In 2017, nearly 160 000 people were newly diagnosed with HIV in the WHO European Region, marking another year of alarming HIV numbers in the Region. However, the pace of increase is slowing compared to previous years.

Continuing a trend that has persisted for the last decade, the majority (82%; over 130 000) of people newly diagnosed in 2017 were from the eastern part of the Region – the highest number ever. Of the remaining diagnoses, 14% were reported from the western part and 4% from the central part. At the same time, countries in the European Union and European Economic Area (EU/EEA) reported a decline in rates of new diagnoses, mainly driven by a 20% decrease since 2015 among men who have sex with men.

These numbers contribute to an estimated 2.3 million people living with HIV in the Region today, among whom 1 in 5 are estimated to be unaware of their infection. Just over half of those diagnosed in the Region are diagnosed at a late stage of infection.

Countries of the Region have made progress towards achieving universal access to HIV prevention, testing, treatment, care and support. This work aims for the so-called 90–90–90 targets: 90% of people living with HIV know their HIV status, 90% of diagnosed people living with HIV receive treatment, and 90% of people on treatment achieve viral suppression. Nevertheless, the response to HIV faces significant challenges.

HIV status and late diagnosis

Due to inadequate levels of access to and slow uptake of voluntary HIV testing and counselling in many countries – especially among key populations at higher risk of HIV infection – many people living with HIV in the Region remain undiagnosed. As a consequence, these individuals do not receive the lifesaving antiretroviral treatment (ART) they need to suppress the virus enough to prevent onward transmission.

Half (53%) of those 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 one third (32%) are diagnosed at an advanced stage (CD4 <200/mm3). CD4 cell count is a measure of the functioning of a person’s immune system.

One fifth of people living with HIV in the Region are estimated to be unaware of their infection. The proportion is higher in countries of eastern Europe and central Asia (EECA), where more than one quarter of people living with HIV are not yet diagnosed.

Late treatment initiation

For HIV treatment to work effectively, it should be started as soon as possible following a positive HIV diagnosis. WHO recommends that ART be initiated in all people living with HIV regardless of their CD4 cell count.

Unfortunately, many people living with HIV in the Region initiate treatment too late, and present with symptoms of widespread immune system damage at the time of ART initiation. This leads to excess morbidity and mortality, including AIDS and tuberculosis (TB). TB is the leading killer of people with AIDS in the Region.

Delayed treatment initiation can also lead to the spread of HIV infection to others, since the virus is not suppressed and can still be transmitted. By the end of 2017, an estimated 66% of diagnosed people with HIV were receiving treatment (50% in EECA) (the second 90–90–90 target). Of people on treatment, 84% had suppressed viral loads (the third 90–90–90 target).

Low access to treatment

Access to HIV treatment is low in a number of countries, notably in the eastern part the Region. As a result, too many people develop AIDS and die from AIDS-related causes in this area. Low access to treatment and care, fear of discrimination, and stigmatization collectively reduce the incentive to take an HIV test. In EECA, only 36% of all people estimated to be living with HIV (diagnosed and undiagnosed) were receiving ART at the end of 2017.

Coinfection with TB

TB remains one of the leading causes of death among people living with HIV and those with AIDS. The risk of developing TB is far greater for people living with HIV, especially if HIV infection is left untreated. During the last decade, the percentage of incident TB cases who were coinfected with HIV increased 4-fold, from 3% to 12%.

Coinfection with hepatitis

Almost three quarters of people living with HIV 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 preventable deaths in the years to come.