The brilliant Dr Cahn

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.

The brilliant Dr Cahn

The genius of Dr. Cahn

Tivicay ® monotherapy, interested. I received the following question:
Under Stribild ® for 2 months on the front line, went to Eviplera ® and Truvada ® + ® Tivicay. Always side effects of Truvada ®, I would experience the mono Tivicay ®.
Why have undergone ® Stribild a priori it could without resistance we exclude from mono Tivicay ®?

I give items on the comment of the ticket: Stribild ®, EACS-2015 Hocqueloux

Questions help me build the note on the presentation of Ch. Katlama at EACS-2015. Thank you! For the impatient, see the slides and abstract.

Given the total blackout in our favorite media, I'm in no hurry ...

The future of therapy under the dolutegravir angle (Tivicay ®) is easy to envisage.

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

2 questions, not one more ...

The genius of Dr. Pedro Cahn is to have responded, in part, to these two questions at once.

Its Dual Therapy of attack, without fail, on naive patients, that in the mouth corner. Especially as Lamivudine, hanging keychain with DTG, is very powerful, and do not synergize with DTG.

This almost monotherapy in treatment of attack open, obviously, the door to the results in attack monotherapy (*). It will eventually come out, probably in 2016 ...

Already the US are building their pitch to finance a large trial on maintenance of combination therapy DTG / 3TC. And again at home what is already acquired at home ... The test, ASPIRE (NCT02263326) is announced here, is no different from our test LAMIDOL

PADDLE, too, will be remade in the US: NCT02582684; by the AIDS Clinical Trials Group

The ING-111521 trial has already shown that monotherapy Tivicay in attack on naive patients, it is possible. The clinic will confirm what we already know.
This same ING111521 test which allowed the manufacturer to claim that 50 mg is better than 10 mg. The higher the dose, the greater the response is quick: the speed of response is in proportion to the dose.

True, but we, we do not care: what interests us is the maintenance of the response.
Not the response speed, the attack ... It depends, a bit, of the dose.
Dr. Pedro Cahn shows that it depends mainly on the initial viral load.

Paddle EACS 2015 Lamivudine dolutegravir Dr Pedro Cahn undetectable

I have classified the patients, the picture presented by Dr. Pedro Cahn, by CV before treatment. (See this post)
We see very clearly that undetectable long in coming when the viral load is high.

And also, that entering the home straight, passing under 400 copies, ensuring the ultimate success, is obtained from the 10 th day (look, this is true for 19 patients: 19/20), as in the attack monotherapy trial: ING111521 (9/10)!

With or without lamivudine, the result is the same ... (*)

So, one can bother taking lamivudine (300 mg, 1 time per day) at the beginning. Without losing sight of removing this accessory, futures (*).

The test PADDLE (*) thus sheds light on what ING111521 plans: the maintenance Monotherapy Tivicay ® is possible. (*) = Treatment-naive patients, therefore / or have never taken INI

It also illuminates the second fundamental question: 10 mg instead of 50 mg, is it sufficient for maintenance?

You do not see what PADDLE sheds light on dosage reduction? See you soon for a future post.

It's fascinating, is not it?