Prevalence of HIV Infection and Resistance Mutations in Patients Hospitalized for Febrile Illness in Indonesia

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  • 1 Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia;
  • | 2 National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia;
  • | 3 Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia;
  • | 4 Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia;
  • | 5 Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia;
  • | 6 Department of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia;
  • | 7 National Cancer Institute, National Institutes of Health, Bethesda, Maryland;
  • | 8 National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;
  • | 9 Faculty of Medicine, Universitas Hasanudin, Makassar, Indonesia;
  • | 10 Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia;
  • | 11 Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia;
  • | 12 Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia;
  • | 13 Sulianti Saroso, Infectious Disease Hospital, Jakarta, Indonesia

HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know their status. In a prospective cohort of 1,453 hospitalized patients with unexplained fever, 46 (3.2%) had HIV, including 15 (1.1%) patients without a prior HIV diagnosis. Among 31 subjects previously known to have HIV, 21 (68%) had been receiving combination antiretroviral therapy (cART) at the time of enrollment. Of 39 HIV cases with HIV RNA levels ≥ 100 copies/mL, sequencing for genotype analysis and resistance testing was successful in 30 (77%) subjects. The most common HIV subtypes were AE (90%) and B (10%). Five (16.7%) subjects had resistance mutations to nucleoside and non-nucleoside reverse transcriptase inhibitors, and all of them were on cART. No evidence of transmitted drug resistance was found in newly diagnosed individuals. Hospital-based screening may be an efficient method to expand HIV testing and identify a significant number of new cases. Access to care, close monitoring, expansion of anti-retroviral options, and ensuring availability of CD4 determinations, viral load testing, and genotyping are crucial to control of the epidemic in Indonesia.

Author Notes

Address correspondence to Herman Kosasih, Indonesia Research Partnership on Infections Disease, Jalan Percetakan Negara No. 29, Jakarta, Indonesia 10560. E-mail: hkosasih@ina-respond.net

These authors contributed equally to this work.

Financial support: This work was supported by the Ministry of Health of the Republic of Indonesia, the National Institute of Health Research and Development, Badan Litbangkes, Indonesia. This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract Nos. HHSN261200800001E and HHSN261201500003I. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors’ addresses: Tuti P. Merati, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia, E-mail: tutiparwati@yahoo.com. Muhammad Karyana and Dona Arlinda, National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia, and Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia, E-mails: mkaryana@gmail.com and arlindona1@gmail.com. Emiliana Tjitra, National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia, E-mail: etjitra@yahoo.com. Herman Kosasih, Nurhayati Lukman, and Wahyu Nawang Wulan, Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia, E-mails: hkosasih@ina-respond.net, unurhayati@ina-respond.net, and wwahyunawang@gmail.com. Abu T. Aman, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, E-mail: atholib04@yahoo.com. Bachti Alisjahbana, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, E-mail: b.alisjahbana@gmail.com. Dewi Lokida, Department of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia, and Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia, E-mail: lokidadewi@yahoo.com. Frank Maldarelli and Chuen-Yen Lau, National Cancer Institute, National Institutes of Health, Bethesda, MD, E-mails: fmalli@mail.nih.gov and chuen-yen.lau@nih.gov. Aaron Neal, H. Clifford Lane, and Sophia Siddiqui, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, E-mails: aaron.neal@nih.gov, clane@niaid.nih.gov, and ssiddiqui@niaid.nih.gov. Mansyur Arif, Faculty of Medicine, Universitas Hasanudin, Makassar, Indonesia, E-mail: mansyurarif64@gmail.com. Muhammad Hussein Gasem, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, E-mail: mhgasem@gmail.com. Pratiwi Sudarmono, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, E-mail: psdrmn@yahoo.com. Usman Hadi, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, E-mail: usmanhadi@sby.centrin.net.id. Vivi Lisdawati, Sulianti Saroso, Infectious Disease Hospital, Jakarta, Indonesia, E-mail: viandrashakti@gmail.com.

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