Research Article: Latent Toxoplasma gondii Infection and Associated Risk Factors among HIV-Infected Individuals at Arba Minch Hospital, South Ethiopia

Date Published: November 9, 2014

Publisher: Hindawi Publishing Corporation

Author(s): Tsegaye Yohanes, Serkadis Debalke, Endalew Zemene.


Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii (T. gondii). The parasite has cosmopolitan distribution, infecting almost all species of warm-blooded animals. Latent T. gondii infection in HIV/AIDS patients is a risk for development of cerebral toxoplasmosis (CT). The aim of this study is to determine seroprevalence of latent T. gondii infection and assess its associated factors among individuals infected with HIV in Arba Minch Hospital, south Ethiopia. A facility-based cross-sectional study involving 170 HIV-infected individuals attending Arba Minch Hospital antiretroviral therapy (ART) clinic was conducted from April to June 2013. Data on demographic profile of the study participants and factors associated with T. gondii infection were gathered using a questionnaire. Serum was tested for IgG anti-T. gondii antibody by enzyme-linked immunosorbent assay (ELISA). Data were analyzed using SPSS version 20 software. Seroprevalence of latent T. gondii infection among the study participants was 88.2%. Consumption of raw meat (AOR = 4.361; 95% CI: 1.409–13.496) and involvement in farming/gardening activities (AOR = 4.051; 95% CI: 1.112–14.758) were independent predictors of T. gondii seropositivity. This study revealed high prevalence of latent T. gondii infection, similar to other studies. Monitoring of the patients to prevent reactivation of the latent T. gondii infection is recommended.

Partial Text

Toxoplasmosis is a disease caused by Toxoplasma gondii (T. gondii), an obligate intracellular parasite infecting virtually all species of warm-blooded animals. The parasite has a worldwide distribution with an estimated one-third of the world’s population being infected. It has a complex life cycle, undergoing sexual phase in the feline definitive host and asexual phase in its intermediate hosts. The parasite is transmitted to humans mainly by accidental ingestion of its oocysts from cat faeces, consumption of infected raw meat, and rarely vertical transmission during pregnancy [1]. Clinical presentations of the disease are diverse and mainly depend on the immune status of the host. The disease is usually self-limited in immunocompetent individuals, rarely causing pulmonary toxoplasmosis [2]. However, it may result in life-threatening disease, cerebral toxoplasmosis (CT), in immunocompromised individuals [3].

In this study, seroprevalence of anti-Toxoplasma gondii IgG antibody among the HIV positive study participants was 88.2%. T. gondii is an important opportunistic parasitic infection in HIV-infected individuals. Primary infection with T. gondii results in initial IgM anti-T. gondii antibody response, followed by IgG antibody, which apparently remains for life. Detection of specific IgG anti-T. gondii antibody, therefore, indicates chronic infection with the parasite. Chronic T. gondii infection in HIV-infected individuals is a risk for development of CT [16], especially when CD4+ T lymphocyte count falls below 100 cells/μL [17]. The high prevalence of chronic T. gondii infection in our study participants, therefore, highlights the need for prevention of CT [18]. This requires regular monitoring of the HIV-infected individuals and treatment of the eligible ones [3]. It is likely that T. gondii is also highly prevalent in unrecognized HIV-infected individuals, putting them at high risk of developing CT. An earlier report documented low utilization of HIV counseling and testing among men in Ethiopia [19]. Cerebral toxoplasmosis is one of the central nervous system disorders and AIDS-defining opportunistic infections in HIV/AIDS patients [20–23].

In conclusion, seroprevalence of latent T. gondii infection is high among the study participants, similar to most of the studies. The rate of T. gondii seropositivity significantly increased with age. Self-reported consumption of raw meat and history of involvement in farming/gardening activities were the main predictors of T. gondii seropositivity among the study participants. Creating awareness about T. gondii infection and follow-up of their status is recommended. Moreover, screening of T. gondii infection in HIV-infected individuals should be considered. Further studies are required to determine incidence of TE in HIV-infected individuals in the area.