Sallam Malik, Al-Khatib Arwa Omar, Sabra Tarneem, Al-Baidhani Saja, Al-Mahzoum Kholoud, Aleigailly Maryam A, Sallam Mohammed
Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan.
Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan.
Viruses. 2025 Feb 27;17(3):336. doi: 10.3390/v17030336.
The extensive genetic diversity of HIV-1 represents a major challenge to public health interventions, treatment, and successful vaccine design. This challenge is particularly pronounced in the Middle East and North Africa (MENA) region, where limited data among other barriers preclude the accurate characterization of HIV-1 genetic diversity. The objective of this review was to analyze studies conducted in the MENA region to delineate possible barriers that would hinder the accurate depiction of HIV-1 genetic diversity in this region. A systematic search of PubMed/MEDLINE and Google Scholar was conducted for published records on HIV-1 genetic diversity in the English language up until 1 October 2024 across 18 MENA countries. The pre-defined themes of challenges/barriers included limited sampling, data gaps, resource and infrastructure constraints, HIV-1-specific factors, and socio-cultural barriers. A total of 38 records were included in the final review, comprising original articles (55.3%), reviews (21.1%), and sequence notes (10.5%). Libya (15.8%), Morocco (13.2%), Saudi Arabia, and MENA as a whole (10.5% for each) were the primary sources of the included records. Of the 23 records with original MENA HIV-1 sequences, the median number of sequences was 46 (range: 6-193). The identified barriers included the following: (1) low sampling density; (2) limited clinical data (21.7% with no data, 60.9% partial data, and 17.4% with full data); (3) reliance solely on population sequencing and insufficient use of advanced sequencing technologies; (4) lack of comprehensive recombination analysis; and (5) socio-cultural barriers, including stigma with subsequent under-reporting among at-risk groups. The barriers identified in this review can hinder the ability to map the genetic diversity of HIV-1 in the MENA. Poor characterization of HIV-1's genetic diversity in the MENA would hinder efforts to optimize prevention strategies, monitor drug resistance, and develop MENA-specific treatment protocols. To overcome these challenges, investment in public health/research infrastructure, policy reforms to reduce stigma, and strengthened regional collaboration are recommended.
HIV-1广泛的基因多样性对公共卫生干预措施、治疗以及成功的疫苗设计构成了重大挑战。这一挑战在中东和北非（MENA）地区尤为突出，该地区数据有限以及其他障碍使得无法准确描述HIV-1的基因多样性。本综述的目的是分析在MENA地区开展的研究，以确定可能阻碍该地区准确描述HIV-1基因多样性的障碍。对PubMed/MEDLINE和谷歌学术进行了系统检索，以查找截至2024年10月1日在18个MENA国家以英文发表的关于HIV-1基因多样性的记录。预先定义的挑战/障碍主题包括采样有限、数据缺口、资源和基础设施限制、HIV-1特异性因素以及社会文化障碍。最终综述共纳入38条记录，包括原创文章（55.3%）、综述（21.1%）和序列注释（10.5%）。利比亚（15.8%）、摩洛哥（13.2%）、沙特阿拉伯以及整个MENA地区（各占10.5%）是纳入记录的主要来源。在23条包含MENA地区HIV-1原始序列的记录中，序列中位数为46条（范围：6 - 193条）。确定的障碍包括：（1）采样密度低；（2）临床数据有限（21.7%无数据，60.9%部分数据，17.4%完整数据）；（3）仅依赖群体测序且先进测序技术使用不足；（4）缺乏全面的重组分析；（5）社会文化障碍，包括污名化以及随后高危人群报告不足。本综述中确定的障碍可能会阻碍绘制MENA地区HIV-1基因多样性图谱的能力。对MENA地区HIV-1基因多样性的不良描述将阻碍优化预防策略、监测耐药性以及制定MENA地区特异性治疗方案的努力。为克服这些挑战，建议投资公共卫生/研究基础设施、进行政策改革以减少污名化并加强区域合作。
