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Author Topic: Dual therapy  (Read 6341 times)

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Offline TH_guy

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Dual therapy
« on: September 14, 2016, 06:26:17 am »
Hello everyone!
I'm positive since 2014 with early HAART started (3 month after get infected). Currently I'm on Complera ( edurant + truvada, taking separate meds ).
But I thinking switching to Tivicay + Edurant. Is anyone on this forum who tried this experimental schemes or participant of trials?
I have few guys who take same meds but want have more information from real hands.

Thanks!

Offline Jim Allen

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Re: Dual therapy
« Reply #1 on: September 14, 2016, 06:35:07 am »
Hi

Welcome to the forum.

Have you spoken to your ID doc regarding participating in therapy trials? and have you asked them about switching to dual therapy as an option?

Jim
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Offline TH_guy

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Re: Dual therapy
« Reply #2 on: September 14, 2016, 06:47:48 am »
Thank you for welcome :)

I haven't any opportunity going into any trials because mostly I'm manage everything by myself.
And doctor who I talked about such switching, he not agree with me.
I already read all investigations/trials available about dual therapies and I can imagine cons and pros.

So I just want collect more information as possible and maybe someone can share their experience.

Offline Jim Allen

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Re: Dual therapy
« Reply #3 on: September 14, 2016, 06:56:16 am »
Hi

No problem.


Well I am sure someone has some anecdotal stories, I am not sure what you mean with manage yourself. My thoughts are if any of the stage 3 trial result  were good than just to wait and I sure the current therapies will change.

Your doc disagreed, did the doc mention why?

I already read all investigations/trials available about dual therapies and I can imagine cons and pros.
Care to share a link and details of any published stage 3 results with us as a reference to this?

Take it easy

Jim. 
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Offline eric48

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Re: Dual therapy
« Reply #4 on: September 14, 2016, 04:01:15 pm »
What you are refering to is described here:
https://www.poz.com/drug/dolutegravir_rilpivirine

the Sword 1 trial is currently on going:
SWORD-1:
https://clinicaltrials.gov/ct2/show/NCT02429791

The trial is paid for by ViiV. Just as any other investor ViiV is not putting millions of $ without having a hint of success.

Their apraisal is based on various smaller scale single center trials, which have taken place in Europe.
A larger scale international trial (DORISS) had been planned but cancelled as it was duplicating SWORD-1 (and public funds got reallocated)

the idea to use one NNRTI + 1 INI is not new: one exemple can be found here:
http://www.ncbi.nlm.nih.gov/pubmed/24145365

You may want to contact the clinical investigators for further information on the preliminary data, with Tivicay (tm) + Edurant (tm) (aka DTG+RPV)

Furtheron, Rilpivirine in combinaison with Cabotegravir (a sister to Dolutegravir) did well in the LATTE trials

Alternatively, some small phase IV trials, with Tivicay (tm) + Lamivudine (Generic) have been published already (PADDLE) and larger scale trials are on-going. all this is available : google is your friend
« Last Edit: September 14, 2016, 04:05:20 pm by eric48 »
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline Jim Allen

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Re: Dual therapy
« Reply #5 on: September 14, 2016, 05:53:38 pm »
@OP

Well stage 1  trial is interesting but a few years away from being treatment if successful. If you can't be part of the trial than i guess like the rest its just waiting to see what is a success or not.

Jim
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Offline TH_guy

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Re: Dual therapy
« Reply #6 on: September 15, 2016, 06:39:28 am »
Hi Guys,

@eric48, yes sure, I did read this and some in vitro researches. My question was mostly about if anyone here already taking dual therapy and can share their experience.

@Jim, By meaning I manage this by myself, means, I do everything by myself, buy drugs, make labs, trying to keep myself updated about HIV and related diseases. If I can't find solution then I visit infections doctor for consultation.

BTW I still thinking do not wait till these trials will be finished. Probably I will start it on my own risk.

Offline eric48

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Re: Dual therapy
« Reply #7 on: September 15, 2016, 07:38:17 am »
Doing everything byoneself is unusual, yet, there are many circumstances , in this vast planet, where this is legitimate, and even encouraged by local authorities who do not have enough funding to serve everyone.
If your local guidelines specify treatment from CD4 = 250 and you have 500, then, in most cases there are no other way.

Blame it on the local government, but not the individual, who , indeed, is taking care of the situation and, treating HIV has many advantages, including protecting others from transmission.

When you do so, it is wise to stick to published guidelines: in that respect your current approach (a generic style Complera) is legitimate.

