115

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



Omnibus at the Salpatrière!

By Charles-Edouard!

It's going well for our friend Joëlle:

First of all, we're happy for you, and as far as medical follow-up goes, look what happens:

Charles-Edouard! and OMNIBUS at the Salpêtrière

The excellent seminar at Pasteur gave us a boost. As ANRS-4D has a 100% success rate in compliant patients, what can Quatuor bring if not a confirmation? At worst, there will be some failures, but so what? We will be able to better circumscribe the eligibility... The procedure is 100% risk-free. We already know that it is 100% without damage or after-effects: a simple return to 7/7, with the same combo, is sufficient, without prejudice.

Quatuor has a mandatory checkpoint, in a few weeks. They are going to publish an intermediate assessment to authorize (or not) the candidates who have been willing to stay in the delayed arm (7/7) to switch to 4/7. We will then know how many patients, in the 7/7 arm, have sent the ANRS packing by switching, on their own, to 4/7, since it is... authorized by Morlat!

The whole of Paris that counts expects excellent results. In particular, the Salpêtrière, which has provided the largest contingent, and therefore has a good idea (patients and practitioners know which arm they are in). Quartet or not, we have the wind in our sails, and it's not to go in circles!

Leibowitch considers himself out of the game because of his age, and wants to pass the baby on. In order to give credence to this retreat(do you really believe it?), he has effectively worked to open up a presentation opportunity for us at the Salpêtrière. The echo of our success at Pasteur comes back to sensitive ears.

So here we are, invited by Pr. Eric CAUMES, to a presentation, a staff, on Thursday 27th. We don't have long to convince, but we start to be a bit broken in.

Between the initial plan, the modifications of summaries, the slides reviewed, then corrected, then rewritten, the rehearsals, it took us 4 full days to work on it: the public and the stake are not the same!

ICCARRE is a clinical concept. At Pasteur, they are a bit virginal, but not at the Salpétrière!

A large audience

A presentation by Leibowitch, that attracts! And there, you had the bench and the back bench of the whole Salpêtrière, clinicians, virologists, interns, externs, employees of the industry(sic). In short, it was anything but intimate. If some people had come for the clash, they still got it, a little!

We had come with our die-hard supporters, and fortunately! We were playing outside. On the Salpé side, at least fifty white coats: it's the biggest hospital and university center in France! (of Europe?)

Well, for the atmosphere, let's say frankly that we were received with professionalism and courtesy. This is important because the debate was intense, and the firm organization of the speech a perilous exercise and, let us say it, successful.

Presentation in three parts: Leibo, Ch-E, Leibo

The presentations will be online soon. You too will be entitled to the content.

Leibowitch started with a trick: he won't say a word about 4/7, it's a done deal, and that's not the point. He presents his clinical cases: there are a good fifty patients at 2/7 (including twenty at 1/7). That's a good picture!

Then he passes the floor to me for a mini-presentation: Dynamic Remission and Omnibus: Showing that the Eclipse exists, its dynamics, introducing dynamic remission and the (new) notion of Distance, OMNIBUS and our projects.

As you will have the slides and the topos, I won't go into too much detail... OMNIBUS? It's a validation test of the 2/7 followed by an exploration of the best synergies.

Then Leibo takes the floor again to make the case that it's time for distinguished clinicians to take over. At almost 85 years old(he says... ), he wants to pass the baton. So it's up to you to step up to the plate.

A passing exam

The reader must understand that we are dealing with experienced clinicians. You mess up on an argument, and you're finished... I know my subject well, but not everything, and they ... Yes, I do...

I mention the Visconti... And then Prof. Katlama interrupts me to ask me to define what the Viscontis are, in case there are people in the audience who don't know. Well, I'm doing pretty well, and I'll put the nail in the coffin: all attempts to recreate Viscontis (e.g. SPARTAC trial) have failed. As in the circus, the gladiators test themselves.

Small point of semantics

I mentioned that from now on we would call 'dynamic remission' what is at 1/7 (or even better), and nobody noticed... It seems to pass.

