Concomitant Highly Active Antiretroviral Therapy Research Articles

Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review.

Report four cases of HIV-positive patients managed on biologic therapy and summarize the cases of psoriasis in HIV-positive patients managed on biologic therapy that have been published in dermatologic literature to date. We searched PubMed and Embase databases using the terms HIV and psoriasis or HIV and psoriatic arthritis combined with one of the eleven biologics currently approved for treating psoriasis. We identified 48 cases of anti-psoriasis biologic therapy (including adalimumab, infliximab, etanercept, ustekinumab, and guselkumab) in HIV-positive patients and added four. While data is limited, the evidence available suggests biologic agents are safe and efficacious in moderate-to-severe psoriasis and may even have a favorable effect on CD4 and HIV viral counts when used with concomitant HAART. Further research would be helpful to establish practical guidelines for the use of anti-psoriasis biologic therapy in the HIV population, including that of newer agents.

Head and neck diffuse large B cell lymphomas (HN-DLBCL) in human immunodeficiency virus (HIV) positive patients: long-term results in the highly active antiretroviral therapy (HAART) era.

To report long-term outcomes and toxicity rates after chemotherapy (CHT) followed by radiotherapy (RT) in the highly active antiretroviral therapy (HAART) era in human immunodeficiency virus (HIV) positive patients with head and neck diffuse large B cell lymphomas (HN-DLBCL). Clinical data concerning consecutive HIV patients treated for DLBCL located in head and neck region with CHT and RT were retrospectively reviewed. Systemic treatment consisted of combination CHT agents given with concomitant HAART and regimen was left to oncologists' discretion. Involved field RT was delivered at a total dose of 30-36Gy (2Gy per fraction). Survival rates were estimated using the Kaplan-Meier method. Toxicity was evaluated using National Cancer Institute's Common Terminology Criteria for Adverse Events. Overall, 13 patients were included. There were no missing data. Eight patients had advanced disease (stage III-IV=8; 61.5%). The most common primary tumor location was oral cavity (n=7) with large mass at presentation. All patients completed the programmed treatment. Severe acute toxicity was observed in one patient, only. Overall, three patients had died and no treatment-related deaths occurred. After a median follow-up of 152months, the 20-year overall survival and disease-free survival rates were 65.9 and 41.5%, respectively. Globally, there were no RT-related late complications. This data analysis suggested that CHT followed by RT can be safety proposed in the management of patients with HIV-related HN-DLBCL in the HAART era. Further investigations are necessary to validate our results.

Adverse Drug Reaction Profile in Patients on Anti-tubercular Treatment Alone and in Combination with Highly Active Antiretroviral Therapy.

Adverse drug reactions are very common among patients on anti-tubercular treatment alone or in combination with highly active antiretroviral therapy but comparatively studied very less. Hence, the current study was done to evalaute the adverse drug reaction (ADR) profile in patients receiving anti-tubercular treatment (ATT) and ATT with highly active antiretroviral therapy (HAART). A one year prospective, cross-sectional observational study was undertaken using suspected adverse drug data collection form available under Pharmacovigilance Programme of India. Seventy four patients receiving ATT & 32 patients on both ATT & HAART presented with 74 and 45 adverse drug events (ADE) respectively. Males were more affected than females in both the groups. DOTS category- 1 regimen was mostly responsible for ADE in both the groups. Epigastric pain was the most common ADE in TB patients, while anaemia was the most common presentation in TB with HIV group. On comparison, ADE rate of TB with HIV co-morbid patients was more (55.8%) than TB patients (0.36%) (p < 0.001). Urban population presented more with ADR in TB/HIV group unlike rural population in TB group (p<0.0001). Whereas, illiterate were more involved in TB group unlike literate in TB/HIV group (p<0.05). Type A reactions were more common in TB group (p < 0.001). Addition of drugs for the management of ADR events was more in TB/HIV group (p < 0.001) as compared to TB group. Rest all the parameters were comparable. The study underscores that concomitant HAART and ATT, result in more ADRs in comparison to ATT alone demanding collaboration & integration of National AIDS Control programme and PvPI to enhance drug safety in this field.

Sustained favourable HIV viral load response in South African patients during concomitant HAART and cancer therapy.

