treatment of Human Immuno deficiency Virus type 1 (HIV-1) infection has improved steadily since the advent of combination therapy in 1996. More recently, new drugs have been approved, offering added dosing convenience and improved safety profiles, while some previously popular drugs are being used less often as their drawbacks become better defined. 36
A minimum sample size of 384 was calculated using the Leslie Kish’s method  at a standard normal deviate of 1.96, assuming 50% target population and tolerating 5% sampling error. From our experience in the pre-testing of the study questionnaire, we limited non-response rate to just 5%, giving a rounded figure of 409 for the sample size. Consecutive consenting caregivers of HIV-infected children (15 years and below) who had been on HAART for at least 6 months satisfied the inclusion criteria and were thus recruited till the sample size was attained. Adolescent children, >15 years were excluded as they were often seen in the adult ART clinic of the FMC, Makurdi. The research instrument was a structured questionnaire. It consisted of five broad parts including; socio-demographic characteristics of caregiver and the child; section on whether or not CAM has been used for the child; section on the types of CAM used; section on the reasons for or not using CAM and lastly information on HAART, its regimen and its duration. Vitamins syrup/capsules were excluded from the list of possible CAMs as all the HIV-infected children on HAART were on the routine prescription in our program. The questions in the questionnaire had been summarized in Tables under the Results section. Previous studies [3-5] in Nigeria as well as CAM practitioners in Makurdi informed the list of CAM. Generally, CAM was divided into products and practices. Allowance was also made for any CAM not included in the questionnaire. As previously done by Oshikoya et al. , samples of the CAM products and the photographs of the different alternative medical practices (i.e. body scarification, charm wearing, ritual sacrifice, Chinese medicine, homeopathy and Ayurveda) were shown to the caregivers to aid and confirm a particular CAM
Age is most important risk factor involved with DVT in HIV-infected patients of older than 45 years. Few other factors involved are use of protease inhibitor in highlyactiveantiretroviraltherapy (HAART), most common indinavir, hospitalization and presence of AIDS-defining opportunistic infections such as cytomegalovirus, Pneumocystis jirovecii, and Mycobacterium-intracellularly.  Other recognized
Background: Toxic epidermal necrolysis (TEN) is a rare life threatening dermatological disorder characterized by extensive epidermal detachment and erosion of mucous membranes. It is typically a side effect of some medications. Nevirapine, a nonnucleoside reverse transcriptase inhibitor (NNRTI) is one of the frequently used components of highlyactiveantiretroviraltherapy (HAART). Skin rash is its common adverse reaction, usually mild and rarely progressing to TEN. Ophthalmic involvement is common as well but rarely progresses to blindness especially in the pediatric population. Case presentation: We report the case of a 3 year 5 month old child diagnosed with HIV who developed TEN 8 days after starting a Nevirapine based HAART regimen. Drug withdrawal and supportive treatment alone were the modalities employed to achieve complete re-epithelization of lesions. Patient was lost to follow-up 6 months after being in care and was only seen 3 years later with total loss of vision.
HIV/AIDS is one of the most destructive epidemics the world has ever witnessed. In 2007 an estimated 33.2 mil- lion people were living with HIV (PLHIV) worldwide, while 2.5 million of these people were children under 15 years old. Furthermore, 420,000 Children under 15 years were newly infected with HIV in 2007. Nearly 90% of all HIV-positive children live in sub-Saharan Africa . About 780,000 were estimated to be in need of antiretro- viral therapy . The most efficient and cost effective way to tackle pediatric HIV globally is to reduce Mother to Children Transmission (MTCT). However, every day there are nearly 1200 new infections in children under 15 years of age with more than 90% of these occurring in the devel- oping world and most being associated with MTCT . Trials in the United States and Western Europe have dem- onstrated that HAART is effective in suppressing HIV viral replication and reversing immunodeficiency in children [4,5]. The result has been a reduction in pediatric hospital admissions and a decrease in morbidity and mortality due to HIV/AIDS [6-9]. The introduction of combination ART including protease inhibitors has resulted in striking reductions in HIV-related mortality [10-12]. However, these therapeutic regimens are very complex, often requir- ing that patients take numerous pills multiple times a day with specific timing and food restrictions or requirements. Failure to adhere very closely to the regimens appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV [13- 15].
