Early combination therapy with hydroxychloroquine and azithromycin reduces mortality in 10,429 COVID-19 outpatients.

We evaluated the age-specific mortality of unselected adult outpatients infected with SARS-CoV-2 treated early in a dedicated COVID-19 day hospital and we assessed whether the use of hydroxychloroquine (HCQ) + azithromycin (AZ) was associated with improved survival in this cohort. A retrospective monocentric cohort study was conducted in the day hospital of our center from March to December 2020 in adults with PCR-proven infection who were treated as outpatients with a standardized protocol. The primary endpoint was 6-week mortality, and secondary endpoints were transfer to the intensive care unit and hospitalization rate. Among 10,429 patients (median age, 45 [IQR 32-57] years; 5597 [53.7%] women), 16 died (0.15%). The infection fatality rate was 0.06% among the 8315 patients treated with HCQ+AZ. No deaths occurred among the 8414 patients younger than 60 years. Older age and male sex were associated with a higher risk of death, ICU transfer, and hospitalization. Treatment with HCQ+AZ (0.17 [0.06-0.48]) was associated with a lower risk of death, independently of age, sex and epidemic period. Meta-analysis evidenced consistency with 4 previous outpatient studies (32,124 patients-Odds ratio 0.31 [0.20-0.47], I2 = 0%). Early ambulatory treatment of COVID-19 with HCQ+AZ as a standard of care is associated with very low mortality, and HCQ+AZ improve COVID-19 survival compared to other regimens.

The burden of HIV experience and care among MSM having an HIV-positive seroconcordant steady partner: a possible research hypothesis. Results from the French VESPA ANRS EN-12 study.

OBJECTIVES: Prevention fatigue, relapse into unsafe sex practices and sexual behaviour changes have been reported in the community of men who have sex with men (MSM) since the introduction of highly active antiretroviral therapy. Engaging in a relationship with a seroconcordant partner is perceived by some HIV-positive MSM as an alternative prevention strategy to consistent condom use. This study addresses whether underlying clinical factors exist characterising HIV-positive MSM in seroconcordant stable partnerships, enrolled in the French national cross-sectional survey VESPA ANRS EN-12. METHODS: The study group comprised 322 HIV-positive MSM in stable relationships for more than 12 months, with a serodiscordant (n = 251) or seroconcordant (n = 71) steady partner. Clinical and psychosocial factors were analysed for HIV-positive MSM with a seroconcordant steady partner. RESULTS: Multiple adjustment by logistic regression showed that individuals with a seroconcordant steady partner were more likely to have a history of an AIDS-defining event (OR 95% CI 2.0 (1.1 to 3.7), p = 0.02) or be diagnosed as HIV positive before 1990 (OR 95% CI 2.2 (1.3 to 3.9), p = 0.004). Conversely, HIV-positive MSM experiencing virological success (ie, high treatment adherence and an undetectable viral load) were more likely to have a serodiscordant steady partner (OR 95% CI 0.5 (0.3 to 0.9), p = 0.02). CONCLUSIONS: Longitudinal studies are required to understand to what extent HIV history might influence partnership choices among HIV-positive MSM. Positive prevention programmes and reinforcement of treatment adherence strategies are needed for this population and their steady sexual partners.

Determinants of benzodiazepine use in a representative population of HIV-infected individuals: the role of HIV status disclosure (ANRS-EN12-VESPA study).

HIV infection may result in stressful situations such as disclosure to others and could be a mediator between seropositivity status and psychiatric illness, depression, or anxiety. Several results have shown that anxiolytic use (mainly benzodiazepines [BDZ]) is highly prevalent in HIV-infected individuals, but few studies have highlighted to what extent this use could be associated with HIV disclosure. A national cross-sectional survey representative of people living with HIV and AIDS in France enrolled 2932 individuals in 102 French HIV hospital departments. Face-to-face interviews and self-administered questions collected information about patients' experience with HIV and HIV care, including use of psychotropic drugs, social support, stigma, and disclosure of HIV status. We identified factors associated with regular BDZ use (i.e., more than once a week) using a weighted logistic regression model. Regular BDZ use and anxiety symptoms were reported by 16% and 29% of the patients, respectively. After multiple adjustment for known correlates of BDZ use and anxiety symptoms, individuals who had disclosed their HIV status to relatives or friends were found to be more likely (OR [95% CI] = 1.78 [1.02-3.09]) to regularly use BDZ. These results show both to what extent disclosure to others continues to be a stressful step in the course of HIV infection and that disclosure is something that could be identified by BDZ use. They also highlight the need for appropriate case management and psychiatric care to help patients manage the consequences of disclosure.

