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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.



The Eclipse is getting longer with the (new) INIs
and LIVE COVID...

By Charles-Edouard!

DTG changes everything... and nothing at the same time

Let's make the hypothesis A that the 'modern' administration, i.e. earlier and with DTG (or BIC), which are at the top of the first-line recommendation, gives a significant possibility to control the virus. Indeed, Hocqueloux has stated, somewhat naively, that to hope to cure one would have to treat earlier, stronger. You and I, we are already in the treatment and, for us, the project of treating earlier does not concern us. It doesn't matter... To test hypothesis A, we take 'modern' patients, in the sense of A, treated early with a second generation INI. We stop the treatment and see if one of the patients controls the virus. And we compare... Compare to what? To the history... That is to say, the period when the treatment was deferred somewhat, and when the first generation INIs did not exist. Nothing better, therefore, as a comparator than Davey's series, which dates from 1999, that is to say 2-3 years after the arrival of triple therapy... My table with the published eclipses is here: Time on the rebound: I finally see you!

&nbspPt.	T50
1	5,4
2	3,8
3	8,9
4	11
5	47
6	8,4
7	9
8	9,8
9	5,6
10	12
11	9,8
12	11
13	8
14	15
15	13
16	12
17	7
18	7

Historical values (Davey 1999)

source: jstor.org/stable/121215.
In Davey's series, the presence of an Eclipse at 47 days distorts the mean (11) and standard deviation (9) to the point of suggesting that there are statistically negative values. Removing this exceptionally long Eclipse patient gives a mean of 9.2, a median of 9 and a standard deviation of 3, which is already more reasonable.

With these corrected values, the number of patients with an eclipse of less than 7 d. (6 or less) is 16%. With Davey's calculation, we would find 29%. In clinical intermittence, ICCARRE and Faucy find only 2-3%. For the calculation we use onlinestatbook.

The 'classic' risk is lower than it seems

The first error consists in taking an exceptionally high value (47 days), which is a value to be excluded(outlier). The second is to take a statistical model, of Gauss, which is symmetrical, whereas the Eclipse is not symmetrical: there is no negative Eclipse. When the series is temporal, stochastic, it is appropriate to use a Poisson model. But well... Let's pretend, since what we are interested in is an order of magnitude. It is obvious that a patient with an Eclipse of 3.8 days cannot hope to achieve 1/21... In the classical view, in Davey's time, one can have an appreciation of risk such that even the modest 4/7 shows a statistical risk.

Here is the risk calculated in a very primitive way, without incorporating any risk factors. In 4/7, with Davey's figures, we find 19% of patients at risk of failure. With the corrected figures, we find 2%, and, in the clinic, we find very few (e.g. zero intrinsic failures in ANRS-4D). So the risk is overestimated. Let's say that this error of evaluation, made by many 'specialists', and which ICCARRE denies, is, let's say, forgivable a priori. A Gileaolatre could have used this putative risk to try to block ANRS-4D, a priori. If we look closely, it does not hold, but well... That's the past.

What Davey claims, Leibowitch denies

According to Davey, in whom the shortest Eclipse is 4 days, doing the 5/7 (FOTO - Dr. Cal Cohen) is possible, but in Davey 'Classic', the expected failure rate to do 2/7 'direct' is 25%. Besides, there has not been a Truchis, a Leibo or anyone else to attempt the 2/7'direct'. In light of Davey's dônnées on the Eclipse, the 2/7 (or even 1/7) would be unreasonable. Except that the 2/7 have gone through 3/7, validated: they no longer carry the risk of 3/7... The risk to fail, in progressive method is R(2/7)-R/3/7), that is 25% -21% = 4%; in recalculated Davey risk, it is 5%.

As Leibowitch has shown that it is possible to compensate for a negative event (virological failure) by returning to 7/7 immediately, the risk is doubly minimal; it is less than 5% and the negative consequence of the risk (virological failure) is without prejudice, since we know how to compensate. On a personal level, one could find it bad to fail at 2/7, but then, one would have to make up one's mind...

In practice, Leibo has a much lower failure rate, because it also plays a little on the pharmacokinetic window, by using preferentially and almost exclusively NVP(or at least EFV). In this perspective, the 1/15 is unthinkableThe use of NVP, with the possible exception of a few exceptional cases.

With the New Eclipse everything will change!

With the new Eclipse, this will change, and even more so with the arrival of Islatravir.

Live COVID

Multi-therapy: For the moment the concept remains a bit vague, but this article from Le Collectif Citoyen for FranceSoir (which no one doubts is brilliantly inspired) Covid-19: What is the standard treatment? Does it include hydroxychloroquine? opens a new era: that of a cocktail/care pathway where HCQ would only be an option. The hysteria around HCQ (and the prohibition for pharmacists to dispense it, but not for doctors to prescribe it, yes, yes, this is the French ridiculousness: Liberation: Covid-19: is the dispensing of hydroxychloroquine authorized again?) is such that an alternative must be considered. For myself and my relatives, I will not remain without considering anything.

And to make this strategy my own: 'treat the patients who present themselves as well as possible. That means testing them, assessing the status of those who are positive, and treating them with available therapies. ' ( source Covid-19 - Interview with the man at the heart of the controversy: Didier Raoult)

My available tools: Atazanavir, Doxycycline, Zinc. No PCR, but we can access it if needed, and thus initiate a treatment and interrupt it if the PCR comes back negative. The very vaccine-oriented B. Gates declared that the PCR, if the results are not quick, is useless... Yes, it does to interrupt a treatment taken blindly. I don't really care whether it works or not to the point of recommending it or not, which is not my purpose. I treat, and not with Doliprane!

In the news... As the water flows

La pitie salpetriere publishes its results in 5/7 and 4/7, under INIs, Efficacy of intermittent short cycles of integrase inhibitor-based maintenance in virologically suppressed HIV patients. It works! What did you expect?

The genius of French

I find this video, anachronistic, in the air of time...

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good weekend, good stuffing and not too many meds ... Huh?