title: Barriers to a cure for HIV in women.
abstract: BACKGROUND
  Distinct biological factors exist that affect the natural history of HIV and the host immune response between women and men. These differences must be addressed to permit the optimal design of effective HIV eradication strategies for much of the HIV-positive population.
  
  
  RESULTS
  Here, we review the literature on sex-based differences in HIV pathogenesis and natural history in tissues and anatomic compartments, HIV latency and transcriptional activity, and host immunity including the role of sex hormones. We then outline the potential effects of these differences on HIV persistence, and on the safety and efficacy of HIV eradication and curative interventions. Finally, we discuss the next steps necessary to elucidate these factors to achieve a cure for HIV, taking in account the complex ethical issues and the regulatory landscape in the hopes of stimulating further research and awareness in these areas.
  
  
  CONCLUSIONS
  Targeted enrollment of women in clinical trials and careful sex-based analysis will be crucial to gain further insights into sex-based differences in HIV persistence and to design sex-specific approaches to HIV eradication, if required.
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Gianella
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Athe
authors.initials: A
authors.lastname: Tsibris
authors.affiliation: AIDS Clinical Trials Group Community Scientific Subcommittee, Madison, Wisconsin, USA.
authors.forename: Liz
authors.initials: L
authors.lastname: Barr
authors.affiliation: Division of AIDS, National Institutes of Health, Bethesda, MD, USA; cgodfrey@niaid.nih.gov.
authors.forename: Catherine
authors.initials: C
authors.lastname: Godfrey
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D005836:Genitalia, Female / Q000276:immunology; D012739:Gonadal Steroid Hormones / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D006801:Humans; D008297:Male; D012727:Sex Characteristics; D017735:Virus Latency
chemical_list: D019380:Anti-HIV Agents; D012739:Gonadal Steroid Hormones
keywords: HIV cure; HIV eradication; anatomic compartments; female genital tract; immune system; women's health