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3 Responses to “Antiretroviral Rounds: Immediate ART After an OI — Are We There Yet?”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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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