2 Case Reports in Medicine Figure 1 On HAART, her viral reduced from 421,000 copies/ml to 41,000 copies/ml, but CD4+ T cell count dropped from 168 cells/ul to 34 cells/ul. Full blood count revealed micro- cytic hypochromic anaemia (packed cell volume of 24%) and leukopenia of 1.2 × 103/ul. Three separate stool microscopy and culture, including modiﬁed Ziehl Neelsen stain for cryp- tosporidiosis and isosporiasis, were all negative for parasites and bacteria, and also negative for cells such as red blood cells and white blood cells. Apart from mild hypokalemia (serum potassium of 3.0 mmol/l) and low serum albumin of 22 mmol/l, other renal and liver function tests were normal. Chest X-ray and abdominopelvic ultrasound were normal. Hepatitis B and C serology and blood ﬁlm for malaria parasites were also negative. She was rehydrated, and diarrhoea was controlled with an antimotility agent (tablets loperamide) after empiric treatment for infectious diarrhoea using tablets albendazole 400 mg daily for 3 days, intravenous ciproﬂoxacin 500 mg twice daily for one week, and tablets tinidazole 2 g start. Oral ﬂuconazole 200 mg daily for oral thrush, prohylactic septrin 960 mg daily, multivitamins, and haematinics were also given. She had intensive nutritional rehabilitation with locally available high protein and high energy diet as well as fruits and vegetables. Speciﬁcally, “kwashiokor pap” or “kwashi pap”, a high protein local diet made up of a mixture of ground guinea corn, ground soya bean, and ground crayﬁsh, ground dried ﬁsh, roasted ground groundnuts, and boiled water was given orally three to ﬁve times per day, along with variety of other local foods. Figure 2 Additional adherence counselling was given, and ART was switched to Emtricitabine/Tenofovir and Nevirapine on account of anaemia. All symptoms gradually resolved and she gradually regained her physical strength with improved physical activ- ity. At the end of 6 weeks, her weight increased by about 8 kg and she was thereafter discharged to the social welfare, nutritional, and adherence counselling unit. 3. Discussion The pathophysiological mechanisms underlying the HIV wasting syndrome are related to three major factors including inadequate nutrient intake, nutrient malabsorption, and disturbances in metabolism (reviewed in references [10– 12]). The burden of HIV infection impoverishes [13]; in sub-Saharan Africa, women and children are the most aﬀected and they are more likely to suﬀer from neglect, discrimination, and abuse [14]. Poor socioeconomic status has been shown to be a strong determinant of weight loss in HAART experienced HIV-infected patients [4]. These patients were found not to be able to aﬀord regular high- protein and high-calorie meals needed for weight gain and for restoration of lost body cell mass. In the reported case, poverty precluded adequate intake of nutritious meals before and during patient’s illness and this problem was compounded during the illness by anorexia, oral sores,