A Study Comparing Long-acting Methylphenidate (ConcertaTM) vs. Placebo in the Treatment of Memory Loss Due to HIV

There are 11 study visits in 14 weeks. In Part I of the study one-half of the subjects will receive ConcertaTM and one-half will receive placebo. After 2 weeks all subjects will stop their study medication for 2 week (the "washout period"), and then all of the subjects who received placebo will then receive 2 weeks of methylphenidate, and all of the subjects who received long acting methylphenidate will receive placebo for 2 weeks. The subject will be invited to enter Part II of the study if she/he still qualifies. During this portion of the study, the subject will receive ConcertaTM for 8 weeks. The subject does not have to be on Part II of this study to be on this study. Screening visit. (4 hours) There is a screening medical visit. If the subject passes the initial questions for depression and dementia, the subject will undergo the following procedures: There will be a physical examination including a medical and medication history, which will include telling the study staff about all of the drugs that the subject has taken recently or are currently taking, and measurement of vital signs (blood pressure, temperature, height, weight, pulse,breathing rate). The subject will have a physical examination including a detailed test of reflexes, muscle strength,gait, balance, and other functions of brain and nerves to see if he/she has any nerve damage and to see how the brain functions. The subject will take a group of tests called neuropsychological tests. The subject will answer questions, do simple tasks with their hands, and see how long it takes her/him to walk a short distance. Some of these questions are to test the subject for depression and memory abilities. The subject will need to bring in your most recent CD4 cell count (T-cell counts) and HIV viral load on this visit. If the initial screening questionnaires show that the subject fulfills some of the requirements of the study, the subject will be asked to have about 2 tablespoons of blood drawn from a vein in his/her arm, a urine test for drugs of abuse, and a urine pregnancy test if the subject is female and able to bear children. Some of the blood tests are to measure liver and kidney function and to see if the subject is anemic. The subject will have an EKG (electrocardiogram). . Entry Visit (Week 0) If the subject qualifies for this study the subject will return to the clinic for an entry visit. The entry visit will occur within 2 weeks of Visit 1. This visit will take about 3-4 hours. At this visit you will undergo the following procedures: The subject will have a short physical examination and be asked questions about your health and the medications she/he is taking. The subject will be asked to complete another set of tests of memory and mental function. If the subject is a woman of child bearing potential he/she will have a pregnancy test at this visit and every 4 weeks thereafter. Once the subject has completes the entry tests, she/he will be assigned by chance (like flipping a coin) to either ConcertaTM, or placebo. The study treatment groups are: Group A: ConcertaTM 2 tablets taken with food in the morning OR Group B: Placebo, 2 tablets taken with food in the morning. The first dose of study medication will be given in the clinic. She/he will be asked to take 1 tablet of study medication in the clinic and be observed for 2 hours afterward to see if you have any immediate side effects. The blood pressure will be checked again. The first dose of study medication is only 1 tablet of the study medication. On the day after this clinic visit she/he will take your second dose of study medication. This will be 2 tablets of study medication. Thereafter the subject will be taking 2 tablets of study medication in the morning. The study medications will be given as a 2-week supply. Week 1 Visit (1 hour) The subject will be asked brief medical questions and receive a brief physical exam with vital signs and an EKG if indicated. She/he will be asked for a urine sample. She/he will have one short memory test. Week 2 Visit (3 hours) He/she will be asked to come to clinic before he/she takes the daily dose of study medication. He/she are asked to bring your study medications with them, and to take the study medication in the presence of the study staff, who will note the time. He/she will be asked brief medical questions and receive a brief physical exam and a detailed test of his/her brain and nerve function. He/she will have an EKG and a blood test of about 2 tablespoons to check liver and kidney function, and to check for anemia. She/he will also be asked questions about emotions, memory function, and ability to do simple tasks. If she is a woman able to become pregnant she will be asked to have a urine pregnancy test. After this visit the subject will stop taking study medications for 2 weeks (2 week washout period). Week 4 (4 hours) He/she will be asked brief medical questions and receive a brief physical exam, and a detailed test of brain and nerve function. He/she will be asked questions about emotions, memory function, and ability to do simple tasks. He/she will be given a new supply of study medications. The subject will be asked to take 1 tablet of study medication in the clinic and be observed for 2 hours afterward to see if he/she has immediate side effects. Blood pressure will be checked again. On the day after this clinic visit the subject will take 2 tablets of study medication. Thereafter the subject will be taking 2 tablets of study medication in the morning. Week 5 (1 hour) The subject will be asked brief medical questions and receive a brief physical exam and an EKG if indicated. The subject will be asked for a urine sample. He/she will have one short memory test. Week 6 (4 hours) The subject will be asked to come to clinic before he/she takes the daily dose of study medication. The subject is asked to bring your study medications with them, and to take the study medication in the presence of the study staff, who will note the time. He/she will be asked brief medical questions and receive a physical exam and a detailed test of brain and nerve function. The subject will be asked questions about emotions, memory function, and ability to do simple tasks. The subject will have a blood test (about 2 tablespoons) to check kidney and liver function, and to check for anemia. The subject will have an EKG. If she is a woman able to become pregnant she will be asked to have a urine pregnancy test. After the Week 6 visit is completed, and if blood and other tests indicate that the subject is still eligible, the subject will be invited to enter the Part II phase of the study. In the Part II phase,and sign a new consent. In Part II all subjects will receive ConcertaTM for the next 8 weeks. After the new consent is signed, the subject receives a two week supply of Concerta. Week 8 (1 hour) The subject will be asked brief medical questions and receive a brief physical exam and an EKG if indicated. He/she will be given a 2 week supply of Concerta. Week 10 (1 hour) The subject will be asked brief medical questions and receive a brief physical exam and an EKG if indicated. If she is female she will be asked to give urine for a pregnancy test .The subject will be given a new 2-week supply of Concerta. Week 12 (1 hour) The subject will be asked brief medical questions and receive a brief physical exam and an EKG if indicated. He/she will be given a 2 week supply of Concerta. Week 14 (4 hours) The subject will be asked brief medical questions and receive a physical exam including vital signs and a detailed test of brain and nerve function. He/she will be asked questions about emotions, memory function, and ability to do simple tasks. She/he will again receive memory questionnaires and a quality of life questionnaire. She/he will receive an EKG. If she is a woman able to become pregnant she will be asked to have a urine pregnancy test. After thisvisit the study ends.