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

En route towards remission

By Charles-Edouard!

Well said!

Remission: the question resurfaces

I put the remission on the table, even if it may seem surprising. I am talking about remission following ARV treatment: it is the post-treatment control, usually considered impossible.

The debate took place in a context that has evolved a lot and the premises underlying the verdict are flickering one after the other. Today we can build an argument in favor of total or partial remission. A blogger's delusion? Not at all. For part the argument was exposed by recognized authors such as Wainberg, Ananvoranich, and even Siliciano. We will get back to this. Reader, take patience, read, and judge for yourself.

The dominant theory is Siliciano's. Very early, I made a note: "Siliciano is wrong". More and more facts invalidate the premises or conclusions by Siliciano. If it is false, we can consider that patients achieve remission, with and thanks to treatment.

Remission impossible: theory and history

Very early, it was found that when the treatment is stopped, the virus rises and we are not cured. This is our very first post: ICCARRE: Sir, you are cured! What prescience!

Robert Siliciano gives us a theoretical approach in 2003. He makes some hypotheses, over simplistic, on the dynamics of the 'reservoir', reduces everything to a single time constant, that he measures on some patients. He calculates an ... average ... of 44 months half-life, which puts the remission to 66 years of treatment: in other words, impossible.

Nothing has come formally to invalidate his theory. Nothing, really nothing ... Or so little ... A "so-little", which begins to expand. Inaudible yesterday, perceptible today, deafening tomorrow.

First, the discovery of "Viscontis": a handful of patients, early-treated, who keep the virus under control despite stopping treatment. Several attempts have tried to reproduce it (here and SPARTAC trial), without success. Why can't we reproduce the Viscontis?

Then came the idea of ​​reducing the reservoir by a "Shock and Kill", where a pharmaceutical treatment would wake up the reservoir, which the ARV treatment would then kill. For now, it has failed. Here too, the premises are debatable.

Remission and near-remission

The remission means to keep several years, without rebound nor treatment.

Fictitious example of a malignant cancer with "heavy" chemotherapy in 10 sessions: we survive and the cancer has regressed. The doctor suggests about 5 years remission, at most. Relief and disappointment too. The doctor adds: and if you accept an annual maintenance chemo, then your life expectancy is normalized ... Of course, this is not a magic remission in the strict sense, but still ... So we do ... Later, you can even do it once every 2 years.

He who can do more can do less: Can you imagine total remission even though you have not achieved 1/7? No, obviously! And if you have passed 1/7, can you consider the 1/15, as I showed here? Then 1/21, 1/30 and finally the 'true' remission. Me, I managed 1/21, but not 1/30, so I do not try the final step. Moreover, from 1/15, the remission has only little attraction. Frankly! At 1/21, you live very very well! For me, 1/7 remained a bit heavy. Others are happy with it and we understand them!

Remission finally possible: theory and evidence

- The example of HCV shows that we must not despair ...
- There are more post-treatment controllers than they would like us to believe, and who are unaware, as a hospital in Antwerp has demonstrated. Noone will tell you...
- We treat earlier, which may be favorable
- We have not been able to repeat Viscontis: theymay have done something that we did not understand, and that this something is important.
- Siliciano himself, along with Hill, questioned his own theory. He considers that the reduction of the reservoir necessary for a prolonged remission is less than initially thougth
- Wainberg theorized remission by the way of R263K and made laboratories trials: conclusive! (we'll come back to it: that's what I'm trying to do right now)
- The oral prolonged-release medication gives 7 days of medication (for a single dose) that is extended by a 2-week Eclipse (or even 3 ...) and that makes you a once-monthly!
- Leibowitch and his 1/7 have 800 years of proven pharmaceutical remission. With the hundred, or so, patients involved, there will be a few who will want to explore beyond.
- Biologists can not do Shock-and-Kill, while ICCARREs, in advanced mode, do it every day every week. Ah ... Yes ... Think by yourself.
- Dolutegravir should allow to do more (Too bad it is incompatible with NVP or EFV ... too bad ...): for some patients / viruses, it is an Absolutegravir. So...

On the road to remission

Unless you stay, stunned with fear, in a very uncomfortable standard treatment that is too heavy, too daily and above all too unnecessary, once you start 6/7, you've put a finger into it. Here is what can stop you:

- you don't dare explore any further
- the 1/7 suits you, you stop there
- the virus resurfaces

It is only a matter of time that a small group of people attempt the adventure, with only one obstacle: a virus rebound. It is also necessary to develop the technique that will weaken the reservoir and / or the virus. The Quadri by Leibo is a candidate. It's not enough, we need other 'bombs'. We are working on it. We have a lifetime ahead of us!

