Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
National Tuberculosis Control Center, Thimi, Bhaktapur, Nepal.
PLoS One. 2022 Jan 28;17(1):e0262720. doi: 10.1371/journal.pone.0262720. eCollection 2022.
Worldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal.
It was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal.
Among 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30-43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P<0.001) and with the family history of TB (OR = 4.50, P = 0.002).
Prevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.
在全球范围内，结核病（TB）导致的死亡人数超过任何其他传染病。世界卫生组织估计，尼泊尔每年有大约 6.8 万例新发病例。然而，2018 年全国系统仅报告了大约 2.7232 万例新发病例，这意味着尼泊尔每年大约有 4.0768 例新发病例未被发现。尼泊尔国家结核病控制中心在抗逆转录病毒治疗（ART）点进行了这项研究，以估计该国艾滋病毒感染者（PLHIVs）中结核病的流行率，并确定与结核病相关的危险因素。
这是一项 2018 年 3 月至 8 月期间进行的基于机构的横断面研究。选择了 6 个 HIV 病例较多的 ART 点。年龄在 18 岁及以上并在选定研究点参加 ART 项目的 PLHIVs 被认为符合研究条件。根据尼泊尔国家结核病规划的国家结核病管理指南，对同意参加研究的 PLHIVs 进行结核病诊断。
在 403 名 PLHIVs 中，有 40 人（9.9%）被诊断患有结核病。参与者的中位年龄为 36（30-43）岁。与女性 PLHIVs 相比，男性 PLHIVs（13.6%对 5.8%；P = 0.02）和达利特族（22.0%对 5.9%；P = 0.01）中结核病的患病率更高。HIV 期进展到世界卫生组织 3 期和 4 期（OR = 4.85，P<0.001）以及有结核病家族史（OR = 4.50，P = 0.002）的患者发生结核病的风险显著增加。
尼泊尔 PLHIVs 中结核病的患病率为 9.9%。在男性、达利特族、HIV 期进展到世界卫生组织 3 期和 4 期以及有结核病家族史的 PLHIVs 中，发生结核病的风险更高。因此，需要采取有针对性的干预措施，以预防 PLHIVs 发生结核病的风险。同样，需要在尼泊尔提供综合、全面的结核病和艾滋病毒诊断和治疗服务，以管理结核病/艾滋病毒合并感染。
