Siti Qamariyah Khairunisa, Siti Qamariyah Khairunisa and Ni Luh Ayu Megasari, Ni Luh Ayu Megasari and Retno Pudji Rahay, Retno Pudji Rahayu and Adiana Mutamsari Witaningrum, Adiana Mutamsari Witaningrum and Shuhei Ueda, Shuhei Ueda and Muhammad Qushai Yunifiar M, Muhammad Qushai Yunifiar M and Dwi Wahyu Indriati, Dwi Wahyu Indriati and Tomohiro Kotak, Tomohiro Kotak and Adria Rusli, Adria Rusli and Nasronudin, Nasronudin and Masanori Kameoka, Masanori Kameoka (2020) Detection of human immunodeficiency virus type 1 transmitted drug resistance among treatment-naive individuals residing in Jakarta, Indonesia. Infectious Disease Reports, 12 (1). ISSN 20367449

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Abstract

The presence of transmitted drug resistance (TDR) in human immunodeficiency virus type 1 (HIV-1) infected individuals naive to antiretroviral therapy, may affect the effectiveness of treatment. Jakarta, the capital city of Indonesia, recorded the highest number of cumulative HIV infection cases in the country. This study aimed to identify on the appearance of TDR, as well as to identify HIV-1 subtypes circulating among treatment-naive individuals in Jakarta. Whole blood samples collected from 43 HIV-1 infected, treatment-naïve individuals. Viral subtyping and drug resistance testing were performed on HIV-1 pol genes amplified using nested polymerase chain reaction. CRF01_AE was detected most frequently in Jakarta (73.08%). Drug resistance-related major mutation was not detected in protease fragments of pol gene, but two major mutations, K103N (6.67%) and Y181C (6.67%), were detected in reverse transcriptase fragments of pol gene. Our results suggest that TDR was emerged in Jakarta at a certain extent, thus further surveillance study to monitor the TDR prevalence and circulating HIV-1 subtypes in this region is considered to be necessary. Introduction Indonesia reported increasing cases of human immunodeficiency virus (HIV) infections each year. The country recorded 280,623 cumulative cases of HIV infection in 2017, with 48,300 new cases among them.1Indonesia contributed to 18% of new HIV infection and 23% acquired immune deficiency syndrome (AIDS)-related deaths in Asia and the Pacific.2 Jakarta, the capital city of Indonesia, has the highest number of cumulative HIV-infection cases in the country. The city recorded a total of 51,981 HIV cases, with 9,215 AIDS cases.1 As many other countries, HIV infection in Indonesia is mainly caused by HIV type 1 (HIV-1) group M. There are nine subtypes (A, B, C, D, F, G, H, J, and K), as well as circulating recombinant forms (CRFs) and unique recombinant forms (URFs), within the group M.3 Several studies have reported the dominance of HIV-1 CRF01_AE in several Indonesian regions.4–10 As an effort to address the HIV epidemic, Ministry of Health of Indonesia implemented antiretroviral therapy (ART) under national guideline. First-line ART regimen recommended contains two nucleoside reverse transcriptase (RT) inhibitors (NRTIs) and one non-nucleoside RT inhibitor (NNRTI). Zidovudine (AZT), lamivudine (3TC), tenofovir (TDF), and emtricitabine (FTC) are commonly used NRTI in Indonesia, while nevirapine (NVP) and efavirenz (EFV) are commonly used NNRTI. For HIV-1-infected individuals suffering treatment failure despite high adherence to ART, second-line regimen employing two NRTIs and one ritonavirboosted protease (PR) inhibitor (PI) is recommended.11 ART strongly suppresses viral replication and maintain a healthy condition of infected individuals on ART; however, the presence of drug resistant viruses might compromise treatment success.12 The emergence of acquired drug resistance (ADR) in treatment-experienced individuals and transmitted drug resistance (TDR) in treatment-naive individuals residing in several Indonesian regions, including Surabaya, Riau, Bali, and Maumere, has been previously described.5–10 The TDR might disrupt effectiveness of treatment, resulting in unfavorable clinical outcomes.13 Therefore, it is important to monitor the emergence of TDR by a continuous surveillance in order to secure long-term and stable ART in Indonesia. The United Nations Development Program recently categorized Indonesia as a lower middle-income country.14 In such low- and middle-income countries, the emergence of TDR would likely hamper efficient ART since drug resistance testing for TDR monitoring is generally not widely available at clinical sites.15 It is aimed to identify the presence of HIV-1 TDR among treatment-naive individuals residing in Jakarta, Indonesia, and also to clarify the currently circulating HIV-1 subtype/CRFs in the region.

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