B-Tripla and a Bluey on Bondi Beach
By Bob Frascino, M.D.
April 7, 2011
Bronzed Aussie Surfer Dude: Howya going mate? Damn you really got chundered by that wave and rip. Hope ya don't mind my sayin' but that surfboard looked about as useful to you as an ashtray on a motorbike.
Dr. Bob: Cough, cough, cough, sputter, cough.
BASD: No worries mate; just keep breathing. She'll be apples.
Dr. Bob: Thanks, cough, cough, and what's that about "apples"?
BASD: That's "strine" (Aussie slang) for "everything will be all right."
Dr. Bob: I know that, you drongo! But how does "she'll be apples" translate into "everything will be all right?"
BASD: No clue, mate. Hey, since you're a bit of the celebrity 'round here. Any chance you'd answer a few medical questions? After you finish coughing up half the ocean, of course! That heaven-on-a-stick spunk of a lifesaver who just pulled you out of the drink suggested I keep you on dry land and away from your surfie mates for a bit. Fair dinkum. That rip looked like it could have tossed you halfway to Tassie (Tasmania).
Note to reader: Before proceeding, I should probably fill you in on what's going on here. I'm on Bondi Beach in Sydney, Australia with some friends (mates). I have just had a rather spectacular wipeout trying to surf. After being gobbled up by the wave and scraped helter-skelter across the ocean floor for a distance that seemed to me to be roughly the size of Manhattan Island, I was grabbed by a buffed smiling Aussie lifesaver (beach lifeguard). He then shouted, "Look out mate! There's a bluey over there. Let's get you outta here." As he cross-chest carried me across the rip, I saw something that looked like a giant blue condom with strings float by.
And now, back to our story ...
Dr. Bob: First, I have a question for you. What in bloody hell is a bluey?
BASD: A bluebottle.
Dr. Bob: A What?
BASD: You yanks call 'em Portuguese Man o' Wars or some such nonsense.
Dr. Bob: Aren't they deadly?
BASD: Well sure, can be, but usually they don't kill you.
Dr. Bob: Usually?
BASD: What are you reading?
Dr. Bob: I'm checking out bluebottles in this book, The Top 100 Most Venomous Creatures in Australia. Looks like the bluey didn't even make the top 100 list.
BASD: Now what are you doing?
Dr. Bob: Cross-checking another source downloaded onto my Kindle, Creatures and Things That Will Maim or Kill You Horribly While Visiting Australia, Volume 17. It says here a bluebottle may look like a jellyfish, but it isn't. Its stinging venom-filled tentacles can paralyze a fish or cause agony to humans. Serious stings cause fever, shock, breathing problems, heart problems and sometimes death. Damn, and it didn't even make it into the top 100 list???
BASD: Let's change the subject mate. Blueies are boring.
Dr. Bob: Boring? I hate to think what you'd find exciting.
BASD: So, here in Oz (Australia), it's been like a century since we've had a new HIV drug. What's up with that?
Dr. Bob: Well, in reality it's been three years since the last new antiretrovirals hit the market. But I agree three years is a bit of a dry spell. The good news is that a new NNRTI is on its way to pharmacy shelves very soon, and there are a few other promising new drugs in phase 2 and 3 development.
BASD: Cool. What's an NNRTI?
Dr. Bob: It's a non-nucleoside reverse transcriptase inhibitor or "non-nuke" for short. Non-nukes block the activity of reverse transcriptase, a critical enzyme in the HIV lifecycle, so that the virus can't convert itself from RNA to DNA. It's the reverse transcriptase-converted DNA that integrates into our DNA in CD4 cells and causes all sorts of havoc.
Non-nukes are often included in first-line combination antiretroviral regimens. Sustiva (efavirenz) has been the preferred non-nuke since it was introduced in 2002. It's one of the three antiretrovirals in Atripla. Viramune (nevirapine) is an alternative non-nuke, but has limitations. Intelence (etravirine) is the new kid on the block in the non-nuke family, but it's used only for HIVers who have resistance or intolerance to other non-nukes.
A new non-nuke, rilpivirine, appears to be on track for approval by the FDA in the States in May. From what I've heard, it will be approved for first-line use, like Sustiva. Ultimately the manufacturer would like to make a co-formulation single tablet of rilpivirine, tenofovir and emtricitabine, but this might take a while, as the FDA has recently asked for longer-term data on the co-formulated pill. The combination would become the second single-tablet, once-daily regimen. (Atripla was the first.) We've nicknamed the new combination "B-tripla!" (A real brand name has not yet been established.)
Life, Love, Sex, HIV and Other Unscheduled Events
Bob Frascino, M.D., was President and Founder of The Robert James Frascino AIDS Foundation. He had been an outspoken, popular expert in TheBody.com's "Ask the Experts" forums on safe sex and fatigue/anemia since 2000. Once a Fellow of the American Academy of Allergy, Asthma, and Immunology, and the American Academy of Pediatrics, Dr. Frascino served as Associate Clinical Professor of Medicine, Division of Immunology, Rheumatology, and Allergy, at Stanford University Medical Center from 1983 until 2001. He was a member of the American Academy of HIV Medicine and had also been a distinguished member of the executive boards of numerous state and regional associations.
We're inexpressibly saddened to share the news that Dr. Frascino passed away unexpectedly on Saturday, Sept. 17, 2011. Click here to read more and to share your thoughts.
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