Prevalence of pulmonary tuberculosis among HIV infected persons in Pokhara, Nepal.

BACKGROUND:Tuberculosis (TB) is a major public health problem in Nepal. HIV co-infection has further added a serious challenge to control TB. An early diagnosis and treatment of TB in HIV infected individuals can help reduce not only the morbidity and mortality associated in this high risk group but also to control the TB burden in Nepal. METHODS:Clinical and bacteriological examination for pulmonary TB was carried out in 184 HIV positive persons from the community in Pokhara. Questionnaire was used to screen for symptoms and collect participants' demographic information and potential risk factors for TB. RESULTS:Eighty (43.5%) sero-positive participants were young adult (21-30 years), followed by 71 (38.6%) middle aged (31-40 years) persons. Eleven participants were found to have Mycobacterium tuberculosis in their sputum, giving an overall prevalence of tuberculosis of 5.97%. All 11 cases were detected by Acid Fast Bacilli (AFB) culture, of which only three cases were detected by direct microscopy of AFB stained sputum smear. The majority of TB/HIV patients were asymptomatic with low AFB smear positivity. No significant association was found between TB and risk factors like ARV status, common clinical features of tuberculosis and smoking habit. However, significant association was found between the alcohol consumption and TB (X2=4.11, p<0.05). CONCLUSIONS:High prevalence of tuberculosis (5.97%) was found among HIV infected persons. Alcohol consumption was associated with the development of tuberculosis. Majority of the studied subjects were asymptomatic for common signs and symptoms of TB. Weight loss was observed in 43% of the studied subjects followed by chest pain (39.2%), loss of appetite (34.8%), fever (34.8%) and night sweat (26.1%). Only 27% of the TB cases were found to be smear-positive.