Grandir

Interactivity

In a few weeks we will survey selected readers of Growing Up Info to better understand your general impressions of this newsletter and the themes that you would like to see further developed.

As you can see, the theme of our fifth issue is "interactivity". This month, as with every other month, you can win a reference book on HIV/AIDS by sending in your answers. You also have the opportunity to submit your own exercises (clinical case studies). Your experiences concerning HIV+ disclosure to children are of particular interest to us as we are hoping to conduct training sessions on this important topic.

Send your cases to: grandir@sidaction.org

Vitamin A: yes, but…

The beneficial effects of Vitamin A for HIV+ children are no longer in doubt (1). Several studies have shown that taking regular Vitamin A supplements is beneficial and can result in a decrease in mortality, diarrhea and certain respiratory infections (2) & (3). Regular doses of vitamin A seem to also help growth (height and weight) and reduce the risk of failure to thrive as a result of persistent diarrhea (4).

While this is true for children, effects are not as consistently positive for HIV+ adults. It should be noted that:

• during pregnancy, vitamin A appears to have a negative effect on the HIV+ mother's health;
• during breastfeeding this vitamin seems to actually increase the risk of transmission of HIV1 to the child. On the other hand, multivitamins (BCE tablets) that do not include vitamin A, will reduce the risk of transmission (5).

It is important to stress these two factors because of the high number of HIV+ mothers who breastfeed their babies. We need to remember:

• HIV+ women who are breastfeeding should avoid taking vitamin A and should instead take "BCE" multivitamins without vitamin A (whether or not they are also on ARVs)
• HIV+ children (including those whose status is unknown but have been exposed to HIV) who are less than 5 years old living in resource poor countries should receive vitamin A supplements every 4 to 6 months (unless they are already taking a daily dose of multivitamins in pill or liquid form):
  <6 months: 50 000 IU -- <1 year: 100 000 IU -- >1 year: 200 000 IU
• At each medical consultation, verify the date on the child's medical records when vitamin A was last administered.

To find out more
WHO recommendations
www.who.int/entity/nutrition/
publications/Content_nutrient_
requirements.pdf

(1) Irlam JH, Visser ME, Rollins N, Siegfried N
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003650

(2) Fawzi WW et al
J Pediatr. 2000 Nov;
137(5):660-7

(3) Semba RD et al
Nutrition 2005 Jan;21(1):25-31

(4) Villamor E et al
Pediatrics.2002 Jan;109(1):E6

(5) Fawzi WW et al
AIDS. 2002 Sep 27;16(14):1935-44

Conferences in 2006: paediatric HIV at the heart of the debates

The conference "childhood & aids. Rolling back AIDS in developing countries", organized by UNICEF-France, Sidaction and others will take place in Paris, France on June 15th and 16th. The two major themes will be supporting orphans living with HIV/AIDS and medical care and support for children living with HIV. This bilingual conference hopes to bring together 350 delegates from around the world. Researchers, doctors, healthcare workers, community leaders, people living with HIV, young adults orphaned by AIDS and political decision makers will exchange experiences and points of view.

The 16th international conference on AIDS in Toronto in August will also be devoting several sessions to these themes. An interesting satellite symposium on children affected by HIV ("Envisioning the Future") will be held on the 11th and 12th of August by the Canadian NGO, Teresa Group.

Conferences often help create strong links among participants. The organizers of the PATA Conference (Pediatric Aids Treatment for Africa), which was held in November 2005 in Capetown understood this. Now they publish a monthly newsletter that bring delegates up to date on the programs in various countries. In it we learned that a German student just joined the Groote Schuur Hospital in Cape Town to study compliance using microchips which will be placed inside the caps of the bottles of ARVs. Another example is how at the AIDS Research and Family Care Clinic of Mombasa, teenagers living with HIV have their own visiting hours distinct from those of the younger patients. As a result they now feel more relaxed about visiting… Growing Up Info highly recommends the PATA newsletter: simple, concise and rich in concrete advice.

