ethics and elegance

ETHICS AND CHIC OF ICCARRE

By Dr. J. Leibowitch, Emeritus of the University

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

15 years too late, the ANRS capitulates, French guidelines capitulates: abused patients will claim for justice: the ethical fault will be under the spotlights ... REJOICE !, Jacques Leibowitch, front runner explorer of viral strains, viral load, tritherapies, 1/7, high profile possible Nobel candidate, offers you this post!

ETHICS AND CHIC OF THE ICCARRE PROGRAM

By Dr. J. Leibowitch, Emeritus of the University

In denial of the oracles announcing a leaping retroviral devil within 24-48 hours after ARVs are stopped, ICCARRE[4]’s anti-HIV treatments in short cycles have established feasibility / acceptability / effectiveness, without unfitting virological failures.

For fifteen years since the above “universally agreed sentence", facts have affirmed their tenacious obstinacy : HIV, after having been made undetectable under a semester of nonstop synergistic ARVs, repeatedly demonstrated that it WOULD NOT rebound before one to several weeks following a temporary interruption of ARVs.

The responsible physician must be wary of edicting “regulatory over-medication”, be it to shield timorous colleagues, or safeguard co- expert managers, or pacify restless antiviral manufacturers ....

Indeed, the benefits of ICCARRE’s short medicinal cycles lie primarily with ethics and deontology. The liable prescriber is expected to adjust prescriptions to their Necessary and Sufficient Best, to achieve and sustain designated therapeutic objectives (a viral load continuously <50 copies in the long run), when factual reality invites to it = commands it !

Initiated in 2000-2004 by Dybul et al, intermittent maintenance treatment in short, 7 days On / 7 days Off cycles founded its plumb on the 7 to 21 days which regularly separate the interruption of effective ARVs and HIV rebound, in the 2nd phase of ARV therapy which regularly trails after a hearty attack treatment.

In addition, pilot studies on intermittent therapy in short cycles have shown the mitigation of iatrogenic effects, while responding to patient’s demands that prescribers take into consideration the psychological/physiological constraints of unabated therapy.

Beyond ethics and deontology, alleviating constraints and costs under ICCARRE may be the compelling cherry on a compulsory cake : primum non nocere, there is no deontological commendation for over-medication !

Interrupting ARV treatment without instant HIV rebound is made possible by the physiology of the HIV reproduction process in vivo : it pendularly oscillates from a slow linear sub-50 copies growth to an explosive exponential development, returning to soft slowiness under unrelenting ARV co-operation, an OFF to ON dynamic contingent to the internal biophysiological or pharmacological environment.

And whether OFF ARVs, or within the time interval spanning from silent inoculation to blatant primary infection, it takes from 7 to 21 days and more for HIV to deploy its exponential multiplication phase, starting from its submerged slowish growth phase.

That periodicity gives an almost mathematical readability to the observed post-antiviral deference of HIV rebounds, alias post-antiviral delay, anergy, eclipse, sideration … Matters that breach the conventional wisdom on the so-called necessity to never abate on anti retroiviral therapy.

Re-read, think like Hippocrates, not like hypocrites, and ask your questions in the comments section below! Also think about getting in touch with ICCARRE users group!

Breaking News: Pr F. Dabis appointed as ANRS director

[1] Anti Retroviral Therapy; [2] Anti Retro Virals; [3] Persons Living With HIV; [4] Intermittent, in Canny short Cycles, Anti Retrovirals may Retain Efficacy

Comments

Anonymous April 23, 2017 at 12:06 PM




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