PREVALENCE OF MDR-TB AMONGST

PATIENTS WITH HIV AND TB COINFECTION 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.

OUTLINE
Background

Aim

of study
Objectives
Methodology
Results
Discussion
Conclusions
Recommendations

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 (ORiordan et 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 (GenoTypeMTBDRplus) showed high
sensitivity and specificity in detection of MDR-TB among HIV-TB
co-infected Nigerians (Onubogu et al,2011 in press)

Aim of study

To determine the prevalence of MDR-TB among HIV-TB coinfected patients using Hain Line-Probe Assay
(GenoTypeMTBDRplus)

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 coinfected Nigerians
To determine the prevalence of MDR-TB among HIVTB co-infected Nigerians

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

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 monoresistance and MDR-TB was performed according to the manufacturers
instructions (Hain Lifescience GenotypeMTBDR plusTM version1.0 product
insert)
Data analysis:
SPSS version 15.0 statistical software was used
Results were considered significant at P< 0.05

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 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 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%)

FIG.1: AGE DISTRIBUTION OF HIV-TB

CO-INFECTED PATIENTS
40
34.9

Percentage (%)

35

36.7

P=0.896(>0.05)

30

25
20
14.8

15
10
5
0

MTB
N-MTB
5.9

5.3

0.0

1.2

0.6

0.6

10 - 20

21 - 30

31 - 40

40 - 50

Age(years)

0.0
50+

FIG.2 : SEX DISTRIBUTION OF HIV-TB

CO-INFECTED PATIENTS
60

55.6
P=0.471(>0.05)

Percentage (%)

50

42.0

40
MTB
N-MTB

30
20
10

1.8

0.6

0
MALE

Sex

FEMALE

TABLE 1: DRUG RESISTANCE AMONG HIV-TB

CO-INFECTED PATIENTS
Age (yrs)
10-20
21-30
31-40
41-50
50+
Sex:
Male
Female

MDR- TB
Y
N

RIF MONO-RES
Y
N

INH MONO-RES
Y
N

0 (0.0%)
4 (6.8%)
2(3.2%)
2(8.0%)
1(10.0%)
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

9 (100%)
55 (93.2%)
60(96.8%)
23(92.0%)
9(90.0%)

7(7.4%) 87(92.6%)
2(2.8%) 69(97.2%)
P = 0.322

18 (19.1%) 76(80.9%) 2(2.1%) 92(97.9%)

11(15.5%) 60(84.5%) 4(5.6%) 67(94.4%)
P= 0.640
P= 0.379

Category :

Old
New

2( 5.1%) 37(94.9%) 10 (25.6%) 29(74.4%) 2(5.1%) 37(94.9%)

7(5.6%) 119 (94.4%) 19(15.1%) 107(84.9%) 4(3.2%) 122(96.8%)
P= 0.538
P =0.109
P=0.459

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 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 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
Vanacore et al, 2004 in Italy found 30.4% and 12.5%
respectively

CONCLUSIONS/ RECOMMENDATIONS

The

prevalence of MDR-TB among HIV and TB coinfected 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
GenoTypeMTBDRplus was able detect MDR-TB in
HIV-TB co-infected Nigerians which is ordinarily
difficult and should be used for rapid screening of MDRTB in Nigeria to achieve early detection and treatment
with appropriate drug regimen

THANK YOU