Russian Journal of Physiotherapy, Balneology and RehabilitationRussian Journal of Physiotherapy, Balneology and RehabilitationФизиотерапия, бальнеология и реабилитация1681-34562413-2969Eco-Vector6510110.17816/1681-3456-2020-19-4-3Original studiesОригинальные исследованияResearch ArticleModern approach to neurorehabilitation of children with hiv-encephalopathyСовременный подход в нейрореабилитации детей с ВИЧ-энцефалопатиейhttps://orcid.org/0000-0002-6317-4476SaidkhodjaevaSaida N.СаидходжаеваСаида Набиевна
Uzbekistan

PhD, Associate Professor

к.м.н., доцент

dr.saida25@gmail.comhttps://orcid.org/0000-0002-2464-0315MadjidovaYakutkhon N.МаджидоваЁкутхон Набиевна
Uzbekistan

DcS., Professor

д.м.н., профессор

dr.saida25@gmail.comYuldashevКаhramon H.ЮлдашевКахрамон Халдарович
Uzbekistan

DcS., Professor

д.м.н., профессор

dr.saida25@gmail.comTashkent Pediatric Medical InstituteТашкентский педиатрический медицинский институт150820201942202261404202114042021Copyright ©; 2020, Eco-VectorCopyright ©; 2020, ООО "Эко-Вектор"2020Eco-VectorООО "Эко-Вектор"https://rjpbr.com/1681-3456/article/view/65101

Background. Currently, there is no standardized and evidence-based medicine specific therapy for HIV-associated neurocognitive disorders.

The aim of the study was to evaluate the effectiveness of various neurorehabilitation programs, including the use of memantine hydrochloride and the virtual reality feedback method (NIRVANA) in children with HIV encephalopathy (HIVE) in the aspect of neurocognitive status.

Material and methods. The study included 260 children with HIV-positive status and receiving highly active antiretroviral therapy (НAART) according to an individually selected scheme for at least 6 months. All the children included in the study showed signs of HIVE. After the initial examination, all patients were divided into 4 groups: only НAART, НAART + memantine, НAART + NIRVANA and НAART + memantine + NIRVANA. The follow-up period was 3 months. The neurological study included a standard neurological examination, as well as various psychometric scales and questionnaires.

Results. In the groups of active neurorehabilitation, there were significant positive changes in the neurocognitive status: the score of all components of neurocognitive disorders decreased in all three groups with comparable relative dynamics. As a result, by the end of the 3rd month of follow-up in children taking memantine (НAART group + M and НAART + M + H) achieved a significantly lower IQ score compared to children who were only on НAART (p <0.001 for both comparisons). Also in children who received complex neurorehabilitation (НAART + M + H) by the end of the 3rd month of observation, a significantly lower integral score of neurocognitive status assessment was achieved compared to children of the НAART group (p <0.05).

Conclusion. Thus, in the course of this study, it was found that children with HIVE, despite the ongoing НAART, have a tendency to progress HIVE. Children with HIV-associated dementia are most susceptible to progression. The use of active neurorehabilitation, especially a combination of memantine and virtual reality techniques, can significantly improve the indicators of neurocognitive status.

Обоснование. В настоящее время нет стандартизованной и обоснованной с позиции доказательной медицины специфической терапии ВИЧ-ассоциированных нейрокогнитивных расстройств.

Цель исследования — оценить эффективность различных программ нейрореабилитации, включая применение мемантина гидрохлорида и метода виртуальной реальности с обратной связью (NIRVANA, N) у детей с ВИЧ-энцефалопатией (ВИЧЭ) в аспекте нейрокогнитивного статуса.

Материал и методы. В исследование включены 260 детей с ВИЧ-позитивным статусом, принимающих высокоактивную антиретровирусную терапию (ВААРТ) по индивидуально подобранной схеме не менее 6 мес. У всех детей, включенных в исследование, обнаружены признаки ВИЧЭ. После первичного обследования все больные были распределены на 4 группы: только ВААРТ; ВААРТ + мемантин (M); ВААРТ + N; ВААРТ + M + N. Период наблюдения составил 3 мес. Неврологическое исследование включало стандартные методы обследования, а также различные психометрические шкалы и опросники.

Результаты. В группах активной нейрореабилитации отмечались достоверные положительные изменения нейрокогнитивного статуса: балльная оценка всех компонентов нейрокогнитивных нарушений снизилась во всех трёх группах с сопоставимой относительной динамикой. В результате, к концу 3-го месяца наблюдения у детей, принимавших мемантин (группы ВААРТ + М и ВААРТ + М + N), достигнут достоверно более низкий балл оценки интеллекта по сравнению с детьми, которые находились только на ВААРТ (p <0,001 для обоих сравнений). У детей, получавших комплексную нейрореабилитацию (ВААРТ + М + N), к концу 3-го месяца наблюдения также достигнут достоверно более низкий интегральный балл оценки нейрокогнитивного статуса по сравнению с детьми группы ВААРТ (p <0,05).

Заключение. Таким образом, в ходе настоящего исследования обнаружено, что у детей с ВИЧЭ, несмотря на проводимую ВААРТ, наблюдается тенденция к прогрессированию ВИЧЭ, которому наиболее подвержены дети с ВИЧ-ассоциированной деменцией. Применение активной нейрореабилитации, особенно комбинации мемантина с методикой виртуальной реальности, позволяет достоверно улучшить показатели нейрокогнитивного статуса.

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