113

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



Mono-DTG 1/7 (150mg): failure rectified

By Charles-Edouard!

Question read on Doctissimo, from a thoughtful friend

First there is some confusion... Her friend does 1/2 (discussed here). It's not ICCARRE: as for the questions she's asking, they've been answered in the FAQ of the Practical Guide: yes, you can do ICCARRE after having come out of an AIDS stage, and yes, you can easily catch up in case of failure (rare) while remaining on the same therapy.

Mono-DTG 1/7 (150mg) : failure ...

When you do experimental work, you have to go slowly, step by step, and only stop when you fail (when the level rises above a certain threshold). I don't do things by halves, I change my mind as soon as it goes up, even if it's wrong... So I had some small failures, like my failure at 1/27 (150 or 200, I don't remember)... It had worked well until 1/24... Well... Too bad, I would have liked the 1/30... Anyway... Well... My attempt of Mono-DTG, 150 mg in 1/7 has been blown up... And not only a little! Here we change scale.

Usually, I do my CVs conscientiously every 2 months. Except that here, very rarely, I find myself stuck abroad-not cool: no self-service CV on the horizon. I waited... No luck, just at the crucial moment. Well, as a result of all this, I blew up the counter! First of all I blew up my personal counter, my zenith went full speed towards the North. I was a bit surprised but not too much: my natural defenses have not seen the virus for a long time. Now they are caught off guard. And I really blew up the counter: I have more copies than all the published failures in Mono-DTG combined (BMM+P & Domono, plus all the little tests): I'm doing more than 50% on my own! That's to say that it was a heavyweight!

Well, I'll stop the giggling right now, this case is behind us, and well... So let's stop giggling and silently watch the Master who will show you how he managed all this like a boss, finger-in-ze-nose.

I lost 500 CD4s! So what?

I stop answering to the whiners who squeal when they have lost 50 CD4, it's just rubbish. But 500! That's when you've got to put your man down!

You have to have 500 to lose, that's for sure... With my years of lightening, everything is fine on this side: I usually have around 1000. So even with 500 less, we are far from the (mini) risk zone, which starts below 350, as everyone knows(except for the idiots who think that you can catch tuberculosis, salmonellosis or e-coli in a healthy environment).

This is an opportunity to remember that, for the average patient, when you take the virus out of its pharmacological cooler, you are back to where you started, quite quickly. That's why we don't do experimental racing with a Nadir on the floor... On the other hand, ICCARRE 4/7 can be done, since it is no longer experimental.

And I never miss an opportunity to remind that total proviral DNA is anything but a reliable measure of the reservoir, yet it exists... After all, I was the one who first named dynamic remission, thinking that it is a bit illusory to hope for better, for the moment. So read again Segal's famous article : The problem of HIV persistence despite antiretrovirals(which really annoyed Siliciano... Hi, hi, hi... )

Well, come on... We'll catch up with it, no problemo

Enough whining, let's make up for it... Well... at least between Mono-DTG and the good old combo-Leibo to make the 1/15, there is no photo... So, anyway, we would have gone back to the good old tried and true methods. Even the 1/7, it bores me... And since I'm the one who formalized the Choke-and-Mute, on a Leibo-Sonigo intuition, it would be nice if I were a bit consistent with myself.

We have no tools at hand, no genotype, nothing, nada. We're going to work out a strategy, robust while being blind, so we're going to use our neurons and what we know otherwise.

Which strategy to choose?
Well, we have 3 strategies at hand:
A- make a drowning to start again on a healthy basis
B- re-enter the treatment with:
B1 - DTG
B2 - without DTG

Here is the problem you can think about: what would you do in my place? Go ahead... Pros and cons... Have some fun... You'll find out...

We'll see how we did it and why, next time

In the news: everyone wants to kill the HAS

The medical-pharmaceutical underworld has mastered registration with the FDA and has shaped the EMA into a costly but docile re-registration chamber. useless.

All the more so since, afterwards, it is necessary to go back to the bar: in Germany, in the United Kingdom, etc. And in France(ouch!!). And in France, there is the transparency commission: a revolution, a great achievement. Well... They want to kill him... And Juncker, that crook, sold it to them:

Trump's Verbatim:

According to the Dow Jones, it is align standards on pharmaceutical products ...

