Nightmares also categorized as fighting dreams suddenly awake the sleeper from Rapid Eye Movement (REM) sleep. Nightmares can be caused by improper food intake, alcohol withdrawal, digestive or nervous disorders and drug induced (mainly due to the drugs which affect the neurotransmitters). Some of the drugs that can induce nightmares are Beta blockers, Statins, Anti depressants, Anti epileptics, Sedative hypnotics, General anesthetic agents, anti histamines, endocrinal agents etc., The exact mechanisms involved for these drug induced nightmares is not clear. The occurrence of these nightmares due to the intake of various drugs is rare and in all these cases drug withdrawal is beneficial.

Aim: The main aim of this study is to estimate the incidence of switching to second line Anti-Retroviral Therapy (ART) among HIV patients. Objective: The primary objective of this study is to determine the reason for switching to second line ART. The secondary objective of the study is to estimate the rate of treatment failure among HIV patients receiving first line ART. To determine the factors responsible for first line treatment failure. Methodology: A Retrospective Observational study is conducted at a tertiary care hospital, Ongole, Prakasam District, Andhra Pradesh. Incidence of switching to second line ART among 4,187 HIV patients is assessed. Results: In our study, we have collected ART cards of 4,187 patients living with HIV/AIDS. Out of which 3,419 patients are excluded from the study. 768 patients are included for the study who met the inclusion criteria. Of these patients, 739 members are receiving first line regimen and 29 patients are switched to second line Anti-Retroviral Therapy (3.77%). Conclusion: Our study concluded a low incidence of switching to second line ART with an incidence rate of 1.01 per 100 persons a year. Out of 29 patients, failure of first line treatment is majorly observed with AZT+3TC+NVP (Zidovudine+Lamivudine+Nevirapine) among 13 patients (44.82%). Reasons for failure are determined majorly as a result of immunological and virological failure (37.93%). These reasons are associated with decreased adherence of 80-90% among 21 patients (72.41%).