2024-11-22 18:09:00
Rapid HIV screening test, June 2018. CLAUDIO REYES / AFP
In 2023, nearly 5,500 new people will be diagnosed with the human immunodeficiency virus (HIV) in France. This is an estimate from Public Health France (SPF) after correction of the raw number of seropositivity discovered (3,877 cases), in order to take into account the under-reporting of cases.
“For several years, the number of new HIV contaminations has no longer declined in France, even though we have all the tools to prevent transmission”lamented Professor Yazdan Yazdanpanah, director of the National Agency for AIDS Research-Emerging Infectious Diseases (ANRS-MIE), during a press conference on November 21.
That same day, eleven new recommendations on HIV care were presented at the annual congress of the French Society for the Fight against AIDS, in Biarritz (Pyrénées-Atlantiques). The three co-authors, the ANRS-MIE, the High Authority for Health (HAS) and the National AIDS Council (CNS), notably scrutinized several key points: social determinants of infection, preventive treatments, diagnosis and monitoring of people living with HIV, HIV and pregnancy, adaptation of antiretroviral treatments, etc.
43% of infections discovered at a late stage
Since 2012, the number of HIV discoveries has decreased by 10%. But if we except the year 2020, marked by a sharp drop linked to the Covid-19 pandemic, this number has stagnated since 2018 and has even rebounded since 2020.
“This increase particularly affects people born abroad”, note the experts, particularly women infected through heterosexual intercourse and men who have sex with men (MSM).
Another concern, in 2023, 43% of HIV infections were discovered at a late stage (between 200 and 350 CD4 cells per cubic millimeter of blood), including 27% at an advanced stage (AIDS stage), with less than 200 CD4 cells. per cubic millimeter of blood. Between contamination and diagnosis, the median time was 1.9 years for all people discovering their HIV status, and three years for heterosexual men born abroad.
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This delay is a loss of individual opportunity. It also increases the risk of viral transmission, an undiagnosed and untreated person being able to contaminate their partners. Conversely, “if the virus is undetectable in the blood, it is untransmissible, relève Yazdan Yazdanpanah. Screening therefore remains the primary prevention tool.”
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How can public health initiatives address the issue of late-stage HIV diagnoses in the country?
**Interview with Dr. Yazdan Yazdanpanah on the Current State of HIV in France**
**Interviewer**: Thank you for joining us today, Dr. Yazdanpanah. Your insights into the current HIV situation in France are invaluable. Recently, it was reported that nearly 5,500 new diagnoses of HIV were expected in 2023. What are your thoughts on this concerning statistic?
**Dr. Yazdanpanah**: Thank you for having me. It is indeed alarming. The figure reflects not just the diagnoses from the past year but also corrects for under-reporting. The reality is that the number of new infections has stagnated for several years despite the availability of effective prevention tools, which should be a clear signal that something isn’t working as it should.
**Interviewer**: You mentioned prevention tools. Can you elaborate on what these tools are and why their effectiveness seems to be waning?
**Dr. Yazdanpanah**: Certainly. We have a range of effective prevention strategies, such as PrEP (pre-exposure prophylaxis), increased access to rapid testing, and widespread public health campaigns. However, barriers remain—such as stigma, social determinants of health, and gaps in education about these prevention methods. It’s crucial that we address these issues holistically to ensure individuals can access and utilize these tools effectively.
**Interviewer**: At the recent congress of the French Society for the Fight against AIDS, eleven new recommendations regarding HIV care were introduced. What are some key points from these recommendations?
**Dr. Yazdanpanah**: The recommendations cover a broad range of topics. They address the social determinants of infection, emphasize the need for better preventive treatments, and include specific guidance on monitoring people living with HIV. Notably, they also highlight the intersection of HIV and pregnancy, as well as the need for continued adaptation of antiretroviral treatments to meet diverse patient needs.
**Interviewer**: A particularly concerning statistic is that 43% of infections are discovered at a late stage. What does this mean for the individuals diagnosed and the public health response?
**Dr. Yazdanpanah**: Late-stage diagnosis significantly impacts individual health outcomes, as it can lead to increased morbidity and mortality. For public health, it highlights a critical gap in our testing and outreach efforts. We need to enhance our screening protocols, ensure access to testing, and destigmatize the conversation around HIV so that individuals are encouraged to get tested early.
**Interviewer**: Given these challenges, what do you think are the immediate steps that need to be taken to reverse this trend?
**Dr. Yazdanpanah**: First, we need to ramp up awareness campaigns focused on the importance of regular testing, particularly in high-risk populations. Second, expanding access to prevention resources like PrEP is essential, especially in vulnerable communities. Lastly, integrating mental health and social support into HIV care can help to address the broader issues that contribute to transmission.
**Interviewer**: Thank you, Dr. Yazdanpanah, for shedding light on this critical issue. It appears that while we have the tools to combat HIV, a collective effort is necessary to ensure they are effective.
**Dr. Yazdanpanah**: Thank you for discussing this important topic. Together, we can make progress in reducing new infections and improving the lives of those affected by HIV.
