Reservoir measurements-1

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

Reservoir measurements-1

Measure your tank: # 1 total DNA-HIV

The draft Backonstage
[...] I am observing seamless, undetectable for 15 months and no further infection with my virologist then we decided to test the mono Tivicay ® ... strong advice of Charles Edward, his arguments did fly ... [...] Beginning February 23 for me and the first record on April 4 and then 1 every month for 3 months, then every 3 months 1 for 6 months and 1 per semester
A Charles-Edouard
I adore you you're really top ... Where are you taking all this knowledge ... THANK admirable

Back, you read me a long time. If I could be useful to you, you see me happy. I wish your project to succeed as much as mine.

How to measure the tank?

Christine Rouzioux we read here (magazine of the French Society of Virology)

The quantification of total DNA-HIV is by far the most used method. It can be applied on red blood cell, PBMC samples (Peripheral Blood Mononuclear Cells) or whole blood. It measures all forms of DNA-HIV present in CD4 + T cells and monocytes, whether integrated or not integrated. This is a global approximation that can be criticized because of variable effectiveness without doubt to extract and amplify the different forms of HIV DNA within the same sample. However, it remains the simplest [...] and usable in many laboratories.

The reference method, it consists roughly to infect a blood bag and see what happens (Viral Outgrowth Essay). In fact, the only method that puts everyone agrees it is to interrupt the frequent monitoring and see when it bounces, in vivo.
The top = measuring time to rebound.
I look 2: measurement of total DNA and HIV-time measurement rebound. I speak here of the total DNA-HIV, now available in lab city. Well ... It wipes the plaster.

Rouzioux total HIV DNA tank Siliciano Hypodolu Salpetriere PCR Viral Outgrowth Essay Already, check your lab does. The CBCV fact they subcontract to the Salpetriere.
Again, this is very recent, it is appropriate to go where we can.

1 It is not therefore not reimbursed codified: So ... Results: within 3-4 weeks
2 it costs only 70 Euros (out of pocket)
Indeed, even when one considers the relief, it has no practical use. The idea that the reduction is done under reservoir condition is false, nothing justifies, and even made Leibowitch proven otherwise. How clinical decision the extent the total DNA-HIV can she drive? In practice no! Unusable, therefore, not reimbursed by health insurance (and that's good and it suits us!)

3 can have its result without going through the doctor box
Genetic analyzes are delivered by hand by the doctor. It's the law ... This is a count, not a DNA analysis: there are blind ... If we refuse to give you the result, ask the service biologist understand and give you your results. Otherwise too bad, wait until the next visit to the doctor.

4 as it is not paid, your doctor can hardly deny you the order.
Indeed, it is useless ... So we do not pay you! But as you pay for and this is more a bottle when your blood test, therefore, safely, on what basis your doctor Could you refuse the order? ... Bingo!

Now you know to do now ... Do it ... Be aware from his own experience that it is possible, simple and useless is a good way to put hysteria tank in perspective.

We have fun with the toys that have been ...

Note of 30.4.2016: I added the interruption by analytical method.

Good Night and Good Bourre!

Katlama EACS-2015

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

Katlama EACS-2015

Katlama EACS-2015 (Poor Genvoya ® ...)

Read in this lively discussion here:
[...] It would not give me Tivicay ® monotherapy ... so: Tivicay ® + Truvada ®.
600 + 500 euros !!! 1,100 euros / month = this is crazy!
I wanted to try Tivicay ® (+ possibly associated with Lamivudine) but she refused. I hope I do not have issues like in September with Triumeq ®!
What do you think ?
Eviplera ® damn transformed me physically ...

It gives you everything you need to succeed: You do the sorting for some time, you valid (close CV) you let Truvada ® in the closet, you valid (close-CV). Well ... Did she spun monotherapy air to touch it ...

There are only two questions to ask:
1 - Tivicay ® monotherapy (m ') is it possible, and if so?
2 - maintenance, 10 mg is it as good as the 50 mg?

Tickets for EACS-2015 starts here ... Here I pruned the summary of the presentation by Prof. Katlama EACS (Salpetriere, see here) (transparencies are there). This is the perfect example of the study when it is appropriate to read the details: in addition, details are presented. Thank you Christine! If the earlier use of Stribild ® (now Genvoya ®) closes the door of the monotherapy of Tivicay ® 1/4 of these patients, and only to them, they make the mouth!

HYPO-DOLU EACS 2015 monotherapy Tivicay dolutegravir Christine Katlam Genvoya Stribild Barcelona hiv Background: [...]. Dolutegravir, an inhibitor of the latest generation integrase (INI) with high power, long half-life and high genetic barrier in vitro and in clinical studies has potential for monotherapy. Methods: This observational study recruited patients with HIV-RNA CV (VL) <50 cp / ml for at least 12 months, CD4> 350 cells / mm3, with no faults INI; they changed their effective treatment for mono-dolutegravir 50 mg / day. [...]. Data are presented to S24.

