4 ms·

> Because having undetectable levels on day 1 doesn’t mean you have undetectable levels on day X and people don’t test every single day. This is both clinicall

> Because having undetectable levels on day 1 doesn’t mean you have undetectable levels on day X and people don’t test every single day. This is both clinically wrong and a red herring. Once a person has durably achieved clinical undetectability under HAART, they do remain undetectable.

Retric 4y ago
> they do remain undetectable False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ In the first year after achieving VL undetectability, 354/1386 (25.5%) patients experienced low-level VL rebound, the remaining patients maintained consistent undetectability. Low-level rebound occurred less commonly with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART than with other regimens (P = 0.01). Over median 2.2 (range 0.0-7.4) years of subsequent follow-up, 86 (6.2%) patients experienced virological failure, corresponding to 2.30 failures per 100 person-years (95% confidence interval [CI] 1.82-2.79). Independent predictors of virological failure included low-level rebound during the first year after achieving undetectability relative to consistent undetectability (rate ratio [RR] 2.18, 95%0 CI 1.15-4.10), female gender (RR 1.79, 95% CI 1.12-2.85) and receiving a ritonavir-boosted protease inhibitor (Pl/r) relative to NNRTI-based HAART (RR 1.88, 95% CI 1.02-3.46).
- chimeracoder 4y ago
  > False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ > In the first year after achieving VL undetectability... I'm gathering from your comments that you don't have a clinical background in HIV research (because if you did, you would not be posting this as a reply). Not only does your link not prove what you think it does, but it actually says the exact opposite: once a patient has durably achieved clinical undetectability under HAART, they do remain undetectable, even when using older generations of drugs that are no longer first-line treatments. It even states that in the conclusion: " Patients on first-line HAART who maintain consistent VL undetectability for 1 year have a low risk of subsequent virological failure." To spell it out: the mistake you're making is that you're looking at a paper that studies treatment-naive patients and whether or not they durably achieve undetectability, whereas what we're talking about is patients who have already durably achieved undetectability. So the paper you linked isn't particularly relevant to our conversation, because it's studying a completely unrelated endpoint, but by coincidence, it does actually corroborate the point I was making.
  - Retric 4y ago
    What you quoted does not support your point. “have a low risk of subsequent virological failure" Low risk is not zero risk. Also the actual population of people who durably achieved undetectability is effectively a true Scotsman argument in that you reject people who seemed to achieve it who then became detectable again. We don’t have long term data saying all people who are undetectable for N years are undetectable for 40 years because the treatments aren’t that old. All we can do is extrapolate and people who are undetectable for even 4 years have become detectable. Newer treatments look promising but they have even less long term data to extrapolate from. And of course things look even worse when people stop taking treatment for various reasons.
    - elil17 4y ago
      Durable viral undetectability means someone has remained undetectable across all viral load measurements for 12 continuous months. So, no, it’s not a “no true Scotsman argument.” This is a scientific term with a specific definition.
      - Retric 4y ago
        If you’re trying to use it as a scientific term then actually apply the term correctly. They specifically mention failures in such people in the actual paper though do indicate it’s a low risk for that population: https://journals.sagepub.com/doi/epdf/10.1177/135965350801300707 https://journals.sagepub.com/doi/epdf/10.1177/13596535080130... They note risk factors for increased viral load include include illness or vaccination etc. The intent may be to remove people who have regular failures but the definition isn’t purely based on their underlying medical condition. With that 1 year as a benchmark you’re excluding people who happened to experience such risk factors while excluding people who have yet to experience them.
        chimeracoder 4y ago
        > If you’re trying to use it as a scientific term then actually apply the term correctly. Your comments in this thread are a very good example of the aphorism "a little knowledge is a dangerous thing". As I mentioned above, it's pretty clear that you don't have a clinical background in HIV, because you're mixing up terms that have precise clinical definitions and drawing conclusions that are not only not warranted, but actively contradicted by the data. There are a lot of incorrect statements or mistaken assumptions that you're building on here. I've pointed out a few of them already, but without the contextual domain knowledge, it would be difficult to correct them all in a way that's accessible to a lay audience. It certainly would not be possible in the scope of an HN comment. As a general note: it's okay not to be an expert in a given field, but in that case, please keep that in mind when discussing it. The ability to find information which appears intelligible does not in se imply the necessary knowledge to contextualize and interpret that information correctly. That's particularly true when talking about information written for an incredibly specialized audience - even most clinicians would not be expected to read a paper on this topic, because HIV is a fairly unique subfield that requires a lot of domain-specific knowledge.

