The use of second-generation antipsychotics and the changes in physical growth in children and adolescents with perinatally acquired HIV

Abstract

Second-generation antipsychotics (SGAs) are increasingly prescribed to treat psychiatric symptoms in pediatric patients infected with HIV. We examined the relationship between prescribed SGAs and physical growth in a cohort of youth with perinatally acquired HIV-1 infection. Pediatric AIDS Clinical Trials Group (PACTG), Protocol 219C (P219C), a multicenter, longitudinal observational study of children and adolescents perinatally exposed to HIV, was conducted from September 2000 until May 2007. The analysis included P219C participants who were perinatally HIV-infected, 3-18 years old, prescribed first SGA for at least 1 month, and had available baseline data prior to starting first SGA. Each participant prescribed an SGA was matched (based on gender, age, Tanner stage, baseline body mass index [BMI] z score) with 1-3 controls without antipsychotic prescriptions. The main outcomes were short-term (approximately 6 months) and long-term (approximately 2 years) changes in BMI z scores from baseline. There were 236 participants in the short-term and 198 in the long-term analysis. In linear regression models, youth with SGA prescriptions had increased BMI z scores relative to youth without antipsychotic prescriptions, for all SGAs (short-term increase = 0.192, p = 0.003; long-term increase = 0.350, p < 0.001), and for risperidone alone (short-term = 0.239, p = 0.002; long-term = 0.360, p = 0.001). Participants receiving both protease inhibitors (PIs) and SGAs showed especially large increases. These findings suggest that growth should be carefully monitored in youth with perinatally acquired HIV who are prescribed SGAs. Future research should investigate the interaction between PIs and SGAs in children and adolescents with perinatally acquired HIV infection.

FIG. 1.

Change in body mass index (BMI) z-scores from baseline to short-term follow-up (approximately 6 months) by second-generation antipsychotics (SGA) exposure (n = 184). Labels on x-axis: Base SGA, baseline measurement in subjects exposed to SGA; Base no SGA, baseline measurement in subject unexposed to SGA; Fwp SGA, follow-up measurement in subjects exposed to SGA; Fwp no SGA, follow-up measurement in subjects unexposed to SGA.

FIG. 2.

Change in body mass index (BMI) z-scores from baseline to long-term follow-up (approximately 2 years) by second-generation antipsychotics (SGA) exposure (n = 236). Labels on x-axis: Base SGA, baseline measurement in subjects exposed to SGA; Base no SGA, baseline measurement in subject unexposed to SGA; Fwp SGA, follow-up measurement in subjects exposed to SGA; Fwp no SGA, follow-up measurement in subjects unexposed to SGA.