Harmful alcohol consumption and patterns of substance use in HIV-infected patients receiving antiretrovirals (ANRS-EN12-VESPA Study): relevance for clinical management and intervention.

Alcohol abuse affects secondary prevention and disease progression in HIV-infected patients, and adherence and response to treatment in those chronically treated. The objective of this study was to estimate the prevalence of harmful alcohol consumption (HAC) using various indicators and identify which groups of patients may require specific targeted interventions for HAC risk reduction. A cross-sectional survey, based on a random sample representative of people living with HIV/AIDS (PLWHA) was carried out in 102 French hospital departments delivering HIV care. As alcohol abuse is particularly detrimental to patients receiving highly active antiretroviral therapy (HAART), we focused only on those individuals receiving HAART with complete alcohol assessment (CAGE, AUDIT-C, regular binge drinking, N=2340). Collected information included medical and socio-demographic data, HIV risk behaviors, adherence to treatment and substance and alcohol use, together with depression, anxiety, and experience of attempted suicide or sex work. HAC prevalence was evaluated as follows: 12% (CAGE score > or =2), 27% (AUDIT-C), and 9% (regular binge drinking). Three groups were at higher risk of HAC: men who have sex with men using stimulants, polydrug users, and to a lesser degree, ex-drug users. Innovative intervention strategies to reduce HAC and improve HIV prevention and HAART adherence in various PLWHA populations need urgent testing and implementation. Such interventions for alcohol risk reduction remain central to promoting improved HIV prevention and assuring HAART effectiveness in these populations.

Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis.

BACKGROUND: In our institute in Marseille, France, we initiated early and massive screening for coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases. METHODS: We retrospectively report the clinical management of 3,737 screened patients, including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for ten days and 500 mg of oral AZ on day 1 followed by 250 mg daily for the next four days, respectively) for at least three days and 618 (16.5%) patients treated with other regimen ("others"). Outcomes were death, transfer to the intensive care unit (ICU), ≥10 days of hospitalization and viral shedding. RESULTS: The patients' mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11-0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27-0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17-1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed. CONCLUSION: Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments.

Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France.

BACKGROUND: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19. METHODS: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days). RESULTS: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14-95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74-95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision). CONCLUSION: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

['One risk is ok. Are three a sure damage?" Health education's obstacles in the prevention of multiple risks]. / "Un risque, ca va ! Trois risques, bonjour les degats?" Les difficultes de l'education pour la sante a prevenir des risques comportementaux multiples.

Health education can have unexpected effects, sometimes even harmful, in particular when dealing with, on the one hand, multiple risk pathologies and, on the other, one risk factor that is connected to various different pathologies. Certain unexpected effects can be the result of too much information on prevention or when prevention is too focused on one target. In the first scenario, relativity of the information could arise faced with certain health risks or be used against public health objectives. When information is too focused on one target group, it can create discriminatory reactions for the groups at risk, which can translate into denial of the potential risk by those outside of the target group. Other prevention actions can have an unexpected effect, or none at all, because the target behavior is considered functional for the individual. In order to prevent a risk behavior, it is necessary to take into account the threats it is meant to avoid (concurrent risks) and other risk factors meant to attain the same objectives (substitutable risks). In order to understand and avoid different obstacles, people's beliefs and knowledge, which are often rooted in daily behavior and hence difficult to change, must be taken into account. It is also important to situate behavior in context, identifying its function and the concurrent and substitutable risks, which means researching as well the social sciences. In the future, the need for a global health approach will be evident because prevention of risk behaviors increasingly refers to multiple risks in one same pathology as well as concomitant prevention of multiple pathologies.

Health-related quality of life in French people living with HIV in 2003: results from the national ANRS-EN12-VESPA Study.

