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| |  Children With HIV Gain More Weight With Atypical Antipsychotics: Presented at APA By Roberta Friedman, PhD SAN FRANCISCO -- May 20, 2009 -- Atypical antipsychotics as a group, as well as risperidone alone, are independently associated with increased body mass index (BMI) z-scores in children who are perinatally HIV positive, researchers stated here at the 162nd Annual Meeting of the American Psychiatric Association (APA). In a poster presentation on May 18, Suad Kapetanovic, MD, Clinical Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California, presented data from the Pediatric AIDS Clinical Trials Group protocol 219c observational study. Other drugs may also have this effect, but the study numbers were too small to be certain, said Dr. Kapetanovic. Atypical antipsychotic medications as a group did appear to have a greater effect on weight gain than the typical antipsychotic drugs, he added. The children were ages 3 to 24 years and had used prescribed antipsychotic drugs for at least 1 month. They were matched to children in the study who did not use any antipsychotic drugs. The increase in BMI z-score was significant (P = .0013) for 2 years of follow up (206 patients, including controls). "These are kids usually from unstable families," said Dr. Kapetanovic, "who already have fragile health. Adding weight gain is a major concern." He noted that the treatment with antivirals has enabled the children to survive with HIV infection, and taken the wasting from the virus from the picture. But some antivirals such as protease inhibitors can have a metabolic effect, so it may be a problem to add other drugs that also affect metabolism adversely. Dr. Kapetanovic said that if there is an interaction with the drug disposing enzymes in the liver, there could be an increased risk for neuroleptic malignant syndrome or extrapyramidal side effects with these drugs in these kids. Given the study numbers, conclusions are not definitive, but, Dr. Kapetanovic added, if a neuroleptic must be used in children with HIV, "risperidone is not a good one; others may be weight neutral." The researchers also suggest that clinicians should carefully monitor the growth parameters in children with HIV who are being prescribed antipsychotics. [Presentation Title: Relationships Between Use of Antipsychotics and Changes in Physical Growth in Children and Adolescents With HIV. Abstract NR2-010]
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