In the news

Towards DTG+RPV : Juluca ®: Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virological suppression in adults with HIV-1: phase 3, randomised, non-inferiority SWORD-1 and SWORD-2 studies.

Have a good Week, good fuck and do not abuse of meds/drugs

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

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

What to follow in 2018

By Charles-Edouard!

Our friend Myriam does not cool down:

You're right, my dear! Happy New Year and good health to you!

Quatuor

Recruitment is over! Some see it as a sign of strong demand ... Well ... It had been announced 18 months ago and it is late, so recruiters have had ample time to pre-recruit. It's like Corsican ballots: they are full before the elections!

Morlat is a recommendation: not just a case-by-case authorization

We will argue that Morlat recommendation (French Guidelines) is indeed a recommendation; Also note ( as anticipated) the back-pedaling of EACS recommandation.

Genvoya®, Juluca®, Isentress HD®, Zentiva®, AF2B

The regulatory battle is launched! Big Euro-gov will not protect you from over-medication! (read)

Achilles Heel, DOMONO, Absolutegravir, Lanzafame

This subject remains very active. DOMONO has demonstrated the possibility of near-remission (sic): DTG behaves like an Absolutegravir, provided that one preserves one's therapeutic options.

Dual therapies

The variety merchants will give it their best. See the review of the Sword-1 & 2 trials. Question: it works at 100%: did not we overload the mule?

Another recent topic: Mono-DTG would be more favorable than Bi-DTG (and therefore TRIUMEQ®) in the remissionist view of ours ... To be continued...

Leibowitch and the new ICCARRE website

It's new and lacks substance ... It will come ... so, watch for it... Obviously, we will not duplicate, so for ourselves, we reroute our subject to 1/7, Hypodolu, and functional remission. We will discuss the news (there are some ...) in non-infectiousness ...

Transparency, Social Security, Freedom

Well, you have seen the government morgue during the compulsory vaccination and change for the new Levothyrox: citizens react and complain. As for this mainstream newspaper prefers to call patients morons rather than blame itself!

Beyond once-weekly, once-monthly treatment

Buzz in Le Figaro an oral medicine that stays 7 days in the stomach and will allow to go further: we will see how this will allow the monthly 'oral' treatment. The official publication is here.

Reservoirs: things are moving!

The sacrosanct anti-remission dogma is disintegrating: we can twick the reservoirs ...

Half-a-pill strategies

Big success of my post Half-a-pill. Easy and useful strategy: worth working on!

Can we alleviate all treatments ?

We will discuss this subject which is equivalent to "is every treatment overdosed?". Since the inactive HIV dynamics (under control) is different from the active HIV dynamics, for which the dose is defined, obviously everything becomes overdosed, as it goes under control.

remissions

Yes, I promise, we get to this serious topic, I'll develop this year!

Practical Guide 1/7

In the absence of an 'Official' Therapeutic Guide, the most stupid rumors circulated about ICCARRE: our Practical Guide 4/7 put an end to all these imbecilities, skilfully maintained. Now it is the turn of the medics: circulates in Maghreb, a 'subsidized' training (financed by whom? Look for yourself) which repeats again the stupidities of yesteryear.

The refusal to publish a Practical Guide leaves the field tocrooks. If people have time to lose in logorrhea, they can devote a little to what will be useful and practical, right? It takes a lot of time, and this year we start the 1/7 Practical Guide!

The book

Our charts (here and here) have been successful! So, Charles-Edouard! prepares the book. Oh yes!...

Have a good Week, good fuck and do not abuse of meds/drugs

Feel free to comment, to to share and to use

Have a good Week, good fuck and do not abuse of meds/drugs

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

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

Mono-DTG: conflicting meta-analyses

By Charles-Edouard!

News from TRITOMAN:

Super! Nice to hear from you! Yes ... I really think we are on the right track. You see we are now a good little fighting group. Ah! It's really fun! We progress slowly, and well! Best wishes!

Meta-analysis? Meta-what? Meta-who?

Some studies overlap ... To obtain the power of numbers, we would like to aggregate them. When I draw a table of observed Eclipses, in different small studies, I do a metanalysis. (note, I have 3 to add ...). When Dr. Blanco discusses BMM results (Barcelona + Munich + Montreal), at CROI 2017, he does a metanalysis. I add Paris, thus BMM + P ... We sometimes loses the specificity of a study, but gain in number.