It is legitimate to look at the future of therapy.

Tritherapy was a great achievement, but has not always been the goledn standard. Before Tritherapy was Bitherapy (e.g. AZT+3TC) which worked so-so. And before that was Monotherapy (AZT) which was not satisfactory.

The historical move was Mono , then Bi, then Tri. This was made necessary aas each individual component was not powerful enough.

We now have more powerfull therapies, and more coming, so the mouvment might be reversed and simplified to bitherapies and why not Single therapies.

This mouvement has started.

The Sword-1 trial is one exemple.

clinicaltrials.gov is a good database to look at and identify those various trials.

DOMONO (NCT02401828)
DOLBI (NCT02491242)

There is a about a dozen trials that have started or are being started. DOMONO was one of the first ones to start.
I do have friends who are in such trials, which is why I keep a close eye on the outcome

As far as I understand, normally, patients who participate in these trials are asked to refrain from communicating things on the Internet, as the organizers want to collect all data before they can release the results.

Therefore it is quite unlikely that your quest to collect direct testimony at stage will be successful.

Yet, you are absolutly right in keeping an eye on the future of therapy, since, as I can see from here, things are going to change fast in the next year.

NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline Jim Allen

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Re: Dual therapy
« Reply #8 on: September 15, 2016, 11:18:24 am »
@Jim, By meaning I manage this by myself, means, I do everything by myself, buy drugs, make labs, trying to keep myself updated about HIV and related diseases. If I can't find solution then I visit infections doctor for consultation.

BTW I still thinking do not wait till these trials will be finished. Probably I will start it on my own risk.

Well all I can do at this stage is wish you the best with that.

I can't recommend that anyone is experimenting with their meds/health. I don't think we are in a stage of the epidemic that it is needed. We have good meds that work and we should support the efforts made by doctors and scientists to research things.

Jim
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Offline eric48

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Re: Dual therapy
« Reply #9 on: September 17, 2016, 05:55:48 am »
Dual Therapies are not exotic. In a local hospital the breakdown as of 2015 was:
Tritherapies : 76 %
Bitherapies : 19% (710 patients)
Monotherapies : 5% (140 patients)

The Bi-Mono segment was : 18 % in 2014 and 24 % in 2015. Starting 2015 Dolutegravir (Tivicay(tm)) was made available, so this will introduce new Bi-Mono strategies

A precise accounting is given here:
http://www.ncbi.nlm.nih.gov/pubmed/27495698

So this is public, verifiable, information.

With the recent introduction of Dolutegravir and local trials such as Lamidol (DTG/3TC), this share is expected to increase
see:
https://clinicaltrials.gov/ct2/show/NCT02527096

Therefore, it should not be difficult to find Doctors with enough expertize.

So you may want to remain on the look-out and identify strategies that are relevant to you.
browsing through
clinicaltrials.gov
can be usefull

Should it be necessary, I can provide you with a few pointers, but, not all since there are so many
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline Jim Allen

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Re: Dual therapy
« Reply #10 on: September 17, 2016, 10:26:14 am »
@OP

I think overall my stance is don't piss about with this yourself and play doctor because of some trial data. Get a doctor and someone who supports you.

One question though comes to mind why are you trying to chance regime?
You did not mention the why just that your looking into doing it.

Jim
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Offline CaveyUK

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Re: Dual therapy
« Reply #11 on: September 17, 2016, 02:00:29 pm »
I think there is too much of this kind of thinking going on from people who appear to be intelligent, and it is bewildering.

Years ago, when side effects from certain meds were crippling and had long lasting negative issues I could absolutely understand someone wanting to experiment or pause treatment or whatever.

But this is 2016 and the meds are generally well tolerated and options are plentiful if for some reason there are problems. I don't understand the mentality where people are trying to out-think the medical profession.

Yes, there are trials going on and the results of that may influence future approaches, but they are trials and have not conclusively proved anything yet.

Given that modern meds are relatively speaking fairly benign, I can't see the urge to rush to change anything before these results are out. It seems to be like playing russian roulette with your health when it is wholly unnecessary.

It's everyone's choice if they want to play with their life, but I would have thought people with HIV more than anyone would respect the medical profession and the strides that have been made over the years. It seems not.
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Offline TH_guy

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Re: Dual therapy
« Reply #12 on: September 21, 2016, 12:27:14 pm »
Hi guys,
thanks for your warning, but look here:
http://regist2.virology-education.com/2016/14EU/04_Sterrantino.pdf
http://regist2.virology-education.com/2015/13EU/14_Yoshinaga.pdf
and have some other (I can't find link for now )
Yes it is small cohort (132) and Yoshinaga is in vitro, but I think it will works.
So I decide to start.
Will check my VL every month for first 24 weeks and will update here if anyone interesting.

