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- Clinical Characteristics of Patients Infected with Bundibugyo Virus, DRC 2026 August 6, 2026Bundibugyo virus, a filovirus, is currently spreading in the Democratic Republic of Congo. This report presents early data on symptoms and illness severity as well as diagnostic challenges.
- Ebola at 50 — Lessons for Outbreak Response and Preparedness August 6, 2026An accurate history of Ebola begins with partnerships, including those between responders and the populations they serve. One of its key lessons is that equity must be integral to outbreak preparedness.
- Cross-Reactive Bundibugyo Antibody Responses after Receipt of Licensed Ebola Vaccines August 6, 2026The Bundibugyo virus outbreak in the DRC and Uganda has focused concern on potential countermeasures. Investigators assessed cross-reactive immune responses in serum obtained during previous Ebola vaccine trials.
- The Inequality–Pandemic Cycle — Rethinking Preparedness August 6, 2026Increasing pandemic frequency and increasing economic inequality are creating a self-reinforcing cycle. What’s needed is therefore a new, inequality-informed approach to pandemic preparedness.
- The Social Contract of Bundibugyo Ebola Isolation August 6, 2026The lack of vaccines and disease-specific therapeutics for Bundibugyo Ebola has dramatically affected the community’s perception of Ebola treatment centers. In this context, trust becomes critical.
- Clinical Characteristics of Patients Infected with Bundibugyo Virus, DRC 2026 August 6, 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