The study is limited by small size, lack of routine (pre-travel) VL monitoring in most participants, and the failure to explore the role of confounders like socioeconomic status and education but it highlights an important problem of global concern that needs

to be addressed urgently. We would like to acknowledge the support of Institute of Human Virology-Nigeria, Institute of Human Virology, University of Maryland, Baltimore, USA and Centres for Disease Control in Nigeria and USA who have facilitated our work and equipped our Laboratory with flow cytometry and HIV RNA-PCR viral load instruments. We would like to thank Drs Musa Babashani, Jibreel Jumare, Muhammad Ahmed, Mahmoud Maarouf, Hadiza Yahaya, Zaharaddeen Selleck Forskolin Habib, Maryam Abdullahi, and our adherence counselors and treatment support specialist for useful discussions and criticisms. We are indebted to Dr Usman Yakubu with whom the study was conceived, but he is now deceased. We are greatly

indebted to the participants in the study who are living with HIV infections. The authors state they have no conflicts of interest to declare. “
“A literature review was completed using Ovid/ Medline (1950–Present) and Pubmed databases. The following search terms were employed: preexisting medical conditions and altitude, each individual condition and altitude, air travel and preexisting medical conditions, and high altitude medicine. Published articles were used as a source of Selleck Ibrutinib further references not yielded by the primary search. selleck products Textbooks written by recognized experts in the field of high altitude medicine were consulted to source information not available elsewhere. The demographics of adventure travel are shifting. Expanding road, rail, and air networks as well as mechanized mountain lifts have rendered it increasingly possible for people of varying levels of health and fitness to reach remote high altitude destinations (Table 1).1 High altitude cities and employment sites also attract holidaymakers, workers, and business travelers

(Figure 1).2 Passive ascent to altitude by airplane, automobile, train, hot air balloon, or cable car may result in sudden exposure to altitude without adequate time for acclimatization. The environmental conditions at altitude and the associated hypobaric hypoxia pose a significant physiologic challenge to the human body (Figure 2). Furthermore, many high altitude sojourns include strenuous physical activities such as skiing, hiking, and climbing. Emergencies in remote locations demand that the sick or injured rely on their companions or on their own compromised abilities to access the medical help they need. The conscientious traveler will take steps to gain the knowledge and skills necessary to minimize personal risk. However, many at-risk travelers remain naïve to the health risks of high altitude travel.