Results: 28 patients in total with a median of 624 CD4 / mm3 [...]. Thirteen patients had prior exposure INI (n = 13). DNA median was 195 cp / 106 cells [94-641].

The proportion of patients now VL <50 cp / mL was 96% (95% CI: 79-100) to S4, 100% (85-100) to S8, 93% (76-99) to S12 and 92% ( 75-99) in S24.

Three patients [...] had a rebound with the emergence of resistance mutations INI [...]. The concentrations were in the normal range in all three patients. genotypic resistance retrospective analysis based on DNA-HIV showed no INI-RAM [mutation associated with resistance INI] in patients exposed to Inis pt except for # 1 with 74I previously under suppressive therapy containing elvitegravir .

[...]
The usual Cassandras, journalists photocopying, useful idiots, were too quick to point out the failures 3, indiscriminately. By hiding us the details.

Among the hundreds of patients who tried the monotherapy Tivicay ®, there are only 4 patients where it makes the least (1 in Barcelona, ​​3 in Paris) and in every single case the prior use of the INI first generation ( RAL or EVG) is mentioned as an explanatory factor.

So, I would ask the question:
It is known to contain the risk only patients who used the ancient INI. For others, what about the dose?
This is, among other things, that you propose to explore in future posts.
For us, this study Katlama: it's great! The victory assured!
The results PADDLE (Dr Cahn) and Katlama-EACS2015 open a new field. Stay tuned: our victory is there; our enemies are struggling, unsuccessfully, such fatty fish out of water. Poor ... they entangle themselves ...

Good weekend and good fuck!

Monotherapy: Olé

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

Monotherapy: Olé


Monotherapy: Olé!
I'd like to go around the world for about 6 months: How to treat? I can not go back to France every month [...] If I understand you started a therapeutic relief to reduce the number of drugs and thus need fewer pills during your stay abroad.

I already told my doctor relief and he will not do it [...]

Otherwise I might be forced to return after three months, it looks like a prison, in short, thank you for your help :)

The only passage in the monotherapy Tivicay ® does not respond to this question: we must learn to reduce the dose: it's healthy and useful.
With conventional treatments: ICCARRE 4/7 or 1/7 (4/7 ICCARRE enough to this project); with the monotherapy Tivicay ®, consider dose reduction or Hypodolu.
Monotherapy Tivicay ® has the wind in its sails. It is understandable...

And for the stock, there is only one way: save, thus reducing the dosage.

There are only two questions to ask:
1 - Tivicay ® monotherapy (m ') is it possible, and if so?
2 - maintenance, 10 mg is it as good as the 50 mg?

Tickets for EACS-2015 starts here ... Here I pruned the summary of the EACS presentation by Univ. Barcelona (transparencies are here):

HYPO-DOLU EACS 2015 Barcelona monotherapy Tivicay dolutegravir Esteban Martinez Barcelona hiv

Dolutegravir Monotherapy in HIV-Infected Patients with Sustained Viral Suppression: A 24-Week Pilot Study, J. Rojas et al.

Goal:

[...] We have tested the feasibility of dolutegravir monotherapy in patients with treatment options limited due to toxicity problems, interactions, or resistance.

Methods:
Patients without failure or without mutations previously documented proven resistance to integrase inhibitors and with plasma HIV-1 RNA <37 copies / mL for at least 12 months had their antiretroviral treatment (ART) changed dolutegravir 50mg OD [ ...]. primary endpoint was the proportion of patients without new treatment failure (do not go through = failure) at 24 weeks.

Results:

33 (22 IP-18 in monotherapy) patients were included [...] 39% with prior AIDS events, 8 (4-13) years with undetectable HIV viral load, CD4 596 (420-843) cells / mm3. [...] Only one patient of 33 had virologic failure at week 4 (88/155 copies / ml). It has been recommended that increasing the dose of dolutegravir 50 mg BID, but he continued 50mg OD. Viral load remained detectable at 24 weeks (79/101 copies / ml). RNA genotypic resistance tests for HIV and DNA at 4 and 24 weeks did not detect any mutation of the integrase. [...].

Conclusion:

Dolutegravir monotherapy is an option that remains to be confirmed in randomized clinical trials.

What remember: it goes smoothly. One exception (of 37 patients): a multi-treated patient coming, especially a treatment with raltegravir (Isentress) this 'failure' with little consequence because the CV is very low: the patient remains under monotherapy Tivicay ® 50 mg / d. Note also that the mutation (118R) is a mutation cul-de-sac that reduces slightly the efficiency of DTG without opening a path to other viral mutations and therefore exhaust.