HAART was defined as the combination of antiretroviral treatment with at least three drugs, including at least one non-nucleoside reverse-transcriptase inhibitor (NNRTI) or a protease inhibitor (PI), and/or abacavir, or a treatment regimen with a combination of a NNRTI and a boosted PI . We categorized treatment modifications into 3 groups: virological failure, toxicity (covering: abnormalities of body fat distribution, dyslipidaemia, hypersensitivity, gastrointestinal toxicity, neurological toxicity, nephro- logical toxicity, endocrinological toxicity and other tox- icity) and other/unknown (covering: patient’ s wish, doctor’ s decision, other cause, unknown, as part of modi- fication to another HAART, problems with adherence). Data were based on medical files.
Animals of each group were sacrificed while under diethyl ether ansthesia. Animals lay up on a clean paper towel and had all four extremites pinned to thin corkboard. A vertical midline incision with scissors cut from the neck to pubis and opens the peritoneum. Then 3-4mm wide strips of tissue samples were randomly taken from right lobe of liver were cut lengthwise. These tissue samples were transferred by a blunt forceps to a test tube containing 10% buffered formalin that completely immerses the tissues for the purpose of fixation . Following washing, tissues were dehydrated in a series of an increase graded ethanol (70%, 80%, 95% and 100%), cleared in xylene, and embedded in paraffin wax [28, 29]. The sections, which are 5-6 𝜇 m thick, were then prepared using rotary microtome (Leica RM 2125 RTS, Singapore) and stained with hematoxylin and eosin dye for microscopic observation of histopathological changes in the liver [28, 30].
The Human immunodeficiency virus (HIV) pandemic continues to spread in the population making HIV infec- tion one of the most important public health crises in the world . Globally, about 33.3 million persons were esti- mated to be infected with HIV/AIDS in 2010, of these, 22.5 million (68%) are in sub Saharan Africa and about 3 million alone in Nigeria. This makes it the country with the second highest burden of HIV and AIDS in the world after South Africa . The current prevalence rate of HIV in Nigeria as at 2010 based on the sentinel surveillance is 4.1%. Cross River State were the study was conducted currently has the 9th highest prevalence (7.1%) in the country as at 2010 and is found in the South-south geopolitical zone of Nigeria . In the absence of a cure, antiretroviraltherapy (ART) has remained the only available option that offers the possibility of dramatically reducing HIV/AIDS-related morbidity and mortality, while improving the status of PLHIV. It has proved effective in reducing viral load, improving immune function,  and improving the quality of life of PLHIV [3,4]. However, successful long-term treatment of HIV re- quires strict adherence to the HighlyActiveAntiretroviralTherapy (HAART) regimen [3,5,6]. This is especially important in countries such as Nigeria where PLHIV make up 10% of the global burden of HIV/AIDS  and about 1.5 million require treatment . Adherence level of at least 95% and above has been considered ap- propriate to achieve therapeutic success, [8-11] as this maintains optimal viral suppression as demonstrated by Paterson and colleagues [11-13]. Failure to observe sustained desired adherence threshold has been associated with dire consequences such as treatment failure, disease progression and emergence of drug resistant HIV/IADS strains [14,15].
