HIV-related fatigue relieved by psychostimulants

Fatigue, a common manifestation of HIV disease that strongly affects quality of life, is effectively treated with methylphenidate or pemoline, according to a report published in the February 12th issue of the Archives of Internal Medicine.

Dr William Breitbart, and colleagues, from Memorial Sloan-Kettering Cancer Center in New York, assessed the safety and efficacy of psychostimulants in the treatment of HIV-related fatigue by studying the outcomes of 109 HIV-infected, fatigued patients randomised to receive 60 mg of methylphenidate, 150 mg of pemoline, or 8 capsules of placebo daily. While 41% and 36% of subjects receiving methylphenidate and pemoline, respectively, experienced significant improvement in their fatigue, only 15% of placebo-receiving subjects achieved this benefit. The improvement with psychostimulant use was significant on several self-reported rating scales. In addition, the rate of improvement in Piper Fatigue Scale total scores was significantly greater when psychostimulants were given. The researchers found that both psychostimulants were equally effective in treating fatigue. Improvement in fatigue was also significantly associated with improvement in measures of depression, psychological distress, and overall quality of life, they note. Hyperactivity and jitteriness were significantly more common among psychostimulant users, but severe side effects were relatively uncommon.

“This study reflects the first empirical demonstration of the effectiveness of psychostimulants for the treatment of HIV-related fatigue,” the authors state. “The use of psychostimulants in the clinical management of fatigue in patients with HIV disease is most appropriate as part of a comprehensive approach,” the investigators point out. “This approach would include the identification and treatment of AIDS-related conditions that can cause fatigue, such as anaemia, as well as the judicious use of combination antiretroviral therapies to reduce viral load and restore immune function.”