Implementation of the International Classification of Functioning, Disability and Health (ICF, 2001), WHO requires detailed development of the application of this classification for HIV / AIDS in children, which will determine the degree of disability, rehabilitation potential and prognosis for this population.
In HIV-infected children at risk of disability, the following disabilities were identified: self-care, orientation, communication, learning, behavioral control, progressing as immunodeficiency increases and are shown in Table.
To solve this problem, we have adapted a methodology for determining functional classes (FCs) in order to establish the degree of disruption of functions, the main categories of vital activity in children with HIV / AIDS [363].
We have developed clinical and expert criteria for the degree of impairment of body functions, limitations on vital functions due to HIV / AIDS, developed functional classes and methods for their use in medical and social expertise in children with HIV / AIDS and in persons at risk of disability. To determine the functional disorders, we took into account the clinical symptoms, the stage of the disease, the degree of immunodeficiency, the viral load, the presence of concomitant diseases, aggravating the course of the underlying disease, complications.
The severity of violations in functional classes in children with HIV / AIDS and the risk of disability has allowed us to distinguish the following grades: FC 1 (0-25 %) – mild violations; FK 2 (26-50 %) moderate disorders; FC 3 (51-75 %) – severe disorders; FK 4 (76-100 %) is a significant violation, which was determined according to clinical and laboratory methods of the study.
Conclusion
The limitation of certain categories of life activity and disability, as a rule, results in a health disorder predominantly with moderate, severe and marked persistent impairments of body functions (II, III, IV degree). Minor disorders of body functions (I degree) are relatively rare causes of disability and disability.
Quantitative assessment of disability in HIV-infected children at risk of disability
Functionality class |
Clinical and laboratory characteristics |
Limitation of life activity |
1 |
2 |
3 |
FC 1 (0-25 %) |
Level RNA HIV < 10 000 copies/ml (in children older than 5 years) |
Self-service-FC0 Orientation-FC0-1 Communication-FC0-1 Training-FC0-1 Behavior Monitoring -FC0-1 Motor activity-FC0-1 |
Table continuation |
||
1 |
2 |
3 |
FC 2 (26-50 %) |
I Laboratory test data: ALT – increase to 3 norms γ – globulins – from 8 % to 14 % PCR – detection in the blood DNK VSV, CMVI, candida ELISA – specific antibodies of HSV, CMV, candida Immunological study – the level of CD4 cells – 20-24 % HIV RNA level < 20 000 copies / ml (in children over the age of 5 years) II Ultrasound of the liver – hepatomegaly moderate, moderate diffuse changes in the liver parenchyma, enlarged portal vein. |
Self-service- FC1-2 Orientation – FC1-2 Communication – FC1-2 Training-FC1-2 Behavior Monitoring – FC2-3 Motor activity – FC1-2 |
FC 3 (51-75 %) |
I. Laboratory test data: Anemia (< 80g / l), neutropenia (< 1000l / ?l) or thrombocytopenia (< 100 000l / ?l) for 1 month or more
II. X-ray – upper-left infiltrate, atypical manifestations
(LIP clinic)
|
Self-service - FC2-3 Orientation – FC2-3 Motor activity – FC2-3 Communication – FC2-3 Education – FC2-3 Behavior Monitoring – FC2-3 |
End of table |
||
1 |
2 |
3 |
FC 4 (76-100 %) |
Severe depletion or other form of eating disorders, physical development not responding to standard therapy
Lymphoma of the central nervous system or B-cell lymphoma
I. Laboratory test data:
II. Rentgenologically – bilateral reticulonodular infiltrates, more pronounced in the radical zone and extending around the periphery, an abundance of focal shadows – a “cotton” radiograph (PCP clinic)
|
Self-service - FC3-4 Orientation – FC3-4 Communication – FC3-4 Training – FC3-4 Behavior Monitoring – FC3-4 |
Expert diagnosis in the examination of children with HIV / AIDS, including the identification of a set of functional indicators (Table), on the basis of which the degree of impairment of functions, the main categories of life activity is established, reveals the level of rehabilitation opportunities, and the need for various types of medical and social rehabilitation allowed differentiating rehabilitation the activities of patients with HIV infection and improve their quality of life.
Out of 17 HIV-infected children, one patient is not included in the FC. In 2 (11.7 %) children, moderate clinical and functional disorders (FC-2), marked clinical and functional disorders (FC-3) in 15 (88.3 %) were revealed. All patients had indications for disability registration.
The work is submitted to the International Scientific Conference “FUNDAMENTAL AND APPLIED IN MEDICINE BIOLOGY”, November 9–15, 2017, UAE (Dubai), came to the editorial office оn 30.10.2017.