I will answer your qusetions even though you said you were leaving the thread (were you lying or did you just change your mind?)
1) You want the definition so badly, with this word "respond", because you had this little point to make for a long time. As Dr. Patick said today, only 30-40% of patients who develop resistance to crix, rit, or saq respond to nelf. She clearly stated this was the exception and not the rule. When resistance develops from crix, rit, or saq; they are resistant to the other PIs, except 30-40% to nelf. At least nelf gives them another PI option possibility that none of the others can (even VX-478). So what little point do you want to make? That they don't respond to whatever definition you are going to make up? Go ahead.
Lets assume the response is a much smaller reduction in viral load than "undetectable" if a more sensitive assay was used. Once again, this makes another argument of nelf as a first line therapy. What would you suggest these patients who have deveoped resistance to all the first generation PI due to having been treated with just one do next? Not to try nelf because if they were the minority (30-40%) who "respond", their response wouldn't be at "undetectable" levels if a more sensitive assay was used? Do you want to make an argument like this, "once resistance develops to a PI, you are resistant to all PIs"? That is generally true for rit, crix and saq. However there is enough evidence to suggest that this is not true if nelf was used first and resistance develops, the resistant virus of nelf "responds" to the other PIs.
2) Do you work for H&Q? You probably could, their report was a lot like your posts; baseless assumptions- not supported by any facts, and very little lasting effect. The sharp fall of AGPH after his comments were erased in one day. Dissect what? The eventual size of the PI mkt? Lets examine some facts:
A. Evidence to support the hit the virus "early and hard" strategy. The best response and durability of combo therapy occurs the earlier a patient is treated (low HIV RNA viral levels). So far, AGPH and ABT have submitted evidence to support this. Just today, ABT reaffirmed the importance of this at the conference, and it recently has become a widely accepted approach now.
B. Another side effect of PIs: AIDS deaths fell by 19%in the first 9 months of 1996. There will be more people living longer with this virus.
Estimated 40,000 Americans will be infected each year.
C. Two expert panels recently recommended guidelines which strongly endorse triple combo therapy using a PI as standard treatment.
D. FDA Anti-Viral Advisory panel-viral load as a predictor of clinical progression. New therapies will have to conduct longer and larger studies to prove equivalent effeicacy and durability to existing triple combo therapies
E. HIV mkt:
-Approx 900,000- 1 million HIV pos patients in U.S. today.
- 319,000 (35%) are diagnosed yet untreated.
- 310,000 are undiagnosed
- 30% taking RTIs (only 160,000 of the 225,000 taking RTIs are taking a PI). Therefore,
ONLY 18% OF THE PI MARKET HAS BEEN PENETRATED. EXPLAIN YOUR VISION OF THE FUTURE TRATMENT RELATING TO PIs.
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EVENTUAL SIZE OF THE PI MKT IS NOT A PROBLEM
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The side effects/symptoms of being short on AGPH are very similiar to lesser known side effects of CRIXIVAN described in the fol link:
thebody.com
This has been a very eventful month, catch up to the reports.
See you at $140, John. |