In the radio program 'the scientific method', Anne Georget and Dr de Lorgeril, who demonstrated the deception in the Jupiter trial, explain that results depend on the studies retained for the meta-analysis, that meta-analyzes funded by Big Pharma are, by chance, favorable to them: they will be cited ad nauseam, so to make us forget other studies which are unfavorable to them.

Daelig: An educational Pharma-fiction

What follows is an educational pharma fiction. Glioblastoma is an abominable brain cancer. The KSG group, out of solution, buys a 'miracle' molecule, Daelig, which cures glioblastoma in no time. Remission for all, at the cost of a small maintenance treatment. The most pro-active clinicians are launching pilot studies: initiatives are proliferating. A big study, GLIOMONO, blind, is launched. Let's go. Meanwhile, a small Parisian study, shows an unexpected thing: the right-handed patients heal, but not left-handed. In small studies, we have failures but only with left-handed: right-handers are 100% successful; left-handers, failure every time (it's a fiction, so itI made it simple ...).

What do you think of Daelig? It's great or it does not work? You have a Glioblastoma ... Are you trying Daelig?

An academic meta-analysis, excludes GLIOMONO (blind study) and separates right and left handed: it concludes that it is great, subject to initial sorting. A meta-analysis, funded by a competing lab, blithely mixes everything and concludes, conversely, that Daelig is risky.

Easy to understand, no?

Mono-DTG meta-analyzes: Marta Buzzi vs. José Moreira

The first meta-analysis is from José Moreira in Journal of Antimicrobial Chemotherapy: Dolutegravir monotherapy as a simplified strategy in virologically suppressed HIV-1-infected patients.

It concludes the possibility of Mono-DTG, after an initial selection (Achilles heel and compliance). Dr. Blanco presents tables which necessarily lead to the same conclusion, without explaining it. Why does he not explain that he has identified the rules to follow to succeed Mono-DTG? Well imagine that he did and offered a presentation on rules to follow to succeed with Mono-DTG: it would not have been accepted. Rejected by the selection committee, in the same fashion as the Leibowitch's presentation (800 years of remission ...) was rejected by the steering committee, itself driven by ... By naming his presentation: resistance in BMM, Dr. Blanco had managed to make himself acceptable to the paid Guardians, anxious not to offend the 'sponsors'.

By presenting the 'acquired resistances' he will have succeeded in presenting us with the rules to follow in order not to have any ... Diabolical and effective.

On the other hand, it was in the interest of Big Pharma to do have a meta-analysis that would show the impossibility of Mono-DTG: the recipe is simple: amalgamate everything, without distinguishing risk factor. Exactly as in our pharma-fiction: if we mix left-handed and right-handed, and what is a great molecule, appears much less so.

This is made easier by the DOMONO authors (DOLUMONO) who refuse to identify patients at risk, preferring to kill their beloved strategy, rather than admit their gross methodological error: ignore factors of risk made obvious after their trial start! This is where protocolism leads to.

The amalgam: an arch-known recipe

The recipe is well known (and I had denounced in advance ...), we just had to wait for the first moron, who would have an 'interest' in 'demonstrating' inferiority, undern any circumstance, of Mono-DTG. Sorry, we had seen it coming!

Opportunity makes a thief: Alexandra Calmy and Marta Buzzi launch a trial: Evaluation of a Simplified Strategy for the Long-term Management of HIV Infection (Simpl'HIV) NCT03160105: it is a DTG / F-3TC dual therapy trial.

As a trial is a hypothesis test, I challenge you to identify the hypothesis without laughing. What is certain is that it will goes right in the hands of Big-Pharma, and authors do not take an excessive risk: the DTG + 3TC strategy has already been amply validated, including as a first line treatment! (LAMIDOL, PADDLE and ACTG A5353 trials).

Here again, Swiss medicine leaves us speechless, and does not shine with initiative: a meta-analysis completely stupid, as a premise of a clinical trial that is even more!

Obviously, no actor of the French, German, Italian or Spanish medico-pharmaceutical mafia would have dared! They would have been ridiculed by their best clinicians. So, they waited, in hiding, that one commits an ineptness worthy of firing a freshman!

Charlatans of an imaginary risk, the Diafoirus are delighted to quote their new do-not-think-master, to the delight of Big Pharma and sneers, who are not fooled! Check your favorite media: you'll see the replicative power of organized lobbies.



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