HIV infection has led to an increase of both AIDS defining and non-AIDS defining cancers. Immunosuppressive cancer therapy had been noted for increased HIV viral load in cancer patients infected with HIV before the advent of highly active antiretroviral therapy (HAART). Assessing the outcome of concomitant HAART and cancer treatment in regions endemic for HIV is thus important. From a cohort of 34 cancer patients infected with HIV, 10 (six underwent radiotherapy and four chemotherapy) had at least three serial samples collected before, during and after treatment. From each sample, HIV viral load, CD4 + and CD8 + cell count was investigated. HIV genotypic drug resistance was assessed for six patients with a detectable HIV viral load at baseline. Of the 10 patients; one was HIV positive only, three were HIV and HBV co-infected and six were HIV, HBV and HCV triple infected. Four patients were HAART experienced at recruitment, while six were HAART naive with detectable HIV viral loads. A significant HIV viral load decrease (P = 0.0128) was observed in all six patients with detectable baseline HIV viral loads. The four patients on HAART at recruitment maintained lower than detectable HIV viral load status throughout cancer therapy. A positive correlation between the rise in CD4 + cell count and attaining a lower than detectable HIV viral load was also observed (P = 0.0439). This pilot study supports concomitant treatment of HIV/AIDS and cancer in HIV endemic regions irrespective of the type of cancer diagnosed, prescribed cancer therapy or other viral (HBV, HCV or both) co-infections.

Sorafenib for the treatment of unresectable hepatocellular carcinoma in HIV-positive patients

Few data are available on the safety and efficacy of sorafenib in HIV-infected patients with unresectable hepatocellular carcinoma (HIV-u-HCC) and concomitant highly active antiretroviral therapy (HAART). Between July 2007 and October 2010, 27 consecutive HIV-u-HCC patients were treated with sorafenib and concomitant HAART within the Gruppo Italiano Cooperativo AIDS e Tumori (GICAT). Three patients achieved a partial response, 12 achieved a stable disease, and 12 showed progression. The median time to progression and overall survival was 5.1 (range 0.5-13.3) and 12.8 (range 1.1-23.5) months, respectively. Grades 3-4 toxicities included diarrhea (four patients, 14.8%), hypertension (three patients, 11%), and hand-and-foot skin reaction (four patients, 14.9%). Most drug-related side effects were low grade and manageable. This retrospective study shows favorable survival data among HIV-u-HCC patients treated with sorafenib together with a reasonable safety profile.

Colorectal cancer in HIV positive individuals: The immunological effects of treatment

Background and objectivesSince the introduction of highly active antiretroviral therapy (HAART), non-AIDS defining malignancies including colorectal cancer (CRC) have emerged as major health concerns for people living with HIV. MethodsFrom a prospective database of 11,112 HIV seropositive individuals, we identified 11 patients with CRC. Clinicopathological details on the presentation, treatment and outcomes were collected. ResultsAll were male with a median age of 50years (range 36–67) and median duration of HIV infection of 7.2years (range 0–21). Five had metastatic disease at presentation, including 1 patient with a small cell cancer of the rectum. Patients were treated along conventional lines for CRC with concomitant HAART and opportunistic infection prophylaxis. During treatment, median CD4 cell counts fell from 357/mm3 at CRC diagnosis to 199/mm3, although no opportunistic infections were recorded. Three patients have died and the 5-year overall survival measured 65% (95% confidence interval 32–98%). ConclusionsTreatment for CRC reduces cellular immunity and potentially puts HIV patients at risk of opportunistic infections; knowledge of HIV status prior to starting treatment is essential. This risk may be reduced by concomitant HAART and prophylaxis. Clinicians managing CRC should consider screening patients for HIV before starting chemotherapy or radiotherapy.

Concomitant Highly Active Antiretroviral Therapy Leads to Smaller Decline and Faster Recovery of CD4+ Cell Counts During and After Pegylated Interferon Plus Ribavirin Therapy in HIV–Hepatitis C Virus Coinfected Patients

The impact of highly active antiretroviral therapy (HAART) on CD4+ cell course during treatment with pegylated interferon plus ribavirin (PegIFN-RBV) in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is unknown. We determined CD4(+) cell count in 94 HIV-HCV coinfected patients undergoing treatment with pegylated interferon plus RBV at baseline, treatment weeks 4-48 (W4-W48), and months 1, 3, and 6 of follow-up. Of the 94 patients, 70 underwent concomitant HAART (group A) and 24 did not (group B). Group A showed smaller CD4(+) cell decreases from W24-W48 (P = .027) and greater CD4(+) cell increases after cessation of pegylated interferon plus ribavirin therapy (P = .002) than group B showed. Concomitant HAART leads to smaller decreases and faster recovery of CD4(+) cells during and after pegylated interferon plus RBV therapy.

