Prostaglandin E2, thromboxane B2 and leukotriene B4 monocyte production have been determined in human immune deficiency virus (HIV)-infected drug users (n = 36) and healthy subjects (n = 29). Eicosanoids were extracted from the incubates using C18 solid-phase cartridges and determined by radioimmunoassay. An enhanced production of prostaglandin E2 and thromboxane B2 was detected in monocytes from HIV-positive drug users whether or not they had been previously stimulated with zymosan. Concomitant leukotriene B4 increases were not observed. The results reported in this paper indicate that altered cyclooxygenase arachidonic acid metabolism in monocytes from HIV-infected drug users is associated with the severe cellular immunodysfunction characteristic of AIDS. In contrast, leukotriene B4 does not seem to play a role in AIDS-associated immunosuppression.