For us what matters is that it seems to work for 32 of the 33 patients (96%). For one of the two patients who previously took an INI first generation, it does, for the other less ... and when it makes the least, what is proposed? Increase the dose ... The second line following Tivicay ® is Tivicay ®: it is its own antidote.

Question: (? Horse, initial) when it does, what is prohibited to reduce the dose

To repeat: 95% of patients, stable and undetectable, are unnecessary and harmful on-medication!

WHO proves us right

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

WHO proves us right
WHO gives us reason!

It is not allowed to change your mind ... We read with relish this:
There are obvious advantages to treat as soon as possible:
- Avoid the virus develops in large numbers and settled in reservoir cells where treatment can no longer reach
- Be quick undetectable and therefore not contaminating
- Avoid all risks of opportunistic diseases
- Then go quickly to a lighter treatment.

The relief available to earlier treaties, this is factually untrue. Well ... There is progress ... It's hard, but it fits ...

Dose reduction is sometimes presented as an exception, conditioned to a blood test. It is practiced as well in Geneva and Quebec. It is too restrictive.

Dr. Lanzafame (Verona) is the reduction of maintenance dose, without selective condition, other than undetectable achieved and maintained a good time. Dr. Leibowitch same: de facto, its short cycle (5/7 or 4/7) reduced the dose received. Dr. Cal Cohen (FOTO test, total success) even published its concentrations (C Through) well below the concentration 'recommended'. Dr. Lanzafame also published verbatim by patient patient, pharmacological results: undetectable is maintained in all patients including those whose concentration is very low.

The approach went Lanzafame is the universal reduction: it is not conditioned. He tried several maintenance formulas: protease inhibitors, integrase, or non-nukes (Nevirapine, Efavirenz). Total success every time.

Clinicians, poor countries have done the same ... Funding Gates for 12 million USD. This time, in treatment of attack: these are the ENCORE-1 trial, ENCORE-2, EVEN-3. Again, with success.

But what thus takes them all to question the dose imposed by the manufacturer and approved by the FDA? And see, every time, it works!

Try it (must still try ...) it is to adopt.

This is what comes to the WHO, against the current pharmaceutical lobbies, and for the greater good (mental) millions of patients: The valid WHO reducing Efavirenz 600 mg to 400 mg. It is here, p.7.

WHO Lanzafame efavirenz encoure1 hiv hiv AIDS WHO TLE400 Cipla Mylan 400 mg

[WHO] also recommends the use of a dose of Efavirenz 400 mg as an alternative option for first-line for adults and adolescents to enhance the tolerance of efavirenz, following a finding that 400 mg dose was as effective as 600 mg, but with fewer side effects.

The Indian manufacturer Cipla announced this week that it is preparing to launch fixed-dose combinations containing 400 mg of efavirenz. Mylan Laboratories will also launch its own fixed-dose combinations in early 2016 at a price of $ 99 [NdT: year]. UNITAID said that the transition to a 400 mg dose of efavirenz could result in savings of $ 80 to $ 100 million (US) globally by 2020.

The cons, Dr. Gottfried Hirnschall (WHO).

At Mylan, the drug in one pill, once daily taken, bears the name of TLE400. Read the press release.

Manufacturers will apply for approval to the FDA, and get it, why doubt it? It is required to provide the international donors (American ...).

The valid WHO, FDA approved, but you, you are not entitled ... Why?

As effective, with fewer side effects, it's best! Point bar.

Well ... Let us rejoice: The relief came at WHO, without fanfare, but went anyway! When it's in, that's it!

We will discuss the implications for us in a future post.

By then join the discussion. The most active is in Stribild EACS-2015 Hocqueloux

Good Weekend and good fuck!

The brilliant Dr Cahn

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

The brilliant Dr Cahn

The genius of Dr. Cahn

Tivicay ® monotherapy, interested. I received the following question:
Under Stribild ® for 2 months on the front line, went to Eviplera ® and Truvada ® + ® Tivicay. Always side effects of Truvada ®, I would experience the mono Tivicay ®.
Why have undergone ® Stribild a priori it could without resistance we exclude from mono Tivicay ®?

I give items on the comment of the ticket: Stribild ®, EACS-2015 Hocqueloux

Questions help me build the note on the presentation of Ch. Katlama at EACS-2015. Thank you! For the impatient, see the slides and abstract.

Given the total blackout in our favorite media, I'm in no hurry ...

The future of therapy under the dolutegravir angle (Tivicay ®) is easy to envisage.

There are only 2 questions to ask, to collectively and individually:
1 - Tivicay ® monotherapy (m ') is it possible, and if so?
2 - maintenance, 10 mg is it as good as the 50 mg?

2 questions, not one more ...

The genius of Dr. Pedro Cahn is to have responded, in part, to these two questions at once.

