ARVCalc is
an Epi Info database and data-entry program that calculates pediatric doses of
antiretrovirals and medications used for prophylaxis of opportunistic
infections in infants and children living with HIV/AIDS. The user enters
information on height, weight, age, and--for infants—gestational status at
birth, and then is able to choose from several first-line treatment
regimens and one second-line regimen, or alternatively, regimens for prevention
of mother-to-child transmission for both mother and infant. Recommended
doses are calculated and presented, along with notes on methods of
administration and precautions.
The second
page of the same form provides for prophylaxis of the opportunistic infections,
including Pneumocystis jirovecii (formerly carinii) pneumonia
(PCP), tuberculosis, and Mycobacterium avium complex (MAC), with
preferred and alternative regimens for each. Some notes are also provided
on treatment of active PCP disease.
In our
clinic, we enter data once for each child on ARVs and then print the page
containing the calculations as a permanent record to place in the chart.
We suspect that very few physicians will enter the data directly, but that a
nurse or other central person might do the entry and pass the printed results
to the physician in the chart. As the child “outgrows” his or her
dose(s), which may be in a 6-8 weeks in infancy, and in months to a year in older
children, the data will be reentered, and new doses provided. For
educational purposes, however, physicians who do not regularly administer
pediatric ARV therapy may find it instructive to experiment with the various
regimens in the program.
The
guidelines and programs were developed for pediatric use. Most of the
doses, however, have a maximum, which is the adult dose. We would
appreciate hearing from experts in use of ARV’s for adults concerning what
changes would be necessary to be able to use a single program for both adults
and children.
To see
patients already entered, use the arrow buttons in the lower left panel to move
back to previous records. To enter a new patient, click on the NEW
button. After entering a patient’s data, choose a regimen by clicking,
and experiment with the calculations. To calculate regimens for
prophylaxis of opportunistic infections, click Page 2 in the upper left panel,
and work with the choices offered. Note that less common opportunistic
infections and treatment of active tuberculosis are not covered; more complete,
printed protocols should be consulted for further detail.
NOTE THAT
THIS IS A DRAFT OR BETA COPY, and should not be relied upon without checking
against other sources. Feel free to enlist help in evaluating it, but
please do not distribute it for general use until it is further
developed. It is free of copyright or other restriction. Please let
us know if bugs or inconsistencies or serious conflicts with other protocols
are encountered. For those who are familiar with Epi Info or who wish to
experiment, it is easy to modify the check-code using the MakeView
program. We would be grateful to know of improvements that you make or
recommend making. At the moment, CD4 counts and hemoglobins may be
entered in the form, but they are not used in the logic of calculations or
warnings. This could be implemented with additional check code in the
future.
Please send
feedback, suggestions and corrections to:
Andrew G.
Dean, MD, MPH
Consuelo M.
Beck-Sagué, MD