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Title: Genetic Determinants of Drug-Resistant Tuberculosis among HIV-Infected patients in Nigeria
Authors: Dinic, Lana
Akande, Patrick
Idigbe, Emmanuel Oni
Ani, Agatha
Onwujekwe, Dan
Agbaji, Oche
Akanbi, Maxwell
Rita, Nwosu
Adeniyi, Bukola
Wahab, Maureen
Lekuk, Chindak
Kunle-Ope, Chioma
Nwokoye, Nkiru
Kanki, Phyllis
Issue Date: 14-Jun-2012
Publisher: Journal of Clinical Microbiology
Series/Report no.: Vol.50;No.9;Pp 2905-2909
Abstract: Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients and the emergence of drug-resistant tuberculosis (DR-TB) is a growing problem in resource-limited settings. Adequate infrastruc- ture for testing drug sensitivity and sufficient evidence of first-line resistance are currently unavailable in Nigeria. We collected sputum samples from HIV-infected patients enrolled in the Harvard PEPFAR/APIN Plus program over 12 months at two PEPFAR antiretroviral therapy (ART) clinics in the southwest and north central regions in Nigeria. Smear-positive sputum sam- ples were submitted for GenoType MTBDRplus testing ( n 415); mutations were confirmed through sequencing. Our results show high rates of DR-TB in Nigerian HIV-infected individuals (7.0% for rifampin [RIF] and 9.3% for RIF or isoniazid [INH]). Total RIF resistance indicative of MDR-TB in treatment-naive patients was 5.52%, far exceeding the World Health Organization predictions (0 to 4.3%). RIF resistance was found in 6/213 (2.8%) cases, INH resistance was found in 3/215 (1.4%) cases, and MDR-TB was found in 8/223 (3.6%) cases. We found significantly different amounts of DR-TB by location (18.18% in the south of the country versus 3.91% in the north central region [ P < 0.01]). Furthermore, RIF resistance was genetically distinct, sug- gesting possible location-specific strains are responsible for the transmission of drug resistance ( P < 0.04). Finally, GenoType MTBDRplus correctly identified the drug-resistant samples compared to sequencing in 96.8% of cases. We found that total DR-TB in HIV-infection is high and that transmission of drug-resistant TB in HIV-infected patients in Nigeria is higher than predicted.
URI: http://hdl.handle.net/123456789/324
Appears in Collections:Medicine

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