Re: 2019-nCov Coronavirus

14
On the other hand about 300,000 - 600,000 people worldwide die per year from the flu and nobody says anything.
Imagine there would be statistics about the infected......every year a pandemic. then there are different strains of this virus. One coming out of China, others coming out of Europe.......I have the feeling it's not only about the virus. Another 6.6 Million added to the initial jobless claims (about 16 Million in 3 weeks) ......and what does the Dow do? Moving up....Huh! What a silly game!

Re: 2019-nCov Coronavirus

15
RplusT wrote: Thu Apr 09, 2020 10:55 pm On the other hand about 300,000 - 600,000 people worldwide die per year from the flu and nobody says anything.
Imagine there would be statistics about the infected......every year a pandemic. then there are different strains of this virus. One coming out of China, others coming out of Europe.......I have the feeling it's not only about the virus. Another 6.6 Million added to the initial jobless claims (about 16 Million in 3 weeks) ......and what does the Dow do? Moving up....Huh! What a silly game!
DOW moves UP! ahead of Earnings.


Re: 2019-nCov Coronavirus

16
RplusT wrote: Thu Apr 09, 2020 10:55 pm On the other hand about 300,000 - 600,000 people worldwide die per year from the flu and nobody says anything.
Imagine there would be statistics about the infected......every year a pandemic. then there are different strains of this virus. One coming out of China, others coming out of Europe.......I have the feeling it's not only about the virus. Another 6.6 Million added to the initial jobless claims (about 16 Million in 3 weeks) ......and what does the Dow do? Moving up....Huh! What a silly game!
Just guessing but maybe "the Bern" dropping out for president caused the rally. And think your right it's not just about the virus.

Re: 2019-nCov Coronavirus

17
Pava wrote: Fri Apr 10, 2020 3:16 am

DOW moves UP! ahead of Earnings.
Well, that's low impact data. But then, I could understand that in a positive economic situation. But currently!? This situation is like Seventh Heaven for the ones with tons of money. No, it wasn't me. I was watching from the sidelines..... :D ...Stay safe!
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Re: 2019-nCov Coronavirus

19
Update

Tamaida Shimera’s blog on Corona - The main article on coronavirus (COVID-19)
Tamaida ShimeraMarch 15, 2020


Virologists and their handlers playing God (or rather Satan)?

The officially named nCoV-2019 Coronavirus or COVID-19 which is having an outbreak in the Wuhan province of China is referred to in this article as the corona/china virus or new coronavirus.

A retrovirus is a virus that is capable of inserting its genetic material into the host's DNA. The genetic material in advanced life-forms is DNA -also in Viruses it is often DNA. A Rna-virus has RNA for its genetic material. There exist many different types of RNA viruses like for instance the common cold-virus. A retrovirus is a subtype Rna-virus that is capable of inserting its genetic material into the host's DNA. To do this it has to copy its RNA into DNA. It accomplishes this with an enzyme called reverse transcriptase that it produces from its own RNA. Hiv-virus (and hepatitis B) is by all practical purposes the only retrovirus that gives a serious disease in humans (as of 2014). Lamivudine is a medication that is used to treat retroviral infections by blocking the reverse transcriptase enzyme and clinically cure the infection. The common name of all these medicines (chemical compounds) that work like Lamivudine (there has been developed several) are called reverse transcriptase inhibitors (quite obvious as they inhibit the enzyme reverse transcriptase's function)


Let's go back in time to the Ebola infections that hit West Africa in the year 2014. A Liberian rural doctor, Gorbee Logan, reported on CNN at the time that he had cured 13 of 15 Ebola-patients with Lamivudine. Link: .


2 of the 15 Ebola-infected patient had had infection for 4 days or more and had already signs of advanced disease and was too far gone for a cure and died. So he had in effect a 100 percent cure rate for the remaining 13 patients who had fever for 3 days or less. This result is highly statistically significant- i.e. it is too improbable that the cures happened spontaneously by chance and not as a result of the antiviral tablets. Again i.e. the Lamivudine tablets caused the cure. If the untreated death rate (the two hopeless patients should be excluded) was 70 % then the probability of a 100% cure occurring by chance and not be related to the Lamivudine treatment is 0.3 exp 13 =0.000000159 or less than 2 in ten million.

