Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe

Abstract

The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.

Keywords: Chlamydia; Gonorrhea; HIV; HPV; Hepatitis B or C; Post-exposure prophylaxis; Pre-exposure prophylaxis; Prevention vaccine; Syphilis; sexually transmitted infections.

Fig. 1

Geographical areas, HIV incidence, and PrEP initiation in the WHO European Region. Legend: A. WHO European Region in accordance with the WHO HIV/AIDS surveillance report, which includes 53 countries categorized by sub-regions. The following list includes European Union (EU) members (marked with an asterisk) and non-EU countries. Western Europe (23 countries): Andorra, Austria∗, Belgium∗, Denmark∗, Finland∗, France∗, Germany∗, Greece∗, Iceland, Ireland∗, Israel, Italy∗, Luxembourg∗,Malta∗, Monaco, Netherlands∗, Norway, Portugal∗, San Marino, Spain∗, Sweden∗, Switzerland, and United Kingdom. Central Europe (15 countries): Albania, Bosnia and Herzegovina, Bulgaria∗, Croatia∗, Cyprus∗, the Czech Republic∗, Hungary∗, the former Yugoslav Republic (FYR) of Macedonia, Montenegro, Poland∗, Romania∗, Serbia, Slovak Republic∗, Slovenia∗, and Turkey. Eastern Europe (15 countries): Armenia, Azerbaijan, Belarus, Estonia∗, Georgia, Kazakhstan, Kyrgyz Republic, Latvia∗, Lithuania∗, Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. Data from: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2009. Stockholm:European Centre for Disease Prevention and Control; 2010. B. HIV incidence in Europe in the year 2021. Incidence expressed as population per 100,000 persons-year. Data from: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe. 2021–2020 data. Stockholm: ECDC; 2021. C. Cumulative numbers of PrEP initiation in European countries up to Q2 2023. Data from: https://data.prepwatch.org/.

Fig. 2

Prevention strategies for STIs: HIV combination prevention, prevention for bacterial STIs and vaccines. ART: antiretroviral treatment; bNAbs: broadly neutralizing antibodies; CAB-LA: long-acting cabotegravir; CT: Chlamydia trachomatis; Doxy: doxycycline; DVR: dapivirine vaginal ring; HAV: hepatitis A virus; HBV: hepatitis B virus; HIV: human immunodeficiency virus; HPV: human papillomavirus; LEN: lenacapavir; MenB: serogroup B meningococcal vaccine; MPXV: monkeypox virus; PEP: post-exposure prophylaxis; PrEP: pre-exposure prophylaxis; STI: sexually transmitted infection; HSV: herpes simplex virus.