Background:  Perinatally HIV-infected youth often receive psychotropic medication for the management of emotional or behavioral problems that may be linked to the virus or its treatments. Nevertheless, little is known about this aspect of clinical management. We describe psychotropic drug therapy and its association with psychiatric symptoms, in HIV⁺ and HIV^– (control) children and adolescents.  

Methods:  The study sample consisted of 6- to 17-year-olds, 291 HIV⁺ and 246 controls, enrolled in Pediatric AIDS Clinical Trials Group (PACTG) 1055, a prospective, observational study of psychiatric symptoms. Youth and their primary caregivers completed Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) -referenced rating scales (ie, Child and Adolescent Symptom Inventories—4) for their and their children’s symptoms. Screening cut-off scores were computed for attention-deficit or hyperactivity disorder, generalized anxiety disorder, major depression, and dysthymia. Lifetime psychotropic drug therapy and ART histories were obtained.

Results:  Overall, 93 (17%) participants had received at least 1 psychotropic drug therapy during their lifetime:  stimulants (13%), neuroleptics (3%), and selective serotonin reuptake inhibitor (SSRI) antidepressants (6%). More HIV⁺ (22%) than controls (11%) were administered psychotropic drug therapies (OR 2.1, 95%CI 1.3 to 3.4), specifically, stimulants (p = 0.02) or SSRI (p <0.001). Males were twice as likely as females to have been treated (OR 2.0, 95%CI 1.2 to 3.2). Of the 478 youth who self-reported, 28% obtained an screening cut-off score for at least 1 targeted psychiatric disorder in contrast to 14% of 519 caregiver-reports. Where both reported, youth showed significantly higher prevalence (29%) than did caregivers (15%, McNemar p <0.001, n = 465) and overall agreement was weak (κ= 0.20, 95%CI 0.10 to 0.29). The odds of receiving psychotropic drug therapy was greater for youths with caregiver symptom endorsement than for those with only child self-reports (OR 4.1, 95%CI 1.9 to 8.9). Based on youth self-report, 86% of younger children (<12 years) and 67% of older children (≥12 years) who obtained at least 1 screening cut-off score for a psychiatric disorder never received psychotropic drug therapy but may have received non-medication intervention.

Conclusions:  Perinatally HIV-infected children are twice as likely to be prescribed psychotropic medication as controls. Additional research on biologic, psychological, and social variables that influence both the etiology of emotional and behavioral problems and the complex psychiatric treatment decisions in this clinical population is needed.