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

Abstract

Background: Tuberculosis is the leading cause of deaths among HIV patients. In this study, weestimated the prevalence of pulmonary tuberculosis (‎PTB)‎ and identified the factors/co-morbiditiesassociated with active PTB in HIV-infected people visiting the national public health laboratory toassess their eligibility to receive highly active antiretroviral therapy.Methods: A cross-sectional study was conducted to measure the prevalence of pulmonarytuberculosis. 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 inunivariate analyses were included in a stepwise backward logistic regression model to adjust forconfounding.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-cellcounts, and lower CD4/CD8 ratio. However, the backward stepwise logistic regression revealed thatonly 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 (‎AOR3.34, 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 withtuberculosis were significantly more likely to have lower CD4 counts, diarrhoea, and parasiticinfections. HIV treatment programmes should consider these factors for better outcomes.