HIV and AIDS up on pre-Covid levels but tests are 'late' in 60% of cases

Is anyone still thinking about HIV-AIDS? Unfortunately, the attention of institutions is muted and the stigma of the disease still weighs like a boulder: as a result, prevention of this infection, which was the big-killer of the 1980s, is decidedly low in the general population.

"Yet," explains Annamaria Cattelan, Director of the Infectious Diseases Complex Unit of the Padua Hospital, the city hosting the 17th edition of Icar, the Italian Conference on Aids and Antiretroviral Research, of which Cattelan is co-chairman - the numbers tell us that the epidemic has reared its head again in Italy too, where in 2023 we are back to 2,349 diagnoses, a number almost on a par with the pre-Covid level, and with the dramatic figure of 60% of people who discover they have the infection at an advanced stage. With a twofold consequence: on the one hand, advanced damage to the immune system due to the high level of inflammation that causes impairment of, for example, the cardiovascular and neurological systems as well as the development of tumours; on the other hand, widespread contagion to the rest of the population due to a lack of awareness of the disease. Once discovered, the infection can be effectively combated with antiretroviral therapies, which have been easy to administer for years and - Cattelan emphasises - are so low in toxicity that they can be taken for life. The drugs, if taken appropriately, make it possible to eliminate the viral load in the blood and thus the possibility of contagion'.

For all these good reasons, it is necessary to turn the spotlight on European Testing Week, to which a large network of Italian cities is adhering: from 19 to 25 May, to take the HIV test you can go to one of the centres on the map available on the www.fast-trackcities.org portal. In the event of a positive test, the centres provide counselling leading to the necessary referral to the public services: to protect ourselves and our neighbour. Testing weeks are usually in spring and autumn, but it must be emphasised that every day is good for prevention and that the entire sexually active population should be tested for HIV, especially young people but also adults among whom 7-8% are still diagnosed.

According to the 2024 data of the Aids Operations Centre of the Istituto Superiore di Sanità (Iss), the total number of people infected with Hiva in Italy is estimated at around 140,000, with a prevalence of 0.2 per 100 residents. People found to be HIV positive in 2023 are male in 76% of cases. Over the last decade, the proportion of late diagnoses (people in a clinically advanced phase, with low CD4 or AIDS) has increased: 60% had a CD4 lymphocyte count of less than 350 cells/μL.

'Never before has it been so clear what needs to be done,' continues Paolo Meli, Associazione Comunità Emmaus (Bergamo), CICA contact person and co-chair of the Icar congress. 'First of all, we need to facilitate access to testing in order to bring out the submerged, then review the rules of engagement by favouring, for example, the opt-out approach, which helps normalise the HIV test, making it less stigmatising. We must reach out especially to those who do not think they have HIV by not recognising their risky behaviour or who encounter greater barriers to accessing the test, such as migrants and those living in socially fragile conditions: it is estimated that there are about 9,000 people unaware of their infection. The other lever is viral suppression: 25,000 people have an active infection, most of them because they struggle to get continuous treatment or because they are undiagnosed. Putting these people on treatment and supporting adherence to therapy would maximise the 'treatment as prevention' effect: not only would personal health benefit, but the whole community towards zero transmission'.