“There’s still a long way to go” to end the HIV epidemic, says infectious disease expert Gilles Pialoux.

Forty years after its discovery, despite the fight to end it by researchers, doctors, patients and organizations, HIV is still spreading in France and around the world. “With 5,000 new discoveries of HIV status in France 1.3 million in 2022 and worldwide, the fight against AIDS must not stop today”Seduction warns the association, which is organizing a weekend of mobilization from Friday March 22 to Sunday March 24. How can we explain that the epidemic has not been defeated? Franceinfo spoke to Gilles Pialeaux, head of the infectious diseases department at the Tanon Hospital in Paris and Vice President of French Society to Fight AIDS.

Franceinfo: According to Public Health France, between 4,200 and 5,700 people discovered their HIV status in 2022, despite more than thirty Years of prevention. What is the profile of these people newly infected with HIV?

Gilles Pialaux: These figures prove that the objectives of the UN (which Judge “possible” to end the epidemic by 2030) will not be achieved. Of these 5,000 new diagnoses, 54% concern heterosexual people (more than two-thirds of whom were born overseas) and 41% concern men who have sex with men (MSM). It is interesting to see the evolution of these categories. Foreign-born MSM and sexually infected trans people are where new diagnoses are rising the most.

In general, more than half of the new diagnoses were among the foreign-born. It is important to clarify that most of these populations were infected with the virus after their arrival in France. In 2021 and 2022, 61.7% of MSM born abroad were infected on French soil, according to a recent ANRS study. The average time between their arrival in France and their contamination is 7.7 years. These people do not come to France to seek treatment, contrary to popular belief. On the contrary, it proves that the healthcare system does not adequately protect them.

The number of people newly infected with HIV will be lower in 2022 than in 2019. Should we be happy about this?

This decrease is small but obviously positive. On the other hand, we can do better. Anglo-Saxon countries are recording much greater drops in contamination. In France, we had to wait until December 2023 for Public Health France to launch a major joint prevention campaign on all sexually transmitted infections (which combines several prevention tools and allows each person to choose based on their situation) – and only approx. Not only HIV

This is not to throw stones at Public Health France. vice versa. The state should give more resources to this structure to develop a general public campaign, which is broadcast on all television channels, prime time and social networks.

In 2022, 43% of HIV infections were detected in the late stages of infection, a proportion that has not decreased for many years. However, late detection compromises the patient’s chances. How can this delay be explained?

This is a great source of anxiety. Even today, 28% to 30% of new diagnoses occur at the “AIDS stage” (when HIV succeeds in destroying the immune system). For a doctor like me, who saw the first patients affected by the disease in 1983, this is extremely shocking. At Tenon Hospital, where I work, we see this type of patient every day. Worryingly, this figure has not changed since 2012.

This late diagnosis concerns all segments of the population, including French-born heterosexuals. MSM are the least affected by this diagnosis, as they are routinely screened. This late screening is a double loss of luck. A person diagnosed too late is ten times more likely to die within six months of diagnosis. It is also a risk to the population, because a person who is not screened, and therefore not treated, is contaminated.

How do you explain this situation?

It is a collective responsibility. The problem is lack of communication. However, the sexual health plan put in place by the Ministry of Health till 2030 is very good. Moreover, the fact of being able to carry out tests without a prescription in all cities and all laboratories in France is a very good initiative in terms of prevention when you reach the age of majority.

“There are good measures, but they are not yet up to the challenges of this epidemic.”

Gilles Pialoux, an infectious disease specialist

at franceinfo

How can we improve prevention?

First of all, all French people should be better informed. I am sure that most people reading this interview do not know that according to the recommendations of the High Authority for Health (HAS) every adult between the ages of 15 and 70 should undergo a screening test at least once in their life.

Second, at-risk populations should be routinely screened. It is not only MSM and migrants, but also people with multiple partners, who engage in non-consensual or paid sex. In addition, all MSM should be tested every three months. However, only people who get these tests take PrEP (a preventive treatment that prevents HIV from entering the body).

Finally, doctors have not paid enough attention to screening. When we look at 6.5 million tests conducted in 2022, an increase of 3% compared to the previous year, it is still largely insufficient. We have compensated for the delay caused by the health crisis. That’s why I teach medical students that they should be routinely tested for HIV, hepatitis, and sexually transmitted infections.

“There is no cost to add an HIV test to a simple blood test order, whether it’s a pill renewal or a pre-operative check.”

Gilles Pialoux, an infectious disease specialist

at franceinfo

From June 2021, PrEP can be prescribed directly by a general practitioner. Are these treatments used enough?

It is a real success. In 2022, 65,000 people were taking PrEP, corresponding to a 39% increase in one year. In total, 41% of first-time registrations were through community medicine, proving that the system works. On the other hand, the prescription of PrEP should be broadened and no longer only concerns white MSM with an average age of 40 and, to a lesser extent, trans people and sex workers. I’m thinking specifically of women, who represent 34% of new diagnoses but only 4% of people using PrEP, but also people with multiple partners, young people aged 16 to 20… all categories of this population can be of concern. is

The number of cases is falling in France, but what about elsewhere in the world?

To begin, I would like to talk about the UN goals for 2030. They call it “95-95-95”. The ambition is to successfully diagnose 95% of people living with HIV in the world, that 95% of those diagnosed are on treatment and 95% of those on treatment have an undetectable viral load, preventing transmission of the virus. However, whether in France, developed countries or elsewhere in the world, we are not there. Globally, in 2022, we had about 86% of people diagnosed, 76% treated and 71% with an unknown viral load. The road is still long. In France, recent data are lacking but the first is far from reaching 95%. An estimated 28,000 people are unaware of their HIV status.

It has been forty years since the virus was discovered by French researchers. Where is the research on treatment?

During the annual Conference on Retroviruses and Opportunistic Infections (CROI) held in early March in Denver, United States, scientists showed that they are very active in the search for new antiretrovirals.

“Even if we don’t need new drugs, existing drugs are effective enough, we need new formulas that are less restrictive than current treatments and better contribute to prevention.”

Gilles Pialoux, an infectious disease specialist

at franceinfo

This is especially the case for molecules to take an injectable solution once a week or every two or every six months. Research is also being conducted to develop an implant based on the contraceptive implant model, which spreads the molecule for a year or even vaginal rings.

Another important issue is resuming vaccine research, which had almost stalled. The only preventive vaccine trial dates back to the 2000s and had only 31% protection, which was woefully inadequate. Since then, all other vaccine attempts have failed. But Covid-19 has restarted vaccine research. This is very important, because despite all the progress in other areas (prevention, treatment, drugs), there is a place for vaccines. This would make it possible to rely on treatment, which is still very restricted, or on screening.