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8 December 2017, 17:01
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Tilda Swinton supports the groundbreaking French HIV treatment

Tilda Swinton supports the groundbreaking French HIV treatment - picture 1

ICCARRE is a groundbreaking programme reducing the amount of medication required by HIV/AIDS patients during treatment. It presents a short film directed by Blanca Li and starring Tilda Swinton.

The video shows the ideas behind ICCARRE and it’s work -- the tenets of care, support, harmony and balance -- via the choreography of Blanca Li, known for her work with Beyoncé, Daft Punk, Kanye West, as well as more traditional outlets like the Paris Opera Ballet and the Berlin Ballet.

Tilda Swinton told to Vogue magazine that her friendship with the immunologist Jaques Leibowitch made her aware of ICCARRE: "For about a decade now I have witnessed Jacques’s and ICCARRE’s heroic battle to influence governments and global thinking about a more humane and harmonious treatment of HIV." she said.

In September 2017, the French Agency for Research on HIV/AIDS, ANRS, launched a large clinical trial called Quatuor (Quartet in English). Its aim is to show: "the non-inferiority of antiretroviral treatment taken 4 consecutive days a week versus continuous therapy – the current protocol – in HIV-infected patients with controlled viral load for at least 12 months and stable antiretroviral treatment since 4 months."

The trial involves 640 volunteers recruited from 63 public hospitals in France and the Caribbean. Dr. Pierre de Truchis, at Raymond Poincaré Hospital in Garches (Hauts-de-Seine), is the principal investigator.

While the trial is still underway, doctors may well suggest that some of their patients living with HIV switch to only four treatments per week. Indeed, such a possibility was confirmed in May 2017 by the National Council for AIDS and Hepatitis (CNS), even as the organisations remained cautious: "On a case-by-case basis, in conditions similar to those of carried-out studies, a discontinuous-take strategy, 4 or 5 days out of 7, may be considered."

It should be emphasized that any such change requires a rigorous medical follow-up, with close biological examinations of the patient.

We now have 15 years of experience concerning the safety of maintenance medicine treatments alleviated with short breaks. The primary experiment has been conducted since 2003 as part of a protocol called ICCARRE, acronym for "intermittent in close cycles, antiretrovirals remain effective." Led by Dr. Jacques Leibowitch of the Raymond Poincaré Hospital, a group of 48 patients went from seven to five days of treatment per week, and then to four. Despite the reduction, their viral load remained below detection level. The results were considered sufficiently robust by the international scientific community that they were published in 2010 by the FASEB Journal. Similar observations on 94 patients led to a second publication in 2015, adding additional years of experience.

In 2009, Assistance Publique-Hôpitaux de Paris (AP-HP) and Versailles Saint-Quentin University jointly filed for two international patents, one for "maintenance therapies under any standard triple combination" taken four days a week or less, the other for the use to that purpose of innovative quadruple combination therapies.

Convinced by the first results of the ICCARRE protocol, ANRS launched in 2014 its first clinical trial called 4-D (four days) over two years at 17 medical centres in France. More applications to participate in the trial were received than could be accepted, indicated Professor Christian Perronne, the trial's principal investigator. The results presented at the 2016 International AIDS Conference in Durban, South Africa, and published in Journal of Antimicrobial Chemotherapy, indicate that 96 of the 100 patients who scrupulously followed the "four consecutive days out of seven" pattern were 100% successful. Early in the fourth week of the study three patients had a newly detectable viral load, which became undetectable upon the return to daily treatment. One patient left the study.

The results were sufficiently encouraging that the ANRS continued with the Quatuor test. To allow a comparison, it includes a "control" group consisting of patients who continue to take their treatment seven days a week for 48 weeks. This methodology meets the requirements of health authorities for the level of evidence to accumulate before a change in prescribing recommendations. According to the ANRS: "Quartet seeks to demonstrate that the strategy four days out of seven is non-inferior to the seven days a week strategy and that at equal efficiency, patients in the relief group will get secondary benefits [fewer side effects, better compliance…]."