Genotypic Characterization of Human Immunodeficiency Virus Type 1 Isolated from Antiretroviral Treatment-Experienced Individuals in Buleleng Regency, Bali, Indonesia.

Bali, the first province to report a case of HIV in 1987, was placed sixth among Indonesian provinces with the highest cumulative number of HIV cases in 2017. As a popular tourist destination, the spread of genetic variants of HIV through international travel may become a cause for concern in Bali. Tourism is mostly concentrated in south Bali; thus, HIV in less popular regions in north Bali, such as Buleleng Regency, may have viral characteristics different from that in south Bali. Forty-three protease (PR), 40 reverse transcriptase (RT), 27 gag, and 23 env genes were sequenced from 48 samples derived from antiretroviral treatment-experienced individuals. Subtyping revealed CRF01_AE as the dominant circulating recombinant form of HIV-1 in north Bali. Although no major mutation was detected in PR genes, several major mutations were identified in 4 out of the 40 RT genes (10%), indicating the emergence of HIV-1 drug resistance in this region.