Its Dual Therapy of attack, without fail, on naive patients, that in the mouth corner. Especially as Lamivudine, hanging keychain with DTG, is very powerful, and do not synergize with DTG.

This almost monotherapy in treatment of attack open, obviously, the door to the results in attack monotherapy (*). It will eventually come out, probably in 2016 ...

Already the US are building their pitch to finance a large trial on maintenance of combination therapy DTG / 3TC. And again at home what is already acquired at home ... The test, ASPIRE (NCT02263326) is announced here, is no different from our test LAMIDOL

PADDLE, too, will be remade in the US: NCT02582684; by the AIDS Clinical Trials Group

The ING-111521 trial has already shown that monotherapy Tivicay in attack on naive patients, it is possible. The clinic will confirm what we already know.
This same ING111521 test which allowed the manufacturer to claim that 50 mg is better than 10 mg. The higher the dose, the greater the response is quick: the speed of response is in proportion to the dose.

True, but we, we do not care: what interests us is the maintenance of the response.
Not the response speed, the attack ... It depends, a bit, of the dose.
Dr. Pedro Cahn shows that it depends mainly on the initial viral load.

Paddle EACS 2015 Lamivudine dolutegravir Dr Pedro Cahn undetectable

I have classified the patients, the picture presented by Dr. Pedro Cahn, by CV before treatment. (See this post)
We see very clearly that undetectable long in coming when the viral load is high.

And also, that entering the home straight, passing under 400 copies, ensuring the ultimate success, is obtained from the 10 th day (look, this is true for 19 patients: 19/20), as in the attack monotherapy trial: ING111521 (9/10)!

With or without lamivudine, the result is the same ... (*)

So, one can bother taking lamivudine (300 mg, 1 time per day) at the beginning. Without losing sight of removing this accessory, futures (*).

The test PADDLE (*) thus sheds light on what ING111521 plans: the maintenance Monotherapy Tivicay ® is possible. (*) = Treatment-naive patients, therefore / or have never taken INI

It also illuminates the second fundamental question: 10 mg instead of 50 mg, is it sufficient for maintenance?

You do not see what PADDLE sheds light on dosage reduction? See you soon for a future post.

It's fascinating, is not it?

ICCARRE and remission

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

ICCARRE and remission

ICCARRE and remission

I deliberately differs ticket which discusses the presentation of Ch. Katlama at EACS-2015. For the impatient, see the slides and abstract. This is the final blow ...

The questions people will start retrospectively to ask are devastating ...

Tough for doctors: my doctor is zero, its entire design is destroyed:
- Yes, the TasP, it works
- Yes, it works the PreP
- Yes, there are non-drug interactions described
- Yes, it works relief

My doctor is destroyed. I want him in a bit. Even many ...
I see that the change will be painful. Looking back ... All this wasted time and all this unnecessary suffering inflicted. Today and tomorrow ... How to manage the inevitable turning towards the relief?

Here are a few open questions: What is Triumeq ®? Is prescribe Stribild ® today do not restrict future options?

Should we wait? Yes ... we can wait ... wait what? Wait until when? At one point, he must turn his cuti, and change software.

If doctors do not change now, they will find themselves at odds vis-à-vis patients, which themselves are asking questions and finding answers.

Yes! ICCARRE it's a good plan! ... No doctor (not the unique case, not reproduced, Hutter, Berlin) has never offered not even a year of remission in chronic patient.

Leibowitch, Cohen, Faucy, Dybul, Butler, for ten years or so, demonstrated the concept pharmaceutical remission. Leibo explained here.

Reducing medication on 40-85% ICCARRE offered an average of three years of remission without medication and without virus per patient, saving approximately € 3 million for only 94 patients [...]. In addition, it should be emphasized again, 4 days / week, there was no any viral escape, among 94 patients. Over 10 years, avoid over medication, useless, equivalent to a saving of four years without HAART and virus free.

Even among the few Visconti, only a few have a lasting remission: the vast majority, the honeymoon lasts only a few months at best a few years: They count their years of remission.

How do they count their years of remission? They contemplate the years of non-drug taking, triple therapy years remained in the closet.

Well me too ... I can do the same ...

ICCARRE HIV cure HIV remission Lamivudine relief sparing economy Visconti
There are so many that it's not easy to keep everything on a photo. There are so many! To facilitate taking pictures, I am limited to lamivudine, since it speaks to everyone: almost all patients taking lamivudine, fluoridated or not, coformulated or not. If you see 3TC or FTC in your combo, then that's it ...

This is not it poses a problem of toxicity identified (although ...) is that goes with it ... And then the accessories, toxic, are varied. I circumscribe the Lamivudine, it speaks to everyone. In his head, just multiply by 3!

