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Saturday, January 23, 2016

Monotherapy: Olé


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.

Monotherapy: Olé


Monotherapy: Olé!
I'd like to go around the world for about 6 months: How to treat? I can not go back to France every month [...] If I understand you started a therapeutic relief to reduce the number of drugs and thus need fewer pills during your stay abroad.

I already told my doctor relief and he will not do it [...]

Otherwise I might be forced to return after three months, it looks like a prison, in short, thank you for your help :)

The only passage in the monotherapy Tivicay ® does not respond to this question: we must learn to reduce the dose: it's healthy and useful.
With conventional treatments: ICCARRE 4/7 or 1/7 (4/7 ICCARRE enough to this project); with the monotherapy Tivicay ®, consider dose reduction or Hypodolu.
Monotherapy Tivicay ® has the wind in its sails. It is understandable...

And for the stock, there is only one way: save, thus reducing the dosage.

There are only two questions to ask:
1 - Tivicay ® monotherapy (m ') is it possible, and if so?
2 - maintenance, 10 mg is it as good as the 50 mg?

Tickets for EACS-2015 starts here ... Here I pruned the summary of the EACS presentation by Univ. Barcelona (transparencies are here):

HYPO-DOLU EACS 2015 Barcelona monotherapy Tivicay dolutegravir Esteban Martinez Barcelona hiv

Dolutegravir Monotherapy in HIV-Infected Patients with Sustained Viral Suppression: A 24-Week Pilot Study, J. Rojas et al.

Goal:

[...] We have tested the feasibility of dolutegravir monotherapy in patients with treatment options limited due to toxicity problems, interactions, or resistance.

Methods:
Patients without failure or without mutations previously documented proven resistance to integrase inhibitors and with plasma HIV-1 RNA <37 copies / mL for at least 12 months had their antiretroviral treatment (ART) changed dolutegravir 50mg OD [ ...]. primary endpoint was the proportion of patients without new treatment failure (do not go through = failure) at 24 weeks.

Results:

33 (22 IP-18 in monotherapy) patients were included [...] 39% with prior AIDS events, 8 (4-13) years with undetectable HIV viral load, CD4 596 (420-843) cells / mm3. [...] Only one patient of 33 had virologic failure at week 4 (88/155 copies / ml). It has been recommended that increasing the dose of dolutegravir 50 mg BID, but he continued 50mg OD. Viral load remained detectable at 24 weeks (79/101 copies / ml). RNA genotypic resistance tests for HIV and DNA at 4 and 24 weeks did not detect any mutation of the integrase. [...].

Conclusion:

Dolutegravir monotherapy is an option that remains to be confirmed in randomized clinical trials.

What remember: it goes smoothly. One exception (of 37 patients): a multi-treated patient coming, especially a treatment with raltegravir (Isentress) this 'failure' with little consequence because the CV is very low: the patient remains under monotherapy Tivicay ® 50 mg / d. Note also that the mutation (118R) is a mutation cul-de-sac that reduces slightly the efficiency of DTG without opening a path to other viral mutations and therefore exhaust.

For us what matters is that it seems to work for 32 of the 33 patients (96%). For one of the two patients who previously took an INI first generation, it does, for the other less ... and when it makes the least, what is proposed? Increase the dose ... The second line following Tivicay ® is Tivicay ®: it is its own antidote.

Question: (? Horse, initial) when it does, what is prohibited to reduce the dose

To repeat: 95% of patients, stable and undetectable, are unnecessary and harmful on-medication!

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