In June, 2008, a 58-year-old woman was referred from a rural district hospital to our antiretroviral treatment (ART) clinic in Blantyre, Malawi, because of suspected ART failure. She was diagnosed with HIV in 2000 and had started the ART regimen of twice daily stavudine (30 mg), lamivudine (150 mg), and nevirapine (200 mg) in fixed dose tablets, according to national protocol, following a bacterial pneumonia in 2004. At the start of 2008 she began to lose weight, dropping from 45 kg to 34 kg. She also complained of numbness of the feet, polydipsia, and genital itching. ART failure was excluded (CD4 count 833 cells per muL, HIV-1 viral load <400 copies per mL), but diabetes mellitus was diagnosed (random blood glucose 25.8 mmol/L), and she was sent back to her district hospital with recommendations for treatment.
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