Hindawi Publishing Corporation Case Reports in Medicine Volume 2010, Article ID 192060, 5 pages doi:10.1155/2010/192060 Case Report HIV Wasting Syndrome in a Nigerian Failing Antiretroviral Therapy: A Case Report and Review of the Literature Dimie Ogoina,1 Reginald O. Obiako,1 and Haruna M. Muktar2 1 Department of Medicine, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria 2 Department of Haematology, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria Correspondence should be addressed to Dimie Ogoina, dimostic@yahoo.co.uk Received 15 September 2010; Accepted 3 December 2010 Academic Editor: A. R. Satoskar Copyright © 2010 Dimie Ogoina et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The HIV wasting syndrome represented the face of HIV/AIDS before the advent of highly active antiretroviral therapy (HAART). Although the incidence of wasting has declined since the introduction of HAART, weight loss remains common in patients receiving HAART, especially in the setting of a failing HAART regimen. As we are not aware of any previous reports from Nigeria, we report a case of the classical wasting syndrome in a Nigerian female who had both virological and immunological HAART failure due to poor adherence. The inﬂuence of a failing HAART regimen, socioeconomic status, and other clinical variables in the wasting syndrome are discussed. 1. Introduction HIV wasting syndrome has been deﬁned by the Centre for Disease Control (CDC), USA, as involuntary weight loss greater than 10% of baseline weight associated with either chronic diarrhoea for at least 30 days or chronic weakness or documented fever for at least 30 days in the absence of a concurrent illness or condition other than HIV infection that could explain ﬁndings (e.g., tuberculosis, cryptosporidiosis, or other speciﬁc enteritis) [1] Although the wasting syndrome has declined since the introduction of highly active antiretroviral therapy (HAART) [2, 3], weight loss still remains a common cause of morbidity and mortality in HIV-infected patients receiving HAART [4, 5]. In Nigeria, weight loss and severe wasting often compli- cates HIV/AIDS [6–9], but we are not aware of any report speciﬁcally describing the risk factors, features, clinical course, and outcome of the wasting syndrome as deﬁned by CDC, especially in patients receiving HAART. We describe a case of the classical wasting syndrome in an unemployed Nigerian widow and discuss the inﬂuence of a failing HAART regimen, socioeconomic status, and other clinical variables in the wasting syndrome. 2. Case History A 32-year-old HIV-1-infected widow was admitted to our tertiary hospital with a 6-month history of progressive lethargy, anorexia, recurrent fever, vomiting, watery non- bloody diarrhoea, and progressive weight loss. She went from 50 kg to 21 kg in 5 months, a 42% weight loss. She was unemployed and had no source of regular income to care for herself or her 3 children. Hence, her meals before and during her illness were irregular and consisted mainly of carbohydrate diet. On examination, she was conscious, prostrated, severely wasted with generalised wasting of muscle groups, loss of subcutaneous fat, and prominence of bones. There was no evidence of localised subcutaneous fat atrophy or fat redistri- bution. Her body mass index was 10.2 kg/m2, and the mid- upper arm circumference was 10 cm (Figures 1 and 2). She had hypoproteinemic hair and skin changes, dehydration, fever (37.8◦C), pallor, and oropharyngeal candidiasis but no lymphadenopathy. Chest, cardiovascular, and abdominal examinations were normal. She was on HAART (Zidovudine, Lamivudine, Nevi- rapine) for 16 months but adherence was poor (<70%).