Prevalence of HIV infection and resistance mutations in patients hospitalized for febrile illness in 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. © 2021 by The American Society of Tropical Medicine and Hygiene