1 / 22

Background

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

ping
Download Presentation

Background

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adherence to HAART in French HIV-infected injecting drug usersThe contribution of buprenorphine drug maintenance treatment(Contact: Bruno SPIREspire@marseille.inserm.fr)B Spire, C Raynaud, MP Carrieri, JA Gastaut, JP Cassuto, J Moreau, JP Moatti and the MANIF 2000 study group

  2. Background

  3. Efficacy of HAART • 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

  4. Factors associated with 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

  5. How is adherence among French IDUs? • 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)

  6. Objectives • 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

  7. Methods

  8. The MANIF 2000 Cohort • 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

  9. Methods • 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)

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

  11. Results

  12. Adherence rate • 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)

  13. Adherence and viral load 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=164 n (%) Non Adherent Adherent Virological success 61(57) 23 (40) Virological failure 46 (43) 34 (60) p = 0.04

  14. Most frequent reasons reported to skip doses 46 % 36 29 21 21

  15. Non-Adherence to HAART in the MANIF 2000 cohort (n=164)

  16. Financial problems ADHERENCE Alcohol/ 20 U-months Active IDU vs DMT Troubles with the police Higher education OR > 80 pills /week Sex NLE/ 2 events Ex IDU vs DMT Lack of social support Regular job Treatment naïve Age/10 y ADHERENCE

  17. 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

  18. 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).

  19. Discussion

  20. Limitations • Selection of a particular subgroup of IDUs? • Short-term adherence • No possible comparison between Methadone programs and buprenorphine DMT

  21. Discussion 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

  22. C Boirot 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

More Related