：Can you spare 10 minutes? (你能撥出十分鐘嗎？)

High school 的時候會有空堂，就是沒有排任何課，我們也稱那堂為spare。
A: What is your next class? (你下堂課是什麼？)
B: Social (社會學)
C: Spare (空堂，沒課)

不過上面的應該算是非常口語的例子吧！

◆ developing world

直接翻應該是開發中國家，我想。不過這裡應該是指第三世界(Third World)的國家，像非洲那邊很多愛滋病患者的國家。

記得以前國中的時候有學過「未開發」、「開發中」和「已開發」三種，那時候台灣是開發中國家，十幾年後的今天，好像還是開發中國家，什麼時候才能進步成已開發國家阿？詳細的解釋和分級方法可以看這裡。

At least that's what patients like Cristina Pena hope for. Now a 22-year-old college student in Los Angeles, Pena was infected at birth by her mother, who was unaware that Pena's father, now deceased, had transmitted the virus to her before she became pregnant. Pena 在不知情的情況下跟HIV生活，雖然她並不清楚HIV是什麼。她小的時候，她母親都跟她說，她每天吃的藥是治療耳朵發炎用的，但她說，「你總是相信父母的。」在她九歲的時候, she finally asked her mother about the drugs and learned the truth. "I had started on AZT at five, and throughout my childhood, I was on various studies of new medicines, like 3TC. I was a complete test case," she says. "I had spinal taps, fluid checks, brain scans, bone density scans; you name it, I've done it."

至少那是像Cristine Pena 這樣的病患所希冀的。現年22 歲在洛杉磯的大專生Pena 是在出生的時候被母親所感染的，她的母親在不知道她已過世的父親有愛滋的情況下被感染了，之後還懷孕了。

「我五歲就開始用AZT，而且我整個童年都被用來試驗像3TC之類的新藥。我完全是個試驗品，」她說，「我做過spinal taps, fluid checks, 腦部掃描，骨骼密度掃描。你說的出的，我都做過。」

◆ hope for

這個提出來只是想提醒，這裡有加 for，而不只是：that's what someone hope (for).

◆ decease：死亡

這裡多學一個字，原來並不只有death 或 pass away 可以用來表示過世，還有這樣高級的說法喔。

◆ learn the truth

◆ on various studies of new medicine

這裡應該是指她成為為很多新藥試驗研究的對象

 you name it (idiom): everything one can think of.

◆ "you name it, I've done it." 你說的出的，我都做過。

◆ AZT(azidothymidine): antiretroviral, nucleoside reverse transcriptase inhibitor

上一篇說過的，inhibitor會抑制enzyme的活動，而AZT抑制的是用來進行反轉錄的reverse transcriptase。AIDS之所以難對付是因為它的基因會不停的突變(mutation)來對抗inhibitor，而且突變的速度很快。Inhibitor 只能減緩病毒在人體內繁殖的速度，並不能消滅病毒，通常只靠一種inhibitor是不夠的，要配合其他的inhibitors才能達到較好的效果，就是所謂的雞尾酒療法(cocktails)。

After learning about her HIV status, she says she definitely started taking her medications more seriously. "But it was an ongoing struggle. I did feel sick most of the time — I had nausea and diarrhea. The medicine gave me a bitter, bitter, bitter taste that would come back up in my throat hours later in school. If I could get away with not taking them, I would." Knowing the truth also meant that Pena began living a double life. Only her closest friends knew her diagnosis; most of her classmates were unaware of the daily battle she fought with HIV. "I was worried if I was going to graduate," she confesses. "if I was going to make it to prom — everything was if, if, if, if. It was like I had a new life that I had jumped into, and I was wearing different costumes at different times."

自從她明瞭她的情況，她就開始很認真的吃藥。「但那真是一項折磨，我一直都覺得不舒服，我會反胃噁心和腹瀉。藥物的苦味總會在幾小時後往上蔓延到喉嚨，如果我可以不吃那些藥，我會不吃。」知道真相讓Pena 開始她雙重態度的生活，只有她最親近的朋友知道她的病，大多數的同學都不知道她每天都要與HIV奮戰。「我很擔心我無法畢業，」她坦承，「即使我想要參加舞會，那都只是如果、如果，我好像開始新的生活，不停的換裝扮。」

◆ nausea：反胃、噁心

◆ diarrhea：腹瀉

◆ prom：高中、大學期末的正式畢業舞會，這裡應該是指畢業舞會。

When the protease inhibitors became available in 1996, Pena was one of many young AIDS patients who jumped on them. 她說，從她小時候開始，她所要服用的藥，劑量就不停的增多。"There were more pills at every birthday," she says. "As my weight increased, they would up the dose." The protease inhibitors were powerful but the side effects were brutal. "Since I was on medications for so long, it almost seemed like second nature to lose my appetite and be nauseated," she says.