The present study also observed relationship between BMI and TC [OR 2.158 (95% CI 1.014- 4.59) p=0.044], and between BMI and HDL-c [OR 0.316 (95% CI 0.112-0.88) p-0.023]. Other studies [36,37] have also reported similar relations between obesity (high BMI) with high blood pressure, high TC, and low levels of HDL-c in both men and women of diverse racial and ethnic groups, and among children . Association between BMI and dyslipidemia was also documented among HIV infected children on HAART, and those not on HAART [12-15]. In Triant et al.  study, a significantly higher prevalence of dyslipidaemia (23.3% vs 17.6%) was seen in HIV-infected patients than in the non-HIV cohort (p<0.0001). Also, TC, HDL-c, LDL-c, and apolipoprotein B which were all low in HIV infection were noticed to be markedly elevated following HAART administration [12,13,15]. As earlier explained, this elevation could be as a result of alteration in the cytokine profile, decreased lipid clearance, and increased hepatic synthesis of VLDL from effect of chronic HIV infection and use of HAART [10,11]. Elevation with resultant misdistribution in fats will directly affect BMI and body image through the process of lipoatrophy and lipohypertrophy. Though not part of objectives of the present study, there is clear evidence of virological failure from the mean VL of the study participants after long period on HAART (≤ or ≥ 10 years). This could be as a result of non-regular VL monitoring in our center because the HIV program in our facility does not support such regular monitoring until recently. VL assay is requested by the attending physician only when there is clear evidence of immunological or clinical failure. It is a well-documented fact that virological failure occurs as first event, followed by immunological and clinical failure usually months or years afterwards . For this reason peculiar to us, and I believe to most HIV centers in resource limited settings where VL is not routinely done, patients with virological failure are not detected earlier enough for possible switch to 2 nd line medication. However, most recently, there is a change in policy which supports twice yearly monitoring of VL for all patients on both 1 st and 2 nd line HAART, hence patients with virological failure will be detected early enough for switch to 2 nd line medication.
Results: Very important increase in CD4+ was observed and VL decreased quickly and it remained low during the follow-up study. Children with CD4+ <25% at baseline achieved CD4+ >25% at 9 months of follow-up. HIV-infected children who achieved undetectable viral load (uVL) were less than 40% in each visit during follow-up. Nevertheless, HIV-infected children with VL >5000 copies/ml were less than 50% during the follow-up study. Only baseline VL was an important factor to predict VL control during follow- up. Virological failure at defined end-point was confirmed in 30/42 patients. Along the whole of follow-up, 16/42 children stopped HAART with NFV. Baseline characteristics were not associated with therapeutic change.
A fasting venous blood sample was obtained for meas- urement of glucose, triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, complete blood count (hemoglobin, hematocrit, white blood cell count and differential) and basic metabolic panel (electrolytes, blood urea nitrogen and creatinine). Metabolic syn- drome was defined as central obesity (waist circum- ference > 94 cm) plus any two of the following: raised triglycerides (> 150 mg/dL), reduced HDL cholesterol (< 40 mg/dL), elevated blood pressure (> 130/85), elevated fasting blood glucose (> 100 mg/dL) . Framingham cardiac risk factor scoring (FRS) was calculated according to standard criteria, accounting for age, total cholesterol, smoking history, HDL cholesterol and systolic blood pres- sure . Exercise levels were quantified based upon the subject’s reporting of activity as 1) no exercise activity 2) Mild = once per week 3) Moderate = 2–4 times per week and 4) High = greater than 5 times per week.
Medicinal plants are plants which contain substances that could be used for therapeutic purposes or which are precursors for the synthesis of useful drugs. The medicinal value of these plants lies in bioactive phytochemical constituents that produce definite physiological action on the human body. The use of herbal medicine has become more prevalent and the past few decades have witnessed a rapidly increasing demand worldwide. 
In response to the high levels of resource utilization and costs of care for patients with HIV/AIDS, several studies have focused on identifying predictors of early hospital readmission (within 14 days). This issue was examined among HIV-infected patients with bacterial pneumonia and Pneumocystis Carinii pneumonia. One study prior to the widespread availability of HAART found leaving hos- pital alone to be a leading risk factor for early readmis- sion, citing this as an important indicator of social isolation . A similar study conducted when HAART was widely available found that female gender, homeless- ness, residence in a poor neighbourhood, AIDS diagnosis, IDU status, leaving hospital against medical advice (AMA) and previous admission within 6 months was associated with early readmission .
The difference in rate of virus rebound we observed between pre-HAART nucleoside-experienced and naive patients likely is related to the nucleoside experience itself and not to some other confounding factor that is different between the 2 groups. This is because the effect is very large and highly significant; the difference in initial virus load response to therapy has been observed in many studies [1–7], and a likely underlying mech- anism (resistance) has been identified. Furthermore, all patients in both groups appear to have been at least initially adherent to therapy, because an initial virus load response was achieved, so major confounding due to differences in adherence seems to be improbable. We also found that the difference persisted (and was not diminished) after adjustment for calendar period, spe- cific drugs used, age, HIV risk group, and sex.
