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.
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.
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. The nutritional results are applicable to adults.
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.
Please send feedback, suggestions and corrections to:
Andrew G. Dean, MD, MPH
Consuelo M. Beck-Sagué, MD