Factors associated with high prevalence of pulmonary tuberculosis in HIV-infected people visiting for assessment of eligibility for highly active antiretroviral therapy in Kathmandu, Nepal.

Background: Tuberculosis is the leading cause of deaths among HIV patients. In this study, we estimated the prevalence of pulmonary tuberculosis (PTB) and identified the factors/co-morbidities associated with active PTB in HIV-infected people visiting the national public health laboratory to assess their eligibility to receive highly active antiretroviral therapy. Methods: A cross-sectional study was conducted to measure the prevalence of pulmonary tuberculosis. Data on probable risk factors in patients with and without PTB were compared, calculating the odds ratio as a measure of association. Factors showing significant association in univariate analyses were included in a stepwise backward logistic regression model to adjust for confounding. Results: The prevalence of pulmonary tuberculosis was 32.4 % (95% confidence interval (CI) 30.25–34.56). In the univariate analysis, patients with PTB were more likely to be older, married, and have a longer duration since the diagnosis of HIV, diarrhoea, parasitic infection, lower CD4 T-cell counts, and lower CD4/CD8 ratio. However, the backward stepwise logistic regression revealed that only the CD4 T-cell count < 200/μL (AOR 11.69, 95% CI 6.23–21.94), CD4 T-cell count 200–350/μL (AOR 2.52, 95% CI 1.30–4.89), diarrhoea (AOR 2.77, 95% CI 1.78–4.31), parasitic infection (AOR 3.34, 95% CI 2.02–5.50) and ‘sex with partner’ as probable modes of transmission (AOR 0.44, 95% CI 0.20–0.93) were independently associated with pulmonary tuberculosis. Conclusion: A high prevalence of pulmonary tuberculosis was observed. Participants with tuberculosis were significantly more likely to have lower CD4 counts, diarrhoea, and parasitic infections. HIV treatment programmes should consider these factors for better outcomes.

Seroprevalence of HIV and hepatitis C co-infection among blood donors in Kathmandu Valley, Nepal.

We assessed the seroprevalence of human immunodeficiency virus (HIV) in different categories of blood donors and the hepatitis C virus (HCV) co-infection rate. A total of 33,255 blood samples were screened for HIV using a third generation ELISA test at the Central Blood Transfusion Service, Nepal Red Cross Society, Kathmandu from December 2006 to September 2007. The seroprevalence of HIV was 0.19% (95% CI= 0.15-0.25) and co-infection with HCV was found in 10.8% (95% CI= 4.4-20.9). There were no significant differences in HIV seroprevalence among the different categories of age, sex, type of donation and time of donation. The study revealed a relatively lower seroprevalence of HIV among blood donors in Kathmandu Valley than reported earlier but a higher HCV co-infection rate. The similar seroprevalence between first time and repeat donors suggests the need for more improved donor education and counselling.