Prevalence of viral load suppression and acquired drug resistance among people living with HIV in Nepal: a nationally representative surveillance study.

OBJECTIVES: This is the first nationally representative study to estimate the prevalence of viral load (VL) suppression and acquired HIV drug resistance (ADR) among people living with HIV (PLHIV) in Nepal. METHODS: A cross-sectional study recruited 1418 PLHIV from 20 ART centres in Nepal, using a two-stage cluster design. Participants were eligible if they were HIV-positive individuals on ART for 9-15 months or at least 48 months. Plasma specimens were collected and tested for the quantification of HIV-1 RNA. Specimens with a VL ≥1000 copies/mL were further processed for sequencing of PR and RT genes of HIV-1. The sequences were then analysed to detect mutations causing HIV drug resistance. RESULTS: The prevalence of ADR was 3.7% (95% confidence interval [CI]: 1.8-7.6) and 3.0% (95% CI: 1.8-5.2) among PLHIV who received ART for 9-15 months and 48 months or more, respectively. The prevalence of VL suppression was 95.3% (95% CI: 91.7-97.4) among those on ART for 9-15 months, and 96.5% (95% CI: 94.7-97.7) among those on ART for at least 48 months. The prevalence of any detectable acquired resistance to antiretroviral drugs was 80.7% (95% CI: 58.6-92.5) among those on ART for 9-15 months with VL ≥1000 copies/mL and 81.6% (95% CI: 55.4-94.0) among those on ART for at least 48 months with VL ≥1000 copies/mL. CONCLUSION: This study suggests that improved accessibility to VL monitoring and timely assessment of drug resistance in routine HIV programs are crucial in Nepal to ensure access to HIV treatment for all in need.

Vitamin D Deficiency among Patients Presenting to Outpatient Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Vitamin D deficiency is a global health concern with over billions of people worldwide being vitamin D deficient or insufficient. Many epidemiological studies have reported cardiovascular diseases, autoimmune diseases and neoplastic diseases to be associated with vitamin D levels. This study aims to find out the prevalence of vitamin D deficiency in patients presenting to the outpatient Department of Medicine of a tertiary care center. Methods: This was a descriptive cross-sectional study done among 362 patients in the outpatient Department of Medicine of a tertiary care center between May, 2016 and August, 2016. Ethical Approval was taken from Institutional Review Committee (Reference number: 21082015). Convenience sampling was done. Informed consent was obtained and data were collected. Data were analysed using the Statistical Package for the Social Science version 25.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Out of 362 patients, vitamin D deficiency was found in 215 (59.39%) (54.33-64.45 at 95% Confidence Interval) patients. Conclusions: The prevalence of vitamin D deficiency was found to be lower to the other studies done in in similar settings. Physicians should be aware of the growing prevalence of vitamin D deficiency. Keywords: avitaminosis; prevalence; vitamin deficiency.

Depression and Quality of Life among the Chronic Kidney Disease Patients.

BACKGROUND: Depression and other mental illness are very common among chronic kidney disease and also Quality of life has been found significantly impaired in chronic kidney disease. The objective of our study is to study Depression, Quality of life and its associations in chronic kidney disease. METHODS: This was a descriptive cross-sectional study. We used convenient method of sampling for data collection. The World Health Organization Quality-of-Life 8-question scale was used for estimating quality of life and Beck Depression Inventory  was used for the assessment of depression.  Independent samples t-test was conducted to analysed bivariate relationship of sociodemographic factors with depression and Quality of life scores and multiple linear regression analysis was performed to determine predictors of Quality of life. RESULTS: The 75.5% participants found to have depression. Depression was found statistically significant across socioeconomic status (p value 0.04) and other medical comorbidities (p value 0.04). Variables found to be significantly associated with total quality of life in multiple linear regression analysis were caste (p value 0.03), socioeconomic status (p value 0.009) and depression (p value 0.001). CONCLUSIONS: Depression and reduced quality of life is very common among chronic kidney patients. Low socioeconomic status and comorbid medical conditions were associated with depression and caste, low socioeconomic status and depression were associated with low quality of life. Screening and management of depression should be included in the routine care and it could help improving the quality of life of patients with chronic kidney disease.