Division of Medical Virology, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa.
Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A5C1, Canada.
Retrovirology. 2021 Aug 3;18(1):21. doi: 10.1186/s12977-021-00565-1.
HIV-1 persists in infected individuals despite years of antiretroviral therapy (ART), due to the formation of a stable and long-lived latent viral reservoir. Early ART can reduce the latent reservoir and is associated with post-treatment control in people living with HIV (PLWH). However, even in post-treatment controllers, ART cessation after a period of time inevitably results in rebound of plasma viraemia, thus lifelong treatment for viral suppression is indicated. Due to the difficulties of sustained life-long treatment in the millions of PLWH worldwide, a cure is undeniably necessary. This requires an in-depth understanding of reservoir formation and dynamics. Differences exist in treatment guidelines and accessibility to treatment as well as social stigma between low- and-middle income countries (LMICs) and high-income countries. In addition, demographic differences exist in PLWH from different geographical regions such as infecting viral subtype and host genetics, which can contribute to differences in the viral reservoir between different populations. Here, we review topics relevant to HIV-1 cure research in LMICs, with a focus on sub-Saharan Africa, the region of the world bearing the greatest burden of HIV-1. We present a summary of ART in LMICs, highlighting challenges that may be experienced in implementing a HIV-1 cure therapeutic. Furthermore, we discuss current research on the HIV-1 latent reservoir in different populations, highlighting research in LMIC and gaps in the research that may facilitate a global cure. Finally, we discuss current experimental cure strategies in the context of their potential application in LMICs.
尽管经过多年的抗逆转录病毒疗法 (ART),HIV-1 仍在受感染个体中持续存在,这是由于形成了稳定且寿命长的潜伏病毒库。早期的 ART 可以减少潜伏库,并与 HIV 感染者(PLWH)的治疗后控制相关。然而,即使在治疗后控制者中,一段时间后停止 ART 不可避免地会导致血浆病毒血症反弹,因此需要终身抑制病毒治疗。由于全球数百万 HIV 感染者持续终生治疗的困难,治愈无疑是必要的。这需要深入了解储库的形成和动态。中低收入国家(LMICs)和高收入国家在治疗指南、治疗可及性以及社会污名化方面存在差异。此外,来自不同地理区域的 PLWH 存在人口统计学差异,例如感染的病毒亚型和宿主遗传学,这可能导致不同人群之间的病毒库存在差异。在这里,我们综述了 LMIC 中与 HIV-1 治愈研究相关的主题,重点关注承载 HIV-1 最大负担的撒哈拉以南非洲地区。我们总结了 LMIC 中的 ART,强调了在实施 HIV-1 治愈疗法时可能遇到的挑战。此外,我们讨论了不同人群中 HIV-1 潜伏库的当前研究,重点介绍了 LMIC 的研究以及可能促进全球治愈的研究空白。最后,我们在其在 LMIC 中的潜在应用背景下讨论了当前的实验治愈策略。
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