Ghanaian Hospital Survey Finds High Toxoplasma Infection Rates Among HIV Patients

A cross-sectional survey conducted among 207 adult patients living with HIV at Ho Teaching Hospital in Ghana’s Volta Region revealed an overall Toxoplasma gondii seroprevalence of 72.5 percent. The clinical investigation was undertaken to assess regional antibody seropositivity and identify risk factors, addressing a knowledge gap given that no prior epidemiological data existed for HIV patients in Ho. Out of 207 individuals tested, 133 participants, representing 64.3 percent of the sample, tested positive exclusively for immunoglobulin G antibodies, reflecting past exposure to the protozoan parasite. A single participant, representing 0.5 percent of the cohort, tested positive solely for immunoglobulin M antibodies, indicating potential acute infection. Furthermore, 16 participants, accounting for 7.7 percent of the cohort, tested positive for both immunoglobulin G and immunoglobulin M antibodies. In total, 150 patients demonstrated reactive serological markers, showing that nearly three-quarters of the evaluated clinic cohort harbored immunological evidence of parasitic exposure.

Toxoplasmosis is a widespread zoonotic infection caused by Toxoplasma gondii, an ubiquitous obligate intracellular coccidian protozoan parasite that infects animals and humans, with an estimated global burden exceeding one billion people. Although most immunocompetent individuals experience a chronic, asymptomatic, and subtle infection, the parasite presents grave health hazards for immunocompromised hosts. In individuals with intact immune defenses, a coordinated cell-mediated response involving CD4-positive T-cells, macrophages, and cytokines forces invasive tachyzoites into dormancy, establishing a lifelong encysted state that remains clinically silent. In individuals living with HIV, however, progressive depletion of CD4 T-helper cells sparks immune dysfunction that impairs cytotoxic T-lymphocyte activity, leaving the body vulnerable to opportunistic pathogens. Globally, an estimated 13.1 million people living with HIV are co-infected with Toxoplasma gondii, with approximately 87.1 percent concentrated in sub-Saharan Africa. When circulating CD4 cell counts fall below 200 cells per microliter, impaired immunological containment permits reactivation of dormant cysts, driving life-threatening systemic disease.

Across sub-Saharan Africa, documented seroprevalence figures among cohorts living with HIV range widely, spanning from 31.7 percent in Nigeria and 54.5 percent in Mozambique to 85.7 percent in Ethiopia, while earlier studies in other Ghanaian localities recorded rates between 25.0 percent and 74.4 percent. These discrepancies stem from environmental variations, dietary customs, feline contact, water sources, and sanitary behaviors. Ghana’s national HIV prevalence has remained stable between 1.5 percent and 2.0 percent since 2004, with recent statistics citing a 1.5 percent rate among adults aged 15 to 49 years, wherein women bear over 60 percent of the burden. Regionally, the Volta Region accounts for roughly 5 percent of the national HIV burden, representing approximately 19,000 individuals living with the virus. Ho Teaching Hospital serves as the primary tertiary referral center for the Ho Municipality’s 177,281 residents. The hospital’s antiretroviral therapy clinic oversees roughly 1,000 registered patients, seeing 15 to 30 attendees daily for medication, health education, tuberculosis screening, nutritional counseling, and viral load monitoring.

To execute the survey, the research team recruited participants from February through April 2025 in alignment with the Consensus-Based Checklist for Reporting of Survey Studies recommendations. Sample size determination drew upon Cochran’s formula, using an expected prevalence parameter of 74.37 percent established in previous literature, a standard Z-value of 1.96 corresponding to a 95 percent confidence interval, and an allowable error margin of 0.05. This calculation yielded an unadjusted sample size of 292.9 individuals. Given the clinic’s accessible population of 700 actively attending registered patients, researchers applied a finite population correction factor, reducing the requirement to 206.7 subjects, and subsequently enrolled 207 participants. To confirm statistical adequacy, an achieved power analysis was performed in G-Power version 3.1.9.7 using an exact one-sample binomial test for proportions with an expected proportion of 0.7437, an effect size of 0.10, and an alpha threshold of 0.05. This analysis yielded an achieved power of 97.06 percent, confirming adequate sensitivity to detect the hypothesized effects.

Participant selection employed consecutive sampling of clinic attendees, an approach designed to minimize selection bias compared to arbitrary convenience recruitment, though authors noted clinic-based sampling warrants caution regarding broader extrapolation. Eligible participants were adults aged 18 years and older with confirmed HIV diagnoses documented in medical records, actively enrolled in antiretroviral therapy, and willing to provide written informed consent. Individuals were excluded if they failed to meet national treatment criteria, withheld consent, had incomplete clinical records, or were severely ill at recruitment. Prior to study enrollment, patients completed standard clinic procedures, including physical examination and vital signs assessment for blood pressure, temperature, weight, respiratory rate, and oxygen saturation. Data were collected via face-to-face interviews using a structured questionnaire capturing socio-demographic indicators, clinical histories, and behavioral exposures like cat ownership, gardening, undercooked meat consumption, fruit washing, and water sources. The questionnaire underwent expert review, a pilot test in 20 external patients showing a Cronbach’s alpha of 0.78, and was administered in English, Ewe, or Twi.