The fact that Lamivudine kills a virus is proof that the virus in question is a retrovirus. The Ebola virus was categorized before the 2014 eruption as an RNA virus and not a retrovirus in Wikipedia. It is still so categorized ln Wikipedia. It has been transformed into a laboratory before the African endemic. Such a transformation from RNA to retro-virus cannot happen spontaneously.

So why did not the Ebola (of 2014) succeed in wreaking total global havoc globally? It did not spread by coughing/air-droplets like the coronavirus. Contagion carriers died before they could infect many people. President Putin was heavily involved in the West African Ebola crisis of 2014 from October that year. The Epidemic fizzled out shortly after Russian medical specialists arrival after gaining steam for a year. I think he convinced the West African governments to use anti-retroviral medication


The terrible thing with retroviruses is that once infected you will have a copy of the virus genome inside your own DNA. So even if you survive the initial infection you will get a new infection from reactivation of the virus from the copy in your own DNA at a later date. If a retrovirus takes hold in the human population we will never get rid of it.

Doctors in India say they found copies of parts of the Hiv-virus in the corona/china virus. In Thailand they report on one patient cured after one day with anti-HIV medication. The only thing that makes sense from the perspective of a virologist with intent to enhance the deadliness of the new coronavirus is to include the genes that code for reverse transcriptase. It is easy to ascertain this by treating infected patients with Lamivudine or other reverse transcriptase inhibitor-medication and observe the therapeutic result.

This new corona-virus is a terrible virus even if it should not have retroviral functionality/metabolism. In addition to producing a strong/fulminant lung infection which can cause death by oxygen-deprivation/suffocation it also causes inflammation and swelling in heart muscle according to reports. Heart muscle affection can explain the sudden deaths, videos on the web showing people suddenly collapsing dead, as cardiac arrests (sick cardiac cells do not propagate electric impulses – a prerequisite for a heart to beat).


This nCoV-2019 virus because it is essentially geographically uncontainable would in a war situation kill the foe but also the friend. Therefore the corona/china virus is a global indiscriminate human extermination agent and not a suitable warfare agent. Of course the virologists that put a virus like this together know this about their creation.

A virus infection with 15% mortality rate, highly, exponentially contagious, showing several days of symptoms-free incubation and maybe like flu-virus able to avoid immunity by changing its surface-proteins is a terrible threat. Such a virus that recurs from a copy of itself in the hosts/human DNA is a truly apocalyptical prospect. This latest virus is made in a laboratory and so was the Ebola virus version of 2014. Possibly virologists are working on making even other new deadly retroviruses. There is enough proof to conclude that virology labs across the world are collaborating on the construction of these dangerous viruses. I think there is no other reasonable conclusion than that their release into the natural environment is not accidental but deliberate.


Appropriate action should be:

Treat infected patients with Lamivudine and observe the effect. I am sure it will work. After this treat prophylactically to avoid that people should become perennial carriers of a dormant virus that will reactivate. Official communications from WHO says that probably 60 to 80 percent of the world population will be infected. That means 60 to 80 percent of the world population will be carriers and would need lifelong therapy with Lamivudine. I will not contemplate all the consequences. But isolation camps could become death camps for dissidents to a globalist policy like gun right advocates.


Addendum 1:
. I think that this is an attempt by the shadow rulers of the world to attempt a great culling. You have all these minions of the elites up through history to the present talking about the desirability of such a culling: Bertrand Russel, Prince Philip, Paul Ehrlich, Cass Sunstein etc, and of course the progenitor of all these exterminationists Thomas Malthus (The first Malthusian). The Georgia Guide stones recommend a world population of some hundreds of millions. During the Ebola epidemic they even put a metal plaque on one of the guide stones that just read 2014 (It was later removed). I think that referred to the Ebola epidemic – and that they expected a great culling then. The Ebola virus is still endemic in Congo (I am sure it is the 2014 retrovirus variety) while all eyes are on China it could be introduced into the US via the leaky US Mexican border. Congolese migrants have been observed near the border recently.

