Adnkronos (Adnkronos) – Without additional interventions, annual spending on HIV management could exceed €2,03 billion by 2030, an estimated annual increase of 3,6%. A significant portion of this burden, approximately €1,4 billion, would be associated with potentially avoidable new infections. From this perspective, PrEP (Pre-exposure Prophylaxis) should not be viewed solely as a preventive tool, but as a lever for sustainability capable of reducing new infections, future treatment costs, and pressure on the healthcare system.
These are the findings of the report "Changing the Trajectory of HIV in Italy: Prevention, Equity, and Innovation for a Sustainable National Health Service," presented today in Rome during a press conference on "HIV in Italy: Costs and Challenges for the National Health Service – Is It Possible to Change the Trajectory?", organized by Cencora and ViiV Healthcare.
With respect to the disease – a note states – the report analyzed the epidemiological, clinical, economic, and organizational framework of the country using various available evidence.
In 2024, 2.379 new HIV diagnoses were recorded in Italy. In 40,3% of cases, the infection was discovered when the immune system was already severely compromised, and 83,6% of new AIDS diagnoses involved people who had tested positive for the virus in the previous six months. A 2021 study estimated that the delay in treatment of HIV-positive patients, caused by the Covid-19 pandemic, could lead to a worsening of their clinical condition and an increase in HIV-related mortality, while timely resumption of treatment for HIV-positive patients could prevent up to 687 deaths in the tenth year of the study.
The simulations were conducted assuming continuous treatment for patients already diagnosed, without therapeutic interruptions, and immediate initiation of therapy for patients newly diagnosed during 2021.
In a recent study of people with HIV in Italy, 93% of participants were virologically suppressed, while 42% had reported suboptimal adherence levels in the previous 12 months. Furthermore, more than 50% of people with HIV followed were over 50 years old, and approximately 60% had at least one comorbid condition unrelated to the infection. The average direct cost of management is estimated at €9.762,92 per year per person with HIV, while the cumulative lifetime cost, over a 39-year horizon, is €222.674,77 per patient.
"Today, we have treatments that allow people with HIV to enjoy a life expectancy and quality of life comparable to that of the general population, but these results depend on timely diagnosis and ongoing management," says Massimo Andreoni, Professor Emeritus of Infectious Diseases at Tor Vergata University in Rome and member of the Italian National Health Council, who authored the report's preface. "This is complemented by highly effective preventive strategies, such as long-acting PrEP, which can drastically reduce the risk of infection and transmission in a specific population setting, which by definition is highly at risk and does not adopt any type of prevention strategy. If we consider that, on average, a person with HIV, during the years without a diagnosis, could potentially transmit the infection at least once and, more likely, multiple times, we can consider the data from the analysis presented conservative compared to the actual savings achievable. Therefore, it would be appropriate to consider strengthening preventive measures across the country: this could also have a favorable impact on the finances of the healthcare system."
Access to testing, PrEP, and care remains marked by significant regional disparities, the document reports. In 2024, 75,6% of people using PrEP were concentrated in three regions: Lombardy, Lazio, and Emilia-Romagna. "The tools to change the trajectory of HIV already exist: effective therapies, innovative prevention strategies, a consolidated regulatory framework, and regional experiences that demonstrate how concrete results can be achieved," emphasizes Stefano Vella, associate professor of Global Health at the Catholic University of the Sacred Heart in Rome and of Clinical Research Methodology at the University of Rome Tor Vergata, former director of the Department of Pharmaceuticals at the Istituto Superiore di Sanità, and author of the report's foreword. "The real challenge today is ensuring that existing solutions are uniformly accessible across the country," he continues. "Investing in prevention means not only reducing the number of new infections and improving people's quality of life, but also contributing to the sustainability of the National Health Service. These savings are coupled with improved control of sexually transmitted infections: consider the fact that new long-acting strategies, administered periodically in hospital settings, allow for additional population monitoring, including for other infections such as chlamydia, gonorrhea, and syphilis, as well as hepatitis and human papillomavirus."
To establish best practices as a consistent and measurable standard across all regions, the report identifies several priorities, including strengthening national governance, expanding the provision of rapid and local testing, ensuring uniform access to PrEP, and updating diagnostic and therapeutic care pathways and integrated hub-and-spoke models: networks that connect referral centers and peripheral services, involving local services and communities.
"We are confident that the fight against HIV today requires an increasingly integrated approach, combining scientific innovation, prevention, institutional dialogue, and attention to people's needs," observes Fabio Vecchio, Market Access, Government Affairs, and Communications Director of ViiV Healthcare Italia. "The report presented today aims to contribute to a reflection based on evidence and concrete data, providing useful analyses and proposals to support the decision-making process and facilitate the simplification of pathways for more equitable, consistent, and timely access. Our commitment in this area is total and translates not only into the development of innovative solutions, but also into strengthening partnerships with all system stakeholders to generate greater efficiency and optimize HIV costs."
Finally, in the executive summary – the note concludes – the report states that the main challenge is not to introduce new tools, but to transform existing good practices into shared organizational standards capable of reducing territorial inequalities and improving the overall effectiveness of the HIV response.
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