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Addressing an HIV cure in LMIC.

Sherazaan D Ismail1, Joshua Pankrac2, Emmanuel Ndashimye2,3

  • 1Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa.

Retrovirology
|August 4, 2021
PubMed
Summary

A cure for HIV-1 is essential due to lifelong antiretroviral therapy challenges. Understanding the latent viral reservoir in diverse populations, especially in low- and-middle income countries, is key to developing effective HIV-1 cure strategies.

Keywords:
CureHIV-1LMICsLow-and-middle income countriesReservoir

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Area of Science:

  • Virology
  • Immunology
  • Global Health

Background:

  • Human immunodeficiency virus type 1 (HIV-1) establishes a persistent latent reservoir despite antiretroviral therapy (ART), necessitating lifelong treatment.
  • Early ART initiation can reduce this reservoir and lead to post-treatment control, but viral rebound occurs upon treatment cessation.
  • Lifelong ART presents significant challenges globally, underscoring the urgent need for an HIV-1 cure.

Purpose of the Study:

  • To review HIV-1 cure research, focusing on challenges and opportunities in low- and-middle income countries (LMICs), particularly sub-Saharan Africa.
  • To examine the impact of demographic and treatment differences on the HIV-1 latent reservoir in various populations.
  • To discuss the applicability of current experimental HIV-1 cure strategies in LMICs.

Main Methods:

  • Literature review of HIV-1 persistence, latent reservoir dynamics, and ART implementation.
  • Analysis of demographic factors (viral subtypes, host genetics) influencing the viral reservoir.
  • Evaluation of experimental cure strategies for potential LMIC application.

Main Results:

  • Significant disparities exist in ART access, guidelines, and social stigma between high-income countries and LMICs.
  • Demographic variations in PLWH (People Living With HIV) across regions impact viral reservoir characteristics.
  • Gaps in research within LMICs need addressing to facilitate a global HIV-1 cure.

Conclusions:

  • A comprehensive understanding of the HIV-1 latent reservoir across diverse populations is crucial for cure development.
  • Tailoring cure strategies to the specific contexts of LMICs, considering implementation challenges, is essential.
  • Addressing research gaps in LMICs is vital for achieving a global functional cure for HIV-1.