Offline zach

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Re: Dual therapy
« Reply #13 on: September 21, 2016, 01:33:38 pm »
Quote
>Yoshinaga is in vitro, but I think it will works. So I decide to start.

 ???  :o  ??? you think it works?!?! It's a Stage 1 trial, and you think it works?!?!?

Don't try this at home kids, this new member is taking a HUGE risk without good reason and no medical guidance.

TH_guy, you read those reports... so explain this portion back to me in layman's terms

Quote
concentration stepwise increasing method showed the similar results as the constant concentration method with

  • resistant virus emerged timing is the same as that with the highest drug concentration condition in the constant concentration method
  • combination of RPV+DTG could stop HIV proliferation at the lowest concentration among combinations investigated in this method although RT/E138K or Y181C emerged

based on that, and given it's implications.... what dosages of which meds do you plan on taking? how do you plan to source your meds? where in the world do you live that you think you're just going to be able to access those meds at will? DTG isn't widely available.

very important here... if a mutation at RT/E138K or Y181C does emerge. how will you even recognize that? do you even know what lab to order to look for that? what will you do to compensate for that if it does happen?

you think you've put some thought into this, i think what you're about to do is stupid and dangerous.

let's do a word cloud of the concerning phrases that jumped out at me reading your thread

Quote
experimental schemes

I'm manage everything by myself

doctor who I talked about such switching, he not agree with me (HUGE RED FLAG)

I can imagine cons and pros

I do everything by myself, buy drugs, make labs, trying to keep myself updated about HIV and related diseases

I still thinking do not wait till these trials will be finished. Probably I will start it on my own risk.

my advice, don't do it, it isn't necessary


------


PS... Eric, that's some really piss poor advice you're giving, enabling a new member to self manage.

Quote
there are many circumstances , in this vast planet, where this is legitimate, and even encouraged by local authorities who do not have enough funding to serve everyone.

but that clearly isn't the case here, where the OP is already on a successful regimen, and their doctor opposes this change of treatment

you offering to assist is reckless, hubris, and beyond the scope of what we should be doing on this forum. you are far from qualified, you are not a doctor, and we don't offer medical advice here

Offline Jim Allen

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Re: Dual therapy
« Reply #14 on: September 21, 2016, 03:13:56 pm »
I think Zach has said it all and this thread deserves a health warning for sure.
We should not be encouraging people to play doctor, even if it is with themselves.

@OP

Stop plying doctor just because of some trial data. Messing around with stuff yourself and on top of that stuff you don't fully understand, based on some trial data and now some (poor quality) dodgy slides is a potential disaster   
- Speak to a doctor.  (Get one)

Jim
« Last Edit: September 21, 2016, 03:18:02 pm by JimDublin »
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Offline TH_guy

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Re: Dual therapy
« Reply #15 on: September 22, 2016, 11:06:06 am »
Hi Guys,
Sorry if my message is hardly to read, english is not my native language but I will try to explain my choice.

For the main: reason of all of this is eliminate TDF as i has problem with bones already with regiments I have access to (I do not have access to TAF).
I already infected for few year and I always keep my self updated about current researches. Plus I never had AIDS or any related disease + early start ( it was my choice, (doctor say I can walk more year with >500 cd4) two years ago guidelines do not require immediate start )). So I'm not newbie.

Doctors just follow guidelines and I can't judge them it is actually mostly right way. So I don't see red flag here, it is just rules.

Quote
how will you even recognize that? do you even know what lab to order to look for that? what will you do to compensate for that if it does happen?
As in trials they do, check VL. I have access to lab with 12 copies sensitivity. I will also control my chronic inflammation levels, with immunogram.

Also have researches that DTG can used even as mono therapy.  So no problem about medications access.
Even more weak 3TC is used used as dual therapy trials...

If it fails I will roll back to some old meds and it will really sucks. But I think this is will not happen.

Quote
what dosages of which meds do you plan on taking? how do you plan to source your meds? where in the world do you live that you think you're just going to be able to access those meds at will? DTG isn't widely available

Money is not big problem. I'm not rich but I can pay for year in advance for meds. I already bought Tivicay for 1 year.
I will take standard 50mg of DTG + 25mg of RPV with food. As second choice I thinking about DTG+RPV+3TC. But not sure if I need lamivudine, will think more about this.

