Manic Syndrome Associated with Efavirenz Overdose

be a risk factor. All of this, combined with the fact that patients are generally living longer, would make one expect an increased rate of incidence. However, given the dramatic rise in the number of recent reports of osteonecrosis occurring in association with HIV infection, the possibility that HAART can cause or, through its immunological effects, exacerbate the symptoms of osteonecrosis needs to be explored. Further studies clearly are needed to elucidate the pathogenesis and natural history of osteonecrosis in HIVinfected patients. We reemphasize that there is an association between osteonecrosis and HIV infection that must be recognized by clinicians who care for these patients, particularly since early detection and intervention is essential for a favorable outcome in the treatment of osteonecrosis, regardless of its cause.