Ias 2011 Presentation

8/10/2019 Ias 2011 Presentation

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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., TochukwuC.E., Ejezie C.E., Omoloye R.M., and Idigbe E.O.

Nigerian Institute of Medical Research (NIMR) Lagos,Nigeria.


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OUTLINE

Background

Aim of study

Objectives

Methodology

Results

Discussion

Conclusions

Recommendations


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BACKGROUND

The global HIV infection epidemic has caused explosive increasesin MDR-TB{ Mycobacterium tuberculosis strain developingresistant 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 andinstitution of appropriate treatment regimen (ORiordanet al, 2008)

WHO recommends the use of Line Probe Assays (LPAs) for rapidscreening of MDR-TB in low and medium income settings (WHO,2008)

Hain Line-Probe Assay (GenoTypeMTBDRplus) showed highsensitivity and specificity in detection of MDR-TB among HIV-TB

co-infected Nigerians (Onuboguet al,2011 in press)


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Aim of study

To determine the prevalence of MDR-TB among HIV-TB co-

infected patients using Hain Line-Probe Assay

(GenoTypeMTBDRplus)


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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


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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


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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 manufacturersinstructions (Hain Lifescience GenotypeMTBDR plusTMversion1.0 productinsert)

Data analysis:

SPSS version 15.0 statistical software was used

Results were considered significant at P< 0.05


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RESULTS

A total of 169 persons made up of 72(42.6%) females and 97 maleswere recruited into the study. They have mean age of 349.99 years

165 (97.6%) were positive for MTB-Complex (HIV-TB co-infected)and 4 (2.4%) were negative by GenoTypeMTBDRplus

New cases: patients who have not received anti-TB treatment for up to1 month were 126 (76.4%)

Old cases: patients who have received anti TB treatment for >1 monthwere 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%)


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FIG.1: AGE DISTRIBUTION OF HIV-TB

CO-INFECTED PATIENTS

5.3

34.936.7

14.8

5.9

0.0 1.2 0.6 0.6 0.00

5

10

15

20

25

30

35

40

10 - 20 21 - 30 31 - 40 40 - 50 50+

Percentage(%)

Age(years)

MTB

N-MTB

P=0.896(>0.05)


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FIG.2 : SEX DISTRIBUTION OF HIV-TB

CO-INFECTED PATIENTS

55.6

42.0

1.8 0.60

10

20

30

40

50

60

MALE FEMALE

Percentage(%

)

Sex

MTB

N-MTB

P=0.471(>0.05)


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TABLE 1: DRUG RESISTANCE AMONG HIV-TB

CO-INFECTED PATIENTSM D R - T B

Y N

RIF MONO-RES

Y N

INH MONO-RES

Y NAge (yrs)

10-20

21-30

31-40

41-5050+

0 (0.0%) 9 (100%)

4 (6.8%) 55 (93.2%)

2(3.2%) 60(96.8%)

2(8.0%) 23(92.0%)1(10.0%) 9(90.0%)

P = 0.925

1(11.1%) 8(88.9%)

7(11.9%) 52(88.1%)

11 (17.7%) 51(82.3%)

9(36.0%) 16(64.0%)1(10.0%) 9(90.0%)

P = 0.355

0 (0.0%) 9(100)

2 (3.4%) 57(96.6%)

3(4.8%) 59(95.2%)

1(4.0%) 24(96.0%)0(0.0%) 10(100%)

P = 0.978

Sex:

Male

Female

7(7.4%) 87(92.6%)

2(2.8%) 69(97.2%)P = 0.322

18 (19.1%) 76(80.9%)

11(15.5%) 60(84.5%)P= 0.640

2(2.1%) 92(97.9%)

4(5.6%) 67(94.4%)P= 0.379

Category :

Old

New2( 5.1%) 37(94.9%)

7(5.6%) 119 (94.4%)P= 0.538

10 (25.6%) 29(74.4%)

19(15.1%) 107(84.9%)P =0.109

2(5.1%) 37(94.9%)

4(3.2%) 122(96.8%)P=0.459


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DISCUSSION

We found 26.7% of HIV-TB co-infected patients resistantto one or more anti-TB drugs, which is comparable to26.9% reported in Cameroun by Kuaban et 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 Rajasekaran et al,2009

Vanacore et al,2004 from Italy reported prevalence ratesof drug resistance and MDR as 14.5% and 2.6%respectively among new cases; but we recorded highervalues 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 butVanacore et al, 2004 in Italy found 30.4% and 12.5%

respectively


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CONCLUSIONS/ RECOMMENDATIONS

The prevalence of MDR-TB among HIV and TB co-infected patients is documented. This strongly highlightsthe need for the national strategies for surveillance and

effective clinical management of MDR-TB cases inNigeria

Although we recorded the prevalence of MDR-TB as5.5% among HIV-TB co-infected Nigerians , 73.3% ofthem were sensitive to both RIF and INH, the two most

import anti-TB first line drugsGenoTypeMTBDRplus was able detect MDR-TB in

HIV-TB co-infected Nigerians which is ordinarilydifficult and should be used for rapid screening of MDR-TB in Nigeriato achieve early detection and treatment

with appropriate drug regimen


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THANK YOU

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Ias 2011 Presentation