Providing safe care to patients in the remote radiology suite requires a clear understanding of the complexity of procedures being undertaken, potential complications and careful, thorough assessment of patients.

(normal 80-99), white blood count 9 5 x 109/l (normal 4-11) with evidence of malabsorption; albumen 28 g/l (normal 35-55), zinc 10-5 iimol/l (normal 11 5-20), and iron 5-8 ,umol/l (normal 14-3-36). The inflammatory indices were raised; erythrocyte sedimentation rate 60 mm/hour (normal <10) and C reactive protein 99 mg/l (normal <10).

HIV has reached pandemic proportions in Southern Africa. Great emphasis is placed on the prevention and containment of HIV transmission by suppressing virus replication using highly active anti-retroviral therapy (HAART). HAART has proven to be highly effective if taken correctly, and has lead to increased life expectancy. Increasing numbers of HIV-positive patients on antiretroviral (ARV) therapy or HIV-exposed individuals taking prophylaxis present for surgery and critical care management. The anaesthesiologist should be familiar with the anaesthetic implications of HIV as well as the possible drug interactions while on ARV treatment. This article focuses specifically on the anaesthetic implications of the patient on HAART.HAART is HIV treatment with a combination of three or more ARV drugs from five broad classes. The specific HAART regimen in use in South Africa is considered in detail in this article. The pharmacokinetics of the ARV drugs is complex, and subject to interactions at many different sites. Serious drug interactions are possible, including drugs commonly used in anaesthesia. Drug interactions and recommendations are discussed in detail.ARVs are known to cause multiple systemic side effects, including lactic acidosis, Immune Reconstitution Inflammatory Syndrome (IRIS), premature atherosclerosis and increased cardiovascular risk, hyperlipidaemia, insulin resistance, skeletal disorders, hepatotoxicity, lipodystrophy, mitochondrial abnormalities, allergic reactions and pancreatitis.Non-compliance is common, and leads to the rapid development of resistance. The anaesthesiologist may inadvertently exacerbate this in the perioperative period. Recommendations regarding the interruption of treatment and fasting are made. Alternative routes for HAART administration are also explored. The management of the critically ill patient on a HAART regimen is discussed.

Hammersmith Staff Rounds Systemic candidiasis: an unusual complication of eating mutton Commonly affects the skin, eyes, and costochondral joints I FIG 1-Fundal appearances in candidiasis showing yellow-white chorioretinal lesions, white vitreoretinal lesions often associated with traction, andfluffy white intravitreal ball-like lesions

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