Long Term Results of Stanford V Regimen and Highly Active Antiretroviral Therapy (HAART) In 59 Patients (pts) with HD and HIV Infection (HD-HIV)

AbstractAbstract 4827 Background:The introduction of HAART has significantly improved the outcome of pts with HD-HIV. However there are no data on the long term follow-up of HD-HIV pts treated with conventional chemotherapy (CT) regimens. In 2002, we reported the results of a prospective phase II study with the intensive 12-week CT with adjuvant radiotherapy (Stanford V) and concomitant HAART in 59 pts (Spina et al. Blood 2002;100:1984-1988). Methods:To analyze the long term outcome of patients included in the Stanford V and HAART protocol. Results:The median follow-up is 67months (range 3–156 months The 5-yr overall survival (OS), freedom from progression (FFP), disease free survival and event free survival are 54%, 52%, 60% and 37%, respectively. The 5-year OS is significantly different in pts with an international prognostic score (IPS) >2 in comparison to that of pts with an IPS <3 (84% vs 36%, p= 0.0005). Similarly, the percentages of FFP at 5 years in these groups are 72% and 45% (p= 0.03). Conclusions:Our data confirm the long term efficacy of Stanford V regimen in combination with HAART in HD-HIV. However, Stanford V is significantly less effective in pts with IPS>2 and therefore new strategies be tested in this setting.Supported by AIRC and ISS grants. Disclosures:No relevant conflicts of interest to declare.

Mitochondrial Toxicity Is Associated with Virological Response in Patients with HIV and Hepatitis C Virus Coinfection Treated with Ribavirin and Highly Active Antiretroviral Therapy

The combination of highly active antiretroviral therapy (HAART) plus ribavirin (RBV) in patients with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection has been reported to cause mitochondrial toxicity (MT). Sixty-four patients with HIV-HCV coinfection who were receiving antiviral therapy were evaluated for MT. Patients with concomitant HAART showed greater increases in lactate levels than did patients without HAART, and this difference was more pronounced in patients who received higher dosages of RBV. The incidence of pancreatic enzyme elevations and symptomatic pancreatitis was higher among patients who received HAART and high-dose RBV. Hepatic steatosis increased in patients who received HAART and high-dose RBV. Patients who showed signs of MT achieved higher rates of sustained virologic response than did patients without MT (73% vs 44%).

Impact of γ‐chain cytokines on T cell homeostasis in HIV‐1 infection: therapeutic implications

CD4(+) T cell lymphocytes are a major target for human immunodeficiency virus type-1 (HIV-1) infection. During this chronic infection, CD4(+) T cell loss (induced through direct viral replication), generalized immune activation and increased susceptibility to apoptosis result in impaired T cell homeostasis with subsequent development of opportunistic infections and cancers. Highly active antiretroviral therapy (HAART) has a well-defined, beneficial effect on HIV-1-related clinical outcome; however, it does not lead to normalization of immune dysregulation. In order to boost both CD4(+) T cell restoration and HIV-1 specific immunity, immunotherapy with gamma-chain cytokines has been used in HIV-1-infected patients during concomitant HAART. In this review, we summarize the role of gamma-chain cytokines, especially interleukin (IL)-2 and IL-7, in influencing T cell homeostasis and proliferation, and discuss how immunotherapy with these cytokines may be beneficial to reconstitute the T cell compartment in the context of HIV-1 infection. The intriguing results of two large trials evaluating the efficacy of IL-2 in restoring immune function during HIV-1 infection are also discussed. In addition, we consider the promises and caveats of the first phase I/II clinical trials with IL-7 in HIV-1-infected patients and the knowledge that is still lacking in the field of T cell reconstitution through gamma-chain cytokines.

