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History:

Both children and adolescence living HIV-1 that has been acquired perinatally faces a number of risks to their mental wellbeing, possibly beginning with the exposure of the in utero to the ARV medication that is administered at the time by the pregnancy-carrying mother (Kapetanovic, 2009).  There is also the risk on a developing brain to constant exposure to immune dysregulation that is synonymous with the HIV infection (Kapetanovic, 2009).  Not to mention the likes of efavirenz and other ARV drugs forming ARV regimen in use at that stage, that have also been found to have side effects affecting the central nervous system (Kapetanovic, 2009). The mental health  risks continues up to childhood due to probable prior or subsisting parental mental diseases and drug abuse, together with environmental factors like inadequate housing, insufficient social support, and poverty (Kapetanovic, 2009).     

Affected anatomical pathway:

Studies points to increased psychiatric illnesses, school problems and cognitive disorders within people who were infected with HIV-1 perinatally (Kapetanovic, 2009). It is under this backdrop that the prescription of second-generation antipsychotics (SGA) has found wide acceptance in treating HIV-1 related psychiatric illnesses. This practice of treating HIV-1 Related psychiatric illnesses with SGA is unlikely to end or even halt any time soon, especially with the US Department of Food and Drug Administration approval of the drug, Risperidone in treating autistic children and adolescents, together with adolescents suffering from schizophrenia and youth with type 1 bipolar disorder (Kapetanovic, 2009).

One of the greatest advantages of Second-Generation Antipsychotics (SGA) over ordinary antipsychotics is their almost non-existent relation with extrapyramidal symptoms.   However there is enough evidence to suggest the existence of a relation between its (Second Generation Antipsychotics) use and weight gain.  Further studies confine this weight gain associated with SGA regimens to certain drug under SGA wide range, in this case I am referring to suggestion to the effect that the weight gain is more prominent on adolescents and children treated with either risperidone or olanzapine, then followed by the drug, quetiapine (Kapetanovic, 2009).

The mode of study and its similarities to other disease:

This issue of weight gain in perinatally HIV infected children and adolescents as been a subject of discussion for quiet some time. In fact it started with issues of mental health risk on perinatally HIV infected children and adolescents which was latter discovered to be associated with a range of factors like; exposure of a developing brain to immune dysregulation that is common with HIV infection, the exposure of in utero to ARV medication that is normally taken by infected expectant mothers, while being exacerbated by the like of poverty, prior mental health problems and drug abuse on the part of the expectant mother among others (Kapetanovic, 2009).

This assessment of the effect of SGAs to the HIV patient is not one of its own. In fact almost all psychiatric drugs have been put into similar treatment, before they were confirmed to have had an effect of increasing the weight of those people who had been prescribed them (Stiehn, et al, 2004).  The same can be said of drug for heart condition which have were found to have an effect on the male libido after being subjected to similar assessment (Stiehn, et al, 2004).

The importance of this treatment stem from the way it builds on what has been gathered concerning the subject matter which in this case is the perinatally HIV infected children and adolescence. Through these findings to the effect that there is a relationship between weight gain and the prescription of SGAs to perinatally HIV children and adolescents, we can be able to explain weight gain in cases of autism which has been found to be caused by "risperidone", which is the same SGAs that has been blamed for weight gain in cases of perinatally HIV infection on children and adolescences (Stiehn, et al, 2004).          

Description of the purpose of the study:

This study basically explores the effect of second-generation antipsychotics (SGAs) on the physical growth of adolescence and children infected with HIV-1 perinatally. This is because of the claims that have been made in relation to the use of SGAs by children and adolescent who have acquired HIV perinatally. This study is even more important because of the high number of perinatal HIV transmission, (either through transplacental transmission, breast feeding or delivery) in the United States that has been observed in recent times.  United States emphasizes on looking at HIV not just as a fatal and progressive infection, but rather, as one that is life limiting, which is why the issue of weight gain and other side effects that might be occurring in course of addressing this infection become a central issues that require serious attention and corresponding resources. 

Therapeutic targets, treatment options and current translational research:

Like I have mentioned in course of this paper children and adolescents suffering from perinatally transmitted HIV faces a multiplicity of mental risks, starting from their time in the womb all the way to their youthful years. It is in this regard that a whole range of drugs have been formulated to address this mental risk that has particularly been found to be more prominent and dangerous to the quality of life of the victim. Some of the SGAs that I am referring to in this case include efavirenz, risperidone, aripiprazole, ziprazidone, clozapine, paliperidone, and olanzapine among others, one (risperidone) of them has particularly been found to be associated with increased in body weight of those perinatally infected HIV patients who have been under them (Stiehn, et al, 2004).        

Method and techniques used and their limitations:

In researching the effect that SGAs have on the perinatally HIV infected children and adolescence the researcher evaluates data from PACTG (Pediatric AIDS Clinical Trials Group), a multicenter study, Protocol 219C cohort study, and Longitudinal observational study of adolescence and children that are perinatally infected with HIV that was conducted in year 2000. The first step involved taking the heights and weights using a stadiometer and a weighing machine respectively every three month from the routine visits of the participants. The study focuses on the two groups of perinatally transmitted HIV children and adolescents who are under several SGAs (risperidone, aripiprazole, ziprazidone, clozapine, paliperidone, and olanzapine) and those under conventional antipsychotics (chlorpromazine, halopreridol, thioridazine, perphezine, molindone, droperidol, and pimozide).

The first results were evaluated after the first six month, results which were to show any short-term change on the weight and height of the two set of participants. The second results were analyzed after the first two years to assess any long-term change in weight and height on the two sets of participants. All short term models were adjusted according to race, primary caregiver, stimulus use, PCG educational level, P1 use, follow up length, and school sport participation. Long-term models were adjusted according to stimulus use, PCG education level, follow-up length, CDC class, P1 use, school sport participation, and PCG.  All these analysis were conducted using data gotten from P219C data management center on May the year 2007 and acted upon using the SAS 9.1 software.

Results and finding:

From the findings of the study it is no doubt that SGA and especially risperidone contributes greatly in weight gain both in the short and long term on children and adolescents who have been perinatally infected by HIV. In this regard clinicians treating adolescents and children perinatally infected by HIV and those with comorbid psychiatric disorders that require SGAs are advised to routinely observe growth and metabolic parameters using a careful assessment of history, physical, and standardized height and weight (Chearskul, et al, 2009). It is at this point that treatment-based adverse effect should be weighted against the risks involved if the psychiatric disorders are left untreated (Chearskul, et al, 2009).    

Summary:

Ordinary HIV regiment that have been administered on children and adolescent who have acquired HIV perinatally to address the problem of psychiatric disorder that have been found to be prevalent on such patient have always been considered to have a whole range of side effects. One such side effect which made the use of Second-Generation Antipsychotics (SGAs) a relief in the medical field was its positive effect on mental health of HIV infected persons, however as the study which is the subject of this paper has confirmed, they have on their part the effect of increasing weight on those perinatally HIV infected children and adolescents under their use.

In light of these findings this study recommends that growth be carefully monitored in children and youth with perinatally transmitted HIV who are under SGAs. This study has significantly added on the body of knowledge that has been there on HIV which is a worthy breakthrough. It will be important to direct the future research on the interaction that exist between PIs (protease inhibitors) and SGAs) on perinatally HIV infected children and adolescents.

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