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.
Keywords: Mozambique; Toxoplasma gondii IgG; Toxoplasma gondii IgM; co-infection Toxoplasma gondii and HIV; latent and acute toxoplasmosis; toxoplasmosis and neurological and psychiatric disorders.
Plain language summary
Toxoplasmosis is a disease caused by the zoonotic and food-borne parasite, Toxoplasma gondii. It predominantly manifests in immunocompromised individuals, such as those living with human immunodeficiency virus (PWH), causing neurological and psychiatric impairments due to brain infections. The few existing studies in Mozambique on the burden of neurological and psychiatric disorders have not yet assessed the profile of neurological and psychiatric disorders in patients with HIV or the possible role that this parasite might play as a causative agent. The present study revealed that at least 54.5% of PWH were seropositive for Toxoplasma gondii antibodies and 68.5% had neurological and psychiatric disorders. Additionally, the majority (65.1%) of the patients with neurological and psychiatric disorders were seropositive for Toxoplasma gondii antibodies. Our findings highlight the need to screen for this parasite to clarify its role in the etiology of neurological and psychiatric disorders in both PWH and people without HIV for better healthcare delivery and management.
© 2025 Manuel et al.
Keywords：toxoplasma gondii infection; people living with hiv; cross-sectional study
背景： 本研究旨在确定莫桑比克马普托居住的HIV阳性人群（PWH）中弓形虫病的血清学流行率，探讨HIV/获得性免疫缺陷综合征（AIDS）与弓形虫病之间的相互作用，包括基于世界卫生组织（WHO）HIV/AIDS临床分期、基于CD4+T细胞计数的免疫抑制程度和相关风险因素等HIV相关的因素。此外，本研究还旨在评估受试者的神经精神障碍（NPD）的流行率及其与弓形虫病血清学阳性的可能关联。
方法： 我们进行了一项描述性横断面研究，在2020年3月至2021年10月期间，纳入了莫桑比克马普托中央医院收治的200名年龄超过18岁的患者。参与者通过便利抽样招募，与他们入院的原因无关。收集参与者的社会人口统计学和临床数据，如年龄、性别、WHO HIV/AIDS分期和CD4+T细胞计数等信息。使用国际疾病分类标准评估神经精神障碍（NPD）。从每位参与者处采集5毫升静脉血样，采用商业酶联免疫吸附法检测抗弓形虫IgM和IgG抗体。
结果： 参与者的年龄在18至72岁之间，其中大多数是女性（64%）且未就业（57%）。总体而言，54.5%的患者至少有一种抗弓形虫IgG（52%）或IgM（6.5%）血清阳性。弓形虫感染的风险因素与年龄组18至28岁、男性和未就业有关（p
结论： 弓形虫病可能在PWH患者中导致神经精神障碍。为了更好地理解弓形虫与神经精神障碍以及HIV的复杂相互作用，建议进一步开展研究。
关键词： 莫桑比克；弓形虫IgG；弓形虫IgM；弓形虫和HIV共感染；隐性和急性弓形虫病；弓形虫与神经精神障碍。
简易摘要
弓形虫病是由人畜共患寄生虫 Toxoplasma gondii 引起的疾病，主要在免疫功能低下的人群中表现出来，例如HIV阳性人群（PWH），会导致由于脑部感染而引发神经精神障碍。目前莫桑比克关于神经精神障碍负担的研究很少，并且尚未评估 HIV 患者中神经精神障碍的状况或该寄生虫作为病因的作用。本研究发现至少54.5%的HIV阳性患者检测出弓形虫抗体血清阳性，68.5%的参与者有神经精神障碍，其中大多数（65.1%）患有神经精神障碍的人群表现出抗弓形虫抗体阳性的状况。我们的结果强调了筛查该寄生虫的重要性，以明确其在 PWH 和非HIV人群的神经精神障碍病因中的作用，从而更好地提供和管理医疗服务。
