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Aliyu Gambo Gumel Permanent E-Mail Address Pattern of Mycobacterial Infections and their Associations with HIV among Laboratory Confirmed Cases of Pulmonary Tuberculosis in Nigeria Item Type dissertation Authors Aliyu, Gambo Gumel Publication Date 2012 Abstract Background: Nigeria has the fourth highest tuberculosis (TB) burden worldwide. In this study, mycobacterial agents from clinically symptomatic TB patients, regardless of HIV co-infection were isolated and characterized, and resistance to isoniazid an... Keywords non-tuberculous; HIV Infections; Mycobacterium; Nigeria; Tuberculosis, Pulmonary Download date 02/10/2021 08:51:47 Link to Item http://hdl.handle.net/10713/2224 CURRICULUM VITAE Name: Aliyu Gambo Gumel Permanent e-mail Address: [email protected] Degree and Date to be Conferred: Ph.D., 2012 Collegiate Institutions Attended: University of Maryland, Baltimore, MD Ph.D., Epidemiology, 2012 M.S., Clinical Research, 2008 Ahmadu Bello University, Zaria, Nigeria MB.BS, Medicine 1995 Professional Publications: 1. Aliyu G., Mohammad M., Saidu A., Mondal P., Charurat M., Abimiku A., Nasidi A., Blattner W. HIV Infection Awareness and Willingness to Participate in Future HIV Vaccine Trials across Different Risk Groups in Abuja, Nigeria. AIDS Care; July, 2010 (1-8) 2. Aliyu G ., Informed Consent of Very Sick Subjects in Nigeria. Account Res. 2011 Jul-Aug; 18:4, 289-296 3. Charurat M, Nasidi A, Delaney K, Saidu A, Croxton T, Mondal P, Aliyu GG , Constantine N, Abimiku A, Carr JK, Vertefeuille J, Blattner W. Characterization of acute HIV-1 infection in high-risk Nigerian populations, J Infect Dis. 2012 Apr; 205(8):1239-47. Epub 2012 Feb 21 4. Sani-Gwarzo Nasiru, Gambo G. Aliyu , Alex Gasasira , Muktar H. Aliyu, , Mahmud Zubair, Sunusi U. Mandawari, Hassana Waziri, Abdulsalami Nasidi, Samer S. El- Kamary. Breaking Community Barriers to Polio Vaccination in Northern Nigeria: The Impact of a Grass Roots Mobilization Campaign (Majigi). Accepted for publication in the journal of pathogens and global health on April 30, 2012 5. Charurat, M, Delaney, K, Ahmed, S, Villalba-Diebold, P, Aliyu, G., Constantine, NT, Onoja, A, Vertefeuille, J, Blattner, W, Nasidi, A. HIV testing and access to care needs of most at risk populations in Nigeria. Accepted for publication in the AIDS Care journal on April 16, 2012 Abstracts : 1. Aliyu G , Sill A, Olanrewaju A, Delany K, Croxton T, Charurat M, , Vertefeuille J, Sheppard J, Nasidi A, Abimiku AG, Constantine N, Blattner W Estimation of HIV-1 incidence in Nigeria: a prerequisite for HIV vaccine trials. Poster abstract presented at the 3 rd AAVP forum Yaoundé Cameroun, October, 2005. 2. Aliyu G , Mukhtar M, Ahmed S, Prosanta M, Charurat M, Abimiku A, Nasidi A, Blattner W. HIV disease awareness and willingness to participate in HIV vaccine trials differ across subpopulations at risk of HIV in Abuja Nigeria. Poster abstract presented at the 4 th AAVP forum in Abuja-Nigeria, November, 2007. 3. Delaney K, Charurat M, Constantine N, Owen M, Keating S, Candal D, Ethridge, Saidu A, Saleh A, Croxton T, Villalba-Diebold, Aliyu G, Vertefeuille J, Sill A, Busch M, Nasidi A, Blattner W. Evaluation of five HIV incidence assays using Nigerian seroconversion specimens. Implications for suiveillance programs in Nigeria. Presented at 2009 international AIDS society July 17-19, 2009. Capetown, South Africa. 4. Delaney KP, Charurat M, Villalba-Diebold P, Ahmed S, Aliyu G, Abimiku A, Vertefeuille J, Nasidi A, Blattner WA. HIV Counseling and Testing (HCT) of Nigerian Sex workers: increased knowledge, increased condom use, no change in risk of infection. Presented at the 2010 International AIDS Meeting in Vienna, Austria. Membership in professional societies 2010 to present American College of Epidemiology 1995 to present Medical and Dental Council of Nigeria Grant award W.H.O grant on HIV vaccine preparedness studies in Africa Funding: $15,000 11/20/2005 to 08/20/2006 Role: Principal Investigator ABSTRACT Title of Dissertation: Pattern of Mycobacterial Infections and their Associations with HIV among Laboratory Confirmed Cases of Pulmonary Tuberculosis in Nigeria Gambo Gumel Aliyu, Doctor of Philosophy, 2012 Dissertation Directed by: Samer S. El-Kamary, M.D., M.P.H Assistant Professor Department of Epidemiology and Public Health Background: Nigeria has the fourth highest tuberculosis (TB) burden worldwide. In this study, mycobacterial agents from clinically symptomatic TB patients, regardless of HIV co-infection were isolated and characterized, and resistance to isoniazid and rifampicin determined. Methods : Suspected TB cases were recruited from two TB clinics into a cross-sectional study. All patients were screened for HIV, and their sputum samples were screened for Mycobacteria using an algorithm that included smear