President Trump's advisers have not given him good advice so far as can be concluded from utterances like: “The epidemic will be over when summer is here and the weather is warmer”.


The official line should be that since there is no established medication one should try what is reported to work in isolated cases where it has been tried (i.e anti-HIV medication). It has been reported on Russian media that homecoming Russians from the Wuhan region have been isolated in a Hospital in Siberia and given medication successfully treating the infection. President Trump should cooperate with President Putin which was heavily involved in resolving the West African Ebola crisis of 2014. The Epidemic fizzled out shortly after Russian medical specialists arrival after gaining steam for a year. The Chinese should of course also cooperate but for some reason they are not forthcoming nor transparent. He could cooperate with pm. Shinzo Abe of Japan to treat the passengers on the cruise ship in Tokyo Bay-(I’m aware that many reportedly has been released) There are little side effects with Lamivudine especially with a therapy lasting days to a week.

HIV- and hepatitis B- patients must-have treatment for life because the offending virus (retrovirus in both cases) is chronically reactivated. Let us not hope that billions of people that have been infected with this Corona-virus, which is orders of magnitude more infectious, also will need lifelong treatment in order to survive. Purportedly several top virologists died in the Malaysian airline crash over eastern Ukraine (MH17) on 17 July 2014 (amidst the peak of the West African Ebola crisis) while they were on their way to a world virology congress in Kuala Lumpur, Malaysia. Was this a coincidence? Is there fear inside the virology specialists community?



The most effective way to spread a virus intentionally would be to add it to the water-tank that moisturizes the air in shopping malls and other big buildings with centralized air conditioning. The legionella bacteria (legionella pneumophila) that cause Legionnaires disease spreads this way. The fact that all patients and staff (allegedly 80 individuals) in a psychiatric hospital in Korea have got the disease when the total infected in Korea is less than 1000 individuals strongly suggests that the corona-virus is spread in such a centralized manner. The same applies to allegedly 80% of a Christian congregation becoming infected. It would seem that people behind the creation of the virus also attempts to speed up its spread by adding it to air conditioning systems.


Conclusion: Every attempt should be made to curb the spread of this infectious disease. The window of opportunity is very small. Patients should be treated prophylactically with Lamivudine (or other reverse transcriptase inhibitors). Lamivudine should be added to the drinking water reservoirs. Not to try will mean that all persons who would like to survive in the long term would need chronic therapy with Lamivudine to avoid a DNA replica of the virus in their DNA being reactivated.


Putting health issues aside and looking at consequences for society:


What would the situation be if 50-80 to 100% of the world population has the coronavirus in their DNA (just like HIV-AIDS patients have the HIV-virus in their DNA) and needs Lamivudine to survive?



The production capacity of today for the medication will not be sufficient and would have to be ramped up. It would seem that a team of bureaucrats would have to decide who should get effective therapy and who should not. Death panels would instantly be implemented. Would you afford to pay for the medication that today costs about 170 US dollars per month per person in the West? Who knows what the medication would cost in a timer of scarcity –may be three times the current amount or more? Would the government get a monopoly on the distribution? If you are a dissenter critical of the government maybe you won’t get the medication. The control of the world population by a ruling elite could be absolutely total and absolutely tyrannical.

To misquote Enoch Powell’s “river of blood”- statement: “I see several tsunamis of blood”


Addendum2:
Tamaida Shimera at 2/28/2020

From <https://www.zerohedge.com/health/corona ... ars-infect>

Two quotes from this article:

1. "Drugs up for consideration include "a series of HIV-1 therapeutic drugs such as Indinavir, Tenofovir, Alafenamide, Disoproxil, and Dolutegravir."

1. "The conclusion is in line with several reports from doctors who self-administered HIV drugs after testing positive for coronavirus, however, there have been no clinical tests to confirm the theory."