Virological failure was defined as a persistent viral load above 5000 RNA copies/mL on two consecutive mea- surements, after at least 24 weeks on HAART, in a treatment-adherent child. Death was ascertained either from the hospital records or from the telephonic conver- sation with the relatives. The clinical response to HAART was determined by decrease in the number of episodes of illness. Immunological response was based on the CD4 values at different time points. The secondary outcomes assessed were change in anthropometric values in terms of z scores at different time points and changes in blood parameters i.e. hemoglobin, erythrocyte sedimentation rate (ESR) over time. We also attempted to determine the factors associated with non-adherence and treatment failure.
overall surface readings of transcripts to capture context and meaning, followed by coding and categorization of recurring concepts/ideas. A master list of all categories was assembled and examined for common themes. Categories of codes were then organized into overarching themes. Data verification was done by a second researcher coding all transcripts. Codes were compared and added or removed based by agreement. The results of our interviews were also compared with the literature and verified with participants. Following coding, a frequency distribution list was developed, and the number of responses for each category of participants was recorded and tallied. Quotations selected were those which best represented the ideas voiced by participants and were also chosen based on the frequency with which they were mentioned.
Initial inclusion criteria were articles with at least an Eng- lish abstract as well as articles of all times and geographic locations.. After reviewing for duplication, selected articles were assessed for accordance with title, abstract and rele- vance to the subject of study. Following PICO guidelines, additional inclusion criteria during secondary review were any individual living with HIV among any age group (popu- lation), HighlyActiveAntiretroviralTherapy (HAART) and ART interventions on QoL (intervention), participants that did not receive ART or HAART (comparison group), stud- ies that reported HIV/AIDS clinical information (out- comes), and any study type (cross-sectional, cohort, and case-control) were included (studies). Qualitative studies, Meta-analysis, Systematic reviews and secondary studies were excluded. Also studies with published papers in any language except English were excluded as well.
According to reports of clinical and autopsy studies, the reported prevalence of cardiomyopathy in HIV-positive patients constitutes a broad range from about 4% 3 to as high as 75% 4 in different studies. Mortality in HIV patients has also been reported to be substantially due to cardiomyopathy with up to 6 fold higher rate of death in HIV+ children 5 . Minimal left ventricular dysfunction in children was associated with 55% mortality in 5 years follow up 6 . The same rates have been reported in adult populations 7 . The effect of antiretroviraltherapy (ART) on the incidence and prevalence of HIV-related cardiovascular disease has also been not well demonstrated. A large study of over 23 thousand HIV positive patients reported that use of ART is associated with increased risk of acute cardiovascular and cerebrovascular events 8,9 . In chronic HIV infection, cardiomyopathy seems to benefit from ART with declining the incidence and mortality of HIV-related mortality in these patients 5
Given that HAART regimens involve the use of nu- cleoside analogues that have the potential to cause mi- tochondrial toxicity, the issue of potential impact on neurodevelopment is of particular importance. As noted, aside from the children followed in the Pediatric AIDS Clinical Trial Group 219/076 study cohort, all previous investigations of neurodevelopmental outcomes in anti- retroviral-drug– exposed patients were retrospective and involved children exposed to either zidovudine alone or dual antiretroviraltherapy. This is the first prospective study of neurodevelopment in children exposed to HAART (for a mean of 17.7 weeks exposure in preg- nancy to at least 3 antiretroviral drugs) with a control group of non–HAART-exposed children from similar so- cioeconomic backgrounds. We therefore believe that this study provides additional reassurance of the relative safety of HAART interventions in pregnancy.
Most cases (18/21) of peripheral neuropathy and all cases of lipodystrophy were observed in patients receiving stavudine therapy. Similar findings have been reported earlier.  We observed an incidence of 1.39% of peripheral neuropathy but no case of fat redistribution with stavudine. However, earlier studies have reported an incidence of peripheral neuropathy as 10%, 12% and a prevalence of lipodystrophy as 25%. [26,27.28] Low incidence seen in our study may be contributed to under diagnosis and that the drug is well tolerated in this part of the world. Recently updated WHO guidelines on ART for HIV/AIDS patients do not recommend use of stavudine as a first choice in first-line regimens due to these adverse effects.