A Cross Sectional Study on the Bidirectional Interactions Between Leptospirosis and HIV Infection Among Patients from Maputo Central Hospital, Mozambique

Abstract

Introduction

This study aims to determine the baseline seroprevalence of leptospirosis, a zoonotic and neglected disease, in people living with HIV (PWH) in Maputo, Mozambique, and to evaluate the relationship between selected HIV-related factors that might influence risk of coinfection with leptospirosis, such as degree of immunosuppression, as assessed by CD4 cell count, World Health Organization (WHO) HIV/AIDS clinical stage and antiretroviral therapy (ART) intake.

Methods

This was a descriptive cross-sectional analysis of 157 PWH, aged over 18 years old, admitted to the Maputo Central Hospital, in Maputo, Mozambique, between March 2020 and October 2021. The study participants were recruited as a convenience sample regardless of the reasons for their admission. We collected sociodemographic and clinical data, including ART and WHO HIV/AIDS clinical stage, and blood for CD4 cell count and detection of Leptospira IgG antibodies using a commercial Kit ab247199 Leptospira IgG ELISA (www.abcam.com/ab247199) with sensitivity and specificity of 100% and 97.3%, respectively. Laboratory testing was performed at the Faculty of Medicine, Eduardo Mondlane University and Laboratory of Clinical Analysis, in Maputo.

Results

Participants were aged 18 to 72 years (median age 39 years; SD ± 10.5), the majority were female 100 (63.7%), from urban areas 138 (87.9%), with secondary-level education 80 (51%). The overall seroprevalence of Leptospira IgG antibodies was 40.1%. The median CD4 cell count was 385 cells/µl (02 to 2297; SD ± 378.47). Higher seroprevalence of Leptospira antibodies was found among participants with CD4 cell counts <250 cells/µl (54.8%), WHO HIV/AIDS stage IV (70.2%) and those on ART (92%), though there were no statistically significant differences between groups with and without Leptospira antibodies.

Conclusion

Our study confirmed that Leptospira antibodies are highly prevalent in PWH in Maputo; however, Leptospira infection was not associated with the degree of immunosuppression, WHO HIV/AIDS clinical stage, or the use of ART. Our data support the need for routine screening for leptospirosis in PWH in Mozambique. Future studies are warranted to characterize the incidence and outcomes of symptomatic leptospirosis in this patient population and to identify circulating serovars and species in the country and region, as well as the implicated reservoirs.

Keywords:

• leptospirosis
• co-infection Leptospira and HIV
• Leptospira IgG
• Mozambique

Institutional Review Board Statement

The study was approved by the Mozambique National Bioethics Committee of Health with the number 128/CNBS/2018 and by the administrative authorities from the Maputo Central Hospital.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Sharing Statement

The data sets used and/or analyzed during the current study will be available from the corresponding author on reasonable request.

Consent for Publication

All authors consented to the publication of this article.

Acknowledgments

We are indebted to the study participants who consented to participate in this study and to the staff of the Department of Medicine at the Maputo Central Hospital, who helped identify study participants and supported collection of data.

Abstract of this paper was presented at the AFREhealth 6th Annual Symposium, 2023 in Maputo, Mozambique, https://afrehealth.org/2023symposium/list-of-posters by Comia IR, Manuel L, Miambo RD, Carimo A, Manjate PF, Maholela A, Banze L, Buene T, Nhacupe N, Sousa IM, Benson CA, Schooley RT, Sacalal J, Noormahomed EV.

Author Contributions

Jahit Sacalal and Emília Virgínia Noormahomed contributed equally as senior mentors. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. All authors read and approved the final version of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The research work and student fellowship (IRC and LM) were supported by the grant number D43TW010568 from the National Institutes of Health (NIH)- Fogarty International Center (FIC), titled Enhanced Advanced Biomedical Training in Mozambique (AEBTM). Additionally, RTS and EVN received support from the above-mentioned grant to support their efforts as PI and co-PI, respectively. RDM, IMS, LB, and TB received support from the above grant as mentors. NN, AC, PFM, AM, CAB, RTS, JS, and EVN received support from the grant number R25TW011216 also from NIH-FIC and PEPFAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.