Epidemiological, Therapeutic, and Molecular Challenges of HIV in the Central African Republic: A Literature Review

Abstract

Background: Human immunodeficiency virus (HIV) remains a major public health challenge in sub-Saharan Africa. The Central African Republic (CAR) is characterized by a generalized epidemic with persistently high prevalence, ongoing transmission, and significant structural health system constraints. Despite progress in antiretroviral therapy (ART) scale-up, important gaps persist in early diagnosis, retention in care, and virological suppression. Methods: This study is an analytical literature review based on secondary data from institutional reports and recent peer-reviewed publications (2021–2024), including UNAIDS reports, the National HIV/AIDS Strategic Plan, and articles indexed in PubMed, PubMed Central, and PLOS ONE. A qualitative thematic analysis was conducted to synthesize epidemiological, therapeutic, virological, and programmatic evidence related to HIV in the Central African Republic. Results: The evidence indicates that HIV remains highly prevalent in CAR, with sustained transmission and suboptimal progress toward the 95–95–95 targets, particularly in relation to viral suppression. Although antiretroviral therapy coverage has improved, retention in care remains a major challenge, with frequent loss to follow-up. The introduction of Dolutegravir (DTG)-based regimens has improved treatment efficacy and simplified therapeutic management; however, its impact is limited by logistical constraints and insufficient access to viral load monitoring. Molecular data highlight substantial HIV genetic diversity, including the circulation of HIV-1 group O, HIV-2, and multiple subtypes, as well as frequent HIV–hepatitis B virus co-infections. Virological failure remains particularly concerning in pediatric populations, mainly due to poor adherence and structural barriers. In addition, HIV testing remains predominantly serological, limiting early detection of acute infections, while genomic surveillance and bioinformatics capacity remain underdeveloped. Conclusion: HIV in the Central African Republic remains a complex and evolving epidemic driven by epidemiological, therapeutic, and structural challenges. Strengthening early diagnosis, improving retention in care, expanding access to viral load monitoring, and enhancing molecular and genomic surveillance capacities are essential to improving long-term epidemic control.