Since there are now so many proposals on the table, it was agreed to call from now on what has less molecules and intermittence, the x/7. Yes, because otherwise it is confusing! We learn, in passing, that the Salpé has about fifty patients on Mono-DTG, without any problem...

A lively debate, stormy at times, and an ultra positive conclusion

Under the firm direction of Prof. Caumes, Prof. Katlama takes over. Well... She is in front of her troops, so she paints us a pro domo picture, where the Salpé is portrayed as a proactive actor: 1/3 of patients are on lighter prescriptions. Well... We came to give the keys of the city to Caesar, so it's in the right order...

There are still some who are bothered by ICCARRE-le-Grand. Virology is the first one to shoot, and the reservoir's patati and patata. I'm taking out my public challenge: prove, by a contingency table, that total DNA is a predictor of the Eclipse's closure. I know there isn't one... But then, Katlama, reports that in MONOI there was only one real failure, but a few blippers, in whom there was a small reservoir effect, which is normal and expected, according to her.
No need to raise. That doesn't answer my challenge... Especially since she could have used her ULTRASTOP test, which she didn't do, and which reinforces my idea that there was little argument to be found there... Huh? Well... Now we've kicked you out of the total DNA with a big kick in the pants.

Roland Tubiana noted that I had presented advantageous openings of the Eclipse, measured in very early treated patients, with low reservoir. This is factually correct! We don't point out, because in fact, we can't do anything about it... The tendency, among the few clinicians who do analytical interruptions, is to choose favorable patients a priori, so as not to get too bored... We don't have recent values on 'broken arms', but we have 20,000 weeks at 2/7 (or even 1/7)! That's 20.000 eclipses, of at least 1 week, repeatedly!
So as long as the eclipse is of more than one week, whether it is of 7, 15, 21 days, we don't care a bit, for the subject of the day.

Then he laid out a known speculation, that even below the threshold of undetectability, things might be happening and that, well, there you go, that might sustain some replication and inflammation, what do I know.... What do I know, indeed... It's Nessie, the Loch Ness monster, we've never seen anything, never proven anything... It is purely speculative...

So it's a bit annoying, for nothing... But well... Leibo, he likes to show off, and the young interns who dreamed of a clash have been served. It's even better than at Bourdin or Ruquier. And then, it was the language of a rifleman! Well... Let us pass...

In fact, the bottom line is that Katlama, the story of an OMNIBUS trial at 2/7, likes it... That's it! We had plenty of marbles, arguments, pleas, but, in fact, useless: OMNIBUS pleased!

We had presented it in broad strokes, so she asked us to refine our project.
That was all! It lasted an hour, and it was agreed that we would refine OMNIBUS, and follow the usual path.

A success... I'm proud of it!

For a success, it is a success. Since it was bibi who presented it, I was a bit surprised: it went through like a charm(well... it will do... ). Well, after 4 days of preparing a nice shot in the cage, it took me 3 days to recover!

I'm exhausted... More in the next issue!

Have a good weekend, good stuffing and not too many meds... Right?

114

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



Misconceptions 2018

By Charles-Edouard!

Hello Charles,

I see your testimonial where you say you blew your copy counter and lost 500 CD4s. Quite surprising, how do you explain it?

It was a trial with DTG 150 mg, 1 day out of 7: the rest in a future post... Don't worry... I became undetectable again quickly and my CD4 came back to 950 immediately (after a step at 700)
In my case, the CD4 count is yo-yoing: sometimes I lose (or gain) 300-400 CD4 even in stable periods, while keeping a rather stable percentage... The blood counting machine does not count CD4, no... It counts the lymphocytes and determines the percentage, then it simply multiplies it. When you are in the high percentages, the slightest fluctuation in the total number of lymphocytes, arithmetically, causes a big fluctuation in the count. One day I will do a paper on the subject: the fluctuation is natural, and it is the absence of fluctuation that is not...