Biological sampling involved collecting 3 to 5 milliliters of venous blood under aseptic conditions into ethylenediamine tetraacetic acid tubes immediately after questionnaire administration. Serological testing for Toxoplasma gondii antibodies utilized a two-step qualitative membrane strip rapid diagnostic test from Shanghai EIDERE Medical Technology Company Limited, manufactured under lot 20250101 on January 1, 2025, with an expiration date of January 4, 2027. Per manufacturer directions, technicians dispensed 10 microliters of plasma into the sample well, added two drops totaling 70 microliters of buffer solution, and recorded visual outcomes after a 15-minute incubation period. The diagnostic mechanism relies on immunochromatographic antigen-antibody interactions, wherein plasma antibodies bind to nitrocellulose-immobilized antigens to produce visible burgundy bands in the test region. An integrated control line capturing human immunoglobulins validated assay performance for each test strip. A sample was classified as seropositive if control bands developed alongside burgundy bands for immunoglobulin G, immunoglobulin M, or both markers simultaneously, whereas the presence of solely the control band defined seronegativity.

Socio-demographic evaluation of the 207 enrolled participants established that women formed the majority of the clinic cohort, totaling 160 individuals or 77.3 percent, while men accounted for 47 individuals or 22.7 percent. This gender distribution aligns with Ghanaian and regional sub-Saharan trends where females bear a disproportionate burden of HIV infection due to biological vulnerability, gender inequalities, and socioeconomic factors. Adults aged 46 to 60 years constituted the largest age bracket at 95 patients (45.9 percent), diverging from national patterns where HIV peaks among ages 15 to 49, an outcome attributed to the exclusion of minors under 18 years and extended survival on antiretroviral therapy. Married individuals formed the largest demographic group at 89 participants (43.0 percent), and 111 participants (53.6 percent) resided in rural communities. Clinically, 70.0 percent of the cohort had received an initial HIV diagnosis more than five years earlier, and 69.6 percent had taken antiretroviral medications for over five years, confirming an aging patient population maintained on long-term therapy.

Statistical cross-tabulation and Pearson chi-square tests performed in SPSS version 25 demonstrated notable differences in seropositivity across demographic characteristics. Patients aged 60 years and above recorded the highest seroprevalence at 90.7 percent, with 39 out of 43 testing positive, representing a statistically significant increase compared to younger tiers (p < 0.001). Marital status also displayed significant variation (p = 0.03), where divorced participants registered a 90.9 percent seropositivity rate (30 of 33). Living location showed meaningful differences on univariate testing (p = 0.04), with rural residents displaying 78.4 percent seroprevalence (87 of 111) compared to urban counterparts. Conversely, classical exposure vectors failed to show statistically significant links to parasitic serostatus. Consumption of undercooked meat was reported by only 44 participants (21.3 percent), while 145 participants (70.0 percent) did not own domestic cats. Awareness regarding toxoplasmosis was exceptionally low, with 190 patients (91.8 percent) reporting no previous knowledge of the infection, highlighting notable educational gaps.

In multivariate logistic regression modeling, researchers included residential setting, cat ownership, undercooked meat consumption, and duration of HIV diagnosis as pre-specified covariates, independent of bivariate significance. With 150 seropositive patients and 9 model parameters, the events-per-variable ratio was approximately 17, exceeding accepted requirements for model stability. Bivariate analysis initially indicated nearly twofold increased odds of seropositivity among rural residents (crude odds ratio 1.90; 95 percent confidence interval, 1.02 to 3.52; p = 0.04). However, after adjusting for age, dietary habits, cat ownership, and duration of HIV diagnosis, statistical significance disappeared (adjusted odds ratio 1.64; 95 percent confidence interval, 0.85 to 3.16; p = 0.14). The regression model revealed no independent predictor variables with statistically significant adjusted odds. The investigators observed that rural residency likely represents a surrogate marker reflecting overlapping socio-demographic exposures and environmental factors rather than functioning as an autonomous causal driver of parasitic transmission.

Synthesizing these findings, the authors concluded that the high Toxoplasma gondii prevalence in Ho reflects cumulative lifetime exposure and latent reactivation under waning cell-mediated immunity rather than acute behavioral transmission. Several study limitations were noted: the cross-sectional design precluded establishing causal or temporal sequences; qualitative rapid diagnostic tests have lower sensitivity and specificity compared to confirmatory enzyme-linked immunosorbent assays or polymerase chain reaction techniques, possibly introducing misclassification; self-reported dietary and pet exposures carried potential recall and social desirability biases; and lack of CD4 lymphocyte counts prevented direct correlation between immune suppression levels and reactivation risk. Furthermore, single-center recruitment in one hospital restricts generalizability across varied environmental contexts. Based on their results, the authors recommended integrating routine toxoplasmosis screening, targeted chemoprophylaxis, and patient education into routine antiretroviral care, strengthening regional laboratory diagnostic capabilities with advanced testing, and pursuing multi-center longitudinal investigations incorporating CD4 counts to refine evidence-based preventive care.

Subject of Research: Toxoplasma gondii seroprevalence among patients with HIV in Ghana

Article Title: High seroprevalence of Toxoplasma gondii infection among patients with HIV attending clinic in a tertiary hospital in Ghana: a cross-sectional survey

Article References: Orish, V. N., Tsadidey, E., Adzah, D., Ablordey, K., Buti, B. A., Dzefi, E. Y., De-graft Tawiah, J., Duneeh, R. V., Matthew, D., Nwaefuna, E. K., Dika, N. D., Abaka-Yawson, A., Asunluya, P. W. S., & Tetteh, R. E. (2026). High seroprevalence of Toxoplasma gondii infection among patients with HIV attending clinic in a tertiary hospital in Ghana: a cross-sectional survey. Discover Medicine, 3(1), Article 145. https://doi.org/10.1007/s44337-026-00715-4

Image Credits: AI Generated

DOI: 10.1007/s44337-026-00715-4

Keywords: Toxoplasma gondii, HIV, Ghana, seroprevalence, Ho Teaching Hospital, opportunistic infections, antiretroviral therapy, parasitology, High, Toxoplasma, gondii, infection