The backend is usually non-negotiable legacy stuff in my experience, but you can add your own layer of business logic in node or python gluing all those other endpoints together.
I don't really care about the frontend frameworks used as long as they're truly frontend frameworks. That build should live its life as a folder of static html/css/js on a web server.
What I'm saying is that this was a solved problem a very long time ago going back to almost the beginning of the internet with CGI (as long as your output response from those scripts were xml or json). Any attempt to deviate from this architecture will be, as you say, a rat's nest. All forms of server side rendering are terrible.
The meaningful depths of full stack are past that gateway and can go all the way down to kernel modules if it has to, but it usually doesn't. Frontend is the surface and should stay on the surface. Javascript should not be used deeper than nodejs. Nodejs should not be used to render html. Nothing should render html on the backend. Who is this not obvious for? What year is it?
HTMX is a wrapper around old functionality pitched to devs that learned that frontend "really, really needs" all the complexity. It's being used by people who never needed all that complexity for tasks that didn't need a whole frontend stack.
Of course it fits them better than the alternative that they have heard about being the only modern way to build apps (a massive frontend stack where the framework isn't even a framework anymore so we built another framework around it).
The thing that htmx users often miss is that you can have most of those nice things without pulling in htmx, htmx is definitely not right for most use-cases, htmx itself is quite the large JS dependency (and you still need to write JS to use it properly), it's not "just hypermedia", and on and on.
Personally I think the solution-space that HTMX fits in is extremely narrow between normal HTML/CSS/JS and "fuller" frontend apps (hopefully built on lighter stacks than the current react meta).
Sure, you could do the basics of that workflow with twenty lines of your own JS, and save a dependency. But that's the kind of thing that is generally very unscalable, because unless you're very disciplined it quickly becomes a mass of spaghetti. The virtue of HTMX is more in how it channels and limits your code, than in the new capabilities it grants you (which were all in common use as of 2005 or whatever).