Misconceptions 2018

Whether writing The Book or preparing for our conferences, I find that I have to fight a bit of the same ideas that are at the root of excessive and unnecessary over-medication. These ideas, promoted by a corrupt system, end up being an obstacle to research and to a better quality of life. Just like the list of doctors or drugs, I want to make a list, to comment it and to see what changes from year to year...

The opportunity is given to me by the appearance on youtube of such an attempt to drown the judgment of the patients in an endless, useless and especially... false logorrhea.

Of course, there is no lack of misconceptions around the world: religion, homeopathy, integrative medicine, Keynesianism, the European 'nation', creationism, cholesterol, etc. It is even fun to dissect them. It is even fun to dissect, with precision, in order not to be accused of conspiracy or arrogance, which are the tricks liars use when they are pushed to their limits...

How to spot a misconception in modern medicine

All this junk is not medical in the noble sense and is treated as risk management, something people do on a daily basis, sometimes like Mr Jourdain, without knowing it.

Philosophers have developed Logic to serve as a tool. Now, we must be open to other tools. For the most banal deceptions, Atlantis, the black cat, etc., follow Michael Shremer who reviews the bullshit detection kit. In modern medicine, we have a wonderful tool: the contingency table, well explained at the beginning of this video.

In all circumstances, ask for the confusion table (see Wikipedia)

List of misconceptions

Here is a list of common ideas that we will see how (or if) they are invalidated:
Pharmacokinetics, Total Proviral DNA, Abusive Indication Extension, Achilles Heel, Bombology, Honesty of Scientists, that will be plenty for today...

Chance, you can go and watch this ultimate of stipendiated deception that is HIVonAir, and I even recommend this episode Is it possible to eradicate HIV from the body of an infected individual? by Dr Laurent Hocqueloux , Dr Anne-Geneviève Marcelin , Dr Gilles Peytavin , Pr Gilles Pialoux

Here we see Pharmacokinetics (Dr Gilles Peytavin) and Virology (tanks, Dr Anne-Geneviève Marcelin) summoned to the debate on the question of remission, displaying their knowledge, without advancing things one iota!

What is (total) remission? It is an eclipse that does not close! So any discussion about remission is a discussion about the closing of the Eclipse(its opening, at CV < 50, is a given, it opens every time)

Pharmacokinetics: it's pathetic

Pharmacokinetics is a useful science, when invoked properly! Since the Eclipse lasts on average 14-21 days, starts with a 1-2 day pharmacokinetic extinction phase, explain to me how pharmacokinetics has a role to play in the end of the eclipse? It's impossible because, from the middle of the Eclipse, there is nothing left! And if someone insists, insist on a confusion table where PK is able to predict anything about the end of the Eclipse: This is the public challenge to Gilles Peytavin: show, by a confusion table, that PK is involved in the end of the pharmacodynamic window (the Eclipse).

And if you can't do it, please go back to your studies and don't bother the debate anymore: it' s pathetic.

We don't care whether a viremia leaks into the sperm a little, a very little or a very little: this is the strength of the Swiss statement, clinically confirmedto affirm the non-infectivity, notwithstanding the possible presence of viremia in the semenso we don't care. And it has nothing to do with the closing of the Eclipse! Goodbye Berthe!

Proviral DNA: off the track

Rouzioux has been pumping the air for more than a decade to make us believe that proviral DNA is predictive of anything. She recently added another layer here: this marker is easy to use, precise, specific, practical, robust and reproducible. Let's comment: easy to use(yes, so what?), accurate(oh really? +/- 1 log , is that accurate?), specific(of what? with more than 95% of Junk, unable to replicate, it is specific of what?), practical(yes, so what? practical if it doesn't bring anything, what's the point?), robust(well, come on! prove it!) and reproducible(yes... it's also a characteristic of systematic errors to be reproducible). A good measurement must be accurate, faithful and sensitive: but this thing has no sensitivity! You might as well weigh a coin with a weighbridge!

