Genetic Determinants of Drug-Resistant Tuberculosis among HIV-Infected Patients in Nigeria
| Autor: | Agatha Ani, Phyllis J. Kanki, E O Idigbe, Rita Nwosu, Chindak Lekuk, Bukola Adeniyi, Chioma Kunle-Ope, Maureen Wahab, Dan I Onwujekwe, Lana Dinic, Oche Agbaji, Maxwell O. Akanbi, N N Nwokoye, Patrick Akande |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Microbiology (medical)
Adult DNA Bacterial Male Tuberculosis Genotype Opportunistic infection Epidemiology Antitubercular Agents Nigeria HIV Infections Drug resistance Mycobacterium tuberculosis Drug Resistance Bacterial Tuberculosis Multidrug-Resistant medicine Humans biology Transmission (medicine) business.industry Isoniazid Sputum medicine.disease biology.organism_classification Virology Molecular Diagnostic Techniques Genes Bacterial Female medicine.symptom business medicine.drug |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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