Growing Up Info 8

Infos

Toronto 2006: A new coalition concerning children

What should be remembered from the International AIDS conference in Toronto? There was an abundance of scientific pediatric information. We will talk more about it in upcoming issues of Growing Up Info. On the political score, Toronto witnessed the beginning of a vast coalition concerning the cause of children infected or affected by HIV/AIDS, the Coalition on Children Affected by AIDS (CCABA).

The initiative for this coalition came from a Dutch organisation called the Bernard Van Leer Foundation which has gained notice for numerous publications these last few years on orphans and AIDS. Composed of members from NGOs in the South and the North, the CCABA coalition’s goal is to unite non-governmental entities, including foundations and granting organisations, involved in comprehensive care of children who are infected and/or affected by HIV/AIDS. Currently, few French representatives are included in this coalition but we hope that French-speaking organizations will join soon.

Concluding that too few abstracts concerning pediatric HIV were included in international conferences, CCABA published a guide, available in French, which gives advice on how to write a professional abstract. This will be useful in getting ready for Mexico, 2008! The CCABA coalition also launched a discussion forum animated by HD-Net called “Children IAC-2006.” On the forum you can read comments on some of the more interesting presentations given in Toronto on pediatric HIV.

To find out more
CCABA’s website
www.ccaba.org

Guide to writing abstracts on pediatric HIV
www.ccaba.org/resources.html#D

Bernard Van Leer
Foundation website
www.bernardvanleer.org/

To subscribe to the “Children IAC-2006 discussion forum, send an email entitled
“Please add me to Children-IAC2006” to:
join-Children-IAC2006
@eforums.healthdev.org

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Malaria and HIV during pregnancy

In Growing Up Info #7 we began discussing the topic of the interaction between malaria and HIV; here is some additional information for pregnant women.

The effects of HIV on malaria:
Pregnant women living with HIV are at greater risk of coming down with malaria regardless of how many times they have been pregnant. The concentration of parasites is often higher in the blood and in the placenta.

The effect of malaria on HIV:
The viral load increases during episodes of malaria regardless of the degree of immuno-suppression. To date no clear link has been established regarding mother to child transmission of HIV .

Effects of co-infection of HIV-Malaria:
Co-infection increases the risk of anemia in mothers, and can contribute to low birth weight, intra uterine growth retardation and premature birth.

How to limit these effects?
HIV infection changes how individuals respond to anti-malarial prophylaxis. A pregnant woman living with HIV will have to take three doses of prophylactic medicine (Sulfadoxine - Pyrimethamine) instead of two.

This kind of prevention is not advisable for women already taking Cotrimoxazole (remember : CTM to be started only after the first trimester of pregnancy). Taking these two medicines together increases the risk of adverse side effects.
Finally, it is no longer necessary to demonstrate the effectiveness of impregnated bednets in preventing episodes of malaria in the mother and their consequences on her and her unborn child's health, for example: low birthweight, prematurity as well as anemia in the mother.

To conclude, while it has not been clearly established that co-infection HIV/malaria increases mother to child transmission of HIV there are still serious consequences for the mother and the child. All pregnant HIV+ women should be offered effective prophylactic measures against malaria.

To find out more
The WHO report on malaria and HIV interactions (313 ko)
http://www.who.int/malaria/
malaria_HIV/Malaria
HIVinteractions_report.pdf

Rubric à brac

ANECCA is publishing a French version of their manual on how to treat pediatric AIDS in Africa

For the last five years the African Network for Care of Children Affected by HIV/AIDS (ANECCA) has been publishing guidelines and training health professionals to improve the quality of care for children living with HIV in Africa. This network of caregivers, clinicians and sociologists works as much on prevention and treatment of the illness as on the provision of care adapted to the needs of children.

In 2004, ANECCA published the first handbook on pediatric AIDS in Africa. Having become an acclaimed reference, this book contains practical information for all healthcare workers at every level.

A new version has just come out and for the first time it is available in French; not only has a gap been filled but also it is an excellent tool for French speakers! Two chapters are particularly interesting: Chapter 9 on adolescent issues and Chapter 11 on counseling and psychosocial support.

However, given that the new WHO recommendations were released only a few weeks ago, the handbook unfortunately uses the 1994 CDC definition of immunosuppression in the main section, only adding a reference to the newer 2006 WHO recommendations, which should be used as a reference. The manual also exhibits dosage tables for cotrimoxazole as prophylaxis that are based on weight while the new recommendations are based on age (see corrected exercise below) but both methods are valid.

To find out more
ANECCA website
www.anecca.org

To download the handbook
(1.9 Mo)
http://www.anecca.org/index.php
?option=com_downloads
&Itemid=51&func=selectcat
&cat=3

Remue-Méninges

Answers to last month's quizz questions

In Growing Up Info 7, you had to answer a quiz question regarding cotrimoxazole. Here is the answers.

I. A Toxoplasmosis and D Pneumocystis
II. B False. All children exposed to HIV should take CTX until proven to be HIV- (generally 18 months, HIV-antibody test)
III. A It is about the dose expressed in trimethoprime (cotrimoxazole = trimethoprime + sulfamethoxazole)
IV. B False. Only once the restoration of the immune system is confirmed (in general 6 months with no signs of immunosuppression)

We now have to follow WHO’s new recommendations for 2006 and simplify prophylaxis:

Age	SingleDaily Dose	Liquid Suspension 5ml = 200mg / 40mg	Adult single pill 400mg / 80 mg
> 5 weeks < 6 months	100 mg / 20 mg	2.5 ml = 1/2 teaspoon	1/4 tablet
> 6 months to 5 years	200 mg / 40 mg	5 ml	1/2 tablet
6 – 14 years	400 mg / 80 mg	10 ml	1 tablet
> 14 years	800 mg / 160 mg	-	2 tablets

Here is a new question

You are in consultation with a couple and their newborn child. What words would you use to describe to parents living with HIV all the reasons why they should be using an impregnated bednet for their newborn?

We want to thank everyone for their reasoned answers even though the rules of the game mean rewarding the first-arrived right answer. The winner this time is Dr Zamba from the CTA in Libreville!

WHO's new recommendations
http://www.who.int/hiv/pub/
guidelines/WHO CTX.pdf

Be the fastest at giving us the right answers and you will win a reference book on HIV /AIDS! Please send us your answers and explanations at grandir@sidaction.org

Grandir

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