Concerning quote 1: All these five different medicines listed (Indinavir, Tenofovir, Alafenamide, Disoproxil, and Dolutegravir) are reverse transcriptase inhibitors. Just like Lamivudine.


This fact is not mentioned anywhere in the article. If it had been mentioned it would be evident to the discerning reader that the offending virus is a retrovirus and created in a virology laboratory by genetic splicing/manipulation (see definition of retrovirus above).


Why are all these different medicines mentioned while the most salient fact about them (their common mode of action) is not? Answer: Not to report on all the doctors self-medicating and curing themselves would be taken as evidence that curative therapy is being covered up and would cause outrage in the population.


So they feel obliged to mention that these medicines work but they try to obfuscate the way they work: blocking reverse transcriptase. So they state some gibberish speculation about dividing a protein at a “furin-like cleavage site” and generally hide behind some indiscernible microbiological lingo that is meant for no one but the initiated high priests of the temple. Reverse transcriptase inhibitors,

the medicines (listed under 1)), the real action is mentioned above. They have shown themselves 100 percent effective in preventing reactivation of dormant Hiv-virus in Hiv/Aids-patients when taken properly. It is the absolute main treatment and other medical compounds used are ancillary. The goal in our current global pandemic situation is of course not to prevent reactivation, but should be to prevent the coronavirus from entering the human gene pool on a permanent basis.


Great authors have tried to alert the human race about the dangers it faces from an all-powerful hidden ruling class (oligarchy/plutocracy) an have written allegorical books: George Orwell in his two seminal works (1984 and Animal Farm) and Ian Fleming in his James Bond series of books which all of them was about a hidden supra-state bent on wreaking havoc on humanity either by destroying the financial system (Goldfinger) or exterminating "undesirable" humans (Moonraker). Both of these authors were British intelligence officers (Fleming a very high ranking MI6 officer) with an understanding of the hidden power-structure and their plans and machinations. By the way John F. Kennedy communicated that he liked the 007-books after which the sales of them sky-rocketed. JFK knew the plots in the Bond-books were more than only good stories. Both authors met an early demise (as did JFK).


George Orwell talks about the ruling elite’s ultimate intention with war: “The war is not meant to be won, it is meant to be continuous". Paraphrasing it to the Coronavirus epidemic: "The war by the global authorities (dictated from Washington) against the coronavirus epidemic is not meant to be won, the coronavirus epidemic is meant to be continuous (by virtue of its implementation as a retro-virus)". Had this epidemic happened 50 years ago or earlier there would have been no humanity today. Today the ruling exterminationist of the world will observe the recurring phases of new epidemics until the global population number is down to Georgia Guidestones-levels (a couple of hundreds of millions of people). Then reverse transcriptase inhibitors will be introduced. If you are a bothersome person to the elites a dissident or a demonstrator you will not get the medication.

By the way do you think that the ruling elites of the world and their minions would release this killer bug into the environment without having an antidote for themselves? These select few Satanists already have Lamivudine or an equivalent reverse transcriptase inhibitor in their medicine cabinet.

We the hoi polloi, unwashed masses can look forward to a perfect, murderous, unassailable tyranny.


Addendum 3
Tamaida Shimera at 3/1/2020


Links and background to Ebola crisis of 2014 and how it pertains to the Corona epidemic of today


CNN-reporter Elizabeth Cohen's role in exposing ultimately by deduction the man-made origin of

The 2014 Ebola crisis.

Elizabeth Cohen was the reporter that interviewed dr. Gorbee Logan who discovered Lamivudine's effectiveness against Ebola during the height of the epidemic in September 2014.

https://edition.cnn.com/2014/09/27/heal ... -hiv-drug/


Her interview with the Liberian rural doctor took place on the 27th of September. Why did she return to the United States 9 days later when she had discovered a probable cure for the epidemic.

https://www.breitbart.com/politics/2014 ... ing-signs/

Ebola-exposed reporter ‘shocked,’ ‘horrified’ by lack of screening returning to US airports

From <https://www.bizpacreview.com/2014/10/07 ... rts-150611>

She entered the US at Atlanta (CNN headquarter)’s Hartsfield-Jackson International Airport and she was horrified at the lack of security/ medical control of herself and other passengers from the heavily Ebola-hit West African region. One would guess that this female CNN reporter was suspicious of the establishment’s commitment to stop the epidemic when she also had experienced her employer's lack of interest in what ought to be a groundbreaking report.


