Human Immunodeficiency Virus Infection in Romania Versus Europe: An Epidemiological and Public Health Perspective, 2024 Update.

BACKGROUND/OBJECTIVES: This study presents a comprehensive and updated epidemiological and public health assessment of human immunodeficiency virus (HIV) in Romania during 2022-2024, situated within the wider European context. METHODS: For this retrospective descriptive study, we analyzed national surveillance data from the National Institute of Infectious Diseases "Prof. Dr. Matei Balș" and European Centre for Disease Prevention and Control (ECDC) reports, between 1985-2024, focusing especially on 2022-2024 period. Key indicators included incidence, mortality, transmission routes, age and gender distribution, and treatment coverage. Comparative analyses were performed between Romania and European Union (EU)/Eastern Europe data. RESULTS: Between 1985 and 2024, Romania registered a cumulative total of 28,793 HIV cases, with 18,768 individuals living with HIV (PLHIV) as of 2024. In that year, 810 new HIV cases were diagnoses, indicating a modest uptick compared with 2022-2023. Heterosexual transmission continued to predominate (59.4%), followed by cases among men who have sex with men (MSM) (30.5%) and intravenous drug users (IDUs) (5.2%). Men represented more than three-quarters of all new infections. Mortality displayed considerable year-to-year variability, increasing from 125 HIV-related deaths in 2023 to 193 in 2024. Despite this, treatment coverage improved steadily, with 16,464 individuals receiving antiretroviral therapy (ART) by the end of 2024. At 2.51 cases per 100,000 population, Romania's incidence remained below the European average of 3.5 per 100,000. Nonetheless, the proportion of infections attributable to MSM transmission rose sharply-from 3.91% in 2007 to 32% in 2024-bringing Romania's epidemiological profile increasingly in line with broader trends observed in Eastern Europe. CONCLUSIONS: These findings suggest that although Romania maintains a comparatively lower HIV incidence than the European average, the evolving transmission dynamics-most notably the substantial increase in MSM-related cases-signal a shifting epidemiological landscape that warrants strengthened, population-specific prevention measures and continued investment in comprehensive treatment and monitoring frameworks.