An ongoing dialogue on HIV/AIDS, infectious diseases,
3 Responses to “Antiretroviral Rounds: Immediate ART After an OI — Are We There Yet?”
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
Learn more about HIV and ID Observations.
FROM NEJM — Recent Infectious Disease Articles- The Eyes Have It March 5, 2026A 47-year-old man was brought to the ED by EMS after being found dyspneic in his car. He reported having been drinking for 6 hours before presentation. He noted a sensation of tongue swelling and difficulty breathing.
- Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges February 26, 2026In persons with HIV and barriers to adhering to antiretroviral therapy, a long-acting injectable treatment (monthly cabotegravir plus rilpivirine) resulted in better virologic control than standard oral ART.
- Microbial Flora in War Wounds from the Ukrainian Front Line February 26, 2026Battlefield injuries are often contaminated with potentially infecting microbes. In this study, swabs obtained in the field after injury were profiled. Microbes and potential antimicrobial-resistance genes were characterized.
- Primary Measles Infection February 26, 2026A previously healthy man presented with a 5-day history of fever, nausea, and vomiting and a 2-day history of an itchy rash. Examination showed an exanthem consisting of minute macules and subtly elevated papules.
- From Efficacy to Access in Long-Acting HIV Therapy February 26, 2026Over the past three decades, advances in antiretroviral therapy (ART) have dramatically improved life expectancy, decreased frailty, and improved quality of life for persons with human immunodeficiency virus (HIV).1,2 These gains have accrued primarily among those who can reliably access health care and adhere to daily treatment. For...
- The Eyes Have It March 5, 2026
I never start with Atripla per se, but split it as Truvada plus Sustiva for the first month or so, in case pt doesn’t tolerate efavirenz side effects.
Practicing in New York city I see many patients similar to the case that was described.
The immediate versus delayed initiation of ART in my view should depend on CD4 count. I may start ART in a patient with CD4>100 earlier than the one with CD4<50.
The lower the CD4 count the more chance of other hidden OIs . These infections should be screened first before initiating ART . This can be done safely in 2-4 weeks with special screening for significant OIs like CMV, crypt, etc….
This lag in initiation of ART and the medication/s needed for treatment of thepresenting OI while screening for other OIs also safeguard us against complexity of overlapping side effects by introducing the medications stepwise. Patient tolerance improves and compliance improves as well.
Excellent site, keep up the good work