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

Isac Rodrigues Comia; Leonardo Manuel; Regina Daniel Miambo; Awa Abdul Carimo; Percílio da Floca Manjate; Ana Edith Maholela; Lucas Raimundo Banze; Titos Paulo Buene; Noémia Nhancupe; Irina M Sousa; Constance A Benson; Robert T Schooley; Jahit Sacarlal; Emília Virgínia Noormahomed

doi:10.2147/RRTM.S445878

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

Res Rep Trop Med. 2024 Feb 12:15:1-11. doi: 10.2147/RRTM.S445878. eCollection 2024.

Authors

Isac Rodrigues Comia^#^{1

2

3}, Leonardo Manuel^#^{1

2

3}, Regina Daniel Miambo^{3

4}, Awa Abdul Carimo^{3

5}, Percílio da Floca Manjate^{3

5}, Ana Edith Maholela^{3

6}, Lucas Raimundo Banze^{2

3}, Titos Paulo Buene^{2

3}, Noémia Nhancupe^{2

3}, Irina M Sousa^{3

7}, Constance A Benson⁸, Robert T Schooley⁹, Jahit Sacarlal², Emília Virgínia Noormahomed^{2

3

9}

Affiliations

¹ Department of Research and Extension, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique.
² Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
³ Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique.
⁴ Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique.
⁵ Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
⁶ Department of Medicine, Maputo Central Hospital, Maputo, Mozambique.
⁷ Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique.
⁸ Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.
⁹ Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA.

^# Contributed equally.

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: Leptospira IgG; Mozambique; co-infection Leptospira and HIV; leptospirosis.

Grants and 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.