OBJECTIVE: Since the advent of HAART, the assessment of health-related quality of life (HRQL) has become a major concern in the therapeutic follow-up of people living with HIV. DESIGN: HRQL was evaluated for 2235 participants in the ANRS-EN12-VESPA Study. These participants completed the Medical Outcome Study 36-Item Short Form Health Survey (MOS SF-36) questionnaire. Anxiety and depression were assessed using the Hospital Anxiety and Depression (HAD) scale. Individuals were considered to have an 'acceptable' physical (and mental) HRQL if their MOS SF-36 scores were greater than the 25 percentile of the corresponding age-sex-specific distribution of scores in the French general population. METHODS: Logistic regression models were used to identify factors associated with an 'acceptable' physical and mental HRQL among demographic, psychosocial and clinical characteristics. Potential selection bias caused by non-random missing responses to the MOS SF-36 questionnaire was statistically tested. RESULTS: Physical and mental HRQL were 'acceptable' in 1176 (53%) and 1152 (51%) individuals, respectively. After adjusting for sociodemographic factors, HIV clinical status and hepatitis C co-infection, high HAD scores and the consumption of anxiolytic, antidepressant and hypnotic drugs were found to be negatively associated with normal physical and mental HRQL. CONCLUSION: The role of disclosure and discrimination is determinant in HRQL, and the various cultural and psychological dimensions require further research. The presence of other infections or co-morbidities requires a comprehensive care system including medical staff and social worker teams. HIV should increasingly be regarded as a chronic disease characterized by different pathological conditions requiring a comprehensive and multidisciplinary approach.

Awareness of non-occupational HIV postexposure prophylaxis among French people living with HIV: the need for better targeting.

BACKGROUND: Since 1998, French HIV prevention guidelines have recommended the use of HIV post-exposure prophylaxis (PEP) after unprotected sex with a HIV-positive partner who should be informed about this option. This study analysed factors associated with PEP awareness in a population of individuals living with HIV/AIDS (PLHAs). METHODS: In 2003, a face-to-face survey was conducted among PLHAs selected from a random stratified sample of 102 French hospital departments delivering HIV care. Those who knew about PEP and those who did not were compared to identify factors related to PEP awareness in the sub-sample who reported that they had been sexually active in the prior 12 months. RESULTS: Among the 2,280 sexually active PLHAs, the median age was 40 years. Women comprised 26% of the sample, 41% were homosexual men and 16% were immigrants. Thirty percent of individuals reported not being aware of the availability of PEP. After multiple adjustment, factors associated with lack of PEP awareness were a low educational level, unemployment, older age, and CD4 cell counts<200. In addition, homosexual men showed a higher level of PEP awareness compared with the other participants, especially when compared with immigrant heterosexual men and women. Individuals who reported having unprotected sex with a non-HIV-positive steady partner also independently showed lower levels of PEP awareness. Finally, reporting having casual partners was associated with better awareness. CONCLUSION: Awareness of PEP is insufficient among PLHAs, especially among immigrants. Programmes aimed at improving positive prevention among PLHAs are much needed and should be promoted.

Unprotected sex in regular partnerships among homosexual men living with HIV: a comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study).

OBJECTIVE: We investigated factors associated with unprotected sex in regular partnerships among homosexual men living with HIV. METHOD: We used data from a French national representative sample of people living with HIV (ANRS-EN12-VESPA survey). This analysis included men in a regular partnership with another man for at least twelve months. Unprotected sex was defined as reporting at least one episode of sexual intercourse without a condom with this regular partner in the previous 12 months. Separate analyses were conducted in sero-nonconcordant couples and in HIV-positive seroconcordant couples. RESULTS: 285 and 193 homosexual men respectively reported a regular sero-nonconcordant and seroconcordant partner. Unprotected sex was reported by a higher number of respondents within seroconcordant (46.7%) than within sero-nonconcordant couples (15.6%). In both seroconcordant and sero-nonconcordant partnerships, unprotected sex was significantly more frequent when episodes of unprotected sex with casual partners were reported. In seroconcordant couples, those who had more than four casual partners were also more likely to practise unprotected sex with their regular partner. Among sero-nonconcordant couples, binge drinking and absence of disclosure of one's HIV-positive status to the partner were also independently associated with unprotected sex. CONCLUSIONS: A limited number of sero-nonconcordant homosexual couples persist in reporting risky sexual behaviour. Prevention messages should encourage communication and HIV disclosure. The relationship between unprotected sex with both casual and regular partners also calls attention about the underlying psycho-social and interactional factors that may influence sexual behaviours of people living with HIV in regular relationships, independently of the status of the partner.

