APNAC @ XVI IAC 2006, Toronto [pictures]

Edwina sharing APNAC study results

A Brief Report of APNAC @ XVI IAC 2006

Dr.Patrick Li @ APNAC Skill Building Session @ XIV IAC 2006, Toronto Photo: C Thangsing

Dear APNAC Members,

It is my pleasure to report to you the APNAC workshop which was held successfully on 15^th August. It was attended by over 30 participants from many different countries (including Angola, Cambodia, Cameroon, Canada, China, Guatemala, Haiti, India, Kenya, Kuwait, Mexico, Mozambique, Nigeria, Romania, South Africa, Sudan, Thailand, Trinidad-Tobago, Uganda, UK, USA and Zimbabwe). The participants were from a broad range of background, including doctors (internists, HIV clinicians, neurologists, ID physicians and paediatrician), nurses, occupational therapist, social worker, researcher and communication/educator. I appreciate very much the contributions of the co-facilitators, Adeeba, Chinkholal, Subsai, Iris and in particular Edwina who travelled the long distance to Toronto despite her recent leg injury. There were such enthusiastic responses and interaction from the participants that we did not have time for the case presentation or hands-on demonstration. Among the audience were Dr. David Simpson from Mount Sinai School of Medicine and Dr. Charles Farthing of AIDS Healthcare Foundation, who provided many useful comments and suggestions during the workshop.

I must say that we learned a lot ourselves from the workshop, and a number of very useful suggestions have been raised which could be considered by APNAC when thinking about our future projects. These include:

- training in neurological assessment and examination for non-neurologists

- clinical algorithm for paediatric patients

- management algorithm for patients presenting with seizures, taking into account drug interactions with the anti-epileptic medications

- advocating for access to medications for treatment of CNS OIs

The APNAC clinical algorithms might need further enhancement taking into consideration the following issues:

- incorporate use of corticosteroid for patients presenting with meningitis or CNS mass lesions

- incorporate detection of meningeal signs in assessing patients with hemispheric lesions

- clarify the duration of treatment for cerebral tuberculosis required for gauging the response

- revisit the approach to administer anti-toxoplasma therapy for patients with non-enhancing brain lesion even when toxoplasma IgG is positive

- consider incorporating the role of lumbar puncture in assessing patients with raised intracranial pressure or focal signs, in view of its utility in differentiating tuberculosis and toxoplasmosis (Many participants reflected that toxoplasma serology and cryptococcal antigen were generally not available in resource-limited settings. Further guidelines on the precautions of lumbar puncture in such patients would be necessary.)

- develop algorithms for optimal management of neuroAIDS, with advice on the approach when the relevant diagnostic tools are not available

According to the participants, there do not seem to be any similar groups focused on neuroAIDS in Africa or Latin America and I think APNAC is serving a very unique function. Many of the participants have left us their email address with the intention of communicating with others working on neuroAIDS. One doctor from Japan asked Edwina why they are not included in APNAC. While it will be costly to bring everybody together to discuss in person the APNAC projects, we should maintain our momentum with regular communication through other means. I am therefore pleased to let you know that Chinkholal has established a website for APNAC (http://apnac.blogspot.com). We can use it to communicate with one another as well as other workers interested in neuroAIDS. We can also post useful training and reference material on neuroAIDS. I sense that APNAC will gain increased recognition and importance if we keep up with our effort.

Best regards,

Patrick

At IAC 2006

August 15 2006: Patrick Li, Iris Chan, C Thangsing, Chhim Sarath, Charles Farthing, Adeeba and Subsai at the APNAC Skill Building Session on 'Neurological Treatment and management in Resource limited settings. SB Room 2, Metro Convention Center

APNAC successful Skill Building Session !

APNAC Members at the XVI International AIDS Conference, Toronto. Post successful skill building session attended by participants from over 15 countries.

APNAC Skill Building Program, IAC 2006 Toronto

Skills Building Workshop on NeuroAIDS : XVI International AIDS Conference, Toronto

Asia Pacific NeuroAIDS Consortium

Management of NeuroAIDS in Resource-limited Settings 15th August 2006

Asia Pacific NeuroAIDS Consortium (APNAC) (http://apnac.blogspot.com)

APNAC was established in 2002 by a group of HIV and ID physicians, neurologists, neuroscientists, neuropsychologists and social researchers with a shared interest in HIV-related neurological diseases. Members come from Australia, Cambodia, China, Fiji, Hong Kong, India, Indonesia, Malaysia, Papua New Guinea, Thailand, USA and Vietnam. Its activities include training and clinical researches in neuroAIDS.

Workshop Objectives

Ø Increase awareness and understanding of the clinical presentation of neuroAIDS

Ø Introduce clinical algorithms and bedside tests to enhance capability of diagnosing and managing neuroAIDS in resource limited settings

Ø Sharing of experience in overcoming the barriers to managing neuroAIDS in resource-limited settings

Ø Create opportunity for future collaboration and mutual support

Faculty Members

Dr. Edwina Wright, Alfred Hospital, Melbourne, Australia

Dr. Chinkholal Thangsing, AIDS Healthcare Foundation (Asia Pacific), New Delhi, India

Dr. Adeeba Kamarulzaman, University of Malaysia Medical Centre, Kuala Lumpur, Malaysia

Dr. Patrick Li, Queen Elizabeth Hospital, Hong Kong

Dr. Subsai Kongsaendao, 2 Rajathivi Hospital, Bangkok, Thailand

Ms. Iris Chan, Queen Elizabeth Hospital, Hong Kong

Programme Outline

Session I: Opportunistic diseases in HIV infection

2.15 – 3.45 pm

1. Pattern of neuroAIDS in developing countries (Edwina Wright)

2. Barriers to diagnosis and management of neuroAIDS in resource limited settings (Chinkholal Thangsing)

3. Management algorithm for neuroAIDS in resource limited settings (Adeeba Kamarulzaman)

4. Case illustrations in management of neuroAIDS (Patrick Li)

Session II: Cognitive impairment and peripheral neuropathy in HIV infection

4.15 – 5.45 pm

1. Peripheral neuropathy in HIV infection (Subsai Kongsaendao)

2. Cognitive impairment in HIV infection (Patrick Li)

3. Bedside tests for cognitive impairment (Iris Chan)

4. Hands-on experience (APNAC members)

5. Wrap-up session of workshop

APNAC Countries

ASIA PACIFIC NEUROAIDS CONSORTIUM is represented by :

Australia
India
Cambodia
PNG
Indonesia
Myanmar
Fiji
Malaysia
Hong Kong
Singapore
Thailand

APNAC in Toronto

August 15, 2006:

Asia Pacific NeuroAIDS Consortium is here in Toronto and continues to makes its presence to increasing awareness regarding the neurological manifestations of AIDS and the importance of treatmentof neuro AIDS. APNAC will be conducting a Skills Building session at the Toronto - International AIDS Conference, 2006.

The various sessions at the Skill Building room 2 at 2:15 PM till 4:15 PM will have various presentation from APNAC members. Edwina Wright [Australia], Patrick Li[HongKong, China],Chinkholal Thangsing,[India], Iris Chan, [Hong Kong, China], Subsai. [Bangkok, Thailand]. The session will also have a demonstration of examination and other technique and skills for the clinical diagnosis of different neurological manifestation of HIVAIDS.