Antiretroviral and Prophylactic Medication and Nutrition Calculator (ARVCalc3)

Installation for Microsoft Windows® XP or 2000

1.      If Epi Info is not already on this computer, install it from www.cdc.gov/epiinfo. Or, if you already have the installation file for a recent version of Epi Info, on a CDROM disk, for example, run it and answer all questions affirmatively. Be patient; it may take a little time to start installing.

2.      Download ARVCalc3.zip and copy or unzip the files to a folder called ARVCalc3 (or exARVCalc) from this site or a CD. 

3.      Double click on ARVCalc3.zip.exe to install ARVCalc3. Allow it to install in the folder called C:\ARVCalc3\ if possible, but choose another location if you already have ARVCalc3 installed and have entered your own data in C:\ARVCalc3\ (not a very likely situation, but reinstalling in the same location could overwrite existing files.).  

4.      An icon or shortcut called ARVCalc3” should be copied automatically to your desktop. If the icon appears, then you have successfully installed the module for calculating nutritional percentiles and zscores, using the US growth reference curves released in the year 2000.

5.      If you are not able to install the nutritional module, a message will pop up each time you run ARVCalc3, saying that you do not have the DLL called US2KAny. To solve this problem, ask someone with "administrative privileges" on the computer to run the batch file called ConfigNUT.BAT in the ARVCalc3 folder. You also have the option of using ARVCalc2, which does not have the nutritional features.

6.      Click the ARVCalc3 icon to run the program. English is on the left side of the screen and Spanish on the right. The DEMO, contains 19 sample records. Click DEMO; after a pause, a data entry screen should appear. You can page through the records using the arrows in the lower left corner of the screen. Note the different regimens, doses, and preparations used and the nutritional calculations that are done from the age, weight, height, and sex. The DATABASE button brings up the same form with an empty database table for your own use.

(Note for Microsoft Vista users. The ConfigNUT.bat program runs automatically after installation in Windows XP, but in Windows Vista, you have to run it as follows. From the START menu and ALL PROGRAMS, find ACCESSORIES. RIGHT CLICK on the COMMAND PROMPT entry in this menu, and you will see a choice to RUN AS ADMINISTRATOR. Make this choice and you should have a command window. Now, using the commands "CD \ARVCALC3\" (CD means Change Directory), and DIR, find the program called ConfigNUT.bat and type its name. The program should run and register the module called US2KAny.wsc, which contains the US BMI standards. Close the Command Prompt window, and use the icon on the desktop to run ARVCalc3.)

What is ARVCalc3?

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 two second-line regimens, 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. 

For ages 24 months through adulthood, ARVCalc3 calculates Body Mass Index to measure wasting or obesity. For adults, the results are presented as categories. For ages 2 to 20 years, ARVCalc3 compares the BMI with the US national standards for BMI by age and sex and gives a percentile value, a z-score, and a text interpretation. For example, a patient in the 4th percentile has less body mass for height squared than 96% of the standard population of the same sex and age, and would be described as "underweight".

For children from birth to 24 months, the results are given as weight-for-length percentiles and z-scores for age. To obtain weight-for-age, remove the child's length temporarily (inches or cm.). To obtain length-for-age, remove the weight. You will need both measurements for calculating the doses of some of the medications, however.

 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. 

Background

The regimens and doses are based on a DRAFT Guide for Pediatric Care of Patients with HIV / AIDS prepared by the Ministry of Health of the Dominican Republic and revised by one of us, but not yet approved for general use.  This guide is, in turn, based on:

Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. October 26, 2006 1-126. Available at http://aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf.

Treating Opportunistic Infections Among HIV-Exposed and Infected Children   Recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America, and the New York State Department of Health AIDS Institute Pediatric and Adolescent HIV Guidelines, Pediatric Antiretroviral Therapy ( http://www.hivguidelines.org/public_html/p-arv/p-arv-appa.htm ).  The draft Dominican document is used here to illustrate how ARV protocols can be expressed in check code within an Epi Info form, and it is assumed that other users may prepare their own version.  Two versions are provided, one in Spanish and the other in English, with compatible databases. The English version of the first document above can be accessed by clicking on the button called "Pediatric ARV Guide" in ARVCalc3, and the Spanish version is accessible from the corresponding button on the Spanish screen.

Intended use

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.

Is it Useful for Adults? 

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.  The nutritional results are applicable to adults.

Working with ARVCalc

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.

Warning and Plea for Input

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. 

Please send feedback, suggestions and corrections to:

 

Andrew G. Dean, MD, MPH

andy.dean@gmail.com

Consuelo M. Beck-Sagué, MD

rocknrollmd@hotmail.com