Access to antiretroviral treatment among French HIV infected injection drug users: the influence of continued drug use. MANIF 2000 Study Group.
OBJECTIVE
To determine the influence of continued drug use and its perception by prescribing physicians on access to antiretroviral treatment among French HIV infected injection drug users (IDUs).


METHODS
Cross sectional including enrollment data (October 1995-1996) of the cohort study MANIF 2000. Access to treatment is compared in three groups: former IDUs (n = 68) and active IDUs whether or not this behaviour remains undetected (n = 38) or detected (n = 17) by physicians.


METHODS
Hospital departments for specialist AIDS care in south eastern France and inner suburbs of Paris.


METHODS
All enrolled patients with CD4+ cell counts < 400 with detailed clinical history, access to treatment, risk behaviours, and past drug use as reported by both physicians and patients (n = 123).


RESULTS
A minority (43.9%) already received an antiretroviral treatment. Active IDUs had worst socioeconomic and psychological conditions but only those detected by physicians were considered as poorly compliant. Logistic regression showed that, with respect to ex-IDUs and independently of clinical stage, active IDUs, whether or not they were perceived as such by physicians, were threefold more likely not to receive antiretroviral treatment.


CONCLUSIONS
Even among French HIV infected IDUs who have regular access to AIDS specialised hospital care, continued drug use reduced the likelihood of being prescribed antiretroviral treatment. To reduce delays in access to new treatments, specific efforts must be devoted towards both AIDS specialists and IDU patients to overcome current stereotypes of non-compliance associated with continued injection.
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*