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

Abstract

Introduction: Human immunodeficiency Virus (HIV) causes progressive impairment of the body’s cellular immune system leading to increased susceptibility to tumors, and the fatal conditions knows as acquired immunodeficiency syndrome (AIDS). Due to lack of vaccines and/or effective easily accessible therapies, the disease is posing a life long devastation not only to the individual but also to the society. Nepal’s social economic status, prevailing norms and values, cultural my vthson sex and sexualities and huge population of marginalized communities make it extremely vulnerable to the HIV/STIs epidemic. Furthermore, the high migration rate, more particularly as we see in hilly regions of western Nepal, is still a major actor for steep increase of HIV/AIDS epidemic in Nepal. The unique feature in the pathogenesis of HIV/AIDS is that the primary target cell for HIV is immune cells bearing CD4 marker at their surface. With the infection of HIV, there will be gradual decrease of human immune cells bearing CD4 antigen receptor, the most important being T helper cells (CD4 T cells ), B lymphocytes, macrophage and natural killer cells leading to development of wide varieties of opportunistic infections (OIs) i.e. severe infections induced by agents that rarely cause serious diseases in immune competent individual. In this way AIDS related mortality and morbidity, which is significantly higher in number as compared to other diseases, is actually due to OIs rather than HIV itself. So, the success of any HIV/AIDS care and management project depends on effective diagnosis and treatment of opportunistic infections. Tuberculosis is a chronic disease caused by Mycobacterium tuberculosis(also known as tubercle bacilli) primarily affecting the lungs and transmitting from persons to persons by droplet (air borne) method. Tuberculosi skills more people than any other single infectious diseases (Grange 1990). Realizingthe serious public health threat posed by tuberculosis, WHO in 1993 declared it a 'global emergency’ (Cheesebrough 2002) The disease is more prevalent in crowded, low income groups, alcoholics, smokers, close-contacts of known tuberculosis casesand surprisingly high inimmuno-compromised persons, particularly in HIV infected persons, both in persons with prior tuberculosis infection who are newly infected with HIV and in persons with prior HIV infection who are newly infected with tuberculosis (Sonneberg 20004, Hanna 2005).