Adherence to HAART in French HIV-infected injecting drug users: the contribution of buprenorphine drug maintenance treatment

Objectives: To assess adherence to highly active antiretroviral therapies ( HAART) in a cohort of French patients infected by HIV through injection dru g use (IDU), and the impact on adherence of buprenorphine ambulatory drug m aintenance treatment (DMT) which has been widely introduced since 1996. Design: Adherence assessment at first visit after initiation of HAART in th e MAN-IF2000 cohort study. Methods: Patient's face-to-face and self-administered questionnaires. Univa riate and logistic regression adjusted odds ratios (OR) to compare characte ristics of nonadherent versus adherent patients. Results: Of the 164 patients, 34.8% took less than 80% of the prescribed HA ART doses during the previous week. Decrease in viral load titres after ini tiation of HAART was significantly lower among non-adherent patients. After adjustment by logistic regression, non-adherence was associated with young er age, alcohol consumption, frequency of negative life-events during the p rior 6 months and active drug use. However, IDU in buprenorphine DMT reache d higher levels of adherence (78.1%) than ex-IDU (65.5%), although this dif ference did not reach statistical significance. Conclusion: Prescription of buprenorphine DMT may increase adherence to HAA RT among HIV-infected opiate-dependent patients. Reducing the negative impa ct of stressful life-events through psychosocial interventions should be co nsidered, even for those who have stopped using drugs. (C) 2000 Lippincott Williams & Wilkins.