It is an observation “dramatically constant” that HIV experts in France draw up. In almost a third of patients, in fact, the diagnosis is far too late and treatment begins at an already advanced stage of the infection. A situation which, since the beginning of the 2000s, has not improved. And this, “despite the screening and access to care policies deployed”underlines Sophie Grabar, public health doctor at Inserm and at Saint-Antoine hospital (AP-HP, Sorbonne University, Paris).
This is demonstrated by the results presented on Thursday March 14 at a press conference by the National Agency for Research on AIDS and Viral Hepatitis – Emerging Infectious Diseases (ANRS MIE). Shortly before, these data were revealed during the conference on retroviruses and opportunistic infections, which was held from March 3 to 6, in Denver (United States).
Between 2002 and 2016, 64,400 people living with HIV were included in French hospitals (except in Nouvelle-Aquitaine, where patients are followed separately), within a cohort set up by the ANRS MIE. “This cohort brings together approximately 68% of all patients treated on French territory”, specifies Sophie Grabar, who coordinates monitoring. Its advantage: it makes it possible to measure the impact of care on mortality.
Significant impact on mortality
The results are edifying. Among the patients in this cohort, only 51% arrived at the hospital at an early stage of infection: their CD4 cell count (the soldiers of immunity which are the main targets of HIV) was greater than or equal to 350 cells per cubic millimeter of blood; 20% reached an intermediate stage of infection, with a CD4 count between 200 and 350.
Even more serious, 28.4% of patients presented to the hospital with advanced disease. Among them, 19.5% had a CD4 count below 200 cells per cubic millimeter; and 8.9% even had declared AIDS, characterized by the presence of at least one “opportunistic” disease linked to the virus (tuberculosis, Kaposi’s sarcoma, malignant non-Hodgkin’s lymphoma, etc.).
Another distressing observation: the proportion of people taken into care very late did not improve, or very little, between the period 2002-2013 and the period 2014-2016, going from 28.8% to 26.5%. A recent study, covering the Nouvelle-Aquitaine region, supports this observation. “In 2021, 30% of patients living with HIV remained in care at an advanced stage”laments Sophie Grabar.
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