Seroprevalence and Risk Factors for Toxoplasma gondii Infection in People Living with HIV: A Cross-Sectional Study from Maputo Central Hospital, Mozambique.

Abstract

Background: This study aimed to determine the seroprevalence of toxoplasmosis in people living with HIV (PWH) in Maputo, Mozambique, exploring the interactions between HIV/acquired immunodeficiency syndrome (AIDS) and toxoplasmosis, including HIV-related factors such as the World Health Organization (WHO) HIV/AIDS clinical stage, degree of immunosuppression based on CD4⁺ T-cell count, and associated risk factors. Additionally, it aimed to assess the prevalence of neurological and psychiatric disorders (NPD) among study participants and its possible association with toxoplasmosis seropositivity.

Methods: We conducted a descriptive, cross-sectional study of 200 patients aged >18 years who were admitted to Maputo Central Hospital, Maputo, Mozambique, between March 2020 and October 2021. The participants were recruited by convenience, regardless of the reason for their admission. Sociodemographic and clinical data, such as age, sex, WHO HIV/AIDS stage, and CD4⁺ T-cell count, were collected. NPD disorders were assessed using the International Classification of Diseases criteria. Venous blood (5 mL) was obtained from each participant to determine anti-Toxoplasma gondii IgM and IgG antibodies using commercial enzyme-linked immunosorbent assay.

Results: Participants were aged 18-72 years, with the majority being female (64%) and unemployed (57%). Overall, 54.5% of patients tested positive for at least one anti-Toxoplasma gondii IgG (52%) or IgM (6.5%). Risk factors for Toxoplasma gondii infection (p < 0.05) were associated with age group 18-28 years, being male and unemployed. Moreover, 68.5% of the participants had NPD and of those, 65.1% exhibited anti-Toxoplasma antibodies. We found a significant association between anxiety and IgM seropositivity for p = 0.016. Though three out of four participants with positive anti-Toxoplasma gondii IgG had mood disorders, no significant association was found between Toxoplasma gondii infection with mood disorders, nor with other NPD assessed (56% depression, 33% motor disorder, 25.5% psychosis, 17% cognitive impairment, 7.5% mental retardation).

Conclusion: Toxoplasmosis may contribute to NPD in PWH patients. Further studies are recommended to better understand the complex interactions between Toxoplasma gondii, NPD disorders, and HIV.