On the side of the commission, the question of soybeans is minimized, almost 'anecdotal' according to the commission, but quite strategic for Trump: indeed 95% of American soybeans are GMO and rotten with Glyphosate: how can we ban glyphosate (RoundUp) with one hand and massively import glyphosate soybeans with the other?

The real question is the harmonization of marketing authorizations (and prices... in the minds of Americans...)

Juncker is a crook... Who did he swindle? Trump? By promising him what we can't deliver? Will France stand up to the enormous pressure to make us swallow American crap at a low price?

The Transparency Commission (HAS) has rejected SYMTUZA® and Descovy® by giving them a shitty ASMR... Well... They could have looked at Isentress HD®, but that went under the radar... ASMR in shit... Well ... well, at leastthat's it...

Oh well, no... The obscure transmission belts, exactly what the commission of transparency is used to fight, start to work and here we are with a firework of vitriolic communiqués by the usual bouzigues: TRT-5 and SFLS, all these kindly sponsored people... Pffff... And never a single patient case to highlight, of course...

The HAS emphasizes the existence of alternatives in case of toxicity. One of the arguments of the puppets is to say: 'look at that! It is authorized in Germany, in UK, etc...'.
'France would thus be one of the only two countries in Europe to have this situation', the SFLS notes, amazed.(Oh the beautiful argumentation!). Certainly, but the argument of the HAS is the existence of alternatives to toxicity... And as an alternative of choice, there is relief... And this does not exist in Germany or in England and even less in... USA! Nor... in the SFLS, as you can see...

So, when we no longer have the transparency commission, we will only have the opacity of Washington, and then we will suffer...

Other news: it's back to school!

- Several times we asked the question: can we do better than EFV 400 mg, for example 200 mg? Well, Lanzafame has done it... And he took the opportunity to withdraw TDF (or ABC), that is to say EFV 200 mg + 3TC 300 mg 7/7 with as an alternative NVP 200 mg + 3TC 300 mg. It is here; we will come back to it!

- Moncay's results are in line with all the other trials not taking into account the Achilles heel: it's a disaster... Cata announced by Katlama... Cata inflicted to the patients... Pffff... We would have liked to believe that Hocqueloux was smarter than Raffi. We are disappointed... But Mono-DTG, at Lanzafame, still works well...

- This publication by Molina: Doxycycline prophylaxis for sexually transmitted bacterial infections: promises and dangers. It's a debate... Paris now has a whole school of doctors, once fervent activists of tradi-prevention, who have turned their backs and say of PreP: 'it works like a vaccine, it's miraculous...'. What remains are the other STIs and the need to find an effective and economical prophylaxis for them. We'll come back to that...

- We have listed one more doctor, a long-time alleviator, whom we did not know: Dr. JEAN DEROUINEAU. That's it... Know how to take part in it

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Have a good Week end, Good back to school, good stuffing and not too many meds ... Huh?

112

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



Are there many PTCs?

By Charles-Edouard!

Well, another false testimony...

What test? Specify... The false testimony is often: I have a friend of a friend who has tried lightening... I've broken it down here: True and False Testimonials. One mistake is to lump all lightening together. Just as there is not THE vaccination but Vaccinations (some work, some don't), there is not THE alleviation but ALLEGATIONS. Forget Mono-IP (mediocre and obsolete) or TRULIGHT (to be avoided), it's rubbish. Fortunately ICCARRE (and also Mono-DTG) works very well, even excellently.

Let's take a patient, rather allergic, with multiple resistances, happy on Eviplera®. Happy yes, but for how long? When the slow, pernicious renal toxicity sets in, then, for real, he has no nice options left. Another patient, with the same profile, has started to lighten Eviplera, progressively, step by step, she is at 3/7... She postpones the renal toxicity as much: Who wants to travel far spares his mount! So you have to ask yourself questions BEFOREhand. With a good doctor: I published a list

Let's go back to the PTCs: are they numerous?

We saw in the previous post what PTCs (Post-Treatment Controllers) are: they treat, interrupt for good, the virus rises and then falls back to a very very low set-point, undetectable. Are they cured? No, it only lasts for a while, 3 years on average. The situation of the Elite controllers is rather enviable, therefore, that of the PTCs too. If the proportion of PTCs was 100%, we would be saved; if, on the contrary, it is 0%, then it is big-Pharma that is saved. That's why we never tell you about it.

