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December 2001

A 13-year-old HIV-infected girl presents with fatigue and shortness of breath. Laboratory tests reveal a hemoglobin concentration of 7.1 gm/dL and hematocrit of 19%, with 4.4% reticulocytes. Antiretroviral medications, including stavudine, didanosine, and hydorxyurea, are discontinued temporarily. Three weeks later, her hemoglobin concentration and hematocrit are 5.9 gm/dL and 18%, respectively. Bone marrow aspiration reveals cellular inclusions like those shown in the figure.

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