當1996年protease inhibitors 可以開始使用，Pena 是第一批使用的年輕AIDS病患之一。

「每年都有更多的藥要吃，」她說，「當我體重增加，他們就會調高藥的劑量。」Protease inhibitors 很有效，但是副作用很可怕。「自從我開始吃藥，沒有食慾和反胃似乎就成為我的習慣。」

◆ be on medications

◆ up the dose

◆ second nature: an acquired behavior or trait that is so long practiced as to seem innate. (第二天性、習慣)

諺語(proverb)：Habit is second nature.

Because of those side effects, Pena, in consultation with her doctor, has decided to stop taking her medications for a while, but anticipates she will have to go back on them soon. While she realizes that her decision is controversial, and not for everyone, she notes that since she is part of the first generation of kids who will spend their lives taking ARVs, they and their doctors will also have to take responsibility for what their lifelong regimen looks like. "There is an ongoing battle between researchers and HIV," she says, "and there is still much trial and error. Everything keeps changing. Treatment has changed, and the way people look at treatment has changed. And caught up in between are everyone's individual lives. We all have so much to learn from one another, and I don't think that there is a master plan or treatment that will work for everyone."

因為這些副作用，Pena 和她的醫生談過之後，決定暫時停藥看看，但是她預測她很快就會需要再吃。她的這個決定引起爭議，因為她是第一批試驗ARV藥物的人，而他們的醫生則對他們的生活狀況有責任。「這對研究學者來說，是一場對抗HIV的戰爭，很多的嘗試和失敗。所有事物都不停的改變，治療方法改變，人們看待治療的角度也改變，在(和病毒)追趕之間每個人都有自己的生活。我們有太多需要從對方身上學習的東西了，而我不認為有什麼一定的方法可以適用於每個人。」

◆ consultation：諮商、諮詢

◆ in consultation with

◆ regimen：養生之道

◆ in between：在兩者之間

在這裡的master 為主要的意思，master plan 即主要的計畫、計策。

我們做實驗的時候如果好幾個tube都要加一樣的混合溶液，我們不會一個tube一個tube加每樣溶液，因為這樣不但費時，而且每個tube的誤差會比較大，通常我們會先做一個master mix，就是把所有要用的容易混在一起，然後在加到各個tube裡。

What will work for anyone affected by HIV, however, is learning how to find strength and hope from each other. "I just want other people with HIV to know that it doesn't stop me from reaching my goals in life," says Alisha Saleem, 20, a Florida college student who has lived with HIV for her whole life. "If you have a strong, positive attitude, you know that you can still achieve anything whether you have the illness or not. I take my medicines every day, and it's hard. Sometimes I don't want to take them, but I know I have to. I want to educate other teens and adults out there about how HIV positive people can still be normal, and act normal." By living successful lives as normal teens, girls like Saleem and Pena are doing much more that - they are living beacons of hope for the millions of children born with HIV in the developing world.

對每個病患都適用的唯有從彼此之間找到力量和希望。「我只是希望讓其他有HIV的人知道，這些都無法阻止我邁向我的目標，」現年20歲，在佛羅里達，整個人生都與HIV為伍的大專生Alisha Saleeem 說，「如果你有正面的態度，不管你有沒有病，你都可以做到任何事。我每天都需要吃藥，這是個難事。我不想吃，但是我知道我必須吃。我想教導其他愛滋病人怎樣才能正常生活。」像Saleem和Pena這兩個可以和健康青少年生活得沒兩樣的女孩，做得其實更多-- 她們已經是其他落後國家中的百萬愛滋病童希望的指標了。

◆ positive attitude

◆ beacon：指標、燈台；引導的人或物
例：an air beacon (航空信號)

◆ beacons of hope

這裡應該是指她們(Pena & Saleem)是其他落後國家，生來就有愛滋病的小孩的希望。

HIV positive 是指患有愛滋病的人，也就是驗出來為HIV病毒陽性。positive 在這裡指陽性，陰性是用negative。


 citation from The American Heritage® Dictionary of Idioms. Houghton Mifflin Company, 1992. Answers.com 03 Dec. 2006. (按圖可連結到引用頁面)