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3 Responses to “Antiretroviral Rounds: Immediate ART After an OI — Are We There Yet?”
Paul E. Sax, MD
Associate Editor
NEJM Clinician
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FROM NEJM — Recent Infectious Disease Articles- Scrofuloderma August 29, 2026A 72-year-old man presented with a 2-month history of a painful lump on his neck. Cytologic analysis of fine-needle aspirate was consistent with suppurative lymphadenopathy. The lesion subsequently ulcerated and released purulent discharge.
- Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis August 28, 2026Among adults with endocarditis caused by S. aureus, E. faecalis, or streptococcus species, tailored-duration antibiotic therapy led to 13 more days alive without antibiotics than standard therapy, but with a higher incidence of relapse.
- Severe Plasmodium falciparum Malaria August 20, 2026An 82-year-old man was brought to the ED after being “found down.” One week earlier, he had returned from a 1-month visit to Chad. A peripheral-blood smear showed ring-form trophozoites within erythrocytes.
- Case 24-2026: A 74-Year-Old Man with Dyspnea, Proximal Muscle Weakness, and Hypoxemia August 20, 2026A 74-year-old man with myasthenia gravis was evaluated for dyspnea, proximal muscle weakness, hypoxemia, and a painful tongue lesion. Medications included prednisone and mycophenolate mofetil. A diagnosis was made.
- A Regional Measles Outbreak — South Carolina, 2025–2026 August 13, 2026In South Carolina, 997 measles cases occurred in the reported outbreak. In one health care system, 81 cases were identified. Most were in unvaccinated persons; 13 persons were hospitalized, and 2 had measles encephalitis.
- Scrofuloderma August 29, 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