I have to Leibowitch (and certainly not to my doctor ...) years of remission!

To discover: Here a recording transcribed by the family committee:

ICCARRE HIV cure HIV remission Jacques Leibowitch Garches relief
If doctors do not do what I [Leibowitch] do, that's their problem and it is your problem. Defend yourself, demand your right to fair dosage, because it's going to be real news to me. The news is yes, you can reduce 40 to 80% HIV maintenance treatment. That's the good news

That's the good news!

Jackpot

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

Jackpot

Jackpot and small cachoteries

PADDLE, unveiled at the EACS-2015, and already commented here and there (see the slides) is the hot topic. For those who understood my page on monotherapy Tivicay ®, and my comments on its effectiveness, these results are not a surprise ... It works, illico monotherapy Tivicay, attack, on 7 patients on 10 of the trial NCT00708110 (ING111521), which lasted only 10 days ... So, obviously, we're not surprised.

And we are not after our surprises (which are not ...)

This is not only very powerful but also overdosed! Just wait ...
It will eventually come out ... If you read well ING111521 test is in it.

soon we will ask two questions:

- Stribild ® he still has a place on the front line?
- Triumeq ® it is a useless medicine?
And ... How did it happen? How is it that a clinician or Argentine ahead of the (alleged) 'flagship' American or French? There has not been a clinician in the US, the country's pharma-business, for having had the idea; idea that they denigrate the pretext that all these little tests are done off the 'declaration' official '. We, who cares ...

® Shionogi, ViiV Healthcare ®: Jackpot and other cachoteries

Sovaldi ® was made famous by its exorbitant price. Gilead Science has for itself in one year the acquisition of Pharmasset, small-scale company, with the sofosbuvir for 11 Billion Dollars. The insured the solvent world have felt pass. Stribild ®, the same manufacturer is 1/2 million dollar income per new patient enrolled: 2500 USD / month / patient: US $ 30,000 per year for the duration of patents ... What we will do last at least 20 years ... it's been at least $ 600,000 / patient.

Shionogi, with its dolutegravir will not be outdone. Unknown to the general public, Shionogi, Osaka, Japan, has already made famous for inventing the best inhibitor '3-coenzyme A reductase Hydroxymethylglutaryl' rosuvastatin. Rosuvastatin? Yes, the famous Crestor ®, as useless as dangerous, but has excellent potential inhibition. Marketing via the English Astra Zeneca (formerly Imperial Chemical) makes a blockbuster, one of the biggest profits of the pharmaceutical industry.

So to inhibit, inhibit Shionogi knows ... And it relates. It remains to find a business partner: this time it will ViiV Healthcare. Dolutegravir will generate huge profits at the expense of Stribild ® and insured, but that was already officially recorded. The squabble ViiV vs Gilead is hilarious, except that the victims are the patients and the financial statements (hence employment ...). With its excellent result, Shionogi will sell quite expensive to ViiV its molecule, in a deal that is of the same order as the acquisition of Pharmasset. Technically less obvious but of the same order of magnitude. Sales in 3 parts:

HYPO-DOLU monotherapy Tivicay dolutegravir Shionogi ViiV healthcare
- Shionogi is allocated, free of charge, 10% of ViiV Healthcare,
- Shionogi therefore recover 10% of all profits ViiV without deadline
- Shionogi also earn a royalty fee on its molecule for life.

ViiV Healthcare is estimated at 23 billion Euros, thus 2.3 billion live in the pocket of Shionogi. The agreement was sealed in 2012. Welcome gift. The course is multiplied by 5! This is the Jackpot! (Deserved or not according to the convictions of each).

At GSK, the main shareholder of ViiV Healthcare, we are happy, it was the molecule that kills, but was allowed to pass 2 billion, plus royalties. Then we have a plan (which, Shionogi, thief at the fair, will find nothing wrong, his silence is acquired, at great cost ...).

As Astra Zeneca (perfidious Albion ...), ViiV (GSK), is very familiar with the workings.

First, from there, the Japanese researchers are invited to return to their dear studies and not trumpeting the extraordinary power of DTG. The language elements are: DTG is good.

And above all, we do not go further ...

Cachoteries:

Was the article cited above, published three years after the trial (3 years! ...), And its formalism imposed (Table patient characteristics before treatment), we would not be aware of anything ... only this table allows us to affirm that Emax is higher than the 2.6 announced (and probably much higher ...). If you do not have the picture, you can not you realize qu'Emax is underestimated. So do not worry ... This table will disappear.

HYPO-DOLU monotherapy Tivicay dolutegravir Emax NCT00708110 ING111521 undetectable Will also disappear 7 patients (70%) undetectable after just 10 days. monotherapy.

