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Sunday, February 26, 2017

Ten green bottle

Ten green bottles hanging on the wall

... and if one green bottle should accidentally fall there'll be nine green bottles hanging on the wall


This was originally published here, in French. For your convenience, we provide this translation. Practical aspects may differ where you live.

Breaking News, 28/02: the results of DOMONO, here soon with exclusive data! ...

This blog is dedicated to the once-weekly, our choice, and, our title! Many reject it, out of ignorance; others are not eligible: Tivicay ® Monotherapy is a less prefered alternative. We discuss it, with some reluctence, so that relief is open to all.


Would be so easy to throw out monotherapy with the bathwater. Ah! ... I would so much like to be paid to applaude as soon as one of the ennemy lashes out at des-escalation. Ah! That would be easy! one alarmist presentation of DOMONO and, quick, we throw the mono-Tivicay ® to the pits ... Pff ... So naive!

Make no mistake: there will always be patients or practitioners to consider Tivicay® Monotherapy. Always. In the ICCARRE perspective of ours, they are wrong! Because ICCARRE (1/7) is better choice.

But being uninterested in either, is even more stupid! How many times have I wanted to force feed, with Tritherapy, the throat of those cheerleaders quacks!

Better try to understand how to use it right ...

As in "the ten green bootles", there is a method, an algorithm and ... and broken glass.

Achilles' Heel is no fad!


The Achilles heel? See this post ... Pr. Katlama opens a hypothesis to criticism and the general public; Then I am told that I am delusional ... Bullshit!

Dr. Celia Oldenbuttelle described in Antiviral Therapy, the first non-Achilles' Heel failure. She cares to specify:


If Dr. Celia Oldenbuttel cares to describe, with so many details, her counter-example, it shows that she gives credit to Katlama's hypothesis.

Dr. José Blanco, in his presentation to CROI 2017, will do the same (see below). So Katlama's theory, probably necessary, probably not sufficient, is taken seriously in Paris, Barcelona and Munich. This is not a Charles Edward's fad. Try to invalidate the hypothesis! Try it and publish! Get us entertained!

Barcelona, ​​Montreal and Munich


Let us reward the self-abnegation of forerunners! How? By learning from their experience ... For Oldenbuttel, it is viable for selected (sorted) patients. Dr. Blanco adds together Barcelona, ​​Montreal and Munich: 122 monotherapies. Let's look at the effect of a sorting algorithm on actual success.

MINIDOLU vih HIV Dolutegravir Tivicay MonoDolu DOMONO CROI 2017 jose blanco


And now, we're going to pop those green bottles hanging on the wall, one by one, until last!

First algorithmic rule: exclude the "Achille's heel" (= Trojan horse): They are not entitled to it (perhaps wrongly, but well ...).

Bing! Bing! Bing! Bing! Bing! Bing! We blow up SIX! 6 tell us how to avoid their mishaps. That is more than half!

Second algorithmic rule, mandatory for de-escalation: NIET to the forgetful. They give as much ammunition to the consulting fees fed enemy. By escaping the overdose, they plunge others into it!

TWO less! 50% and 88% compliance (overestimated, be sure...) is unacceptable!

Third algorithmic rule: we exclude from the analysis patients whose VL is detectable at inclusion! Should we exclude them from this strategy? That is another question; Exclude them from the analysis: yes ... (as for ANRS-4D or any formal trial).

Then there are 3 failures, over more than a hundred. And there is no dosage for compliance. Remember, before analysis of dosages, there was also 3% failure in ANRS-4D.

One of them perseveres, with courage (maybe he knew what to expect) and re-suppresses (<37) always in monotherapy. No dosage, nothing ... A failure? Not for him: he is happy, happy, happy. Is he the only one? No, two other patients take the same path while remaining under Tivicay ® mono! And the despised denigrators look very silly!

MINIDOLU vih HIV Dolutegravir Tivicay MonoDolu DOMONO CROI 2017 jose blanco
So, it is true, there are 2 ... Let 1, 2 or 3%. With viremia so small that it can be treated the first TRI at hand even to return to something lighter, and, consider the 4/7, which in our eyes was a better strategy. Hopefully they will understand!

No! The Tivicay ® mono is not the loser here!



The loser is the poor patient who, in maintenance, remains hooked, not matter what, to her shock TRItherapy, as useless as dangerous. And in the head quarters, they enjoy their cigars...

Indeed, the control group (bi and tritherapies, study in progress), has 6-7% failure!

