Background: the global scale-p of antiretroviral therapy (ART) is the primary factor contributing to the decline in deaths from acquired immune deficiency syndrome (AIDS)-related illnesses. However, the emergence of transmitted drug resistance (TDR) compromises the effects of ART in treatment-naive individuals, which may hinder treatment success. The present study aimed to identify the presence of TDR among treatment-naive individuals in Buleleng, Bali, which is currently ranked sixth among Indonesian provinces with the highest cumulative human immunodeficiency virus type 1 (HIV-1) infection cases. Methods: thirty-nine ART-naive individuals in Buleleng Regency General Hospital were enrolled in the present study. Blood samples from participants were subjected to a genotypic analysis. Results: 28 protease (PR) and 30 reverse transcriptase (RT) genes were successfully amplified and sequenced from 37 samples. HIV-1 subtyping revealed CRF01_AE as the dominant circulating recombinant form in the region. No TDR for PR inhibitors was detected; however, TDR for RT inhibitors was identified in five out of 30 samples (16.7%). Conclusion: these results indicate the emergence of TDR among ART-naive individuals in Buleleng, Bali. This issue warrants serious consideration because TDR may hamper treatment success and reduce ART efficacy among newly diagnosed individuals. Continuous surveillance with a larger sample size is necessary to monitor TDR among ART-naive individuals.

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Latar belakang: peningkatan cakupan terapi antiretroviral (ART) merupakan penyebab utama penurunan mortalitas akibat faktor terkait acquired immune deficiency syndrome (AIDS). Akan tetapi, timbulnya transmitted drug resistance (TDR) mempersempit pilihan ART yang efektif bagi individu yang belum pernah memperoleh terapi (ART-naive), yang mana dapat menghambat kesuksesan terapi. Bali menempati peringkat ke-enam sebagai provinsi di Indonesia dengan jumlah kasus kumulatif infeksi HIV tertinggi. Tujuan penelitian ini untuk mengidentifikasi adanya TDR pada individu ART-naive di Kabupaten Buleleng, Bali.

Metode: tiga puluh sembilan individu ART-naive berpartisipasi dalam studi ini. Analisis genotipik dilakukan terhadap sampel darah yang diperoleh dari partisipan.

Hasil: 28 gen protease (PR) dan 30 gen reverse transcriptase (RT) dari 37 sampel berhasil dianalisis. Subtyping menunjukkan CRF01_AE sebagai circulating recombinant yang paling dominan di Kabupaten Buleleng, Bali. TDR terhadap inhibitor PR tidak ditemukan, akan tetapi TDR terhadap inhibitor RT teridentifikasi pada lima dari 30 individu (16,7%).

Kesimpulan: adanya TDR pada individu ART-naive di Kabupaten Buleleng, Bali, perlu diperhatikan karena dapat menghambat keberhasilan terapi dan mempersempit pilihan terapi yang efektif. Surveilans berkesinambungan perlu dilakukan untuk monitoring TDR pada individu ART-naive.