This is what Anne-Geneviève Marcelin demonstrates with her onion diagram, which must be read with a Log scale in your head

By the way, ask for the confusion table: in ICCARRE 1/7, ANRS-4D, SEARCH 019 it is impossible to establish! To be a predictor of failure in short or ultra short cycles, there would have to be failures! Oh yes, it is a poor predictor in an equally poor alleviation: the Mono-IP. How does Mono-IP contribute to the remission effort?

This is the public challenge to Anne-Geneviève Marcelin: show, by a confusion table, that the total proviral DNA measurement anticipates the end of the pharmacodynamic window (the Eclipse). And, if not, go back to your studies, without stuffing us any more. Thank you very much...

Well... You remember the famous 'Rouzioux criteria': not one of them has withstood ANRS-4D: laminated. So, we hope not to see it again on our screens!

the Abusive Indication Extension: inexcusable torture

The U=U is a valid argument to present to the patient who is reluctant to enter treatment, in the absence of even mild immunosuppression (CD4 > 350). And if this is not a concern, it is criminal to impose a treatment without demonstrated benefit.

The START trial, where all the excess morbidity occurs in the countries of the South, whose sanitary conditions have no comparison with those of the North(go and catch tuberculosis in Sweden or a fatal salmonellosis in France, it's ridiculous!), demonstrates, contrary to the vulgate, that the over-risk in the North is null: indeed the over-risk is exactly proportional to the real over-risk in the South (TREMPANO) and the null over-risk in the North(HIV-CAUSAL)

Here again ask for the confusion table! That of the North, of course! The risk in our over-aseptised countries is out of all proportion to that in Zimbabwe(who would be stupid enough to believe it?).

You are promised a better immune restoration to enter the treatment (too) early: here too, demand the confusion table! Yes, the confusion table! Because no one ever gives it! And for good reason!

The Achilles heel: a concept to be invalidated

The Achilles' heel(I named it that) is a weakness in DTG induced by the previous use of RAL or EVG. This risk factor is amply confirmed (BMM+P cohort) and even confirmed(sic), a little late, it is true, by the authors of DOMONO!(resic). So it is not a false idea! But it is a not very specific predictor. Sensitive, but not very specific. It is a predictor that can be read in the patient's file. Yes, it is. But the virus doesn't have a periscope to read, over the virologist's shoulder, what is in the file! It only knows how to 'read' DNA. The day we will also be able to read and predict, with more specificity, that day, the Achilles' heel will be obsolete. Until then, it remains the best we have! But you still have to take the trouble to read the file... Hein Hoqueloux, you've been fooled on this one...

Bombology: we just have an embryo

When the Eclipse closes, it is the end of the mini-remission. It closes around 14-21 days. , on average. For some 7 days, 30 days for others. Therefore, at 1/7, we are in no-failure mode, and who cares about having a predictor? At 1/7 we are in the white zone, the comfort zone. As the search for dynamic remission is a Darwinian process, when the patient's rhythm changes from 1/7 to 1/10, 1/15, etc., we will eventually enter the grey zone. And there, looking for a predictor makes sense.
Well... At 1/7, pharmacokinetics is in the toilet... I get it... Measuring the reservoir has a very small chance, very small unless you use another method than proviral DNA, as easy as useless... Achilles? We don't really care... Mono-DTG for 1/15??? I don't feel it... But well, the proposal exists, so we'll see. There is still the 'Science of Bombs': in Choke-and-Mute, we vitrify the system with a mega-bomb, and then we take advantage of the Eclipse. How to build a mega-bomb? A weak bi (DTG/3TC) a concrete bi(DTG/XXX, I'll come back to that soon), an unexpected TRI (NVP/DTG/X), the patented Quadri, the Dodecatherapy(I'll come back to that soon)? There is bound to be something that is better than another. In any case, Isentress®, we don't feel it... Kaletra® ??? It's not a done deal!

So for the moment Bombology, the 'Science' of the best synergies, is a bit of alchemy. We are already lucky that the Leibo patent works, but if we no longer have Videx® or if we are allergic to Abacavir, we have to find something else!

So Bombology is a technique to be developed, we need people, ideas, money and volunteers(in large numbers), we will get there. And then, one day, someone will come up with a concept that will invalidate this trial and error research.
So, it's not a bad idea, but we'll have to do it right...