Dr. Anthony Fauci (a member of the White house coronavirus task force)

A man that could but was very unwilling to cure Ebola in September 2014.


There was also a lack of interest from the doctor who was tasked with the responsibility of handling the Ebola crisis in the U.S. In the same CNN-article, https://edition.cnn.com/2014/09/27/heal ... -hiv-drug/ , he responded with the following seemingly disinterested, cavalier attitude:

"Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases says that theoretically, Logan's approach has some merit. Lamivudine is a nucleocide analog, and other drugs in this class are being studied to treat Ebola.

Fauci asked CNN to give Logan his email address, saying perhaps his lab could do some follow up work."

As stated earlier the probability of Dr. Gorbee Logan's result happening by chance and not the result of Lamivudine therapy is less than 2 in 10 million so Dr. Fauci should have been very interested if he was interested in a cure.


CDC (Center for disease control) director Robert Redfield (a member of the White house coronavirus task force)


Here's another beauty that will do everything to thwart the corona task force effort

Has been charged with falsifying data in a scientific paper seeking falsely to prove that vaccination during an ongoing infection can be helpful in curing it.

This idea has been proposed by other (pseudo-) scientists but has never been corroborated in any study.

https://time.com/5211143/robert-redfield-cdc-director/



President Putin's involvement


In an article by The European union times dated Oct 19th, 2014:

Putin Warns Of Nuclear War Over Obama Ebola Apocalypse

https://www.eutimes.net/2014/10/putin-w ... pocalypse/



"(The Russian) Federal Security Service (FSB) seeming to show that the Obama regime deliberately caused the spread of the Ebola virus in the West African nation of Liberia and then embarked upon a massive cover-up to conceal this crime against humanity."



Putin also points out that the responsibility for handling the crisis

Dr. Admiral-Doctor Nicole Lurie who over 8 years had developed a highly competent team for handling epidemics like the Ebola crisis at the time was replaced with a deep state operative with no medical experience whatsoever.


Putin threatened that this deliberate mishandling of a threat to humanity would possibly lead to nuclear war if not rectified. A Russian Ebola team arrived in West Africa in primo/Medio October 2014 and the Epidemic stopped soon afterward. He probably knew that Lamivudine was an effective treatment and aware of dr. Gorbee Logan's work.


Liberia initially declined assistance from the Russians because of "alleged pressure from Uncle Sam".


West Africa: What are US Biological Warfare Researchers Doing in the Ebola Zone? By Jon Rappoport August 02, 2014


https://www.globalresearch.ca/what-are- ... ne/5394582


Tulane University

Corgenix Medical Corp.


These entities had been present in west-Africa for some years prior to the purportedly injecting citizens with "vaccines" and "antibodies". Since the new Ebola virus at the time had been modified in a laboratory to become a retro-virus, Tulane University and its eventual collaborators are the prime suspects in its creation.

Doctors in Wuhei are not reinventing the wheel - in case they developed/seeded the virus they got help from those who perfected the transformation of the Ebola virus into a retrovirus. Or maybe the high-security virus research lab in Wuhei was not involved in the development or the seeding of the corona-virus at all. As suggested elsewhere in this article contaminating the water tank used for moisturizing air in air conditioning in a shopping mall or other building with the traffic of many people would be the most effective way of spreading the virus quickly to many people.


From: The Ebola Breakout Coincided With UN Vaccine Campaigns

By Yoichi Shimatsu

From <https://rense.com/general96/ebobreakout.html>

The Spread of Ebola at the beginning was not geographically contiguous - consistent with the spread of the live virus from vaccination stations operated by Doctors without borders:

"The reason for suspecting a vaccine campaign rather than an individual carrier is due to the fact that the ebola contagion did not start at a single geographic center and then spread outward along the roads. Instead. Simultaneous outbreaks of multiple cases occurred in widely separated parts of rural Guinea, indicating a highly organized effort to infect residents in different locations in the same time-frame."