The hospital of Antwerp has identified 4 PTC among its 124 exploitable patient cases: 3%.
In the CHAMP cohort it is estimated at 3%. We have the same estimate (3%) by 2 different methods: let's keep this 3%. From a medical point of view stricto sensu, these people no longer need treatment.

Many useless tritherapies

So, we have a lot of people on AIE (Abusive Extension of Indication), about 25% (?), for whom the START trial shows that there is no clinical benefit, and for whom the only benefit is to become non-contaminated.
We have 3% who could do without treatment after having taken a treatment (of induction, of what? we will see that...), and 0.5% of Elite controllers who will be put, and maintained unnecessarily, under treatment, ad vitam.

When these patients realize this, they grumble, which is normal. Dr Hocqueloux presented the state of play in the Viscontis cohort (see poster, summary). It was the occasion to remind that the Visconti cohort is post-hoc (i.e. made up of patients, early treated, controlling the virus) but that we do not manage to obtain the PTC in the cohorts of very early treated patients. Based on his fragmented observations, Dr. Hocqueloux concludes: you have to treat them early, very early, and for a long time (to hope for TPC). But where does he get this from? Where is the proof??? In France, we have cohorts of early-treated patients, so go ahead, guys, show us that you have more than 3% of PTCs. The lack of clinical benefit of treating early, too early, is explained by Dr Ananworanich Favorable clinical phenotype achieved in less than half of those treated for acute HIV infection (see slides, abstract).

So, in summary, there are poor young people who are bored with treatments, with the promise of a possible post-treatment control, which has never been shown again(SPARTAC trial and even PRIMO cohort). In ordinary chronic patients, we have 3% of PTCs and in early treated patients, who have not developed any embryonic immune response: 0%. Hocqueloux can rant on and on, the problem is there: there is no statistical or clinical benefit for the patient to treat too early.

How to condition to get more PTCs

We find more PTCs in chronic patients than in PRIMO: it is not the fact of treating in Primo that is favorable, so... it is something else... That's what we need to focus on. And here, the new Eclipse Equation sheds light on this: if we improve the EpiGeneDist and/or Immune Response factors, we increase the Eclipse. One AND/OR the other.

The observation of the A5068 trial is that we can hope to increase the rate of PTCs from 3 to 15% (or even more...), by introducing time interruptions, of modest duration (1 month) repeatedly. This is more interesting to develop than this poor Hocqueloux who is watching the cows go by, without making any progress.

Are you a PTC who doesn't know it?

To find out, and in the absence of a predictive tool, the only way is to stop and look long enough at what is happening. If you are in the LOTTI test range, it's all good: if you are a PTC, you have won the prize, if you are not, you have, at least, benefited from the LOTTI interruption (very favorable procedure). If you are in the SMART bracket, let others do it, there are better things to do: ICCARRE

Or you have a clinician who is able to do a viral expansion test in blood bags: method proposed by Van Gulck (Antwerp). If the virus has difficulties to grow in the blood bag, while it only needs a few days in vitro(in vivo it takes a few weeks...), then maybe...

The real question is: are there methods to either increase the Eclipse or to increase the number of PTCs. The Shock-and-Kill will have disappointed: 3 methods are still in the running: vacation cycles (Ragon), DTG cycles (Wainberg), Short Cycles (Leibowitch)

PTCs, Eclipse, ICCARRE and DTG

Increasing the Eclipse is not the same as increasing the number of PTCS. These are 2 different objectives, and in my personal opinion, the search for a benefit for the patient makes it more important to use ICCARRE (1/7, Leibowitch) than Ragon (PTC, Bruce Walker). This is still interesting: because one can consider combining the methods: a TRI-protocol.

We will soon see the avenues open to us...

The universal French genius

Here is a rare intervention(youtube) of Pr Schinazi. Shina-Quoi? Yes, this is the occasion to remind you that he is the inventor of 3TC, F-3TC (which almost everyone uses) and ... Sofosbuvir (which cures you of HCV in a jiffy). His Wikipedia entry. Millions of lives saved, that deserves a tribute. Especially since his speech is rich. He reminds us: 'doing nothing has consequences'.

And to remind our brilliant ANRS, SFLS, CNS, and so on that there is no French molecule... Zero, Nada... That should make you a little more humble. No?

Link

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97% of patients overmedicated, 22 million without treatment... Let's stop this scandal!