Oxaliplatin Based Chemotherapy and Concomitant Highly Active Antiretroviral Therapy in the Treatment of 24 Patients with Colorectal Cancer and HIV Infection

Although FOLFOX4 is considered the standard chemotherapy regimen for colorectal cancer (CRC), few data are available on its results in human immunodeficiency (HIV)-related CRC. The results were analyzed to evaluate feasibility and activity of FOLFOX4 plus highly active antiretroviral therapy (HAART) in metastatic CRC (mCRC) HIV-seropositive patients. From January 2002 to March 2007, 24 patients were selected among the CRC HIV-seropositive patients treated with FOLFOX4 and concomitant HAART within the Italian Cooperative Group on AIDS and Tumors (GICAT). Four median cycles of chemotherapy were administered; the most common severe toxicity was neutropenia (37.5%). An overall response rate of 50% was observed; 4.2% of patients achieved complete response and 45.8% partial response. No opportunistic infections occurred during or immediately after chemotherapy. The median CD4+ count was 380 (range 220-570) at diagnosis. To our knowledge, this is the largest study describing activity and tolerability of FOLFOX4 and HAART, in this setting. FOLFOX4 plus concomitant HAART resulted feasible and active also in HIV-seropositive patients. Moreover, the concomitant use of HAART did not to seem to increase the FOLFOX4 toxicity. This study suggests the good tolerability of the FOLFOX4, making it a reasonable option for combination with HAART.

The First Case Report of APL (ACUTE PROMYELOCYTIC LEUKEMIA) in An HIV Positive Patient On (Highly Active Antiretroviral Therapy) Treated with ARSENIC TRIOXIDE.

Abstract 4166We report here for the first time the use of arsenic trioxide in the treatment of Acute Promyelocytic Leukemia in a patient with HIV on HAART (Highly Active Antiretroviral Therapy).A 37 year old man with a 7 year history of asymptomatic HIV infection, an undetectable viral load and a CD4 count of > 800 cells/mm3 presented with a furuncle and a new onset leukopenia. He denied constitutional symptoms or bleeding problems, but he did complain of fatigue and apthous ulcers. His medications included Epivir, Viramune, Videx EC, Viagra and Avelox. He denied smoking, ETOH abuse or intravenous drug abuse.On Physical Exam, he was afebrile and he did not have organomegaly or lymphadenopathy. Laboratory results revealed a white blood cell count of 1.6 K/uL with 7.9% neutrophils, 90.7% lymphocytes, 0.2% eosinophils, 0.3% basophils and 0.9% monocytes, hemoglobin of 12.4 g/dL, MCV of 96.3fL and platelet count of 112K/mL. Coagulation studies were normal. Bone marrow biopsy revealed a hypercellular marrow with immature myeloid cells (CD34 Positive and HLA-DR Negative). Peripheral blood PCR studies were positive for t (15:17) PML-RARA Translocation. The diagnosis of (APL) Acute Promyelocytic Leukemia (AML-M3 Subtype) was made and he was admitted to the hospital for induction chemotherapy with ATRA (All-Trans -Retinoic-Acid) 40 mg orally twice daily with Idarubicin 12mg/m2 followed by consolidation and maintenance treatment. He continued to take his HAART throughout his chemotherapy. Pt tolerated therapy well. On Day 68 Peripheral blood FISH for t 15:17 was done which was negative. On Day 77 a repeat Bone marrow biopsy revealed a complete remission with no evidence of leukemia and a normocellular marrow maturing trilineage hematopoiesis, and normal cytogenetics. He was non-compliant with maintenance ATRA because of nausea. He remained in remission for 1 year after which repeat labs on a routine visit showed leukopenia and thrombocytopenia. A bone Marrow biopsy done at that time showed recurrent APL with 80% infiltration with promyelocytes. Arsenic Trioxide 0.15 mg/kg/day therapy was begun. After 3 months of therapy the patient achieved complete remission with a normal bone marrow biopsy and a negative PCR for t (15:17) with no evidence of leukemia. Subsequently he underwent standard consolidation treatment 0.15 mg/kg/day 5 days a week for 4 weeks. Seventeen months later he is in Complete Remission and is doing well while still on Highly Active Antiretroviral Therapy.The occurrence of AML has been reported in HIV with a predominance of M2, M4 and M5 subtypes. Six cases of APL in HIV patients have been reported to date. In all of these cases ATRA and an anthracycline have been used to induce remission. Here we report the seventh case of APL/HIV and first successful use of arsenic trioxide with concomitant HAART. On the day of submitting the subtract, he presented with pancytopenia and is currently being worked up for possible relapse. Disclosures:No relevant conflicts of interest to declare.