Conclusions:

CNN wanted to hide the fact that a probable cure for the 2014 Ebola epidemic had been discovered. Also no other of the Mainstream media organizations referred to the discovery.


Dr. Anthony Fauci should not be a part of the Trump administration's task force against the current Coronavirus task force led by vice president Pence, because of his lack of interest in solving the 2014 Ebola crisis.



Robert Redfield being suspected of falsifying research-papers should not be trusted to participate in the task force either.



President Putin who orchestrated the resolution of the Ebola crisis of 2014 should cooperate with President Trump to resolve the current corona-virus-crisis.



Tulane University researchers and associates involved in the Ebola/Lassa virus experiments must be interrogated about their real actions and eventual crimes against humanity.

The technique has developed in American laboratories. If the Chinese were involved in the release it would have been under American/deep state /Illuminati leadership/orders. This speculation on by whom and how the COVID-19 was released is irrelevant now. All efforts must be concentrated on therapy - i.e. Lamivudine.



President Trump should put aside other concerns and take leadership in the gargantuan task of solving this totally LIFE THREATENING CRISIS instead of delegating the leadership to the vice president.



Tamaida Shimera's blog
https://telegra.ph/Tamaida-Shimera-on-c ... ints-03-13

https://telegra.ph/Tamaida-Shimeras-blo ... D-19-03-15

https://telegra.ph/Tamaida-Shimera-on-c ... lery-03-02

https://telegra.ph/The-truthers-you-bel ... iver-03-06

https://telegra.ph/Tamaida-Shimeras-blo ... s-it-03-10

https://telegra.ph/Tamaida-Shimera-on-c ... ctor-03-12

https://telegra.ph/Tamaida-Shimera-on-c ... ines-04-12

https://telegra.ph/Tamaida-Shimera-on-c ... utin-04-12

https://telegra.ph/Tamaida-Shimera-on-c ... Team-04-12

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Re: 2019-nCov Coronavirus

20
Update

Antiviral Therapy
Jose I. Bernardino, Jose R. Arribas, in Infectious Diseases (Fourth Edition), 2017

Nucleos(t)ide Reverse Transcriptase Inhibitors
Reverse transcriptase inhibitors act through one of two mechanisms. First, as ‘chain terminators’, they block the elongation of the DNA chain through blockage of further nucleosides. This mechanism is characteristic of the nucleoside and nucleotide analogs and depends on the intracellular phosphorylation of the drugs into the corresponding triphosphate. Second, they act by competition/binding of the reverse transcriptase in functionally essential sites. NNRTIs act only through this mechanism and not as ‘chain terminators’. In general, nucleoside analogs have good oral bioavailability, are only minimally bound to plasma proteins, do not interfere with cytochrome P450 enzyme systems, and are excreted through the kidneys. Because of these metabolic characteristics, they have relatively few interactions with other drugs as compared with PIs and NNRTIs. They are generally active against HIV-1 and HIV-2.

The most widely studied nucleoside/nucleotide backbones for initial ARV treatment are zidovudine–lamivudine, abacavir–lamivudine, or tenofovir with either lamivudine or emtricitabine although due to toxicity issues zidovudine is prescribed less often.

Zidovudine and Stavudine
Zidovudine is a thymidine analog and was the first ARV agent available for use. Its association with lipoatrophy has driven its relegation in guidelines to that of an alternative agent. This toxicity starts to manifest after 12 months on treatment and may affect up to 50–60% in the medium to long term. In individuals with lipoatrophy, switching away from zidovudine may result in a partial reversal of the subcutaneous fat loss. Zidovudine remains a recommended agent for use in pregnant women to prevent mother-to-child HIV transmission.

Viruses resistant to currently recommended first-line NRTIs (tenofovir, abacavir, lamivudine, and emtricitabine) will usually be susceptible to zidovudine and so could be useful as a second-line agent.