I don't want argue about choice, according information I have, this is therapy is works. Just want hear someone from big community who already uses this scheme. I know that mostly peoples uses their insurance payed or government so them can't use this experimental schemes. But I thought anyone who in trials maybe can share their stories.

Anyway, thank you very much about warning, I really appreciate this.

Offline Jim Allen

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Re: Dual therapy
« Reply #16 on: September 22, 2016, 11:39:35 am »
I don't want argue about choice

Its not an argument.

At the end of the day you are free to do whatever you like however I will warn not to play doctor with yourself and that is more for the readers who have no reason to mess about with a proven therapy.

according information I have, this is therapy is works.

Just on a note don't claim here something works just because of a few slides/data points from some trials.

Whatever you do for the rest is up to you, i wish you the best.

Jim
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Offline eric48

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Re: Dual therapy
« Reply #17 on: September 24, 2016, 06:34:09 am »
doctor say I can walk more year with >500 cd4

Is it correct to understand that you had been denied treatment because your CD4 were high ?

Is this still the current guideline where you live (by the way, where do you live ?) ?
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline eric48

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Re: Dual therapy
« Reply #18 on: September 25, 2016, 04:48:04 am »
this post by Dr Gallant may help you sort out things:
http://hivforum.tumblr.com/post/144063943496/when-might-we-see-the-dolutegravir-rilpivirine

Some points are relevant to your situation, some less.

In any case, Dolutegravir + Lamivudine are also being evaluated in large scale trials, so some of the concerns may only be temporary.

lamivudine is patent-free and is among the cheapest, if not the cheapest, depending where you live.
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline TH_guy

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Re: Dual therapy
« Reply #19 on: September 30, 2016, 05:21:57 am »
Hi Eric,
Quote
Is it correct to understand that you had been denied treatment because your CD4 were high ?
Yes. Thailand. But I'm not sure what guidelines they use for now. Anyway I'm not a thai person, so no free drugs :)

Quote
http://hivforum.tumblr.com/post/144063943496/when-might-we-see-the-dolutegravir-rilpivirine
Thanks for link Eric. I do not have access to TAF, this is why I doing such experiments.

Anyway, I already switched to dual therapy.
And you know I feel really better.
It's looks like I woke up very fresh and (feel like) have a really good sleep, my brain is working better - this is 100%.
Also (that surprise for me) I get rid off my skin allergy, well actually i wasn't sure if it allergy before but after TDF is getting out skin is better.

I'm in Thailand so Lamivudine or Rilpivirine does not matter, here in thailand Rilpivirine is cheap ( original ). But I like idea of 3TC because no need take with food.

Offline eric48

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Re: Dual therapy
« Reply #20 on: September 30, 2016, 09:59:05 am »
Hi,

I personnally do keep an eye on the ongoing trials; I am on a regimen that do not have food requirement and is 2 pills.

The idea of Dual Therapy appeals to me, and I do not mind the 2 pills.

I would expect those trials results to be released during 2017. This much I can wait.

i would presume that as soon as those trial results are published, people on this forum will want to gain knowledge about it.

It will be interesting to see how things evolve, especially in mainstream guidelines and medical recommendation.

I will wait for the trial results, of course... but, I am quite optimistic that thing will evolve;

Please keep us posted!

 
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline TH_guy

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Re: Dual therapy
« Reply #21 on: February 15, 2017, 10:55:44 am »
Hi guys,
Small update.

SWORD-1 and SWORD-2 details was released at CROI 2017.
Only two virological failures from 1024 peoples on the study.

http://www.thebodypro.com/content/79359/two-drug-regimen-shines-in-hiv-treatment-switch-st.html

The Phase 3 study results lend support to a switch strategy for people who may be on a virologically successful HIV treatment regimen but nonetheless desire a change to reduce their overall drug burden or curb the risk of certain adverse effects, such as changes in bone markers associated with the use of tenofovir (Viread).

Offline Jim Allen

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Re: Dual therapy
« Reply #22 on: February 15, 2017, 11:05:44 am »
Yup.

We have a thread here with more details: https://forums.poz.com/index.php?topic=65054.0

Will keep that one updated. Short is if it becomes available for treatment and if it does I wonder if the cost will be lower overall for nations buying this. Wait and see I suppose. 

Don't play around with you meds on your own and certainly not without doctors supervision

Jim
« Last Edit: February 15, 2017, 11:10:42 am by JimDublin »
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