In 2016, more than 160 000 people were newly diagnosed with HIV in the WHO European Region, the highest number of people ever newly diagnosed in 1 year since HIV case reporting began in the 1980s.

Continuing a trend that has persisted for the last decade, the majority (nearly 80%) of people newly diagnosed were from the eastern part of the Region, 17% from the western part and 4% from the central part. This contributes to an estimated 2.4 million people living with HIV in the Region, among whom more than a quarter are estimated to be unaware of their infection.

Despite the progress towards achieving universal access to HIV prevention, treatment, care and support across the Region over the last decade, the response to the HIV epidemic still faces many challenges.

Unknown HIV status and late diagnosis

Because of inadequate access to and uptake of HIV testing and counselling, especially among the key populations at higher risk of HIV infection, not all people living with HIV (PLHIV) in the WHO European Region are diagnosed. As a consequence, many PLHIV are not receiving lifesaving antiretroviral treatment (ART) and their virus is not suppressed sufficiently to prevent further transmission. Half of people diagnosed with HIV in the Region are diagnosed at a late stage of infection (with CD4 cell counts below 350 per mm3 of blood) and 30% are diagnosed at an advanced stage (CD4 <200/mm3). CD4 cell count is a measure of the functioning of a person’s immune system. More than a quarter of PLHIV in the Region are estimated to be unaware of their infection. In eastern Europe and central Asia this proportion is higher, with more than one third of PLHIV not yet diagnosed.

Late treatment initiation

For HIV treatment to work effectively, it is best started at a time when the patient is still relatively healthy. WHO recommends that ART should be initiated in everyone living with HIV regardless of their CD4 cell count. Unfortunately, many PLHIV in the Region start treatment too late, when they are already showing signs of widespread immune system damage at the time of ART initiation. This leads to excess morbidity, including AIDS and tuberculosis (TB), and mortality. Delayed treatment initiation can also lead to further spread of HIV as the virus is not suppressed and can still be transmitted.

Low access to treatment

Access to HIV treatment is low in a number of countries, notably in the eastern part of the Region. As a result, too many people are developing AIDS and dying from AIDS-related causes in this part of the Region. Lack of access to treatment also reduces the incentive to take an HIV test, as does fear of discrimination and stigmatization. In eastern Europe and central Asia, only 28% [22–32%] of all people estimated to be living with HIV (diagnosed and undiagnosed) were receiving ART at the end of 2016.

Coinfection with tuberculosis

TB remains one of the leading causes of death among PLHIV. The risk of developing TB is far greater for PLHIV if the HIV infection is not treated. During the last decade, the percentage of incident TB cases who were coinfected with HIV increased four-fold, from 3% to 12%.

Coinfection with hepatitis

Almost three quarters of PLHIV in the Region are also chronically infected with the hepatitis C virus (HCV). The people most at risk of HIV/HCV coinfection are people who inject drugs and men who have sex with men. Coinfection can lead to life-threatening liver failure. Hepatitis is difficult and costly to treat, and this situation is likely to lead to tens of thousands of unnecessary deaths in the years to come.