Box 2.

Engaging Resource-Limited Countries in HIV Cure Research

Although the majority of people living with HIV reside in resource-limited settings (RLS), very few trials on long-term HIV remission are currently ongoing or planned in these countries. Indeed, among the trial categories of latency-reversing agents, therapeutic vaccines, gene therapy, and broadly neutralizing antibodies for HIV cure, only one is currently ongoing in RLS.53 The roundtable discussion on “Preparedness for HIV Cure in Resource-Limited Settings”* addressed some of the specific issues related to RLS that must be taken into consideration. The panelists discussed how the responses and complication to interventions in RLS may be different from those in high-income settings and may be affected by specific host and environment factors, different HIV clades, and comorbidities. The scientific objective of limiting the seeding of the HIV reservoir may be addressed by early diagnosis, early treatment, and ensuring that patients remain virally suppressed. Although this approach may be technically possible, each of the above steps also represents a challenge in RLS. Nevertheless, although some of the HIV cure clinical approaches (e.g., gene therapy, stem cell transplantation) are difficult to transpose to RLS at present, other strategies such as treatment in early and acute HIV infection and pediatric studies remain feasible. Finally, the panelists also stressed the need for more social research and cost-effectiveness analysis in these settings.

^*The panelists of the “Preparedness for HIV Cure in Resource-Limited Settings” were Paula Munderi (MRC/UVRI Uganda Research Unit on AIDS, Uganda) (Chair), Jintanat Ananworanich (U.S. Military HIV Research Program, United States), Robert Murphy (Northwestern University, United States), and Joseph Tucker (University of North Carolina Project-China, China).