16 European AIDS Clinical Society guidelines also indicate that when preferred regimens are not feasible or available, 17 dolutegravir + lamivudine can be used. 14, 15 In addition, the 2019 update to the US Department of Health and Human Services treatment guidelines for HIV-1 infection supports the use of dolutegravir + lamivudine as initial treatment in patients for whom abacavir, tenofovir disoproxil fumarate, or tenofovir alafenamide either cannot be used or are not optimal. These data led to the approval of the fixed-dose combination of dolutegravir/lamivudine as a once-daily, single-tablet 2DR by the FDA and the European Medicines Agency. 13 Importantly, resistance mutations associated with INSTIs or NRTIs did not emerge in the few participants who had virologic failure. 11, 12 In primary week 48 analyses of the 2 phase III studies GEMINI-1 and GEMINI-2 in treatment-naive adults, dolutegravir + lamivudine was noninferior to dolutegravir + tenofovir disoproxil fumarate/emtricitabine in achieving HIV-1 RNA <50 copies/mL according to the US Food and Drug Administration (FDA) Snapshot algorithm. The integrase strand transfer inhibitor (INSTI) dolutegravir has a high barrier to resistance, making it a well-suited candidate for inclusion in a 2DR, 9 particularly when paired with lamivudine, 10 as previously observed. 7, 8 Thus, a need remains for well-tolerated, potent 2DRs with a high barrier to resistance. 2– 6 Although noninferior efficacy was shown against 3-drug regimens (3DRs), PIs are associated with adverse metabolic effects, long-term toxicities, and drug–drug interactions, limiting their appeal as components of lifelong therapy. 1 As such, early studies investigating 2DRs as initial or maintenance therapy for HIV infection evaluated the pairing of the potent, well-tolerated nucleoside reverse transcriptase inhibitor (NRTI) lamivudine with pharmacologically boosted protease inhibitors (PIs), which have a high barrier to resistance. 1 The core antiretroviral agent in a 2DR must have high potency and a high barrier to resistance. Two-drug regimens (2DRs) can potentially reduce long-term cumulative drug exposure and decrease treatment-associated costs for HIV-1–infected individuals, who require lifelong therapy. Renal and bone biomarker changes favored dolutegravir + lamivudine. Dolutegravir + lamivudine had a lower rate of drug-related adverse events than dolutegravir + tenofovir disoproxil fumarate/emtricitabine (19.6% vs 25.0% relative risk ratio, 0.78 95% CI: 0.64 to 0.95). Eleven participants taking dolutegravir + lamivudine and 7 taking dolutegravir + tenofovir disoproxil fumarate/emtricitabine met confirmed virologic withdrawal criteria through week 96 none had treatment-emergent resistance mutations. Proportions of participants in the HIV-1 RNA ≥50 copies/mL Snapshot category were largely unchanged from week 48 to 96. Professionally they excel in all the creative and media fields.At week 96, dolutegravir + lamivudine (N = 716) was noninferior to dolutegravir + tenofovir disoproxil fumarate/emtricitabine (N = 717) in achieving HIV-1 RNA <50 copies/mL (Snapshot algorithm −10% noninferiority margin) in the pooled analysis (proportion of responders, 86.0% vs 89.5%, respectively adjusted treatment difference, −3.4% ), GEMINI-1 (−4.9% ), and GEMINI-2 (−1.8% ). They are good producers at work unless they become bored. The natives of Gemini sign have golden tongues as well as clever mind, an individual capable of conveying complex ideas in a simple way and of inspiring others. They are often turned off by overly needy types of people who would rather stay at home most of the times. Typical Gemini native looks for idealistic, fun, spontaneous friends who share their interests. Although these people have good communication skills, they have an easy acceptance of opposites. Gemini is ruled by Mercury, the planet connected with change and communication. They are very much in demand socially as they know how to entertain people above all, they are the flirtiest people. They are the most difficult to understand. They are hot and cold almost at the very same moment. Gemini individuals tend to be a romantic challenge to any potential mate, and something of a mystery as well. Our world comes in pairs: good and evil, male and female, yin and yang - and Gemini natives are living proof of it - intellect and freedom combined - loving, versatile and erratic.
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