AIDS: costs set to exceed 2 billion by 2030 without intervention, but treatment is available

In the absence of further action, annual expenditure on HIV management could exceed 2 billion euros by 2030, with an estimated annual increase of 3.6 per cent; a significant proportion of this burden, amounting to around 1.4 billion, would be associated with new, potentially preventable infections. This brings the spotlight back onto the infection that terrified the world in the 1980s and 1990s and which is now partly ‘forgotten’, the latest report – based on official data on cases and infections and in light of available treatments – examines the expected benefits in terms of health and reduced pressure on public healthcare costs. From this perspective, PrEP should not be viewed merely as a preventive tool, but as a lever for sustainability capable of reducing new infections, future treatment costs and pressure on the healthcare system.

With regard to the disease, the report “Changing the Trajectory of HIV in Italia: Prevention, Equity and Innovation for a Sustainable National Health Service”, presented in Rome by Cencora and ViiV Healthcare, analyses the country’s epidemiological, clinical, economic and organisational landscape using various available data.In 2024, 2,379 new cases of HIV were recorded in Italia. In 40.3 per cent of cases, the infection was detected when the immune system was already severely compromised. Another figure highlights the delay in diagnosis: 83.6 per cent of new AIDS diagnoses involved people who had tested positive for the virus in the preceding six months.
A 2021 study assessing the epidemiological and economic consequences of delayed treatment for HIV-positive patients, caused by the pandemic, highlighted how delays in treatment could lead to a deterioration in patients’ clinical condition and an increase in HIV-related mortality, whilst a timely resumption of treatment for HIV-positive patients could prevent up to 687 deaths by the tenth year of the analysis. The simulations were carried out on the assumption of continuous treatment for patients already diagnosed, without any interruptions in therapy, and the immediate initiation of treatment for patients newly diagnosed during 2021.

Treatment has made HIV a manageable chronic condition. In a study of people living with HIV in Italia, 93 per cent of participants were virologically suppressed, whilst 42 per cent had reported sub-optimal adherence levels in the previous 12 months. Furthermore, over 50% of people living with HIV in the study are over 50 years old, and around 60% have at least one non-HIV-related comorbidity. The average direct cost of care is estimated at €9,762.92 per year per person living with HIV, whilst the cumulative lifetime cost, over a 39-year period, amounts to €222,674.77 per patient.

‘Today we have treatments that enable people living with HIV to have a life expectancy and quality of life comparable to those of the general population, but these outcomes depend on timely diagnosis and ongoing care. This is complemented by highly effective preventive strategies, such as long-acting PrEP, which can drastically reduce the risk of infection and transmission of the virus within a specific population group that, by definition, is at high risk and does not adopt any form of prevention strategy,” says Massimo Andreoni, Emeritus Professor of Infectious Diseases at Tor Vergata University in Rome and Member of the Higher Health Council, author of the foreword to the Report. ‘If we consider that, on average, a person with HIV could potentially transmit the infection at least once – and more likely several times – during the years prior to diagnosis, we can regard the data from the analysis presented as conservative compared with the actual savings that can be achieved. For this reason, it would be advisable to consider strengthening preventive measures across the whole country; this could also have a positive impact on the finances of the healthcare system.”

Access to testing, pre-exposure prophylaxis (PrEP) and care continues to be characterised by significant regional differences, the report states. In 2024, 75.6 per cent of people using PrEP were concentrated in three regions: Lombardy, Lazio and Emilia-Romagna.