Modern approach to neurorehabilitation of children with hiv-encephalopathy

Abstract

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.