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