The advent of potent antiretroviral
therapy has altered the expected natural history of human immunodeficiency virus (
HIV) infection and of many previously associated opportunistic complications, including
malignancies. At the same time, HIV suppression has not affected all of these complications equally and the longer expected survival of infected patients may allow the development of newer complications. Additionally, the use of potent antiretroviral combination
therapy may itself lead to hematological toxicities. Together these changes affect the consultation role of the hematology-oncology specialist in comprehensive HIV care and demand ongoing education. In Section I, Dr. Paul Volberding reviews the biology of antiretroviral
drug development and the progression in discovering new agents as the viral life cycle is further elucidated. He briefly summarizes the process of combining agents to achieve the degree of viral suppression required for long-term clinical benefit. In Section II, Dr. Kelty Baker reviews the effects of HIV and its
therapy on hematologic dyscrasia and clotting disorders. She summarizes how
therapy may decrease certain previously common manifestations of HIV disease while adding new problems likely to result in referral to the hematologist. In addition, she addresses the role of
secondary infections, such as parvovirus, in this spectrum of disorders. In Section III, Dr. Alexandra Levine discusses the still challenging aspects of HIV associated
non-Hodgkin's lymphoma and the association between
HIV infection and
Hodgkin's disease. She addresses current controversies in the pathogenesis of
HIV related lymphomas and summarizes a number of recent trials of
combination chemotherapy, with or without
monoclonal antibodies, in their management. Additionally, she reviews the complex relationship of HIV disease with
multicentric Castleman's disease and recent attempts to manage this disorder.