Antiretroviral and Immunosuppressive Drug-Drug Interactions in Human Immunodeficiency Virus–Infected Liver and Kidney Transplant Recipients

Highly active antiretroviral therapy (HAART) has significantly reduced mortality, and prolonged life expectancy of human immunodeficiency virus (HIV)-positive patients. Such improvements have led to increasing numbers of HIV-infected patients with end-stage organ disease as potential candidates for transplantation. A HAART regimen usually consists of a combination of nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI), and/or protease inhibitors (PI). PI are known to strongly inhibit the cytochrome P450 3A (CYP3A) enzyme system that is responsible for the metabolism of immunosuppressive drugs, such as tacrolimus, sirolimus, and cyclosporine. Besides these pharmacokinetic drug-drug interactions, potential pharmacodynamic drug-drug interactions may also occur with concomitant HAART and antimetabolites, such as mycophenolate mofetil. An approach to immunosuppressive management in HIV-infected organ transplant recipients requires attention to such complexities as unique drug-drug interactions and increased drug-related toxicities.

British HIV Association guidelines for HIV‐associated malignancies 2008

British HIV Association guidelines for HIV‐associated malignancies 2008

Possible Antiretroviral Therapy‐Warfarin Drug Interaction

Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) has resulted in significant morbidity and mortality reductions. Lifelong antiretroviral therapy must be incorporated into each patient's medical regimen. Patients with HIV may also have simultaneous chronic medical conditions, resulting in the possibility of complex drug-drug interactions. We report a possible drug-drug interaction between HAART and warfarin in two patients, as assessed by the Naranjo adverse drug reaction probability scale and the Drug Interaction probability scale. Both patients' pharmacotherapy regimens included a nonnucleoside reverse transcriptase inhibitor (NNRTI), nevirapine, or a protease inhibitor, nelfinavir or lopinavir-ritonavir, and two nucleoside analogs. In both patients, high warfarin doses were required to maintain therapeutic international normalized ratios (INRs). Warfarin has two enantiomers, R-and S-warfarin, which are substrates primarily of cytochrome P450 (CYP) 3A4 (R-warfarin), CYP1A2 (R-warfarin), and CYP2C9 (S-warfarin). Protease inhibitors and NNRTIs have variable effects on CYP: induction, inhibition, or mixed. The increased warfarin doses required in these two patients may have been caused by induction of CYP3A4 by nevirapine, CYP2C9 by nelfinavir, or CYP2C9 by lopinavir-ritonavir. Thus, practitioners should prudently monitor INRs in patients receiving warfarin with concomitant HAART that includes either a protease inhibitor or an NNRTI.

FOLFOX4 and concomitant highly active antiretroviral therapy (HAART) in metastatic colorectal cancer (M-CRC) HIV-positive patients (pts): A GICAT experience

15046 Background: This study was performed to evaluate retrospectively the efficacy and tolerance of FOLFOX4 regimen, with concomitant HAART, in M-CRC HIV-positive pts. Methods: From February 2002 ...

Immunologic recovery in survivors following chemotherapy for AIDS-related non-Hodgkin lymphoma

AbstractThe late effects of chemotherapy on immunologic parameters in AIDS-related non-Hodgkin lymphoma (NHL) have not been described. From a cohort of 105 consecutive patients treated with infusional chemotherapy and highly active antiretroviral therapy (HAART), 68 survived more than 3 months following the end of chemotherapy. Their lymphocyte subsets and plasma HIV viral loads were measured at regular intervals for 2 years and values compared with baseline. During chemotherapy, there were statistically significant falls in CD4 (helper T), CD8 (cytotoxic T), and CD19 (B) cell populations but no changes in the CD56 (natural killer [NK]) cell population. Among the 68 survivors, there were statistically significant increases in CD4, CD8, CD19, and CD56 cell populations during the first year of follow up, compared with the values at the start of chemotherapy. During the second year of follow up, there were further statistically significant rises in CD4 and CD19 cell populations, compared with the values at 12 months after chemotherapy. During 244 years of follow-up since chemotherapy in these 68 survivors, 7 second primary tumors and 8 opportunistic infections were diagnosed. Chemotherapy and concomitant HAART for AIDS-related NHL does not cause prolonged suppression of lymphocyte subsets. These data should provide reassurance regarding the long-term consequences of chemotherapy in these individuals.

