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Sunday, September 24, 2017

2017 Treatment hit parade

Summer 2016: we offered a serial: ANRS-4D and the cheaters
Summer 2017: we will debunk DOMONO:it starts here

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

2017 Treatment hit parade

By Charles-Edouard!

Well ... My grandmother would have said "Cancer fore sure!". Well, we also have a new thing: Alzheimer ... My good old doctor, over-medication conscious, always said: "We would like to remove one of them, but which?"
My experience was taking this path ... Why say "alleviation is not for me"? We would like to say: quite the contrary!

My own Hit-Parade 2017

There are various rankings of meds (eg Morlat). One of the most relevant is the Spanish ranking.

Ours is not a recommendation, it is made exclusively from the perspective of refueled remission: the 1/7 (at least ...). These are, at most, considerations to have in mind when discussing with your doctor. Especially since the genotype (mandatory in France), may limit your options ... The ICCARRE exploration invalidates treatments based on IP or Isentress®, from 3/7. Obviously, there are ways simpler than others to reach the 1/7, and benefit from our predecessors, regardless of the medico-pharmaceutical propaganda.

 Classics (see patents) 
 1 NNRTI  + 2 NRTI  for 1/7, we may add, at 2/7  comments 
 Efavirenz  TDF + F-3TC  Abacavir (Ziagen®) or Videx®  This is Atripla®
 ABC + 3TC  TDF or TAF (Viread®) or Videx®  
 Nevirapine  TDF/F-3TC  Abacavir (Ziagen®) or Videx® see bellow
 ABC + 3TC  TDF or TAF (Viread®) or Videx® 
 Modern ones  (usage for 1/7 is being explored) 
 1 INSTI/NNRTI  + 2 NRTI  for 1/7, we may add, at 2/7  comments 
 Dolutegravir  TDF/F-3TC  nothing ?
 ABC + 3TC  nothing ?  This is Triumeq®
 Rilpivirine  TDF + F-3TC  Abacavir (Ziagen®) or Videx®  This Eviplera®&/Complera ®
see below
 ABC + 3TC  TDF ou TAF (Viread®) or Videx® 

Know what to avoid

In the perspective that is ours, discuss with your doctor to avoid: PIs (Kaletra®, Prezista®, Reyataz®) and the 'older' INIs: Isentress®, Stribild® / Genvoya®)

Special case Nevirapine

The group of 'self-proclaimed experts' (we did not say independent experts ...) zapped NVP (document EACS). They also zapped their conflicts of interest declaration (Well ... While they are at it...)

NVP has limitations at initiation and gradually gets excluded from general recommendations. On the other hand, for maintenance, there are no such limitations. We have to make sure we do not have an allergic reaction, but, that's like everything else. This is Leibowitch's favorite molecule for his patent and the path to relative remission (1/7). You may want to switch to NVP using the NVP-switch-kit. As the path to 1/7, using RPV (or even DTG), is not chartered, yuo may want to return to ICCARRE orthodoxy. In switch mode, there are efw to none documented ontraindication. Once daily, it is generic. No medical congress in the West Indies ...

Special case Rilpivirine (Edurant® / Eviplera® : Complera®)

It's very much in vogue and has worked very well in 4/7 (ANRS-4D trial); it has not been explored further. To return to chartered routes, you may want to switch to NVP, using the NVP-Switch-kit or wait for a hypothetical trial in 3/7.

Special case Raltegravir (Isentress®) Elvitegravir (Stribild® / Genvoya®)

HAS has said and reiterated the low genetic barrier of Elvitegravir. In ICCARRE-1, Raltegravir 'trips' at 3/7. So, with that, if you think to go peacefully to 1/7, you have to explain! Moreover, the mere use of RAL or EVG creates an identified, known and published over-risk for DTG in reduced mode (Mono-DTG, or even, by extension, Bi-DTG and DTG / x in X / 7): this is the Achilles' Heel (Prof. Katlama). The bag is full and, for a 1/7 perspective, does not sound good! Their presence at the top of recommendations, not justiciable, open to abuse, speaks volumes. One may be able to correct for this, before considering 3/7, but may be not with Dolutegravir. It is still very limitating!

Special case of Protease Inhibitors (Kaletra®, Prezista®, Reyataz®)

In ICCARRE-1, PIs associated with 2 NRTI 'trips' at 3/7 ... So it's not ideal to move towards 1/7. No? If you can, you may want can go back to ICCARRE's orthodoxy by substituting an NNRTI, but then why did not we do it from the beginning? As an alternative (prospective), the combination of Tivicay ® (DTG) with Prezista ® or Reyataz ® is currently being explored in an x ​​/ 7 perspective (see here).

Special case Videx ®

Stock it! It is already no longer available in Switzerland ...

Counselors are not payers!

Beware of these so-called 'recommendations' issued by 'authorities' who are not and who are exempt from the ire of Justice and Democracy (Europe, unfortunately, has also become this too...). The recommendations of the EACS are irresponsible, in the sense that no one assumes the moral, sanitary or legal responsibility: it is to medicine what an advertising report is to journalism.

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Have a good Week, good fuck and do not abuse of meds/drugs

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