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Feb 11, 2003

I've been HIV+ for five years and have never taken antiretroviral meds. Six months ago I began taking Ritalin for ADD. It's doing wonders but I have a concern due to the fact that Ritalin is a stimulant. Recently, doctors at UCLA discovered that cocaine may increases viral replication. Also, methamphetamines are suspected of increasing HIV activity in the brain. My recent VL was higher than normal (70,000) not the usual <25,000. But CD4s are at the usual 800. Should I be worried about taking Ritalin? Could it increase my VL and speed disease progression as cocaine does? Could it cause HIV to cause more harm than it otherwise would to my brain, over the long run?

Many thanks if you can clear this up!


Response from Dr. Horwath

Ritalin [methylphenidate] is widely used in the treatment of ADHD (attention deficit-hyperactivity disorder). Methylphenidate and dextroamphetamine (Dexedrine) have also been used in the treatment of cognitive problems, such as slowed thinking and impaired concentration, and emotional symptoms, such as apathy, in persons with AIDS. For many, stimulants have been quite helpful in improving thinking, concentration, motivation, and energy.

These stimulants may be associated with side effects, such as insomnia, increased blood pressure, nervousness, decreased appetite and others. There is also a risk of abuse or dependence, especially in those with a past history of drug abuse or dependence. The effects on HIV replication are not known. These facts should be considered before starting amphetamines or methylphenidate.

The UCLA study to which you referred involved cocaine and its effects on viral load and other factors in mice with severe combined immunodeficiency. This disease in mice is studied as a model for AIDS in humans, but is far from a perfect model. The researchers found that mice infected with HIV in the presence of cocaine had higher viral loads than mice who were not exposed to cocaine. This may or may not apply to humans with AIDS, but does suggest the need for further investigation.

Cocaine is a drug very different from amphetamine and methylphenidate. Although each of these drugs have stimulant effects, they are chemically quite different. The effects of cocaine on HIV are not necessarily the same as amphetamine or methylphenidate.

The bottom line is that we do not know the effects of amphetamine and methylphenidate on viral replication in people with AIDS. The UCLA study is a cause for further research, but to my knowledge we have no studies of the effect of amphetamines or methylphenidate on HIV replication in humans.

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