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Saturday, February 25, 2017

Lamivudine to the rescue

Lamivudine to the rescue

By Charles-Edouard!

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

Breaking News, 18/02: the results of DOMONO, here soon with exclusive data! ...

Somes news from Lionel, in La Reunion, under Triumeq® 1/7 (once weekly)


It works, it works !!! And here, it does not surprise us at all! Good Job!

As far as I am concerned, MiniDolu (Tivicay ® 1/4 of daily cachet) worked well (6 months) but I prefer to reinforce, with that little Lamivudine, not unfriendly at all; For the time being: 50 mg of Tivicay® (DTG) + 300 mg of Lamivudine (3TC), Saturday and Sunday, with the goal of concentrating all on Sundays.

It is a bit like those taking Triumeq ® in 1/7 (DTG 50 mg + Lamivudine 300mg + Abacavir 600mg (!)), certainly, but without the Abacavir! ...


Easier to procure than the proven Leibowitch formula (quadrithapy, 1/7, once weekly: 1 NNRTI + 3 NRTI)

Lamivudine, the discreet star of successful trials


Lamivudine is a generic antiretroviral (and antiviral). Its copy fluorinated version is Emtricitabine; It's the same ... The manufacturers continue to feed themselves with crazy $$$, for a classic, now in public domain.

It is reputated innocent ... Reputation probably not well-substantiated, inasmuch as almost everyone takes Lamivudine (or its alter-ego) one can not differentiate: it is impossible to distinguish its toxicity from that imputed to the Virus or to treatment in general.

It has shown up in several recent trials including: Gardel, Paddle, Lamidol, Dual ... Monotherapies (from Tivicay ® or antiproteases) are satisfactory, but are experiencing some failures. Conversely, let's add the innocent (and inexpensive) Lamivudine, and here you are with a quasi-general success.

Adios to 3TC Resistance (M184V)



Like Videx, its intrinsic power is low. 1 Log as monotherapy, with development of mutation at position 184. The mutated virus remains rather sensitive (0.5 Log, env.), therefore, one finds it or her look-alike, within ALL conventional triple therapies: without exception: Atripla ®, Stribild® / Genvoya®, Eviplera®, Truvada® + X, Kivexa® + X, a lot of guys!

Some (surrealists) Researchers, had assessed its power contribution to 12% of TRI.

Most trials have patients without the M184V. Professor Reynes (DOLULAM) observes nevertheless that he has 10 patients (37%) with this mutation, and, it works for them too!

This is also true in MOBIDIP (see below). This is very good news for 'historical' patients: they should no longer be opposed the M184V to prevent them from lighter therapies.

PADDLE



Total success with DTG + 3TC, as frist line, by Dr. Cohen, in Buenos Aires. Tasty Anecdote: There was one patient with a positive viraemia, which should have been called 'virologic failure'. Contrary to our Parisian virologists, who would have stuffed him with tritherapy, good Dr. Cohen decides to persevere, and here he is rewarded with re-suppression.

Dr. Lanzafame does just as well with his Tivicay ® mono, as induction (9 patients published, and others soon to be ...)

LAMIDOL: success of DGT + 3TC maintenance


It is an ANRS trial, of maintenance, where 104 patients have been instructed to take Tivicay ® / Lamivudine, daily, and, there is only one intrinsic virological failure (ICCARRE + ANRS-4D = ZERO intrinsic failure on 190 patients!)

On the other hand, there are failures in DOMONO (maintenance with DTG alone), and there remains the vast question of the Achille's heel, for those who may be punished for taking Isentress ® , Stribild® / Genvoya®.

The price to pay to add Lamivudine, is not expensive at all. Especially since Abacavir or Tenofovir are thus definitely eliminated!

Those who continue to take tablets with 3 or 4 agents, with suspected cumulative toxicity (eg Triumeq®, Stribild® / Genvoya®), beyond the attack phase, are ignoring the progress of the pharmacopoeia and the clinic.

MOBIDIP: maintenance by IP / r + 3TC does better than IP / r



Despite Salpetriere's support, monotherapy under IP, in maintenance, does not attract many patients. The MOBIDIP test (ANRS 12286) probably shot it dead: the monotherapy arm had to be interrupted (too many virological failures), while the Bitherapy arm remains satisfactory.

Prof. François Raffi comments: A higher rate of success than IP/r monotherapy despite the presence of the M184V mutation. Indeed, 97 of the 137 patients in the IP/r + 3TC arm showed the M184V mutation (typical of 3TC resistance).

The conclusion is clear: maintenance with PI/r plus 3TC is associated with a high rate of success despite the presence of M184V whereas PI/r monotherapy can not be recommended.

You might be surprised to see the ANRS in this adventure. Doomed to fail ? Easy to say afterwards ... Here, too, I have repeatedly expressed the opinion that ICCARRE is a better plan!

Well ... At this point, my position is strengthened. MOBIDIP: death of IP Mono.

To go further, read The Magic of 3TC, on page 20.

Good Weekend and good fuck!


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

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