Adherence to HAART in French HIV-infected injecting drug users
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Adherence to HAART in French HIV-infected injecting drug users The contribution of buprenorphine drug maintenance treatment (Contact: Bruno SPIRE [email protected]) B Spire, C Raynaud, MP Carrieri, JA Gastaut, JP Cassuto, J Moreau, JP Moatti and the MANIF 2000 study group. Background.

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Adherence to HAART in French HIV-infected injecting drug usersThe contribution of buprenorphine drug maintenance treatment(Contact: Bruno [email protected])B Spire, C Raynaud, MP Carrieri, JA Gastaut, JP Cassuto, J Moreau, JP Moatti and the MANIF 2000 study group


Background users

Efficacy of haart
Efficacy of HAART users

  • HAART has reduced mortality and morbidity in HIV disease since 1996

    • decrease of opportunistic infections incidence

      6 times average reduction in the French Hospitals statistics (DMI2) in 1997 vs 1995

    • decrease of hospitalization days

      -53% in the DMI2

  • HAART significantly reduces HIV replication, and therefore prevents disease progression

Factors associated with haart efficacy
Factors associated with users HAART efficacy

  • Lack of history of antiretroviral treatment

    (naive patients)

  • Lower viral load before HAART initiation

  • Higher CD4 levels before HAART initiation

  • Lack of use of Saquinavir as a single PI

  • Adherence to treatment is a MAJOR factor

How is adherence among french idus
How is adherence among French IDUs? users

  • In the French context, there is no economic barrier to access to HAART

  • Buprenorphine DMT is widely prescribed in France (57,000 treated individuals in 1998 vs 7700 in Methadone programs)

Objectives users

  • To measure adherence to treatment in HIV patients infected through drug use

  • To identify determinants of adherence in this population

  • To measure the impact of buprenorphine drug maintenance treatment on adherence


Methods users

The MANIF 2000 Cohort users

  • French prospective cohort of HIV-infected injecting drug users with CD4>300 at enrollment and no opportunistic infection

  • Initiated in July 1995

  • Follow-up every 6 months

  • 467 patients included

Methods users

  • Cross-sectional study : Selection of the patient ’s first visit in the cohort after HAART initiation (164 patients)

  • Medical questionnaires, self-questionnaires and face to face interviews

  • Socio-demographic data, depression scales (CES-D), negative life events scales, drug use history, risk behaviours, alcohol and current drug use, access to DMT, adherence assessment

  • Statistical analyses (uni and mulivariate analyses)

Adherence assessment
Adherence assessment users

Patients were considered “non-adherent” if

  • they declared in the face-to-face interview that they took less than 80% of the total dose of antiretroviral drug prescribed during the week prior to the visit


  • if they recognised in the self-administered questionnaire, that they have not been “ totally adherent ” with HAART during the same period.


Results users

Adherence rate
Adherence rate users

  • 467 patients enrolled in the MANIF 2000 cohort

    • of these, 172 patients were started on HAART at the time of study

    • of the 172 patients, data were available for 164 patients (response rate = 95.3%)

  • At 5.3 month in average after HAART initiation, 65.2% (n=107) of patients were adherent to treatment

  • Non-adherent patients have a higher viral load (p=0.006)

Adherence and viral load
Adherence and viral load users

Median decrease in viral load titres after initiation of HAART was significantly lower among non-adherent (0.53 log copies/ml) than among adherent patients (1.04 log copies/ml)

(p = 0.025)


n (%)







23 (40)



46 (43)

34 (60)

p = 0.04

Financial users




20 U-months

Active IDU

vs DMT

Troubles with

the police




> 80 pills




2 events


vs DMT

Lack of







Age/10 y


Significant factors related to non adherence in multivariate analysis 1
Significant factors related to non-adherence in multivariate analysis (1)

  • Negative life events (NLE)

    • number of NLE 20%/event

    • troubles with the police OR = 4.6 95%CI[1.93-10.80]

    • major financial problems OR = 7.3 95%CI[1.32-74.05]

  • Alcohol consumption 20% / 25 monthly glasses

  • Young age -10%/year

  • Active IDU

Significant factors related to non adherence in multivariate analysis 2
Significant factors related to non-adherence in multivariate analysis (2)

  • Young age

  • Alcohol consumption

  • Negative life events (NLE)

  • Active IDU>Ex-Tox>DMT

    • Non adherence was similar among IDU on DMT with or without injecting drug use

    • Physicians tended to perceive ex-IDUs as more likely to be adherent (82.3%) than those on DMT (64.5%) or active IDUs (65.0%) (p<0.05).


Discussion analysis (2)

Limitations analysis (2)

  • Selection of a particular subgroup of IDUs?

  • Short-term adherence

  • No possible comparison between Methadone programs and buprenorphine DMT

Discussion analysis (2)

Associating Buprenorphine with HAART may increase adherence among opiate -dependent patients

  • DMT could be associated with a better medical care taking into account negative life events

  • Better treatment perception among DMT patients

  • DMT could prevent from forgetting, since withdrawing symptoms could occur if buprenorphine doses are missed

Acknowledgements to the manif 2000 study group

C Boirot analysis (2)

AD Bouhnik

MP Carrieri

JP Cassuto

P Dellamonica

P Dujardin

N Escaffre

H Gallais

JA Gastaut

G Lepeu

A Loundou

C Marimoutou

D Mechali

JP Moatti

J Moreau

Y Obadia

C Pradier

D Rey

C Reynaud-Morupt

A Schaeffer

B Spire

C Tamalet

F Trémolières

D Vlahov

Acknowledgements to the Manif 2000 study group