As a conclusion, Tivicay® monotherapy, in maintenance, with careful selection of patients, is, as Dr. Oldenbuttelle says, a safe and effective strategy of de-escalation, in undetectable selected patients ...

Let's keep this in mind because DOMONO is going to be another hurdle!

Reminder: 95% of patients are overmedicated


This was originally published here, in French. For your convenience, we provide this translation. Practical aspects may differ where you live.

Saturday, February 25, 2017

Lamivudine to the rescue

Lamivudine to the rescue

By Charles-Edouard!

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

Breaking News, 18/02: the results of DOMONO, here soon with exclusive data! ...

Somes news from Lionel, in La Reunion, under Triumeq® 1/7 (once weekly)


It works, it works !!! And here, it does not surprise us at all! Good Job!

As far as I am concerned, MiniDolu (Tivicay ® 1/4 of daily cachet) worked well (6 months) but I prefer to reinforce, with that little Lamivudine, not unfriendly at all; For the time being: 50 mg of Tivicay® (DTG) + 300 mg of Lamivudine (3TC), Saturday and Sunday, with the goal of concentrating all on Sundays.

It is a bit like those taking Triumeq ® in 1/7 (DTG 50 mg + Lamivudine 300mg + Abacavir 600mg (!)), certainly, but without the Abacavir! ...


Easier to procure than the proven Leibowitch formula (quadrithapy, 1/7, once weekly: 1 NNRTI + 3 NRTI)

Lamivudine, the discreet star of successful trials


Lamivudine is a generic antiretroviral (and antiviral). Its copy fluorinated version is Emtricitabine; It's the same ... The manufacturers continue to feed themselves with crazy $$$, for a classic, now in public domain.

It is reputated innocent ... Reputation probably not well-substantiated, inasmuch as almost everyone takes Lamivudine (or its alter-ego) one can not differentiate: it is impossible to distinguish its toxicity from that imputed to the Virus or to treatment in general.

It has shown up in several recent trials including: Gardel, Paddle, Lamidol, Dual ... Monotherapies (from Tivicay ® or antiproteases) are satisfactory, but are experiencing some failures. Conversely, let's add the innocent (and inexpensive) Lamivudine, and here you are with a quasi-general success.

Adios to 3TC Resistance (M184V)



Like Videx, its intrinsic power is low. 1 Log as monotherapy, with development of mutation at position 184. The mutated virus remains rather sensitive (0.5 Log, env.), therefore, one finds it or her look-alike, within ALL conventional triple therapies: without exception: Atripla ®, Stribild® / Genvoya®, Eviplera®, Truvada® + X, Kivexa® + X, a lot of guys!

Some (surrealists) Researchers, had assessed its power contribution to 12% of TRI.

Most trials have patients without the M184V. Professor Reynes (DOLULAM) observes nevertheless that he has 10 patients (37%) with this mutation, and, it works for them too!

This is also true in MOBIDIP (see below). This is very good news for 'historical' patients: they should no longer be opposed the M184V to prevent them from lighter therapies.

PADDLE



Total success with DTG + 3TC, as frist line, by Dr. Cohen, in Buenos Aires. Tasty Anecdote: There was one patient with a positive viraemia, which should have been called 'virologic failure'. Contrary to our Parisian virologists, who would have stuffed him with tritherapy, good Dr. Cohen decides to persevere, and here he is rewarded with re-suppression.

Dr. Lanzafame does just as well with his Tivicay ® mono, as induction (9 patients published, and others soon to be ...)

LAMIDOL: success of DGT + 3TC maintenance


It is an ANRS trial, of maintenance, where 104 patients have been instructed to take Tivicay ® / Lamivudine, daily, and, there is only one intrinsic virological failure (ICCARRE + ANRS-4D = ZERO intrinsic failure on 190 patients!)

On the other hand, there are failures in DOMONO (maintenance with DTG alone), and there remains the vast question of the Achille's heel, for those who may be punished for taking Isentress ® , Stribild® / Genvoya®.

The price to pay to add Lamivudine, is not expensive at all. Especially since Abacavir or Tenofovir are thus definitely eliminated!

Those who continue to take tablets with 3 or 4 agents, with suspected cumulative toxicity (eg Triumeq®, Stribild® / Genvoya®), beyond the attack phase, are ignoring the progress of the pharmacopoeia and the clinic.

MOBIDIP: maintenance by IP / r + 3TC does better than IP / r



Despite Salpetriere's support, monotherapy under IP, in maintenance, does not attract many patients. The MOBIDIP test (ANRS 12286) probably shot it dead: the monotherapy arm had to be interrupted (too many virological failures), while the Bitherapy arm remains satisfactory.

