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OUTLINE

PREVALENCE OF MDR-TB AMONGST PATIENTS WITH HIV AND TB CO-INFECTION SEEN AT THE DOTS CLINIC OF N.I.M.R., LAGOS, NIGERIA.

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OUTLINE

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  1. PREVALENCE OF MDR-TB AMONGST PATIENTS WITH HIV AND TB CO-INFECTION SEEN AT THE DOTS CLINIC OF N.I.M.R., LAGOS, NIGERIA. Enya V.N.V, Onubogu C.C., Wahab M.O., Efere L.O., Motayo B.O., Nwadike P.O., Onyejepu N., Nwokoye N.N., Kunle-ope C.N., Raheem T.Y., Igbasi U.T., Tochukwu C.E., Ejezie C.E., Omoloye R.M., and Idigbe E.O. Nigerian Institute of Medical Research (NIMR) Lagos, Nigeria.

  2. OUTLINE • Background • Aim of study • Objectives • Methodology • Results • Discussion • Conclusions • Recommendations

  3. BACKGROUND • The global HIV infection epidemic has caused explosive increases in MDR-TB{ Mycobacterium tuberculosis strain developing resistant to both RIF and INH} (Wells et al, 2007) • Estimated MDR-TB prevalence in Nigeria is 1.9% among new cases and 9.3% among previously treated cases (WHO, 2008) • Nigeria has about 21% of reported HIV-associated TB cases worldwide (WHO, 2008) • Key element in the management of MDR-TB is early diagnosis and institution of appropriate treatment regimen (O’Riordanet al, 2008) • WHO recommends the use of Line Probe Assays (LPAs) for rapid screening of MDR-TB in low and medium income settings (WHO, 2008) • Hain Line-Probe Assay (GenoType®MTBDRplus) showed high sensitivity and specificity in detection of MDR-TB among HIV-TB co-infected Nigerians (Onubogu et al,2011 in press)

  4. Aim of study • To determine the prevalence of MDR-TB among HIV-TB co-infected patients using Hain Line-Probe Assay (GenoType®MTBDRplus)

  5. OBJECTIVES OF THE STUDY • To diagnose MTB-Complex directly from Sputum Smear-Positive specimens of HIV- TB co-infected Nigerians • To determine prevalence of rifampicin mono- resistant and isonoazid mono- resistant cases among HIV- TB co-infected Nigerians • To determine the prevalence of MDR-TB among HIV- TB co-infected Nigerians

  6. METHODOLOGY • Study Site: • DOTS Clinic of NIMR, Lagos, Nigeria • Study type: Cross sectional • Study Period: January to November 2009 • Study Population: • 169 HIV Patients who were diagnosed to have TB • Inclusion Criteria: • Consenting patients • Ability to produce 3 sputum samples • Patients who were sputum smear- positive

  7. Methodology….2 • Exclusion criteria: • Patients who were HIV negative • Patients who were sputum smear-negative for TB • Ethical approval was obtained from NIMR Institutional Review Board • Laboratory diagnosis: • Sputum Specimens were examined for AFB using Ziel-Neelsen Method (NTBLCP) • The sputum samples were graded by direct smear microscopy ( IUATLD) • Rapid Drug Resistance Testing for RIF mono -resistance, INH mono-resistance and MDR-TB was performed according to the manufacturer’s instructions (Hain LifescienceGenotype®MTBDRplusTM version1.0 product insert) • Data analysis: • SPSS version 15.0 statistical software was used • Results were considered significant at P< 0.05

  8. RESULTS • A total of 169 persons made up of 72(42.6%) females and 97 males were recruited into the study. They have mean age of 34±9.99 years • 165 (97.6%) were positive for MTB-Complex (HIV-TB co-infected) and 4 (2.4%) were negative by GenoType®MTBDRplus • New cases: patients who have not received anti-TB treatment for up to 1 month were 126 (76.4%) • Old cases: patients who have received anti TB treatment for >1 month were 39 (23.6%) • Sensitive to both RIF and INH 121 (73.3%) • Resistance to one or more dugs was 44 (26.7%) • RIF mono -resistance was 29 (17.5%) • INH mono -resistance was 6 (3.6%) • MDR-TB was 9 (5.5%)

  9. FIG.1: AGE DISTRIBUTION OF HIV-TB CO-INFECTED PATIENTS

  10. FIG.2 : SEX DISTRIBUTION OF HIV-TB CO-INFECTED PATIENTS

  11. TABLE 1: DRUG RESISTANCE AMONG HIV-TB CO-INFECTED PATIENTS

  12. DISCUSSION • We found 26.7% of HIV-TB co-infected patients resistant to one or more anti-TB drugs, which is comparable to 26.9% reported in Cameroun by Kuabanet al, 2000 • Our result showed MDR-TB prevalence of 5.5% among HIV-TB co-infected Nigerians. This is lower than 14.2% reported in India by Rajasekaranet al,2009 • Vanacoreet al,2004 from Italy reported prevalence rates of drug resistance and MDR as 14.5% and 2.6% respectively among new cases; but we recorded higher values of 18.3% and 5.6% respectively • Our findings showed drug resistance and MDR of 30.8% and 5.1% respectively for previously treated patients but Vanacoreet al, 2004 in Italy found 30.4% and 12.5% respectively

  13. CONCLUSIONS/ RECOMMENDATIONS • The prevalence of MDR-TB among HIV and TB co-infected patients is documented. This strongly highlights the need for the national strategies for surveillance and effective clinical management of MDR-TB cases in Nigeria • Although we recorded the prevalence of MDR-TB as 5.5% among HIV-TB co-infected Nigerians , 73.3% of them were sensitive to both RIF and INH, the two most import anti-TB first line drugs • GenoType®MTBDRpluswas able detect MDR-TB in HIV-TB co-infected Nigerians which is ordinarily difficult and should be used for rapid screening of MDR-TB in Nigeriato achieve early detection and treatment with appropriate drug regimen

  14. THANK YOU

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