Unsafe sex in regular partnerships among heterosexual persons living with HIV: evidence from a large representative sample of individuals attending outpatients services in France (ANRS-EN12-VESPA Study).

OBJECTIVE: Risky sexual behaviour remains frequent among people living with HIV. We analysed factors associated with unsafe sex within serodiscordant couples among heterosexual individuals living with HIV in France. METHODS: In 2003, a face-to-face survey was conducted among individuals selected in a random stratified sample of 102 French hospital departments delivering HIV care. This analysis included adults heterosexual participants in a regular partnership for at least 12 months with a seronegative/unknown serostatus partner, HIV-diagnosed for at least 12 months. Unsafe sex was defined as reporting inconsistent condom use in the prior 12 months. Among men and women, participants who reported unsafe sex were compared with those who did not. RESULTS: 663 heterosexual adults reported being in a serodiscordant regular partnership. Women accounted for 41% of participants and 26% of the sample were immigrants. Unsafe sex with the steady partner was reported by 26% of men and 34% of women (p=0.024). For men, factors independently associated with unsafe sex were being in a relationship for more than 10 years, being in a difficult financial situation and reporting regular consumption of alcohol to excess. Among women, having a history of drug use, not being aware of partner's serostatus, and reporting a difficult financial situation were independently associated with unsafe sex. In addition, immigrant women were associated with safer sex. CONCLUSIONS: A high number of serodiscordant couples continue to report risky sexual behaviour, and related factors are gender-specific. Couple-level interventions are essential in order to prevent HIV-transmission and to encourage negotiation within couples.

[Knowledge and attitudes of private practice nurses about end-of-life pain. Results of a national survey on nurses' attitudes and practices for end-of-life patients, 2005-2006]. / Connaissances et attitudes des infirmiers libéraux face à la douleur en fin de vie. Résultats de l'enquête nationale française "Attitudes et pratiques des infirmiers face aux patients en fin de vie, 2005-2006".

BACKGROUND: Nurses play a crucial role in end-of-life care, especially for outpatients. It is important to assess their knowledge and attitudes regarding pain management during the end-of-life period. METHODS: A random national sample of 602 French nurses providing home care responded to a telephone survey. The questionnaire included a scale of knowledge about pain and a short clinical case related to severe pain management, requiring WHO level 3 analgesia, for a dying patient. RESULTS: The pain knowledge score depended on nurses' training and was higher for those living with another health professional. For the clinical case, only 60% of nurses favored the prescription of the analgesia recommended by international guidelines. This support depended on objective skills in pain management, but was less frequent for elderly or women patients. DISCUSSION: Attitudes toward pain management at the end of life do not depend only on book learning. They are also influenced by more subjective factors that may cause inequality in care for women and the elderly. Nurse training programs should take such factors into account.

Predictors identified for losses to follow-up among HIV-seropositive patients.

BACKGROUND AND OBJECTIVE: This study aims to describe predictors of loss to follow-up (LFU) in the French Hospital Database on HIV infection (FHDH). METHODS: We studied the prevalence and predictors of LFU among 34,835 patients enrolled in FHDH in 1999. Impacts of demographic and clinical factors were studied by using multivariate logistic regression analysis. RESULTS: Among included patients, 1,478 (4.2%) died and 2,950 (8.5%) were lost to follow-up. LFU was more frequent among recently diagnosed patients (<1 year, 16.8%; > 1 year, 7.1). Among recently diagnosed patients, LFU was less frequent among men who have sex with men (MSM) [odds radio (OR) = 0.6, 95% confidence interval (CI) = (0.5;0.7)], and among patients with AIDS [OR = 0.5, 95%CI = (0.4;0.6)], and more frequent among immigrants [OR = 1.3, 95%CI = (1.0;1.5)]. Among less recently diagnosed patients, LFU was more frequent in French Departments of America than in the Paris area. The proportion of LFU fell with age, and LFU was more frequent among intravenous drug users (IVDU) than among MSM [OR = 1.2, 95%CI = (1.1;1.4)]. Patients with viral load >5,000 copies/mL or CD4 cell counts <200/mm(3) were more likely to be lost to follow-up. CONCLUSIONS: Recently diagnosed patients, IVDU, and immigrants are more often lost to follow-up, and should therefore receive special attention.