Active Tuberculosis Does Not Always Imply the Initiation of Highly Active Antiretroviral Therapy in HIV-Infected Patients

Infection with HIV is an important risk factor for tuberculosis (TB). One-half million cases of TB attributable to HIV infection occur worldwide each year. Since the advent of highly active antiretroviral therapy (HAART) the morbidity and mortality of HIV-infected patients have declined. However concomitant TB treatment and HAART are hampered by a high pill burden complex drug interactions treatment-related adverse events and paradoxic reactions. Studies that have assessed the effect of HAART in the course of TB and HIV coinfection are few. All these retrospective studies suggest that coinfected patients with a CD4 count less than 100 cells/mm/3 would probably benefit from early initiation of HAART. Unlike other HIV-associated opportunistic infections TB may occur at high CD4 cell counts. The indication for HAART in these particular cases has not been assessed and current antiretroviral (ARV) treatment guidelines are based on expert opinion. We evaluated retrospectively 93 episodes of TB diagnosed in 87 HIV-infected patients from January 2000 to February 2004 at Bichat Hospital in an attempt to assess the clinical aspects and outcome of TB according to the level of immunosuppression at TB diagnosis and to the prescription of HAART in the course of TB treatment. (excerpt)

Serbian lymphoma study group (SLG): The prognosis of AIDS-related non-Hodgkin's lymphoma

Background The majority of patients with AIDS-related non-Hodgkin's lymphoma (ARL) present with advanced disease, aggressive histological type, B-symptoms, and often with an extranodal localization. The prognosis is generally poor. The use of highly active antiretroviral therapy (HAART), in combination with chemotherapy, has improved the outcome of ARL. Aims The aims of this study were to detect prognostic factors for patients with ARL and estimate efficacy of concomitant chemotherapy and HAART on overall survival (OS) of these patients. Also, two different chemotherapy regimens have been tested: low dose (ld) mBACOD and CHOP. Methods The study series involved 28 patients with ARL treated at the Clinical Center of Serbia in Belgrade during the period 1996–2006. Twenty-six patients had an aggressive type of lymphoma while 2 had an indolent type. Nineteen patients were treated with chemotherapy, 10 with ld mBACOD and 9 with CHOP. Concomitant HAART and chemotherapy were used in 14 patients. Results This study demonstrated that significant factors for OS in patients with ARL were the high International Prognostic Index ( P = 0.019), previous AIDS event ( P = 0.04), aggressive histological type of NHL ( P = 0.007) and extranodal disease ( P = 0.04). The usage of concomitant HAART and chemotherapy had significant effect on median survival (90 months), compared with chemotherapy alone (10 months) ( P = 0.0002). The patients treated with CHOP had a better response than patients treated with ld mBACOD, but this difference was not significant. Conclusions Our data suggest that aggressive presentation of ARL implicates the need not only for more intensive chemotherapy regimens, but the concomitant usage of HAART, which should result in higher rates of OS in ARL patients.

Improved survival and chemotherapy response among patients with AIDS‐related non‐Hodgkin's lymphoma receiving highly active antiretroviral therapy

Highly active antiretroviral therapy (HAART) became available in the US in 1996. Using the population-based cancer registry, we identified 233 patients with AIDS-related systemic NHL diagnosed in San Diego or Orange County in 1994-1999, of whom 137 were diagnosed 1996-1999. We performed Kaplan-Meier analyses to compare survival between patients who received HAART at NHL diagnosis or thereafter versus untreated patients and Cox proportional hazard models for adjusted survival. We used logistic regression to determine if concomitant HAART changed the probability of complete response to chemotherapy and the Mann-Whitney U-test to compare the median number of chemotherapy cycles between patients who received HAART during chemotherapy versus those who did not. Among patients diagnosed with NHL in 1996-1999, 40 (29%) were taking HAART at NHL diagnosis. The median survival was three months among patients who did not receive HAART versus 16 months among HAART-treated patients. HAART, chemotherapy, high performance status, and NHL stage < IV were associated with improved survival. Concomitant HAART, completion of > or = 6 chemotherapy cycles, and NHL stage < IV were associated with complete response to chemotherapy. The median number of chemotherapy cycles was five among patients who received HAART concomitant with chemotherapy versus three among untreated patients. We conclude that HAART should be initiated or continued after NHL diagnosis, including during the period of chemotherapy administration.