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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.
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; Arwa Omar Al-Khatib 2 ; Sabra, Tarneem 3 ; Al-Baidhani, Saja 3 ; Al-Mahzoum, Kholoud 4 ; Aleigailly, Maryam A 5
; Sallam, Mohammed 6
1 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; Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
2 Faculty of Pharmacy, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19111, Jordan
3 Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
4 Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Ministry of Health, Kuwait City 13001, Kuwait
5 Biomedical Engineering Department, College of Engineering, University of Warith Alanbiyaa, Karbala 56001, Iraq; Biomedical Engineering Department, College of Engineering, University of Kerbala, Karbala 56001, Iraq
6 Department of Pharmacy, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai P.O. Box 505004, United Arab Emirates;