Drug use patterns and adherence to treatment among HIV-positive patients: evidence from a large sample of French outpatients (ANRS-EN12-VESPA 2003).

PURPOSE: To study the relationship between drug use and adherence to highly active antiretroviral therapy (HAART) among HIV-positive people, with two alternative measures of drug use: a set of drug uses considered independent and patterns capturing combinations of drug uses. METHODS: A cross-sectional survey conducted among a nationally representative sample of 4963 HIV-positive people randomly recruited in 102 French hospital departments delivering HIV care. The researchers modelled non-adherence to HAART with a set of binary indicators of drug use (model I) or comprehensive patterns obtained with a cluster analysis (model II). RESULTS: In model 1, heroin use, injection drug use, and cocaine/amphetamine/ecstasy use were not significant predictors of poor adherence in contrast with nicotine dependence, cannabis use, and amyl nitrate use. In model II, non-adherence to HAART was more prevalent among profiles characterised by alcohol abuse and multiple addictions, including nicotine dependence and use of various illicit drugs. CONCLUSIONS: Nicotine dependence, cannabis use, and amyl nitrate use are associated with non-adherence only if they are embedded in drug use patterns characterised by alcohol abuse or heroin use. The results also illustrate the interest in investigating the effects of drug use patterns on behavioural outcomes, rather than measuring independent effects of various drug use indicators that are highly correlated.

French general practitioners' prescribing high-dosage buprenorphine maintenance treatment: is the existing training (good) enough?

In France, since 1996, any general practitioner (GP) can prescribe high-dosage buprenorphine maintenance treatment (BMT) for opioid-dependent patients. The health authorities initially provided mandatory specific training, but since 1998, such training is only delivered by specialized networks and the pharmaceutical industry. Among a random sample of GPs from southeastern France (N=345), we found that many untrained GPs, as well as a significant minority of trained GPs, were likely to prescribe an ineffective dosage of buprenorphine or a potentially dangerous treatment (BMT+a short half-life benzodiazepine). These results highlight the necessity to edit clear guidelines, especially concerning situations of polyaddiction and psychiatric comorbidity, and to extend and improve BMT training in France with a renewed involvement of health authorities for quality control of such training. They even suggest that GPs' participation to specialized training sessions should become a mandatory prerequisite for prescribing BMT.

French general practitioners' attitudes and prescription patterns toward buprenorphine maintenance treatment: does doctor shopping reflect buprenorphine misuse?

This study investigated attitudes toward buprenorphine maintenance treatment (BMT) among general practitioners (GPs) and their maintained patients' propensity to turn to several prescribers (doctor shopping), among a sample of 345 GPs prescribing BMT in South-Eastern France. Survey data were anonymously matched to administrative data that provided information about GPs' patients. A simultaneous equation model suggests that GPs' attitude influenced doctor shopping, not the reverse. Doctor shopping was lower among GPs who reported inducting BMT with 8 mg of buprenorphine per day or more, and was higher for GPs endorsing a stringent attitude toward patients. Thus doctor shopping should not be understood exclusively as a deviant behaviour. It is partially physician-driven, and further research is needed to assess whether it reflects patients' dissatisfaction toward inappropriate care supply and the difficulty to establish a good therapeutic relationship between an opiate-dependent patient and a general practitioner.

[Seropositive people infected through intravenous drug use: a persistent vulnerability]. / Les personnes séropositives pour le VIH infectées par injection de drogues: une vulnérabilité persistante.

VESPA is a cross-sectional survey conducted among a national representative sample of HIV-infected outpatients attending French hospitals. Among the 2,932 respondents, 506 (17%) have been infected through intravenous drug use (IDU). These patients were younger and infected for a longer duration. Most of them have stopped injection, but are coinfected by HCV. We observed higher prevalences for indicators related to material vulnerability among those patients infected through IDU. These patients were also more prone to report experiences of AIDS-related discrimination, from relatives, friends, sexual partners but also from health professionals. Among patients infected through IDU, material vulnerability and experience of discrimination from health professionals were significantly associated with poor adherence to highly active antiretroviral therapies.

