Faced with the increase in the number of people living with HIV but not diagnosed in Europe, the World Health Organization and the European Center for Disease Prevention and Control are sounding the alarm. They call for a strengthening of the prevention and screening policy.
- A report by the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) warns of the increase in cases of HIV diagnosed too late in Europe, and more particularly in the part eastern part of the European region.
- The increase in these patients detected too late concerns in particular the over 50s.
The fight against HIV is far from over. In 2019, more than 136,000 people were diagnosed positive worldwide, of which around 20% were in the European Union (EU) and the European Economic Area (EEA) and 80% of these in the eastern part of the European region.
This numbers, published Thursday 26 November by the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), highlight another worrying fact: the increase in the number of people with HIV who are not not diagnosed.
According to the ECDC and the WHO, more than one in two HIV diagnoses (53%) occur at a late stage of infection, when the immune system has already begun to fail. This means that the screening policies implemented in the various EU countries are not effective in detecting the disease at an early stage.
An increase in HIV infections across the European region
According to the study’s figures, the past decade has seen the number of people diagnosed with AIDS, the final stage of untreated HIV infection, halve. However, in the EU/EEA, 74% of the 2,772 AIDS diagnoses in 2019 were made within three months of the initial HIV diagnosis. This shows that there is a significant problem of late diagnosis of HIV infection. However, late diagnosis contributes to the continued transmission of HIV because, often for years, people do not know they are HIV-positive and do not receive treatment.
Another discouraging data: the 10% increase since 2010 in the number of new HIV-positive people diagnosed in the whole of the European region. The proportion of new diagnoses in EU/EEA countries, on the other hand, decreased by 9% over the same period.
According to the authors of the ECDC and WHO report, the number of new HIV diagnoses and the estimated number of new HIV infections across the European region show that the number of people infected with HIV over the past decade is greater than the number of people diagnosed. This therefore indicates that the number of people living with undiagnosed HIV is increasing. In EU and EEA countries, the opposite trend has been observed: the number of people living with undiagnosed HIV has decreased.
Late diagnosis in people over 50
HIV/AIDS surveillance data for 2019 also show that the proportion of people diagnosed late increases with age. Thus, in the European region as a whole, 67% of people aged 50 and over were diagnosed late in the course of their HIV infection. In 2019, one in five new HIV diagnoses was made in a person over the age of 50.
This could be linked to an underestimation of the risk of infection by the elderly themselves or the nursing staff. Older people may also be more affected by the stigma associated with the disease and less comfortable asking for a screening test.
Rethinking European early detection policies
For Dr Andrea Ammon, Director of ECDC, the fight against the global epidemic of Covid-19 must not overlook other public health problems such as HIV. “If we want to reduce the high proportion of people diagnosed late, it is essential to diversify our HIV testing strategies, as indicated for example by the ECDC testing guide.”
To reduce the number of future HIV infections, Europe needs to focus on three main areas, says ECDC. First of all, give priority to a series of preventive measures, such as raising awareness, promoting safer sex through the distribution of condoms, or setting up needle exchange programs and treatment for opioid substitution. HIV pre-exposure prophylaxis (PrEP) should also be promoted.
It is also essential to deploy effective VIG screening services for rapid diagnosis.
Finally, rapid access to quality treatment and care must be guaranteed for those diagnosed. Early diagnosis is important because it allows people to start HIV treatment earlier, increasing their chances of living a long and healthy life and preventing further transmission.
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