Impact of drug maintenance treatment on injection practices among French HIV-infected IDUs

Drug maintenance treatment (DMT) has only been recently introduced in Franc e (methadone programmes in March 1995, buprenorphine prescriptions in ambul atory medicine in February 1996) in relation to risk reduction policies for HIV infection among intravenous drug users (IDUs). Impact of DMT was asses sed in the period of inclusion (October 1995-December 1997) of a French coh ort of patients HIV infected through Intravenous drug use the MANIF 2000 st lrdyl. Among the 429 patients, 48.2% were ex-IDUs, 20.3% were active users not in DMT and 31.5% were in DMT. A majority (73.3% of patients in DMT had persisted in their injection behaviours and their social and psychological characteristics were similar to those of active users not in DMT. Among the 186 active IDUs, those in DMT were more likely to have injected cocaine (4 2.4% and buprenorphine or methadone (21.3%) than those who were not (respec tively 27. 6% and 2.4%, and 23. 6% declared direct needle-sharing behaviour s during the prior six months. Among younger IDUs (less than or equal to 33 years of age) (n = 100), needle-sharing was associated with polydrug use a nd cocaine injection but was not significantly reduced by participation in DMT. These results suggest the need for taking into account differences bet ween type of HIV-infected drug users and developing appropriate multidrug m aintenance treatment programmes, which may imply adaptations of current dos ages of methadone and buprenorphine.