Shionogi while its complacency, brings up the 7 Samurai in the body of the article and in the table. They are there ... But once the agreement is signed, they are silenced: the article is completed by a pharmacokinetic graph, where the designer has made two mistakes; an erratum will be also published to correct an error (but not the other ...). In short, the authors and auditors (reviewers) have missed without seeing the error. The most obvious is that the 7 Samurai became the 3 Musketeers, who, as everyone knows, were 4 ...

In all communication that follows, especially monographs submitted to the FDA, the original table is withdrawn in favor of a differential picture, and 3 of the 7 undetectable through the cracks. It buries ... The FDA does not even mention, and in the documentation provided to the HAS (. See p 11), the ING111521 trial is not even subject: as it is even simpler!

The ViiV plan will allow recovery of the 2 Billion (and more): adding a junk 2 francs 6 under (Kivexa = ABC + 3TC), généricable and manufactured at very low cost, and increases in the price of the drug 50%. In coformulant diamond and glass beads, it increases the profit of 50%. Combined with DTG, here valued at 350 Euros per month ... For patients and potential side effects, too bad for them ...

And now ... Life is beautiful ...

Good weekend and good fuck!

Stribild ®, EACS-2015, Hocqueloux

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

Stribild ®, EACS-2015, Hocqueloux

Stribild ®, EACS-2015 Hocqueloux

Here is a comment that leaves me speechless (with Stribild ®, soon Genvoya ®)
I just read on this blog that the monotherapy Tivicay (tm) was not recommended for people being already under Stribild (tm). Under Stribild (tm), I currently oscillates between 3/7 and 4/7 and I have no problem except that renal function is in steady decline since the beginning of treatment there 1½ years , decrease in low but still constant proportions. Stribild (tm) is my first treatment.

The question is a good reply to the frightened souls (and subsidized).

Prudence they say! Sure ... But also prudent to preserve his organs, all his organs. Renal disease can not be overlooked. A kidney is more important than profits.

Tenofovir (included in Stribild ®) is the most likely cause. There are so many options to transfer Tenofovir ... The proposal to replace the difumarate Tenofovir alafénamide by tenofovir (in Genvoya ®) more commercially attractive than therapeutic.

Anyway, we must descend into the valley polluted from 7/7 to properly validate any new strategy. And, as both do, get rid once and for all tenofovir. Basta!

I will return soon on the results of Ch Katlama at EACS-2015. It might (the conditional!) That users (past or present) first generation INI (RAL or EVG) are required to advance in single strategies Tivicay ® therapy with redoubled caution. For others, it's nickel in nickel ...

The manufacturers know the on-medication (ie legal poisoning): They will therefore propose 'copies' of their généricables molecules, at lower dosages, but a greater strain on the patient: obligation meals and observance 7/7 : it maximizes profits while there are proven solutions that relieve the patient at all levels. First generation INI were helpful, thank you ... Let's move on!

Nothing is easier than to be prescribed Tivicay ® + Lamivudine:
Since EACS, it goes like a letter in the mail. And if you do not succeed, take Rdv at: Reynes (Montpellier), Hocqueloux (Orléans), Lafeuillade (Toulon), Katlama (Paris): there are spoiled for choice. Once confirmed undetectable, is simple to continue: we do not change a winning team!

HYPO-DOLU EACS 2015 monotherapy Tivicay dolutegravir cohen Pedro Cahn Paddle
Dr. Pedro Cahn (PADDLE trial), he has the honesty to provide raw data.
Monitoring patients (DTG attack treatment + 3TC, 3TC which serves as decoration ...) allows to put into perspective a little quick affirmation of the manufacturer: the higher the dose is high undetectable soon be reached. The 50 mg dose of the original horse, provides undetectable every time.

It is especially obvious here that the time the virus remains detectable is in proportion to the initial viral load.

Therefore, keep the horse initial dose (50 mg to 22 Euros per day), to life, to hold a lentivirus, confined to his tank, is a question more legitimate.
Treaties: YES, processed and taken for idiots: NO ...

DTG + 3TC is a virtual monotherapy. Farewell resistance implies that DTG is super-efficient and that the dose can be optimized once the infection subsided.
If you come across a clinician who does not understand this, take your legs to your neck, and leave the poisoner in white coats.
Simplification dolutegravir in mono- or dual therapy maintains viral suppression in treatment-experienced patients, Laurent Hocqueloux

HYPO-DOLU EACS 2015 monotherapy Tivicay dolutegravir Laurent Hocqueloux bitherapy

His post at EACS includes such impressive results for 52 patients pretreated using dolutegravir in mono (n = 21) or combination therapy (n = 31).

Here, nine people had prior experience with an integrase inhibitor. median follow-up of 27 (IQR 24-40) and 45 (IQR 25-70) weeks in mono and dual therapies, respectively, all but one participant maintained viral suppression <50 copies / ml (96% of CV < 20 copies / ml). Only one case of viral rebound in a patient, very few observing under dual therapy DTG / Maraviroc.

