World AIDS Day: ANRS MIE works to end HIV/AIDS as a public health threat

HIV epidemic: encouraging progress, but efforts need to be stepped up to achieve the 2030 targets

The decades-long global response to HIV is at an inflection point. The 2024 Global Report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) showed that ‘the world now has the means to end AIDS as a threat to public health by 2030’[1].

In the world

In 2023, 39.9 million people were living with HIV worldwide [1], including 25.9 million in sub-Saharan Africa. New HIV infections have been reduced by 60% since the peak in 1995. According to a recent publication in the Lancet HIV [2], the number of global new infections decreased by a fifth in the 2010s.

Nearly a quarter of people (9.3 million people) living with HIV do not have access to antiretroviral therapy, with major disparities between regions: from more than 50% in Eastern Europe, Central Asia, the Middle East and North Africa, to less than 20% in Eastern and Southern Africa.

In 2023, 1.3 million people newly acquired HIV, compared with 3.3 million in 1995. However, despite progress, this figure falls short of the 2025 target of 370,000 new infections. Women and girls will account for around 44% of all new HIV infections in 2023. And certain populations appear to be particularly vulnerable, notably men who have sex with men, sex workers, injecting drug users and transgender people.

In France

The last ten years have seen an overall decline in the number of new infections. The availability of HIV testing, increased uptake of HIV testing, the growing use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM), increasingly effective treatments for those infected, with benefits both for individuals and for the population as a whole (an undetectable viral load means that the virus cannot be transmitted) are all factors that have contributed to this reduction.

This has enabled France to come close to meeting the UNAIDS ‘95-95-95’ targets, with 2 out of 3 targets already achieved: 97% of people living with HIV received antiretroviral therapy and 97% of people on treatment have a suppressed viral load (less than 200 copies/ml, the threshold for long-term undetectability). However, more needs to be done in terms of screening. According to Santé publique France, although 94% of people living with HIV know their status, an estimated 10,756 (95% CI 10,244 – 11,267) people live with undiagnosed HIV.

Despite this progress, new infections are still occurring, particularly in key MSM populations and foreign-born people. Santé publique France[3] estimates that 3,650 (IC95% 3,271 – 4,030) people will have been infected with HIV in France in 2023, an average of 10 per day.

[1] Source: Global HIV & AIDS statistics, 2024. https://www.unaids.org/fr/resources/fact-sheet

[2] Global, regional, and national burden of HIV/AIDS, 1990–2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021. GBD 2021 HIV Collaborators. Lancet HIV 2024 Published Online November 25, 2024 https://doi.org/10.1016/S2352-3018(24)00212-1

[3] https://www.santepubliquefrance.fr/maladies-et-traumatismes/infections-sexuellement-transmissibles/vih-sida/documents/bulletin-national/vih-et-ist-bacteriennes-en-france.-bilan-2023

The ongoing commitment of ANRS Emerging Infectious Diseases

Against this background, ANRS MIE continues to play a central role in coordinating and funding HIV/AIDS research, the results of which contribute to more effective prevention and better care for people living with HIV. Here are some of the actions conducted and projects supported in 2024:

The ‘HIV Zero in Île-de-France’ programme: regional mobilisation to end HIV transmission in the region

Among the initiatives and programmes funded by ANRS MIE, the ‘HIV Zero in Île-de-France by 2030’ programme is built on a collective commitment and a set of practical measures in partnership with the Ile-de-France Regional Health Agency. By mobilising all resources and acting on social and spatial disparities, the two institutions are reaffirming their joint commitment to addressing this major public health challenge.

A collaborative effort involving all those (patient associations, healthcare teams, researchers and local authorities) involved in the fight against HIV in the Paris region has led to the emergence of 25 new proposals. Some of these can be rapidly implemented, while others still require further work. Some strengthen existing structures. Others introduce innovative approaches aimed at training and expanding the network of healthcare professionals and services involved in a combination prevention approach. They focus on three priority areas: improving understanding of the epidemic at the local level, expanding access to pre-exposure prophylaxis (PrEP) and maximising the impact of screening and treatment.

For further information, read the press release

ANRS MIE support for research

The following are some emblematic research projects supported by the ANRS MIE:

Improving our understanding of the epidemic: The COINCIDE study has enabled us to gain a better understanding of the HIV epidemic in Île-de-France on a detailed geographical scale. Numerous projects are also being conducted to strengthen our understanding of people living with HIV (PLHIV), such as the national VESPA 3 survey, which has just finished enrolling participants and will study the living conditions and social needs of PLHIV; the Trans&VIH survey, which investigates the life trajectories and living conditions of HIV-positive transgender people in France; and the multi-centre Coquelicot survey, which measures the seroprevalence of HIV and hepatitis B and C among injecting and snorting drug users, and provides information on their drug use and harm reduction practice. This will be published shortly.

In order to maximise the impact of screening and treatment, the NotiVIH study has been designed to encourage partner notification after an HIV diagnosis. In the context of prevention and access to PrEP, the ANRS Prévenir cohort, which is conducted in Île-de-France, will prevent new HIV infections with pre-exposure prophylaxis (PrEP). New strategies are also being investigated. For example, For example, the CABOPrEP study will assess the effect of HIV PrEP with long-acting injectable cabotegravir versus oral PrEP on the persistence and coverage of risky sexual acts in men who have sex with men..

In addition, new studies to improve therapeutic management have been launched: the ELDORADO trial, which compares doravirine-based triple therapy with dolutegravir-based triple therapy; the ANRS BI-LIGHT study examining strategies for reducing the treatment burden in people co-infected with HIV and hepatitis B; and the ANRS 0338 PDVCOH study, which evaluates the loss to follow-up in HIV-infected subjects. The RHIVIERA (Remission of HIV Infection ERA) consortium focuses on developing new tools and strategies for lasting HIV remission. Patient enrolment in the Rhiviera 2 trial has just begun. Also on the same topic, the HELIOS trial investigates the safety and efficacy of immunotherapy in preventing viral rebound after interruption of antiretroviral treatment.

New HIV care recommendations developed in collaboration with the French National AIDS and Viral Hepatitis Council (CNS) and the French National Authority for Health (HAS)

In 2024, ANRS MIE, CNS and HAS published a set of recommendations for the therapeutic, curative and preventive management of people living with HIV and people exposed to HIV. These recommendations have been developed to help professionals offer the best possible therapeutic management of HIV infection.

They are the result of two years’ work and include a number of chapters: new pre- and post-exposure preventive treatments, gynaeco-obstetric and paediatric aspects, specific aspects of antiretroviral treatment, infectious complications associated with HIV infection, screening and management of cancers in PLHIV, virologic monitoring of HIV infection and analysis of antiretroviral resistance, HIV care pathway and HIV adult patient monitoring, access to care, and screening and management of comorbidities in adults living with HIV.

To the press release https://anrs.fr/en/all-news/new-hiv-care-recommendations/