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- Ensitrelvir for Covid-19 Postexposure Prophylaxis in Household Contacts May 14, 2026In a trial, the 3C-like protease inhibitor ensitrelvir was more effective than placebo in preventing Covid-19 in household contacts of patients with SARS-CoV-2 infection.
- Cerebral Syphilitic Gumma May 14, 2026A 50-year-old man presented to the ED with a 1-month history of headache and worsening weakness of the left arm and leg. Brain MRI showed an enhancing lesion with extensive surrounding edema.
- Getting Serious about Tickborne Diseases — Shifting Research Priorities May 13, 2026Research on Lyme disease has emphasized clinical disease and pathogen microbiology rather than the root cause: the infected tick vectors in the environment, which remain uncontrolled.
- Human Infection with Highly Pathogenic Avian Influenza A(H5N5) Virus May 7, 2026Avian influenza can jump species from birds to humans, a fact that arouses concern for serious illness and broader human transmission. In this report, avian influenza A(H5N5) was shown to cause severe human illness.
- Reducing Bacterial Contamination of Blood Bags with a Double Knot May 7, 2026In a study involving 180 blood bags, use of a double-knot closure rather than the usual single knot prevented bacterial contamination. This strategy may reduce the risk of blood-product contamination in resource-limited settings.
- Ensitrelvir for Covid-19 Postexposure Prophylaxis in Household Contacts May 14, 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