microscopy, liquid broth and solid media culture, TB-antigen detection assay, and molecular probe assays, to determine the type of Mycobacterium and pattern of resistance to isoniazid and rifampicin. Results : Of 1,603 patients screened, 466 (29%) had liquid broth culture-positive pulmonary Mycobacterial infection. Of these, 444 (95%) had mycobacterial infections and 22 (5%) were false-positive non-mycobacterial strains. Of the 444 cases, 375 (80%) were infected with Mycobacterial tuberculosis (MTB) complex (354 M. tuberculosis, 1 M. bovis and 20 M. africanum) and 69 (15%) were Non-tuberculous mycobacteria (NTM ). HIV co-infection was detected in 101 (27%) of the MTB complex and 26 (38%) of the NTM cases respectively . Twenty-three (6.1%) of the MTB complex cases had organisms resistant to isoniazid (3.5%), rifampicin (1.3%) or both, i.e. multi-drug resistant TB (MDR-TB, 1.3%), by molecular analysis, and of those, 8 (35%) had a prior history of TB treatment. Currently available molecular assays are incapable of detecting drug-resistant NTM strains. After controlling for prior treatment, cases with any resistance (i.e. at least to one drug) were more likely to be co-infected with HIV compared to cases without any resistance (OR=3.6, 95%CI=1.5-8.8; p=0.0039 ). Compared to M. tuberculosis , the NTM cases were more likely to be HIV co-infected more likely to present with clinical symptoms during the intense Harmattan dust storms from December to February (OR=2.5, 95%CI=1.4-4.5; p=0.0034, and OR=2.2, 95%CI=1.2-3.8; p<0.0067 and respectively), and less likely to be detected by the routine sputum smear test (OR=0.05, 95%CI=0.02-0.13; p<.0001 ). Conclusions: The high frequency of smear-negative NTM cases with HIV co-infection identified during the period of Harmattan dust storm presents a novel public health challenge. Introduction of molecular detection assays to identify smear-negative NTM and MDR-TB is a high priority. Pattern of Mycobacterial Infections and their Associations with HIV among Laboratory Confirmed Cases of Pulmonary Tuberculosis in Nigeria by Gambo Gumel Aliyu Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, Baltimore in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2012 © Copyright 2012 by Gambo Gumel Aliyu All Rights Reserved ACKNOWLEDGEMENTS I would like to extend sincere gratitude to my dissertation committee chair, mentor and research advisor, Dr. Samer El-Kamary for his mentorship, advise, dedication and due diligence in steering the dissertation work to a successful conclusion. I would like to equally extend my heartfelt gratitude to my boss, sponsor, mentor and committee member, Dr. William Blattner for the opportunities, faith and the confidence he has reposed in me without which this work would not have been possible. To the rest of my committee members: Dr. Alash’le Abimiku, Dr. Laura Hungerford, Dr. Kathleen Tracy and Dr. Clayton Brown. I remain sincerely grateful for your commitment, input and resourcefulness in the conduct of this dissertation. I would like to thank the Institute of Human Virology Fogarty fellowship program for sponsoring my PhD program; mentoring and support from past and present advisors of the IHV Fogarty grant including Dr. Abdulsalami Nasidi, Dr. Manhattan Charurat and Joyce Johnson. I also wish to thank the faculty (especially Dr. Patricia Langenberg) and staff of the Department of Epidemiology and Public Health for the support and knowledge I have acquired. The tireless assistance of the academic coordinator, Danielle Fitzpatrick is greatly appreciated. Finally, I thank my family and friends for their tremendous support and encouragement at the critical hours of need. iii TABLE OF CONTENTS I. INTRODUCTION .......................................................................................................... 1 A. Tuberculosis Epidemiology ................................................................................................. 1 1. Mycobacterium Tuberculosis (MTB) Complex ............................................................... 2 2. Non-tuberculous Mycobacterium .................................................................................... 4 B. HIV-Mycobacterium TB Co-infection ................................................................................. 5 C. HIV-Mycobacterium bovis Co-infection ............................................................................. 6 D. Tuberculosis Treatment ....................................................................................................... 6 E. Multi-Drug Resistant TB (MDR-TB) .................................................................................. 7 F. Multi-Drug Resistant TB in HIV ........................................................................................
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