Access to antiretroviral treatment among French HIV infected injection drug users: the influence of continued drug use

Study objective-To determine the influence of continued drug use and its pe rception by prescribing physicians on access to antiretroviral treatment am ong French HIV infected injection drug users (IDUs). Design-Cross sectional including enrolment data (October 1995-1996) of the cohort study MANIF 2000. Access to treatment is compared in three groups: f ormer IDUs (n=68) and active IDUs whether or not this behaviour remains und etected (n=38) or detected (n=17) by physicians. Setting-Hospital departments for specialist AIDS care in south eastern Fran ce and inner suburbs of Paris. Patients-All enroled patients with CD4(+) cell counts < 400 with detailed c linical history, access to treatment, risk behaviours, and past drug use as reported by both physicians and patients (n=123). Main results-A minority (43.9%) already received an antiretroviral treatmen t. Active IDUs had worst socioeconomic and psychological conditions but onl y those detected by physicians were considered as poorly compliant. Logisti c regression showed that, with respect to ex-IDUs and independently of clin ical stage, active IDUs, whether or not they were perceived as such by phys icians, 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 o f being prescribed antiretroviral treatment. To reduce delays in access to new treatments, specific efforts must be devoted towards both AIDS speciali sts and IDU patients to overcome current stereotypes of noncompliance assoc iated with continued injection.