Prof. François Raffi comments: A higher rate of success than IP/r monotherapy despite the presence of the M184V mutation. Indeed, 97 of the 137 patients in the IP/r + 3TC arm showed the M184V mutation (typical of 3TC resistance).

The conclusion is clear: maintenance with PI/r plus 3TC is associated with a high rate of success despite the presence of M184V whereas PI/r monotherapy can not be recommended.

You might be surprised to see the ANRS in this adventure. Doomed to fail ? Easy to say afterwards ... Here, too, I have repeatedly expressed the opinion that ICCARRE is a better plan!

Well ... At this point, my position is strengthened. MOBIDIP: death of IP Mono.

To go further, read The Magic of 3TC, on page 20.

Good Weekend and good fuck!


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

Sunday, February 12, 2017

2017 Darwin Day

2017 Darwin Day


This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.


From a persistent patient:



Tivicay ® monotherapy, once validated, invite to a 4/7 relief (mono Tivicay ®)

It is attractive and has a good balance between reducing toxicity, cost, discomfort, etc.

My MiniDolu experience (1/4 pill, 7/7) was fine, but I'm in small form, so I prefer to take more. The optimal weekly dosage, ballpark estimate, can be between 100 and 200 mg, in the context of my suspected interactions. I am trying 50 mg DTG + 300 mg 3TC, Saturday + Sunday; If it works (thus far, 4 months without VL uptake...), I will move on to 100 mg DTG + 600 mg 3TC on Sunday.


Tomorrow is Darwin Day!



Any aliviating patient safeguard: Drowning! misunderstood by Katlama, denied by American doctrinaires (creationists in by nature...), drowning is the lifeguard buoy that allows the unfortunate aliviating patient (if any ...).

Described by JACQUES LEIBOWITCH (his book How To end AIDS, PLON, or on the net):


Wild-type virus = sensitivity to all initial classes: Cool!

Well ... It does not happen in 5 minutes, so you should have a time reserve (1 year?); When one has entered the treatment early, then the time reserve is guaranteed: this is an argument in favor of early treatment; But who will promote it

Finally, we revisit Darwin, and so on, here are a few ressources:



In French: Anniversary Conference

The image resistance

The Origin of Species (audio-book) is a refutation of William Paley and his Natural Theology

Series

Richard Dawkins Christmas Conferences

And the man created the dog

Best of PZ Myers Arguments And Comebacks



In the news:

- Donald Trump - The price of the medicine: Le Monde and YouTube

- Genvoya authorized for a price decrease

- Lanzafame launches a semi-4/7

- DOMONO: complete results at the CROI

Good Day of Darwin and Good Stuff!



Saturday, February 4, 2017

At-home VL


This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

Immediate VL, without going to the lab ;-)

By Charles Edouard!

From one of our exotic correspondents:

In France also! No prescription needed to get a viral load; Approximately 60 Euros. The practical guide explains how to do this; At initiation of the Short Cycle, it is necessary to increase the VL frequency: month-1, month-2, month-4, month-6, etc.

Soon, VL at your fingertip ...


It may be possible to do a rapid viral load without going to the lab, according to a preliminary study published in scientific reports, followed by a press release. (poorly written); The full version is published by Nature: New pH-detecting semiconductor for the detection of HIV-1 viremia at the point of service

The researchers developed a computer chip and tested. A test amplifies HIV RNA in a small amount of blood and the results are converted into an electrical signal that can be read by a computer or a mobile device.
The entire process takes about 30 minutes.

The limit of detection is 1000 copies / mL: this may be sufficient (*) to ensure:
- there is no replication consecutive of resistance
- the intransmissibility of HIV (see initial study: RAKAI)
- a greater diffusion of the technique

(*): May be ... we will see at that time, we are not there yet ... In the future, we might get better stuff.

It is sufficient (*) for maintenance (ICCARRE ...), and also for optimal dosage analysis with Tivicay ® (DTG) (*).

Monitoring viral load is crucial to the success of HIV treatment. At the moment, testing often requires costly and complex equipment that can take a couple of days to produce a result. We have taken the job done by this equipment, which is the size of a large photocopier, and shrunk it down to a USB chip.

Dr. Cooke adds that "this technology, although in the early stages, could allow patients to monitor their level of virus in the same way that people with diabetes check their blood sugar levels."

Good ... It is not yet on the market ... Until then, VLs are done in the lab, with or without prescription, and the results via Internet!

Good Week-End and Good Fuck!


This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.