Despite years of prevention campaigns, around 5,000 people discovered their HIV status in 2022, according to Public Health France. A figure which shows that the fight against AIDS is still relevant, thirty years after the first edition of Sidaction.
Forty years after its discovery, HIV is still circulating in France and throughout the world, despite the fight of researchers, doctors, patients and associations to put an end to it. “With 5,000 new discoveries of HIV status recorded in France in 2022 and 1.3 million worldwide, the fight against AIDS must not stop today”alerts the Sidaction 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 with Gilles Pialoux, head of the infectious diseases department at Tenon hospital in Paris and vice-president of the French Society for the Fight against 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 Pialoux: These figures prove that the objectives of the UN [qui juge “possible” de mettre fin à l’épidémie d’ici 2030] will not be achieved. Among these 5,000 new diagnoses, 54% concern heterosexual people (more than two-thirds of whom were born abroad) and 41% concern men who have sex with men (MSM). What is interesting to watch is the evolution of these categories. MSM born abroad and trans people infected through sexual intercourse are where new diagnoses are increasing the most.
More generally, more than half of new diagnoses were made in people born abroad. It is important to specify that the majority of these populations contracted the virus after their arrival in France. In 2021 and 2022, 61.7% of MSM born abroad were contaminated 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 protect them enough.
The number of people newly infected with HIV will be lower in 2022 than in 2019. Should we be happy about this?
This drop 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 combined prevention campaign [qui mêle plusieurs outils de prévention et permet à chaque personne de faire un choix en fonction de sa situation] on all sexually transmitted infections – not just HIV.
This is not to throw stones at Public Health France. On the contrary. The State must give this structure more resources to develop general public campaigns, which are broadcast on all television channels, at prime time, and on social networks.
In 2022, 43% of HIV infections were discovered at a late stage of infection, a proportion that has not decreased for several years. However, late detection compromises the patient’s chances. How can these delays be explained?
This is a great source of consternation. Even today, between 28% and 30% of new diagnoses are made at the “AIDS stage” [lorsque le VIH a réussi à faire s’effondrer le système immunitaire]. 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. What is worrying is that this figure has not changed since 2012.
These late diagnoses concern all sections of the population, including heterosexual people born in France. MSM are the least affected by these diagnoses, since they are screened regularly. This late screening is a double loss of luck. A person detected very late is ten times more likely to die within six months of diagnosis. It is also a risk for the population, because a person who is not screened, and therefore not treated, is contaminating.
How do you explain this situation?
It is a collective responsibility. The problem is the lack of communication. However, the sexual health plan put in place by the Ministry of Health until 2030 is very good. Furthermore, the fact of being able to carry out tests without a prescription in all cities and in all laboratories in France as soon as you reach the age of majority is a very good initiative in terms of prevention.
“There are good measures, but they are not yet up to the challenges of this epidemic.”
Gilles Pialoux, infectious disease specialistat franceinfo
How can we improve prevention?
First of all, all French people should be better informed. I am sure that most people who read this interview do not know that every adult aged between 15 and 70 should be offered a screening test at least once in their life, according to the recommendations of the High Authority for health (HAS).
Second, populations at risk must be screened regularly. It’s not just MSM and migrants, there are also people with multiple partners, those who have non-consensual sex or paid sex. Additionally, all MSM should be tested every three months. But the only ones who carry out these tests are those who take PrEP [un traitement préventif qui empêche le VIH d’entrer dans le corps].
Finally, doctors have not paid enough attention to screening. When we look at the 6.5 million tests carried out in 2022, an increase of 3% compared to the previous year, it is still largely insufficient. We have simply made up for the delay caused by the health crisis. This is why I teach medical students that they should make testing for HIV, hepatitis and sexually transmitted infections routine.
“To the slightest prescription for a blood test, whether it is a pill renewal or a pre-operative check, it costs nothing to add an HIV test.”
Gilles Pialoux, infectious disease specialistat franceinfo
Since June 2021, PrEP can be directly prescribed by a general practitioner. Is this treatment used enough?
It’s a real success. In 2022, 65,000 people were taking PrEP, which corresponded to an increase of 39% in one year. In all, 41% of first-time registrations were via community medicine, which proves that the system works. On the other hand, the prescription of PrEP should be broadened and no longer only concerns white MSM aged 40 on average and, to a lesser extent, trans people and sex workers. I am thinking in particular of women, who represent 34% of new diagnoses but only 4% of people using PrEP, but also of people with multiple partners, young people aged 16 to 20… This can concern all categories of the population.
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’s goals for 2030. They call it “95-95-95”. The ambition is to have successfully diagnosed 95% of people living with HIV in the world, that 95% of these diagnosed people have treatment and that 95% of people under treatment have an undetectable viral load, which prevents transmission of the virus. However, whether in France, in developed countries or elsewhere in the world, we are not there. Globally, in 2022, there were around 86% of people diagnosed, 76% treated and 71% with an undetectable viral load. The way is still long. In France, there is a lack of recent data but the first 95% is far from being reached. An estimated 28,000 people are unaware of their HIV status.
It has now been forty years since the virus was discovered by French researchers. Where is the research on treatments?
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 do not need new drugs, existing ones are sufficiently effective, we need new formulas which are less restrictive than current treatments and contribute better to prevention.”
Gilles Pialoux, infectious disease specialistat franceinfo
This is particularly the case for molecules to be taken once a week or injectable solutions once every two or every six months. Research is also being carried out to develop implants, based on the model of contraceptive implants, which diffuse the molecule for a year or even vaginal rings.
Another important point is the resumption of vaccine research, which was almost at a standstill. The only preventive vaccine trial dates from the 2000s and had only 31% protection, which was very insufficient. Since then, all other vaccine attempts have been failures. But Covid-19 has relaunched vaccine research. This is very important, because despite all the advances in other areas [prévention, prise en charge, médicaments], there is a place for a vaccine. This would make it possible to no longer depend on treatment, which is still very restrictive, or on screenings.