HIV, 63% of diagnoses come late. Here are the tests to speed them up
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The data is striking: in Italy the diagnoses with Cs Hiv disease already full-blown, therefore late, have reached 63%. And for this reason the scientific societies Simit and Simeu propose new models with tests that can also be carried out in the emergency room.
Infectiology and Emergency and Urgency Medicine, therefore, proceed together in the fight against HIV, with the aim of promoting tests, a tool they define as “essential for making early diagnoses and rapid start-ups in treatment, the main challenge to be faced after the significant progress science of recent years”.
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Confirmation in the data
The data confirms it: in Italy there has been a decline in diagnoses since 2012. In 2021, the Higher Institute of Health communicated, there were 1,770, but there are still numerous late diagnoses: precisely 63% of people discover that they are been hit by HIV when she already has a full-blown disease, which causes greater difficulties in starting therapies. Some proposals arise from these problems, the result of collaboration between institutions, ISS, scientific societies, associations of the patient community.
New strategies for testing and linkage-to-care
New proposals originated from the scientific conference “HIV Testing & Linkage to care: experience of collaboration between Infectious Diseases and Emergency Department”, organized with the contribution of Gilead Sciences, held on 6 July in Rome. On that occasion, the state of the art was presented with respect to the HIV test offer – examining possible models – and the most effective methods for the timely linkage-to-care of HIV positive people. But there was also discussion on a regulatory update: the reference goes to the National AIDS Plan and the reform of Law 135/90.
Together with the scientific director professor Stephen Vellapresident of the National Commission for the fight against AIDS, Professor Massimo Andreoni (Simit Scientific Director); the professor Andrea Antinori (director of the Clinical Department, Lazzaro Spallanzani National Institute for Infectious Diseases); Silvio Brusaferro (President of the Higher Institute of Health); Daniele Calzavara (Milan Check Point Ets Coordinator); Livio Colombo (director of the Emergency Department, Dea of the San Paolo Hospital in Milan); the honorable Mauro D’Attis (of the Chamber of Deputies); Joachim Galardo (director of the Doctor and Obi Emergency Department, Aou of the Umberto I Policlinico); the teacher Loreta Condili (scientific manager of the Piter platform of the ISS Global Health Center).
And again, the professor spoke Alexander Lazarus (of the Department of Public Health and Infectious Diseases of the Sapienza University of Rome); the professor Claudio Mastroianni (President Simit); Anna Theresa Palamara (director of the Infectious Diseases Department of the ISS); Laura Rancilio (formerly responsible for the AIDS and addiction areas, at Caritas Ambrosiana in Milan); Barbara Suligoi (of the AIDS Operations Center – ISS Infectious Diseases Department); Antonio Voza (national secretary Simeu); the senator Francesco Zaffini (President of the 10th Commission for Social Affairs, Health, Public and Private Employment, Social Security, of the Senate).
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New priorities in the fight against HIV
The new antiretroviral therapies, if taken regularly, make the HIV virus no longer detectable in the blood and non-transmissible, as also summarized in the scientific evidence U=U, Undetectable=Untransmittable, from which the concept of Treatment as Prevention derives . But another tool goes in this direction: it is Pre-Exposure Prophylaxis (PrEP), the reimbursement of which Aifa recently approved: a step forward considered significant, given that in many countries it has drastically reduced the number of new infections. “Despite the extraordinary scientific progress, the fight against HIV in the world still presents many criticalities – underlines Vella -, as demonstrated by the approximately 1.5 million new infections that are registered every year globally, while in Italy the problem of late diagnoses, which are reflected in a delay in treatments and a still congruous number of infections”.
What to do? “There is a need for more information and wider access to the test, especially for those who have engaged in risky behaviour. The tests can be done free of charge and anonymously in hospitals, specialized centres, counseling centres, but also in pharmacies and at the check-points managed by the Community Another way to facilitate access to the test concerns places of first access, such as the Emergency Department and family doctors, who can further investigate the lifestyle of their patients and understand any risk behaviors”.
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The scientific societies and the project of Umberto I
“The start of treatments cannot be separated from an expansion of tests in the population – Mastroianni points out -. Simit is engaged in various collaborations with other specialists of reference, such as the emergency specialists of Simeu and general practitioners of Simg. The goal what is common is being able to take advantage of every opportunity to carry out the HIV test at any useful moment: from access to the emergency room to outpatient visits, up to those situations that may make one suspect the presence of the virus”.
“It is therefore necessary to act in different settings by stimulating the execution of the test – concludes Mastroianni -. At the Policlinico Umberto I, for example, we have launched some projects aimed at testing patients in the emergency room and in all situations where there may be sentinel events that may suggest HIV infection. Important results have already been obtained with this method, identifying people affected by the virus and unaware of their positivity. This has allowed us to start antiretroviral therapy early, which prevents the disease from progressing and allows these people not to transmit the infection”.
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