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



BIKTARVY® for 1/7, why not?

By Charles-Edouard!

BIKTARVY® is the anti-Charles-Edouard... And then???

I have nothing against Biktarvy®. It's just that my choices take into account one constraint: the availability in case of emergency and the cost. How many times have I been stuck, without my luggage or money, without this, without that, on the other side of the planet... So... I like to have backup plans, all the more universal because they are modest. As a result, 'caviar' Medocs are not my cup of tea. Since Gilead has made a specialty of an industrial Mikado, with some legal proceedings in the pan, pushing for Variety and Price, well, it just so happens that I have never taken any Gilead product.

It's kind of the law of the genre. Wealthy pharmaceutical companies are leading the race, at great profit, others are in the pack, and the Indian or Chinese generics companies, fill their pockets without merit. When one masters Nevirapine, its dosage, its intake, then there is no need for Bictegravir®. And Nevirapine is like Chinese, you have to learn it...

You like Bictegravir in 2/7 (or even 1/7 or 1,5/7), why do without it ???

Abacavir probably doesn't fit too well in 1/7... You get used to it, you get a weekly donut, so if you can avoid it... ABC is a weakness of Triumeq®. ViiV has obviously succeeded in gathering evidence of plagiarism, and has led Gilead to a private agreement, which probably includes the payment of royalties to ViiV (or else to Shionogi). BIC is not, strictly speaking, a competitor of DTG. Moreover, as DTG is a computer-designed molecule, based on a 3D mapping of the integrase, and in particular of a catalytic pocket, in a key-lock computer optimization, one wonders whether it is possible to propose a significantly different key for the same lock...

Except for targeting another catalytic pocket or improving the resistance profile of DTG at the margin, it is difficult to see how to hope for an alternative to the DTG pharmacore. Once an enzyme, the lock, has been well mapped, there is no plethora of optimized solutions. There is invention, but without alternative, without competition, a de facto monopoly.

Islatravir is a completely different animalHowever, we will see that they have updated anti-metabolization strategies that make it possible, and even necessary, to reduce the dosage of Islatravir, which is announced at ... 0.75 mg! It will be seen that it is unthinkable to take Islatravir at high doses nor at repeated banal doses: you have to slash the dose or else it's a bang bang bang bang!. We will come back to this...

Before the appearance of Biktegravir®, my proposal of choice was DTG/TDF/F-3TC, BIC being a plagiarism of DTG, we can note BIC = p-DTG, and Biktarvy p-DTG/p-TDF/p-3TC(with p- indicating a plagiarism with marginal over efficacy at most).
A recent query of the public drug database indicates (for France) BIKTARVY® at 724,36 Eu. ; TIVICAY® at 546,74 TRUVADA®: 338,81, its generic at 168,58, that puts Tivicay® + Gé-Truvada at 715 Eu. This was my alternative idea to Triumeq® (752 Eu.). Considering the favorable feedback from my readers on BIKTARVY®, the lack of significant price difference, I think that BIKTARVY® will soon join my pharmacy box.

BIKTARVY®: 100 Euros per month...

14% of a gross salary goes to health insurance. Be net contributornot be in debt to others for his medication expenses, at 1000 Eu./month of medication, it requires a gross salary of 7.000 Eu./Month... Good luck! On the other hand, at 100 Eu/month of treatment costs, it becomes possible again. And, this can be a factor of satisfaction, depending on each one. Considering the rate of reduction that the 1/7 allows, (even, 1,5/7, or 2/7), there is no need to deprive yourself...

Juluca/Truvada: an attractive alternative

There are people who navigate towards 3/7 (or even 2/7) with Eviplera® (now Odyfsey®)... Well... Why not... Others are in Dovato® or Juluca® mode (more rare). The idea of adding DTG to Eviplera is attractive in view of the 1/7. It makes 4 molecules, it is compatible, 2 pills, which reduces the possible impact of the risk of non-absorption. In short, as TRUMP would say: "what are you risking? Personally, I find that, on paper, it is tempting. Especially if you look at what comes next, namely 1/15 and the arrival of Islatravir. It's a question worth considering because patients who enter Cyle Court via the Eviplera® (Odyfsey®) or DTG route are more than a majority (about 2/3), and the convergence of strategies, i.e. merging RPV, DTG, and the 2 zozos, seems very simple to implement. Knowing that, once again, each one sees at noon to his own door.

Mourning the loss of Videx ®.

There isno more Videx ® Well... My readers don't care, since we saw it coming... But at ICCARRE it sucks! No more Videx® = No more ICCARRE? Leibowitch's friends no longer have Leibowitch and no longer have Videx®: that's a lack! Those who could not discuss alternatives to Videx ® before Leibo's departure, will come and ask me... Who else would you want them to talk to? And, we're not going to leave them hanging. If we don't have Videx® anymore, we can't do the Videx®/Nevirapine shock couple, so Nevirapine becomes a problem, too.... There are solutions to this...

Biktarvy®: let's look, peacefully, at what is happening

For the moment, Sally, Joelle, and Evaristo are in 2/7 mode on Biktarvy®, on their own, so we share, we discuss, we observe, and for those who are interested, well, we consider participating in the collective effort. The Short Cycle in Darwinian discovery mode, has no intelligence, we don't learn from the past of other patients, we reflect on the past of each patient.

Weekly intake and 1/15

Apparently it's moving... There is an Olivier who started on his own, integrating some Leibowitchian 'precepts' (progressivity, close CVs) and Leibowitchian 'precepts' (progressivity, close CVs) and bypassing others (progressivity, reinforcement)... So, for the moment, there is a return, which we are told will not be too long, to more concerted rhythms. To be continued, of course...

reminder: for me, 1/X, when X is big, is to be understood in BID (taken morning and evening), on a meal

In the news

- The HAS and the ANSM have rejected Remdesivir! Moreover Gilead has kept a low profile in front of a fiasco announced at the transparency commission: read here. Obviously Gilead is not interested in flooding the French market with Remdesivir, although the opportunity to prove itself in real conditions is there... But well... Billions are made, why bother with patients ?

Francois : The other French genius

The French genius is in trouble these days, hampered as it is by an inept and probably obsolete mode of government. So, I'm bringing out a good old Bach, in an interpretation by Samson Francois, which is remarkable. (Bach/Busoni Toccata, Adagio & Fugue BWV 564)
The youtube source is split in 3: part #1, part #2, part #3

She surpasses the unsurpassable Horowitz, live at Carnegie. Here too, the youtube source is split in 3: part #1, part #2, part #3

Here is an organ version by Ton Koopman

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overmedication is an opportunity if you know how to use it!