Once-weekly HIV therapies: First Line Dolutegravir monotherapy

First Line Dolutegravir monotherapy
This paper was originally published here, in French. We provide this translation for your convenience. Some practical aspects may differ where you live.

This post is a follow-up to attack monotherapy and monotherapy of attack: the scoop.

jesuisdutreize, true pioneer, opens the frontier (in maintenance):

Under TIVICAY® Monotherapy 50 mg for 2 months:

First month: TIVICAY® alone (7/7) still undetectable VL; it appeared that I had a too high a concentration (7/7) with regards to my weight and size.

Second month: monotherapy taken 4/7: still undetectable VL; it appeared that the concentration of TIVICAY ® after 3 days of interruption was undetectable (The logical outcome according to the pharmacokinetics should have been between 600 and 1500 24)

As I want to protect my wife from contamination, it is better that I restrict myself to the 4/7 monotherapy Tivicay ®. I do not know what you think, but, frankly, for me, it is a goal that I suits me fine !!!

We fear Nope: an firstline therapy is taken, the virus is blasted, you let it cool, then, allow it a siesta and you maintain with 4/7. It was nontheless necessary to realize that Tivicay® Monotherapy is an effective firstline therapy (finally ...). If it had been possible with AZT or PIs, we would not be here, with these new questions. If the manufacturer had not cleverly obfuscated results, we would have realized faster!

Lanzafame opens the show: FirstLine Tivicay ® Monotherapy

Like us, Dr. Massimiliano Lanzafame opens his account of experience with the extraordinary results of ING 111521 (the page in French is more complete).

He recalls: Ddolutegravir 50 mg demonstrated a high power with a reduction of 2.5 log after 10 days of monotherapy.

We said: Log 2.5 is a low-estimate: maybe this is more!

The results speak for themselves:

[...]We report our experience in 9 antiretroviral naive HIV-1–infected patients followed [...] Verona, Italy, who started dolutegravir monotherapy after refusing nucleoside reverse transcriptase inhibitors. [...] See Table 1.

No patients had baseline HIV resistance mutations for NRTI, NNRTI, PI, or INSTI. The second table shows total cholesterol, [...] before starting dolutegravir and at the last control. For CD4 cell count, the mean increase was 191 cells per microliter. Serum lipids increased importantly only in 1 patient (no. 1, Table 2), who had also an increase in her body weight.

The results of our small and time-limited study suggest the feasibility of a dolutegravir monotherapy in patients with a viral load lower than 100,000 copies per milliter. Should well powered clinical trials with long follow-up confirm our results, a dolutegravir monotherapy strategy could be used to preserve future antiretroviral drug options, reducing side effects and health care costs.

Crystal clear: First line Tivicay® monotherapy : 9 naives patients = 9 success !
How many successes with First line Tivicay® ?:
- ING 111521 : 8
- Dr Lafeuillade : 1
- Dr Lanzafame : 9
Total : 18 (very good!)
Here, we are expecting confirmation results by Pr Katlama (Paris) ... We are not the least worried!

Normal values vs desirable values

The normal value is estimated as follows: take patients without problem, measure, calculate the mean and standard deviation and anything above (say, 2.5% below and 2.5% above) is deemed not normal.

The 'normal' salary and the desirable minimum wage, are not the same thing!

Desirable: looking at patients without problems, and those with problems, and put a threshold: those above are less problem-prone, those below are more likely problem-prone.

And it's not the same! And not the same at all times ...

Example: CD4 value 'normal' is 800, and, say, greater than 500; the desirable value is > 350 (for short ...)

To determine the desirable value, one must look at Joe-on-the-street patients (excluding those who already have the Achilles heel, it is another matter, and not a matter of concentration) who fail with dolutegravir (excluding other causes such as toxicity). To do this we will have to find patients who are failing with dolutegravir: good luck! Do you know patients failing with dolutegravir? Good Luck!

There, it's that simple: pharmacokineticists are unable to document a desirable dose ... And no one raises the question: why? How come? No ... They do not care. We force-feed, we force-feed ...

Well, then the force-feds are fed-up and fire the quacks: and this is normal!

Sorry... This is desirable !!!

Good Weekend and good fuck