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.

中文翻译：

---

解决中低收入国家的艾滋病毒治疗问题

尽管经过多年的抗逆转录病毒治疗（ART），由于形成了稳定且长寿命的潜伏病毒库，HIV-1在感染者体内仍然持续存在。早期 ART 可以减少潜伏病毒库，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也不可避免地导致血浆病毒血症反弹，因此需要终身治疗病毒抑制。由于全球数百万感染者难以持续终生治疗，因此毫无疑问需要治愈。这需要深入了解储层形成和动力学。低收入和中等收入国家（LMIC）与高收入国家之间在治疗指南、治疗可及性以及社会耻辱方面存在差异。此外，来自不同地理区域的感染者存在人口统计学差异，例如感染病毒亚型和宿主遗传学，这可能导致不同人群之间病毒库的差异。在此，我们回顾了与中低收入国家 HIV-1 治愈研究相关的主题，重点关注撒哈拉以南非洲地区，该地区是世界上 HIV-1 负担最重的地区。我们对中低收入国家的 ART 进行了总结，强调了在实施 HIV-1 治愈疗法时可能遇到的挑战。此外，我们还讨论了当前关于不同人群中 HIV-1 潜伏病毒库的研究，重点介绍了中低收入国家的研究以及可能促进全球治愈的研究空白。最后，我们讨论了当前的实验治疗策略在中低收入国家的潜在应用。