Stavudine is the other thymidine analog in use. It is associated with a higher incidence of lipoatrophy, the onset of which is more rapid. Stavudine can also cause peripheral neuropathy, hyperlactatemia, and lactic acidosis. Stavudine has been dropped from most guidelines in higher-income countries and its widespread use in resource-poor countries, often for reasons of cost, is being widely questioned.

Abacavir and Tenofovir
Abacavir–lamivudine or tenofovir with either lamivudine or emtricitabine have become the most commonly used NRTI backbones in higher-income countries. Although both abacavir and lamivudine have plasma half-lives that do not appear to support once-daily dosing, intracellular concentrations of the active metabolites (both drugs need to be phosphorylated intracellularly) mean once-daily dosing is feasible. The CNA 30021 study demonstrated that abacavir and lamivudine were given once daily (same daily dose) was not inferior to the standard twice-daily regimen.5

The most important adverse effect of abacavir is a hypersensitivity reaction (HSR). This syndrome appears usually 1–4 weeks after starting abacavir and includes fever, rash, abdominal pain, cough, shortness of breath, and hypotension. The most serious problems, including shock and death, occur in those who continue treatment despite the development of hypersensitivity, or in those who stop drug and then are rechallenged with abacavir.

The prevalence of HSR varies widely, being seen most commonly in those of the white race and is linked to HLA-B*5701 carriage. In the Predict study HLA-B*5701 screening reduced the incidence of HSR to zero.6 HLA-B*5701 screening prior to using abacavir has become routine in clinical practice.

Two other important issues affect the use of abacavir. The first is its association seen in some cohorts with worsening cardiovascular risk although a recent meta-analysis from the FDA rules out this association. The second is that, in one large clinical trial (ACTG 5202), of poorer efficacy seen in those ARV-naïve patients who were randomized to receive abacavir and whose baseline viral load (VL) was over 100 000 copies/mL. This fact has not been confirmed in other trials, especially if the third drug is an integrase inhibitor.

Tenofovir is an NRTI that also has activity against HBV. In the GS-934 study, tenofovir, lamivudine, and efavirenz were compared over 144 weeks to zidovudine, lamivudine, and efavirenz. In the primary time to loss of virologic response (TLOVR) analysis, the tenofovir arm performed better. Much of the difference between the arms was related to early discontinuation in the zidovudine arm due to anemia and poorer tolerability.

Tenofovir use is associated in some patients with a reduction in renal function over time when compared to other nucleosides. Close monitoring of estimated GFR and proximal tubulopathy is recommended. Tenofovir has also been associated with a greater decline in bone mineral density than other NRTIs and a recent study has shown a link between cumulative use of tenofovir and osteoporotic fractures. Tenofovir should be used cautiously in patients who have, or are at risk of developing renal disease and osteoporosis.

Lamivudine and Emtricitabine
Lamivudine is a cytidine analog and a component of several recommended first-line combinations. It is very well tolerated and can be given either 150 mg twice daily or 300 mg once daily. It is also available as a component of the fixed-dose combinations Combivir (zidovudine, lamivudine), Trizivir (zidovudine, abacavir, lamivudine) and Kivexa (abacavir, lamivudine). Lamivudine has a low barrier to resistance. Viruses that contain the M184V mutation are, however, less ‘fit’ than wild-type viruses.

Emtricitabine is a cytidine analog similar to lamivudine. These drugs should not be used together. Emtricitabine is also active against HBV and is available as part of a fixed-dose combination with tenofovir (Truvada), with both tenofovir and efavirenz (Atripla), with both tenofovir and rilpivirine (Complera/Eviplera) and with tenofovir, elvitegravir, and cobicistat (Stribild).

Didanosine
Didanosine is an alternative agent for treating ARV-naïve individuals and is usually given in combination with lamivudine and either an NNRTI or a PI. It is associated with pancreatitis, lactic acidosis, and peripheral neuropathy. Recent reports have linked hepatic fibrosis and portal vein thrombosis with this drug. While these adverse effects are relatively rare, their potential severity limits its use.

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