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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.

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