Impact of HAART-related side effects on unsafe sexual behaviours in HIV-infected injecting drug users: 7-year follow up.

OBJECTIVE: To investigate the impact of non-lipodystrophy HAART-related side effects on unprotected sexual behaviours among HIV-infected drug users. DESIGNAND PARTICIPANTS: HAART-treated patients who reported having occasional partners during the follow-up period after HAART initiation were selected among patients of the MANIF 2000 cohort of HIV-infected drug users. METHODS: Visits where patients reported unsafe sexual behaviours with occasional partners were compared to visits where they reported safe sexual behaviours using a logistic model based on Generalized Estimating Equations. RESULTS: One-hundred and ninety-two HAART-treated patients reported occasional sexual partners at least once during follow-up, accounting for a total of 464 visits. Among these 192 patients, 134 (70%) declared at least once unsafe sexual behaviours with occasional partners. During follow-up, three or more HAART-related side effects were reported in 273 of the 464 visits. When comparing visits where patients reported unsafe sexual behaviours with occasional partners (n = 249) with those where they reported safe sexual behaviours (n = 215), experiencing three or more HAART-related side effects was significantly associated with unsafe sex after adjustment for cofactors such as injecting drug status, reporting more than two sexual partners and having sex more than once a week. CONCLUSIONS: Perceived side effects play a role in determining unsafe sexual behaviours. HIV prevention interventions must consider the negative impact of HAART-related side effects on sexual risk-taking behaviours. Drug maintenance programs contribute to sexual risk reduction among drug injecting patients.

Sporting activity and drug use: Alcohol, cigarette and cannabis use among elite student athletes.

AIMS: To study the relationship between sporting activity and alcohol, cigarette and cannabis use among adolescents and young adults, by focusing on elite student athletes (ESAs). DESIGN, SETTING, SUBJECTS: Cross-sectional survey (Spring 2002), in a sample of 460 ESAs (ages 16-24 years) recruited at 40 public centres gathering the young sporting elite from 30 different sports in South-Eastern France, comparison with samples of the general population of adolescents in South-Eastern France. MEASURES: Respondents were asked confidentially by a self-administered questionnaire about their use of licit and illicit drugs, their sporting activity and other aspects of their life-style. FINDINGS: Prevalences of cigarette, alcohol and cannabis use were markedly lower for ESAs than for other adolescents (generally twice or three times as low). Among ESAs, when compared with the practice of an individual sport, the practice of a team sport was correlated positively with alcohol use (OR = 2.7 for girls, OR = 1.8 for boys), and the practice of a sliding sport was correlated positively with cannabis use (for girls: OR = 2.3) and with alcohol use (for boys: 4.3). Girls who entered competition at international level were more prone to smoke cigarettes and cannabis (OR = 6.1 and 2.4, respectively). CONCLUSIONS: As a whole, practising sports as an elite student-athlete can be considered as correlated negatively with cigarette, alcohol and cannabis use. Nevertheless, this relationship depends on the kind of sport practised as well as the level of competition, and further research is needed to understand specific elite athletes' motives for use.

Drug injection cessation among HIV-infected injecting drug users.

This article reports findings from a cohort study that investigated drug injection cessation over an 18-month period among HIV-infected injecting drug users followed up in a clinical setting. At 18th month visit, individuals reporting persistent injection practices were compared with individuals who reported drug injection cessation for at least 12 months. Crude and adjusted odds ratios were used to assess the impact of change in addictive and sexual behaviors, contacts with the drug network, depression, negative life events, clinical status, HIV therapy, and drug maintenance treatment (DMT) on drug injection cessation. After multiple adjustment, a general decrease of addiction practices (alcohol and cannabis) and of unsafe sexual behaviors significantly accompanied injection cessation. Individuals with higher education level, still in contact with the drug network, and not yet treated for their HIV disease were significantly more likely to persist injecting behaviors. These results underscore the importance and the need of monitoring addiction practices and unsafe sexual behaviors among HIV-positive individuals to properly address primary and secondary prevention in the era of highly active antiretroviral treatments (HAART).