Genetic Determinants of Drug-Resistant Tuberculosis among HIV-Infected Patients in Nigeria

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Genetic Determinants of Drug-Resistant Tuberculosis among HIV-Infected Patients in Nigeria

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Title: Genetic Determinants of Drug-Resistant Tuberculosis among HIV-Infected Patients in Nigeria
Author: Dinic, L; Akande, P.; Idigbe, E. O.; Ani, A.; Onwujekwe, D.; Agbaji, O.; Akanbi, M.; Nwosu, R.; Adeniyi, B.; Wahab, M.; Lekuk, C.; Kunle-Ope, C.; Nwokoye, N.; Kanki, Phyllis Jean

Note: Order does not necessarily reflect citation order of authors.

Citation: Dinic, L., P. Akande, E. O. Idigbe, A. Ani, D. Onwujekwe, O. Agbaji, M. Akanbi, et al. 2012. “Genetic Determinants of Drug-Resistant Tuberculosis Among HIV-Infected Patients in Nigeria.” Journal of Clinical Microbiology 50 (9) (June 27): 2905–2909. doi:10.1128/jcm.00982-12.
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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 infrastructure 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 samples 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, suggesting 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.
Published Version: doi:10.1128/JCM.00982-12
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Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:26878273
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