Note, 2016-10-09 : the complete report is available:
Dolutegravir-based monotherapyor dual therapy maintains a high proportion of viral suppression even in highly experienced HIV-1-infected patients

To repeat: 95% of patients, stable and undetectable, are unnecessary and harmful on-medication!

individual testimonies

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

individual testimonies

personal experiences



Posted in the face of Charles-Edouard:

... I have a friend who starts following the experiences that are read on the forums, and in the end he is grilled with a molecule resistant to the virus ...
This is why it should not be limited to read reviews, personal stories on the internet! ... The good and the bad ... Why ?

Bad experiences:
They are rare, which is normal: the failure rate in tests is low. (5% when following a random selection protocol, and 0% if it is known navigate)
In addition, the one who tried would not lead off, he finds himself rather con; and do not brag. Too bad they do not testify, themselves, directly.
The man who saw the man who saw the man who saw the bear ... that's interesting but it does not count!

Good experiences:
iccarre friends richard cross cuts garches hiv
There are many, but the advantage is that one that makes relief feels better, including in his head ... the motivation to testify diminishes! One sentence, testimony, sums up:
Obsessed with HIV and its host of side effects are just a bad memory for me. Today HIV is not present in my life.

Leibo among patients, some gathered their testimonies in a book published, of great aesthetic quality; others have gone on TV: what more?
Clinical trials:

They are led by 'investigators' ... responsible for ensuring that we do not tell everything and anything. You have to read the tests, read the eligibility requirements, and reserves written by the investigators: they are certified testimonies.

Is it easy to read and understand?

NO. First have to find them, sometimes you have to pay for access, and is in English (technical). I still made the effort to collect and translate ALL ALL.

The latest is: www.tinyurl.com/CHE-FASEB2, and here on this blog.

Can we draw a line of conduct?
YES: there are now 4 trials published, documented and ongoing. 300 approx patients. it starts to make sales ... We will not wait until 1000 or 10000!

(The single IP therapy, validated by the report Morlat (ANRS) is 3 different options and it is only 1,200 patients ... it gives an order of magnitude)

But it is not easy to do ...

That is why I regret that no splint it and that, by, default, I formatted and available to all, proposal, argued, to discuss with her doctor.

Guideline is summed up in 3 words:

Effectiveness, progressiveness, close CV

- Carefully check the effectiveness of a strategy before moving to the next
- Getting there gradually
- Frequently check (to avoid a possible replication has bolted)

The individual testimonies are postcards. They make us perceive a territory.
Clinical trials are a mapping.

To resume a fashionable author: map has more value than the territory ...

The route is a path on the map; down the road postcards.
The reliable route is made possible by the card.
The practical guide 4/7, most popular document will soon be 1 year. I honed, but the important thing remains intact. If one day we have an RTU, RTU will be accompanied by a "Therapeutic Use Guide", inspired by the GTU proposed by the instigators of the RTU, in the opinion of the ministry.
It is based on the same card. It leads you to the same place. Wait a GTU (is it written?), It is expected that Marisol Touraine can read a map ...
Vast program ...

Explore a territory requires a conceptual corpus' and even the appearance of a new concept. Ch. Columbus westward from the East to find because believe that the earth is round, it's new.
Our newness, our paradigm shift is simple:
On a virus without mutation integrase (wild i.e. in terms integrase), the selectable mutations dolutegravir lead the virus reproductive impasse resistance never appears. 2 consequences:
- The efficiency is much higher than the usual glass beads
- Efficiency is independent of dose
Any dosage undetectable now is admissible. Understanding the nature of the dose dependence is made difficult because we are obsessed with the inefficiency of old molecules. This will require to change our vision, but facts are stubborn: the course is undetectable, and this can be achieved and maintained, even with low dosages.

I was comfortable with my ICCARRE 1/7 in quadruple, economical and effective. I ruled the world. From this height, the view opens, other peaks are nearby. I go back down in the dark valley polluted (7/7 ... yuck!), I'm going to climb another peak: it is not higher, but the way is without pitfalls ...

And I, still 1/7, on Monday ...

Good weekend and good fuck!

DOLULAM and EACS-2015

This paper was originally published here, in French. We provide the google translation for your convenience. Proper translation will come soon. Some practical aspects may differ where you live.

