Genotypic characterization of human immunodeficiency virus type 1 isolated in Bali, Indonesia in 2016

Introduction
Bali is a famous tourism destination in Indonesia, and many international travelers from several foreign countries visit Bali. A large number of human immunodeficiency type 1 (HIV-1) infections was found; however, the genotypes of HIV-1 strains circulating in Bali has not yet been elucidated in detail. In addition, the information on HIV drug resistance (HIVDR) in Bali is limited.

Material and methods
HIV-1 pol gene encoding 31 proteases (PR gene) and 37 reverse transcriptase (RT gene) as well as 47 gag and 33 env genes were successfully amplified from DNA samples extracted from peripheral blood mononuclear cells samples of 51 antiretroviral therapy (ART)-experienced and 7 ART-naïve HIV-1-infected individuals residing in Gianyar and Denpasar, Bali. Genotyping analyses were then performed. The assessment of drug resistance mutations was based on the guidelines published by the International Antiviral Society-United States of America (IAS-USA).

Results
The major HIV-1 subtype detected in this study was CRF01_AE (94.5%). Recombinant viruses containing CRF01_AE and subtype B genes (5.5%) were also detected. Drug resistance-associated major mutations were detected in 8/31 (25.8%) of RT genes but not in PR genes in integrated proviral DNA derived from ART-experienced individuals. However, drug resistance-associated minor mutations were frequently detected in PR genes derived from most samples.

Conclusions
This study revealed that CRF01_AE was the predominant HIV-1 subtype in Bali, Indonesia. In addition, the emergence of drug resistance mutations was evident in proviral DNA derived from ART-experienced individuals, indicating that continuous surveillance is needed in order to monitor the emergence of HIVDR and new viral subtypes in Indonesia.