I forgot about Septism: what was I thinking???

It's true that with the announced success of Quatuor, we just forgot that this nonsense had also made its time. We will develop in 2019...

The honesty of scientists? In this mercantile era ???

Here again, if you are not already disillusioned, watch again HivOnAir® or the Rouzioux video! It's so distressing that you could cry. Everyone has their own little ditty, the one they know, the one they get paid for. Look at how Peytavin embarrasses even his own colleagues in this golden galley! He can only tell you about what he knows. But is it relevant to the case? No! Then it's talk for nothing. The mistake is not Peytavin, as a person, the problem is to summon him to a debate where he has not contributed anything. But this choice is not trivial: it is motivated.

So, to see the patients, in suffering, being bamboozled in this way, yes, it is sad... The honesty of scientists? A misconception!!!

In the news

- U.S.: 72,000 people died of overdoses in 2017, a record. It's the opioid crisis... And who is it that put this on the market? And who's the one who authorized it? And who is it that prescribed them? You criminals!

- Oh, this is not recent, but the subject is fascinating: When Snails Attack: The Epic Discovery Of An Ecological Phenomenon

The French genius

The genius of the week is Charles-Edouard! You are never better served than by yourself... Honestly, I had a great time watching this conference at Pasteur!
It is now available on YouTube. That's it! We know how to do it too!

Video in 3 pieces:
Part 1
Part 2
Part 3
And the: Verbatim

Otherwise, have a nice time with the choristers, on video: a treat...

Don't hesitate to comment, like, share and use

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

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

Feel free to comment, like, share and use

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!

111

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



By Charles-Edouard!

From a user of Kivexa/ Viramune (NVP/ABC/3TC):

Viramune is among Leibowitch's favorites. A priori we can do 4/7, since Leibo has published it in ICCARRE and the APHP has even taken out a patent. On this basis, we can go up to 2/7 or even 1/7. It would be a shame to change it. The 1/7 has been published very officiallyby Pr. Ch. Peronne, head of the infectious diseases department (the highest 'rank') and Vice-President of the Technical Committee on Vaccinations. More Kosher than that you can't do... But, well... If nobody talks about it, the patient, kept in ignorance, misses it. Too bad...

What is a PTC (Post-Treatment-Controller)?

Everyone knows the Visconti: those patients who were treated early, too much (too much?) and who, after an average of 7 years, stopped the treatment and found that the virus did not return. Asier Saez-Cirion (Pasteur Institute) published an article that made a lot of noise.

We are talking about control over very long periods, not just 3-4-5 months as is often found in Eclipse measurements. The Toronto patient (3-4 months of control) or those of Boston (9 months) are not part of this.

In France, we found these controllers in people treated early. It was concluded a bit quickly(as soon as you see the name Rouzioux, you know there is a wolf) that only early-treated patients can claim this status. We shall see below that this is not the case... Let's just remember that a PTC is a patient who controls her virus, in the long term, following a treatment and its interruption.

Are PTCs unknowing Elite Controllers?

With the AIE (Abusive Extension of Indication), patients who could hope to control their condition are put under indiscriminate, interminable treatment, without consideration of the health environment or the clinical picture. If the treatment is withdrawn, and it was useless, it will show... There, the patient is going to give the doctor(s) a hard time, that's for sure!

That's about 0.5% of the treated population. Rare, but good...

We know a little about the characteristics of these Elite controllers (who are doing very well, without treatment, thank you for them, leave them alone, you thugs!). Asier Saez-Cirion is studying these Viscontis and believes that they are not crypto-controllers-d-Elite, they don't have the profile. So don't confuse: CEs and PTCs should be counted separately...

PTCs: who are they?

The mistake would be to believe that there are ONLY the Viscontis. In fact, there are (many?) others! But to find them, you have to interrupt the treatment, and look for a long time, because the control is not instantaneous: the viral load increases at the interruption and then goes down to a new very low set-point, even < 50. Jon Barnett, author of a 'disappeared' blog, had controlled (well...) after several months (so he didn't understand anything anymore...)

