Speaker
Description
Introduction
Ongoing HIV transmission is a formidable public health challenge in Indonesia, where prevalence is 0.3% and persons with HIV (PWH) are distributed across >6,000 inhabited islands over 5,000 km. Incidence is likely substantial; we estimated c.10% of newly diagnosed PWH were recent infections (Wulan et al., 2023). To identify factors responsible for contemporary HIV spread, we analyzed CRF01_AE sequences from newly diagnosed and treatment-experienced PWH in the context of demographic and clinical data.
Methods
PWH enrolled in “HIV Infection and Risk Related Coinfections / Comorbidities Study in Indonesia” (PROACTIVE; N = 4,329) were recruited from 19 sites in 16 cities, with pol sequences (1,043 bp, HXB2 2253 – 3295) obtained from plasma. HIV subtypes and drug resistance mutations (DRMs) were identified (https://hivdb.stanford.edu/), and genetic relationships were characterized (Bayesian inference; BEAST) using GenBank-derived references, including curated pol sequences from Indonesia (N = 176) and elsewhere (N = 103). Recency was estimated (Wulan et al., 2023) and clinical/demographic information was obtained from protocol records.
Results
We studied 59 treatment-experienced and 19 newly-diagnosed PWH (N = 78; 37.2% female, median age 28 years (IQR1;3 = 23; 35.75)). Suspected transmission modes were MSM (26.9%), heterosexual (53.8%), perinatal (16.7%), and IDU (1.3%). DRMs were found in 94.9% of treatment-experienced PWH. Common NRTI resistance mutations included M184I/V (88.1%), K219Q/E and D67N (20.3% each), and tenofovir (TDF)-associated K65R (19.6%). NNRTI DRMs were common: Y181C/I, K103N, and G190A/S (40.7%, 30.5%, 28.8%). No DRMs were found in newly diagnosed PWH, including 6 recent infections. Bayesian inference identified groups (posterior probability ≥0.95) with diverse members, including individuals with chronic and recent infections, those with DRMs, and members located 2,000-3,000 km apart.
Conclusion
CRF01_AE spread is not geographically restricted within the large Indonesian archipelago. We found a substantial proportion of K65R in TDF-treated PWH.
Keywords: CRF01_AE, DRMs, transmission, Indonesia
