HIV/AIDS in the WHO European Region

Key facts

• Human immunodeficiency virus (HIV) is an infection that attacks the body's immune system, specifically the white blood cells called CD4 cells.
• Thanks to advances in antiretroviral treatment in recent decades, HIV has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
• According to a 2022 estimate, there were approximately 3 million people living with HIV in the Region, of whom an estimated 870 000 were unaware of their infection. Late diagnosis remains a challenge in the Region, with over half of all HIV diagnoses given too late.
• In 2022, 71% of people living with HIV in the Region knew their HIV status, 87% of people with diagnosed HIV infection received antiretroviral therapy (ART), and 90% of people receiving ART had viral suppression.
• The majority (69%, or almost 78 000) of people diagnosed with HIV in 2023 were from the eastern part of the Region.

Overview

Human immunodeficiency virus (HIV) is an infection that attacks the body's immune system, specifically the white blood cells called CD4 cells, which weakens a person's immunity against infections such as tuberculosis (TB) and certain cancers. If the person's CD4 cell count falls below 200, their immunity is severely compromised, leaving them more susceptible to infections. A person with a CD4 count below 200 is described as having AIDS (acquired immunodeficiency syndrome). Modern antiretroviral therapy (ART) consisting of a combination of antiretroviral drugs suppresses the virus and stops the progression of HIV disease. Coformulated pills can be taken once a day and produce minimal side-effects. Effective ART also prevents onward transmission of HIV as the viral load becomes undetectable. Notable progress has been made in the WHO European Region towards the 95-95-95 goals, developed by UNAIDS for 2030, of 95% of people living with HIV knowing their HIV status, 95% of people with diagnosed HIV infection receiving sustained ART, and 95% of people receiving ART having viral suppression.

However, most recent data show significant variation in the HIV epidemic in the Region, with 69% of HIV diagnoses in the eastern part of the Region in 2023.

Prevention

HIV is a preventable disease. The risk of HIV infection can be reduced by:

• using harm reduction services for people who inject and use drugs
• using a male or female condom during sex
• being tested for HIV and sexually transmitted infections

Doctors may suggest medicines and medical devices to help to prevent HIV infection, including:

antiretroviral drugs (ARVs), including

• oral pre-exposure prophylaxis (PrEP) and long-acting products;
• dapivirine vaginal rings; and
• injectable long-acting cabotegravir.

When antiretroviral medication is given before possible exposure to HIV, it is called pre-exposure prophylaxis (PrEP), and when administered after exposure, it is post-exposure prophylaxis (PEP). People can use PrEP or PEP when the risk of contracting HIV is high. Those considering the use of PrEP or PEP should seek advice from a clinician or relevant community representatives.

ARVs can also be used to prevent mothers from passing HIV to their children.

People taking ART when there is no evidence of virus in the blood will not pass HIV to their sexual partners. Access to testing and ART is an important part of preventing HIV.

Underdiagnosis and late diagnosis put progress in danger

Testing for HIV is a critical public health intervention because it is the first step towards treatment and care.

The latest data indicate that the number of people in the Region living with undiagnosed HIV is not decreasing. Countries reported a rebound in HIV testing and case detection since the COVID-19 pandemic, but efforts are still not enough to close the gap among undiagnosed people, especially in eastern Europe and central Asia, where about 40% of all people living with HIV are unaware of their HIV status.

Late HIV diagnosis remains a challenge for most countries in the Region, indicating the need for countries to explore ways of increasing testing access and uptake, including self-testing and community-based testing. In 2023, more than half of those diagnosed were diagnosed late (with a CD4 cell count below 350 per mm 3 ). Late diagnoses are most common among those infected through heterosexual contact (especially men), people who inject drugs, and older people.

HIV treatment works most effectively when it is initiated as soon as possible after a positive diagnosis. When people are diagnosed late and they already have symptoms of widespread immune system damage when they begin ART, they are more vulnerable to AIDS and TB. Delayed treatment initiation can also lead to the spread of HIV infection to others, as the virus is not suppressed and can still be transmitted.

Access to treatment

Despite universal access to testing and antiretroviral treatment, too many people in the eastern part of the Region remain undiagnosed. As a result, people develop AIDS and die from AIDS-related causes in this subregion. Limited access to treatment and care, fear of discrimination, and criminalization of HIV transmission collectively reduce the incentive for HIV testing. Around 40% of all people living with HIV in eastern Europe and central Asia are still not receiving ART.

Coinfections and comorbidities

An untreated HIV infection weakens the body's immune system, lowering a person's immunity against infections such as TB and certain cancers.

In the WHO European Region, TB is the leading killer of people with AIDS. Because it weakens the immune system, people living with HIV are more likely to become infected with TB, and the disease is often more severe.

Another common coinfection is the hepatitis C virus (HCV), especially among vulnerable populations, such as people who inject drugs. If left untreated, HCV infection often leads to life-threatening liver disease, which progresses faster in people coinfected with HIV. Recent developments in hepatitis C treatment have paved the way for the elimination of hepatitis. All people living with HIV should be offered testing for viral hepatitis to allow early diagnosis and life-saving treatment.

People living with HIV are also at risk of developing chronic complications and comorbidities, such as noncommunicable diseases and mental health disorders.

WHO response

The WHO European Region is committed to achieving the global goal to end AIDS as a public health threat by 2030, a commitment that was made when the Member States endorsed the Regional action plans for ending AIDS and the epidemics of viral hepatitis and sexually transmitted infections 2022-2030.

WHO has a set of guidelines and normative documents to support countries' HIV responses in areas of intervention (such as HIV prevention, testing, treatment and care) and in addressing HIV key populations. WHO/Europe facilitates the dissemination and integration of these guidelines within national health protocols in countries throughout the Region. In addition to offering technical assistance for implementation, it monitors countries' uptake of WHO policies and recommendations.