PTCs are not a priori controllers, but rather following their treatment AND its interruption.

So how do you find them? Well, by chance or by looking for them!

Randomized trials of 'therapeutic vaccination'. Volunteers are 'vaccinated', either with a vaccine or a ... placebo... And we ask everyone to stop the treatment, and we look on the long term, to see if the vaccine helps to regain control. There, Oh surprise, we find 'durable controllers'!!! Bingo for the vaccine ??? Well no... They were found in the placebo group... The 'vaccine', in fact, does not work at all!

We will read: The CHAMP Cohort: Post Treatment Controllers Identified from 9 Clinical Studies: it's the topic of the moment!

Another rarity: Antwerp clinicians have found patients who have been lost to time. In Paris, you don't come to the hospital anymore, you're safe, no one comes after you... These patients are renegadesIf they do not take the treatment, they stop it on their own, do not get worse, and probably do not even know that they are in control without treatment (essential before). We see that the CV is zero. And they have a hospital record to shed light on their previous clinical picture! This is not a Belgian joke... A Belgian joke gets around, but this is total radio silence. They talk about the 'Boston patients', who in fact won't control anything, and they hide the Antwerp patients under the pharma-media carpet. Ellen Van Gulck has published: Control of viral replication after HAART discontinuationand a full description here.

PTC: How many are there? Are you? TPC and ICCARRE? TPC and DTG?

Ooh... la la ... That's all for today. Obviously the subject is fascinating. There are many things to look at under a new eye, and it will be for another time ...

Judiciarization

- Levothyrox: 42 patients sue the Merck laboratory.

- Shortage of essential drugs: the Senate and the Academy of Pharmacy sound the alarm. Considering my stock, this is not likely to happen to me... Patients on Videx (BMS) are in trouble, nobody talks about it!

In the news

- Towards a universal hepatitis C testing in France. Well... Yes... There is no point in burying our heads in the sand, especially since the more we treat, the richer Gilead gets. That alone is a good reason; in fact THE real reason?

- Test DODO : 1/2 strategy with Atripla® and also good news from the A-TRI-WEEK trial (also a 1/2...) : because we tell you!
Maintenance at 3 days per week with a single EFV / F-3TC / TDF tablet is effective and decreases subclinical toxicity. That, Gallant, he never talks about it... never... The others ... either...

- Even Alexandra Calmy goes Mono-DTG! Stable HIV-1 reservoirs on dolutegravir maintenance monotherapy: the MONODO study.

The French genius

Splendid, touching, energetic and still subtle. I love to succumb to the carnal power of the interpreter the interpretation! (youtube) Ah, French music!

Note: The prototype of the 'Choke-and-Mute' presentation (Pasteur on 17/05/18) is available, and soon on youtube

Of course, we will watch the France-Croatia game.

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good weekend, good stuffing and not too many drugs ... Right?

110

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



Symfi-Lo... Finally!

By Charles-Edouard!

Another litany of abuse... ICCARRE quickly!
The mithridatization, that is to say the progressive habituation to poisons, inhibitoids or inhibitors, does not remove the toxicity. It is less perceived, that's all!

Symfi-Lo = TLE-400

Symfi-Lo is the first drug to market the TLE-400(Tenofovir-Lamivudine-Efavirenz 400 mg) mitigation strategy. We discussed it in our post WHO proves us right! Well... The progress of this case will have been extremely slow, and the practical implementation is coming on the market: it is not too early! Something must have tipped off some people, and the Kirby Institute has obtained funding($11 million, if memory serves) from the Bill and Melinda GATES Foundation to launch the ENCORE-1 trial.

This involves reducing the dose of Efavirenz from 600 mg to 400 mg

Mylan launches Symfi-lo in the US.

TLE-400 unknown to the public

A few months ago, and this remains true today, a Google search on 'TLE-400' and HIV gave very few results. Actually only 2: a corporate and financial press release from Mylan (copied and pasted on financial websites) and... Charles-Edouard! Well... Now, there is a little more...

