High prevalence of acquired HIV drug resistance among gay and bisexual men on antiretroviral therapy in Surabaya, Indonesia: a call for routine genotypic surveillance

Introduction: HIV affects men who have sex with men (MSM) in a disproportionate way, especially in concentrated epidemics such as Indonesia. Surabaya carries the highest burden among MSM in the country. Yet, evidence on HIV-1 molecular epidemiology and drug resistance is scarce. Methods: A cross-sectional study involved 57 HIV-1–infected gay and bisexual men on antiretroviral therapy (ART) in Surabaya during 2022–2023. Blood samples were taken for HIV-1 pol gene amplification (protease and reverse transcriptase). Sanger sequencing produced subtype data through phylogenetic analysis and RIP. Drug resistance mutations (DRMs) were assessed with IAS-USA 2023 and Stanford HIVdb v10.0. Results: CRF01_AE dominated (82.0%), followed by subtype B (10.5%) and recombinants (7.5%). Sixteen participants had sequences that passed analysis. Five of them (31.3%, 95% CI: 11.8–58.7%) carried major DRMs: K65R (NRTI), K103N (NNRTI), and Q58E/V82A (PI). One case showed resistance to more than one drug class. Overall resistance rates surpassed both regional estimates and the WHO 10% benchmark. Conclusions: See the corresponding section at the end of the paper.