DOLULAM and EACS-2015

DOLULAM and other mono-bi therapies: EACS-2015

One of our readers asks:
If dolutegravir does not change why not take one?
Very good question ... Which leads to another:
If dolutegravir does not change why take in life, the initial dose of horse?
Indeed, 50 mg is a useless overdose.
The 2 questions and 2 answers are linked: my discussion of the extraordinary efficiency of DTG, which is independent of dose, monotherapy, leads to its logical consequence:
-1 Monotherapy Tivicay ® (DOMONO): possible
-2 Dose reduction (HYPO-DOLU): possible

Everything flows efficiency, independent of dose, the DTG. And as one does not go without the other, the same clinicians who understand that monotherapy is possible, understand, sooner or later, that dose reduction in practice: in short cycle is possible. This will be necessary ... Only fools never change their opinion: Even Dr. Molina has become the PreP: that says it all!

And in retrospect, the converts include ICCARRE. And even if they do not understand ... What's important is that the patient, she has everything to gain from this competition between clinicians.

For clinicians, independent, even, indeed, their only and last chance to exist: with injectables, more issues to experiment, regardless of firms. How to experience the Cabotegravir injection in monotherapy if the manufacturer does not provide you? You will buy an injectable combination therapy and separate the nanoparticles encapsulated with your little fingers ???

And that is the triumph of ICCARRE: the short cycle, with a super efficient therapy: the 4-T (quadruple) generic or dolutegravir (and perhaps Bictégravir - GS-9883) ... Whatever ...

Me too, I turned my cuti several attempts to pass the 1/7: if we do not change its software is becoming obsolete.

The downside is that it takes dolutegravir be fully effective ... So there is no mutation (INI due to first generation: RAL and EVG): This is why we must avoid taking Stribild Genvoya ® or ®. For those who have not taken them: Tivicay ® walk alone ... That's Christine Katlama who will give the coup de grace, as we shall see in the coming months ... Evolve or disappear ...

EACS (and / or mono-bi DTG): how much of study: 1, 2 ... No: 7 (not least ...)

PADDLE, DOMONO, Rojas (Barcelona), Katlama (Salpêtrière) Hoqueloux (Orléans), Lamidol, Dolulam (excluding Sword Sword-1 and-2). Translations are available here.

PADDLE test

Presented by Dr. Pedro Cahn (here in discussion with Dr. Cal Cohen, inventor of 5/7) HYPO-DOLU EACS 2015 monotherapy Tivicay dolutegravir cohen Pedro Cahn Paddle Summary: 1066: dolutegravir-Lamivudine as initial therapy in naive patients infected with HIV: first results of the trial PADDLE

Objectives: Based on the results of the test Gardel, we designed a test, proof of concept, which is to assess antiviral efficacy, safety and tolerability of combination therapy of lamivudine (3TC) and dolutegravir (DTG ) in initial therapy.

Methods: A pilot study of 20 HIV-1 infected adult ARV naive. Eligible participants had no resistance INI and CV <100,000 and negative hepatitis B. Viral load was measured at first, then the days 2,4,7,10,14,21,28 then every two weeks until week 12. later, the CV was measured every 12 weeks. The primary endpoint was SVR, defined as the proportion of patients with VL <50 copies / mL at 48 weeks. (Algorithm FDA-snapshot). The interim analysis (S 24) is presented ici.Les patients will be followed for up to 96 weeks.

Results: Participants received 50 mg + DTG LMV 300 mg once daily. Baseline characteristics were: the median CV 24.128 copies / mL (IQR: from 11.686 to 36.794). Four patients = 100,000 copies / mL at the base. Median CD4 count of 407 cells / mm3 (IQR 296-517). Rapid antiviral response was observed. (Median decrease in CV, at week 12 was 2.74 Logs). All subjects achieved a viral load <400 copies and 50 copies / mL. at week 3 and 12, respectively. The observed viral decay rate is similar to that reported in SINGLE-1. Fifteen patients completed their 24 weeks maintaining viral suppression <50 copies. No tolerance / toxicity problems were observed.

Conclusion: During the first 12 weeks of the study PADDLE, dual therapy with lamivudine plus DTG enabled rapid virologic suppression with a safety profile / tolerability favorably in individuals infected with HIV-1, naive treatment. This is the first report of a successful Lamivudine + INI [NdT DTG], combination therapy, in treatment-naïve patients.

DOLULAM Study: DTG + 3TC combination therapy in maintenance

HYPO-DOLU EACS 2015 Dolulam dolutegravir Dr Jacques Reynes Montpellier

Presented by Dr. J. Reynes, this pilot study evaluates a switch to a combination therapy DTG 50mg / 3TC 300 mg, taken once a day for maintenance.

Interim results (S24) were presented at EACS (27 patients). Patients mostly older, heavily pretreated.

No virologic failure were observed, 3 patients discontinued therapy (2 for adverse events) and 1 due to intensified following a blip [NdCh-E yet a blip is not a good reason to change strategy, but ...].

CD4 remained unchanged.

To repeat: 95% of patients, stable and undetectable, are unnecessary and harmful on-medication!