Impact of drug maintenance treatment on injection practices among French HIV-infected IDUs. The MANIF 2000 Study Group.

Drug maintenance treatment (DMT) has only been recently introduced in France (methadone programmes in March 1995, buprenorphine prescriptions in ambulatory medicine in February 1996) in relation to risk reduction policies for HIV infection among intravenous drug users (IDUs). Impact of DMT was assessed in the period of inclusion (October 1995-December 1997) of a French cohort of patients HIV infected through intravenous drug use the MANIF 2000 study). 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 (42.4%) and buprenorphine or methadone (21.3%) than those who were not (respectively 27.6% and 2.4%), and 23.6% declared direct needle-sharing behaviours during the prior six months. Among younger IDUs (< or = 33 years of age) (n = 100), needle-sharing was associated with polydrug use and cocaine injection but was not significantly reduced by participation in DMT. These results suggest the need for taking into account differences between type of HIV-infected drug users and developing appropriate multidrug maintenance treatment programmes, which may imply adaptations of current dosages of methadone and buprenorphine.

Treatment of thymomas. A report of 67 cases.

From 1979 to 1989, 126 patients were treated for thymic tumors. Of these, 67 (53%) had thymomas occurring in 27 men and 40 women; the mean age was 46 years: 24 patients had no symptoms and myasthenia gravis was present in 21 cases. A complete resection was performed in 45 patients, associated in 22 with postoperative adjuvant treatment (radiotherapy, 2; radio- and chemotherapy, 20). Two patients had a partial resection followed by radiotherapy and chemotherapy. Twenty patients had initially only a biopsy and were treated by irradiation in 3 cases, radio- plus chemotherapy in 16, radio- plus chemotherapy and subsequent resection in 1 case. The staging was carried out according to the GETT Classification (stage I A:26; I B:6; II:12; III A:1; III B:18; IVA:4). Thymomas were found to be of predominant epithelial type in 12 cases, predominantly lymphocytic type in 9, and mixed in 46. No recurrence occurred after complete resection. The overall 10-year survival was 71.1%. A good correlation was found according to staging: 96% in stage I; 80% in stage II; 35% in stage III. Presence of myasthenia gravis did not affect the results. The best prognostic factor remains complete resection with postoperative radiotherapy to prevent recurrences. The role of adjuvant chemotherapy needs further evaluation.