Obviously, this does not help the variety dealers... Let's also remember that it is not yet available in our country while the ENCORE-1 trial was published more than 5 years ago! And meanwhile, services are being closed to save money... Pffff...

Amazing recommendation and prioritization

When we allow, in a so-called recommendation document, a strategy that is obviously better, we are recommending it, without daring to say so.

Here is what Dr. Apollo in Harare, Zimbabwe, has to say about it:
Making the same drug with a little less of the same active ingredient is not an insurmountable industrial challenge! Well... We are not shocked that teenagers from the Third World are given priority... What shocks us is that at the usual rate, the French patient, who pays 600 Euros/month, will receive the cheaper and better tolerated formula... last! Isn't that a bit of an ass? You won't get it before 2-3 years, at best, while Mylan already claims 1 million users! We'll sell out... And who will be eating EFV 600 mg for months and months? It's you...

Morlat, Calmy: same error of judgment

And what does Morlat say about it ? He recommends it:

We have fun with it... First, he explains the 'constraint' of having to take 3 pills. As long as Symfi-Lo has not arrived in France, you're going to have a hard time! Secondly, why restrict yourself to patients who complain? When an overdose is useless, it is useless, even if it is tolerated. Useless is good French and it means what it says. Alexandra Calmy makes the same mistake, by doubling this restriction to patients who complain about a restrictive dosage condition. Well NO... Reducing the dose of VFE is clearly not a dosage restriction! Do you think they do dosing in Zimbabwe??? Prof. Calmy was wrong, and Symfi-Lo proves it, once again

Is 400 mg still too much?

Where is the trial at 200 mg, 300 mg or even 100 mg?

Who remembers that in the DMP 266-005 trial, 200 mg did BETTER than 400 mg or 600 mg? Who decided on 600? It was the manufacturer (DuPont Merck)... And no one, no one, has gone back to the drawing board with this univocal decision of the manufacturer. Why 400 and not 500? Because the 200 mg capsule packaging exists, so it's convenient to do a trial.

In fact, we had already reported the words of Pr Kiat RuxRungtham(youtube) who routinely does 300 mg. Well, it's time to ask the question of 200 mg in attack. As far as maintenance is concerned, we are in the midst of a frenzy: the 'threshold' doses are complete nonsense... We'll come back to this...

Dr. Joel Gallant: the moral and ethical fault

Dr. Joel Gallant, a drug promotion frontrunner and principal investigator for Gilead-sponsored trials, published an angry and threatening article condemning the ethical 'misconduct' of those benevolent physicians who bring Mono-DTG into their practice. It was ill-timed, remote-controlled, and in poor taste.

He was also seen ironizing about those patients who would prefer, conditionally, to preserve their psychedelic dreams and remain on Efavirenz. Ironically, to make fun of pharmaco-induced psychic suffering, which still causes thousands of suicides and depressions today, is abject and allows us to measure the immorality of the character.

To promote the latest novelty of Gilead, his sponsor, nothing stops him.

One would have thought that in his time, when he was practicing university medicine, he could have worked to reduce the deleterious effects of over-medication. This was not the case. In the DMP 266-005 trial, 200 mg did BETTER than 400 mg or 600 mg. The manufacturer, surrounded by experts(which ones?), had simply neglected this phase II trial. These trials are mandatory, they do it... Are they obliged to take them into account? Well no... You have to do an optimal dose finding trial and you are free to choose the maximum dose. And the deleterious effects? We don't care about that. Dosage is the doctors' problem. DMP 266-005 is to be thrown up.

And guess who was the principal investigator of DMP 266-005? Guess... Dr. Joel Gallant himself! Brrr, that's chilling... I hope that one day these people will be brought to trial...

In the news

- Luc Montagnier and Henri Joyeux launch a petition for precaution in medicine and health

- A study confirms the extent of the damage caused by Depakine. Depakine? That's what Siliciano is considering for his shock-and-kill... Brrr!

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

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