To find out more
The "childhood & aids" conference website
www.childhood-aids-conference.org/

The "Envisioning the Future" symposium website
www.teresagroup.ca/symposium/
The PATA delegates newsletter www.teampata.org/

The right answer to last month's case study

In last month's issue of Growing Up Info, you were supposed to choose between 5 clinical cases. involving children which required rapid placement on ART. The right answers are A and E. Explanation :
A : stage IV, 9 months = ART
B: stage II, 3 years, TLC > 2500 / mm3 = monitor closely (measure CD4 count as soon as possible)
C : stage III, 9 years old , CD4 > 200 = monitor closely
D : stage II, 18 months old, CD4 > 20 % = monitor closely
E : stage IV, 8 months old 1/2, probable encephalopathy, HIV infection very probable = ART (confirm diagnosis as soon as possible via PCR two months after stopping breastfeeding and/or CD4 count or HIV test at 12 months-a symptomatic child exposed to HIV with a positive HIV test at 12 months is very probably infected).

And a new exercise on dosages...

Dr. ML who works in the local teaching hospital's pediatric unit sees two children each with a very low CD4 lymphocyte count needing to be placed on antiretroviral therapy.

Yacouba, 2 years old, 9 kg, Hb = 12 g/dl, AgHBs-negative, ALAT = 21 IU/l
Isabelle, 10 years old, 20 kg, Hb = 6.4 g/dl, AgHBs-positive, ALAT = 68 IU/l

The available medicines are:
AZT (Zidovudine) : 100ml bottles at 10mg/ml - 100mg caps
3TC (Lamivudine) : 100ml bottles at 10mg/ml - 150mg tablets - 300mg tablets
D4T (Stavudine) : 200ml bottles at 1mg/ml - 30mg caps - 40mg caps
EFV (Efavirenz) : 50mg caps - 200mg caps
NVP (Nevirapine) : 100 ml bottles at 10mg/ml - 200mg tablets
LPV/r (Lopinavir/Ritonavir) : 60ml bottles at 80mg LPV/ml

Indicate the appropriate course to take in each of the following cases specifying the daily dosages as well as the overall quantities during the first month of therapy (number of tablets or caps, or number of bottles if it's in liquid form).

Congratulations to Dr Hubert Banguissa from Congo. He was the first to answer successfully






To assist you
For some ARVs the dosage is calculated based on the child's body surface area (BSA). If the height is unknown, we can estimate the body surface area using the weight. (Weight in kg & Height in cm)

With just a click the CALCUL-ART software developed in EXCEL, will help you calculate the necessary dosages of ARVs based on weight and possibly, the height of the child. It can be downloaded from Growing Up's website:
www.sidaction.org//pro/
international/grandir/outils/

Send your answers to: grandir@sidaction.org
Still a book to win!

Thanks to Jean-Pierre Lombard, from Bamako, for working with us on this new exercise.

Resources and manuals: responding to the needs of AIDS orphans

"Every 15 seconds, a mother or father dies of AIDS." This tag-line is used by FXB International on World AIDS Orphan Day May 7th to remind us of the millions of children around the world growing up without the love and protection of their parents and, often, without their basic rights. You are all too familiar with this reality in your own countries and many of you are involved in activities that support these children, help their families and communities to deal with this issue. That is why we wanted to share with you a few resources that may help you in your thinking and the execution of your programs.

The International HIV/AIDS Alliance, an NGO whose goal is to encourage community responses to HIV/AIDS, has a website where they have posted several interesting documents. The briefing Notes "Building blocks", are available in 7 books of around 30 pages each, and takes on themes such as education, nutrition, psychosocial support, social inclusion and the involvement and support of older people. Their goal is to guide the actions and programs dealing with orphans and vulnerable children and their work is inspired by "best practices" of already existing programs. "Building blocks in practice" contains a complete toolkit for improving the care and support of orphans and vulnerable children.

For English speakers, Alliance has developed many other resources on the care and support of AIDS orphans, including a CD-ROM (Orphans and other vulnerable children support toolkit) as well as a specific website.

To find out more
Thematic Notes
"Building blocks"
www.aidsalliance.org/
sw9170.asp

"Building blocks in practice" www.aidsalliance.org/
sw7466.asp

The CD-ROM
"OVC support Toolkit"
www.aidsalliance.org/
sw7464.asp

"OVC support toolkit" website (For those of you who do not have high speed internet you can visit a "text-only" version-Look in the lower right-hand corner of the screen on the website's main page.) www.ovcsupport.net/sw505.asp

The site of World AIDS Orphans Day www.worldorphansday.org/
en/index.php