Death from AIDS is preventable, so why are people still dying of AIDS in Europe?

It is almost two decades since life-saving treatment for human immunodeficiency virus (HIV) became available. Life expectancy among people living with HIV, for whom optimal therapy is initiated timely, is now close to that of the general population. Despite this, an estimated 1.6 million people died from acquired immunodeficiency syndrome (AIDS)-related illnesses globally in 2012, and the number who died within the World Health Organization (WHO) European Region reached almost 100,000. A large proportion of these deaths occur in the eastern part of the Region, and without changes in the HIV response, the death toll in this region is likely to continue to increase in the coming years. Conversely, in the west, the risk of AIDS-related death continues to decline, reflecting some positive progress.

The majority of AIDS-related deaths would be preventable if available evidence were to be fully implemented. Research findings reported in this issue of Eurosurveillance exemplify the challenges we face as we enter the fourth decade of the epidemic. Better and more comprehensive testing strategies aimed at persons most at risk of contracting HIV are needed, linked to HIV care and treatment programs. Implementation research needs to be at the core of the HIV response.

Diagnosis at a late stage of HIV infection and subsequent delays in starting treatment with antiviral agents are the important factors for the high death toll in parts of Europe and certain subgroups. Pharris et al. in this issue present the latest trends in HIV diagnoses in the European Union/ European Economic Area [4] and show that, based on countries where information is available, about half of the 300,000 people diagnosed with HIV over the past decade had a CD4 cell count of 350 copies/mL or less at the time of diagnosis (defined as ‘late diagnosis’). Consequently, their risk of death within the year of their diagnosis was more than 10 times higher than that of individuals diagnosed early and entering care promptly; those diagnosed late aged 50 years and over carried an even greater risk. This is of particular concern given the increase in the number of persons diagnosed at an older age in Europe with almost two thirds diagnosed at a late stage of infection (personal communication Anastacia Pharris, November, 2014).

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