Retric 4y ago

> they do remain undetectable False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ In the first year after achieving VL undetectability, 354/1386 (25.5%) patients experienced low-level VL rebound, the remaining patients maintained consistent undetectability. Low-level rebound occurred less commonly with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART than with other regimens (P = 0.01). Over median 2.2 (range 0.0-7.4) years of subsequent follow-up, 86 (6.2%) patients experienced virological failure, corresponding to 2.30 failures per 100 person-years (95% confidence interval [CI] 1.82-2.79). Independent predictors of virological failure included low-level rebound during the first year after achieving undetectability relative to consistent undetectability (rate ratio [RR] 2.18, 95%0 CI 1.15-4.10), female gender (RR 1.79, 95% CI 1.12-2.85) and receiving a ritonavir-boosted protease inhibitor (Pl/r) relative to NNRTI-based HAART (RR 1.88, 95% CI 1.02-3.46).

chimeracoder 4y ago
> False. https://pubmed.ncbi.nlm.nih.gov/19043927/ https://pubmed.ncbi.nlm.nih.gov/19043927/ > In the first year after achieving VL undetectability... I'm gathering from your comments that you don't have a clinical background in HIV research (because if you did, you would not be posting this as a reply). Not only does your link not prove what you think it does, but it actually says the exact opposite: once a patient has durably achieved clinical undetectability under HAART, they do remain undetectable, even when using older generations of drugs that are no longer first-line treatments. It even states that in the conclusion: " Patients on first-line HAART who maintain consistent VL undetectability for 1 year have a low risk of subsequent virological failure." To spell it out: the mistake you're making is that you're looking at a paper that studies treatment-naive patients and whether or not they durably achieve undetectability, whereas what we're talking about is patients who have already durably achieved undetectability. So the paper you linked isn't particularly relevant to our conversation, because it's studying a completely unrelated endpoint, but by coincidence, it does actually corroborate the point I was making.
- Retric 4y ago
  What you quoted does not support your point. “have a low risk of subsequent virological failure" Low risk is not zero risk. Also the actual population of people who durably achieved undetectability is effectively a true Scotsman argument in that you reject people who seemed to achieve it who then became detectable again. We don’t have long term data saying all people who are undetectable for N years are undetectable for 40 years because the treatments aren’t that old. All we can do is extrapolate and people who are undetectable for even 4 years have become detectable. Newer treatments look promising but they have even less long term data to extrapolate from. And of course things look even worse when people stop taking treatment for various reasons.
  - elil17 4y ago
    Durable viral undetectability means someone has remained undetectable across all viral load measurements for 12 continuous months. So, no, it’s not a “no true Scotsman argument.” This is a scientific term with a specific definition.
    - Retric 4y ago
      If you’re trying to use it as a scientific term then actually apply the term correctly. They specifically mention failures in such people in the actual paper though do indicate it’s a low risk for that population: https://journals.sagepub.com/doi/epdf/10.1177/135965350801300707 https://journals.sagepub.com/doi/epdf/10.1177/13596535080130... They note risk factors for increased viral load include include illness or vaccination etc. The intent may be to remove people who have regular failures but the definition isn’t purely based on their underlying medical condition. With that 1 year as a benchmark you’re excluding people who happened to experience such risk factors while excluding people who have yet to experience them.
      - chimeracoder 4y ago
        > If you’re trying to use it as a scientific term then actually apply the term correctly. Your comments in this thread are a very good example of the aphorism "a little knowledge is a dangerous thing". As I mentioned above, it's pretty clear that you don't have a clinical background in HIV, because you're mixing up terms that have precise clinical definitions and drawing conclusions that are not only not warranted, but actively contradicted by the data. There are a lot of incorrect statements or mistaken assumptions that you're building on here. I've pointed out a few of them already, but without the contextual domain knowledge, it would be difficult to correct them all in a way that's accessible to a lay audience. It certainly would not be possible in the scope of an HN comment. As a general note: it's okay not to be an expert in a given field, but in that case, please keep that in mind when discussing it. The ability to find information which appears intelligible does not in se imply the necessary knowledge to contextualize and interpret that information correctly. That's particularly true when talking about information written for an incredibly specialized audience - even most clinicians would not be expected to read a paper on this topic, because HIV is a fairly unique subfield that requires a lot of domain-specific knowledge.