Abstract
Introduction: HIV eradication and remission research has largely taken place in high-income countries. In low- and middle-income countries (LMIC), there may be factors that have a substantial impact on the size of the latent HIV reservoir and the immunological response to infection. If a curative strategy is to be available to all HIV-infected individuals, these factors must be understood.Methods: We use a scoping review to examine the literature on biological factors that may have an impact on HIV persistence in LMIC. Three databases were searched without date restrictions.Results: Uncontrolled viral replication and higher coinfection prevalence may alter the immunological milieu of individuals in LMIC and increase the size of the HIV reservoir. Differences in HIV subtype could also influence the measurement and size of the HIV reservoir. Immune activation may differ due to late presentation to care, presence of chronic infections, increased gut translocation of bacterial products and poor nutrition.Conclusions: Research on HIV remission is urgently needed in LMIC. Research into chronic immune activation in resource poor environments, the immune response to infection, the mechanisms of HIV persistence and latency in different viral clades and the effect of the microbiological milieu must be performed. Geographic differences, which may be substantial and may delay access to curative strategies, should be identified.
Highlights
HIV eradication and remission research has largely taken place in high-income countries
In 2015, there were an estimated 36 million people living with HIV (PLHIV), most of whom live in low- and middleincome countries (LMIC)
We searched the following databases: MEDLINE (OVID interface, 1946 onwards), EMBASE (OVID interface, 1947 onwards) and the Cochrane Library. We reviewed this literature to explore biological differences between resource rich and LMIC, focusing on potential differences in the HIV reservoir
Summary
Access to antiretroviral therapy (ART) has improved the lives of millions affected by HIV, but HIV remains incurable. There are important differences in viral strains, HIV-infected populations and the clinical context between resource-rich settings and LMIC. These differences are poorly understood and may be an important barrier to successfully achieving sustained remission or eradication. The size of the pool of latently infected cells, the immune response and viral factors associated with different HIV subtypes may all be important. Factors affecting the reservoir size have not entirely been elucidated, but in LMIC, late presentation to care, the presence of chronic infections causing immune activation and chronic inflammation, increased gut translocation of specific bacterial products and poor nutrition which attenuates the response to infections may be important determinants of the size of the HIV reservoir and may be different in resourcerich and resource-limited environments
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