At the end of 2015, the cumulative number of people diagnosed with HIV in the WHO European Region increased to over 2 million. More than 153 000 new HIV cases contributed to this figure in 2015 – a 7% increase compared to the previous year and the highest annual number since reporting began in the 1980s. Alarmingly, around a third of those people do not know that they are infected.
Despite the progress in 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 low access to and uptake of HIV testing and counselling, especially among the populations most at risk of infection and transmission, not all people living with HIV (PLHIV) in Europe are diagnosed. As a consequence, many PLHIV are not receiving treatment and their virus levels are not suppressed sufficiently to prevent further transmission of the virus. Close to half (48%) of people diagnosed with HIV are diagnosed at a late stage of infection (with CD4 cell counts below 350 per mm3 blood).
- Late treatment initiation: For HIV combination therapy to work, it is best started at a time when the patient is still relatively healthy. Unfortunately, many Europeans with HIV start treatment too late and already show signs of widespread immune system damage, leading to excess morbidity and mortality.
- Low access to treatment: Access to life-saving antiretroviral therapy is inadequate in a number of European countries; as a result, patients who need the therapy often do not receive it. Lack of access to treatment reduces the incentive to get tested, as does fear of discrimination and stigmatization. In eastern and central Europe, only 21% of all people estimated to be living with HIV (diagnosed and undiagnosed) were receiving it in 2015.
- Coinfection with tuberculosis: TB remains one of the leading causes of death among people who live with HIV. The risk of developing TB is far greater for people living with HIV if the infection is not treated. For this reason, the incidence of TB will likely continue to rise in eastern Europe. Between 2011 and 2015, the percentage of HIV/TB co-infection in incident TB cases almost doubled, from 5.5% to 9.0%.
- Coinfection with hepatitis: Almost three quarters of the people living with HIV in Europe 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.