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.
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.