BackgroundHelminthic infections are highly endemic in Mozambique, due to limited access to healthcare and resources for disease prevention. Data on the subclinical prevalence of these diseases are scarce due to the fact that an immunological and imaging diagnosis is not often available in endemic areas. We conducted a cross-sectional study on HIV1+ patients from Beira city in order to determine the seroprevalence of cysticercosis, schistosomiasis, toxocariasis and echinoccocosis and its possible interaction with HIV infection.Methodology/Principal FindingsPatients (601) were voluntarily recruited at the Ponta Gea Health Center and their demographic and clinical data were recorded (including CD4+ cell count and antiretroviral regimen). Mean age was 39.7 years, 378 (62.9%) were women and 223 (37.1%) were men. Four hundred seventy-five (475) patients (79%) were already on highly active antiretroviral therapy (HAART), and 90 started therapy after being enrolled in the study. For serological testing we used a Multiplex Western Blot IgG from LDBIO Diagnostics. The overall seroprevalence was 10.2% for cysticercosis, 23% for schistosomiasis, 7.3% for toxocariasis and 17.3% for echinococcosis.Conclusions/SignificanceNeither age nor the CD4+ count were significantly associated with the seroprevalence of the helminths studied. However, patients with CD4+ between 200–500/µl had a higher seroprevalence to all helminths than those with less than 200/µl cells/and those with more than 500 cells/µl. Female gender was significantly associated with cysticercosis and schistosomiasis, and being in HAART with toxocariasis. Headache was significantly associated with cysticercosis and toxocariasis. There was no association between epilepsy and seropositivity to any of the parasites. The study concluded that a clear understanding of the prevalence and manifestations of these coinfections, how best to diagnose subclinical cases, and how to manage diseases with concomitant antiretroviral therapy is needed.

RESUMO O estudo avaliou a prevalência da Tinea capitis na população estudantil duma Escola Primária e também identificou os agentes causais responsáveis. Escamas do couro cabeludo foram recolhidas das crianças apresentando sinais clínicos sugestivos de Tinea capitis. Dermatófitos foram identificados seguindo procedimentos micológicos padronizados. Este estudo encontrou uma prevalência clínica de Tinea capitis de 9,6% (110/1149). Os dermatófitos isolados foram Microsporum audouinii, Trichophyton violaceum e Trichophyton mentagrophytes. O agente causal mais prevalente neste estudo foi Microsporum audouinii confirmando os achados dos estudos transversais anteriores levados a cabo na cidade de Maputo.Palavras-chaves: Tinea capitis. Tinha. Dermatofitose. crianças escolares.

The study was carried out in two rural primary schools of the District of Magude, the largest district of Maputo Province in 2001. The prevalence of tinea capitis in each school was 11.6% (49/422) and 6.8% (18/263) and affected predominantly male children. The most common dermatophytes isolated from both schools were Microsporum audouinii. However, Trichophyton mentagrophytes was also found to be an important causal agent of tinea capitis in the District of Magude. Although the prevalence of tinea capitis found in our study is relatively high compared to previous cross-sectional studies carried out in Mozambique, it is still closely related to the prevalence rates reported for African countries. Tinea capitis continues to be an important public health issue in Mozambique, particularly in primary school setting.

Background In resource-limited settings, viral load monitoring of HIV-infected patients receiving antiretroviral therapy (ART) is not readily available due to high costs. Here, we compared the accuracy and costs of quantitative and qualitative pooled methods to standard viral load testing. Methods Blood was collected prospectively from 461 patients receiving first-line ART in Mozambique who had not been evaluated previously with viral load testing. Screening for virologic failure of ART was performed quantitatively (i.e. standard viral loads) and qualitatively (one and two rounds of polymerase chain reaction; PCR). Individual samples and minipools of 5 samples were then analyzed using both methods. The relative efficiency, accuracy and costs of each method were calculated based on viral load thresholds for ART failure. Results Standard viral load testing of individual samples revealed a high rate of ART failure (19-23%) across all virologic failure thresholds, and the vast majority of the patients (93%) with viral loads >1,500 copies/ml had genotypic resistance to drugs in their ART regimen. Pooled quantitative screening and deconvolution testing had positive and negative predictive values exceeding 95% with cost savings of $11,250 compared to quantitative testing of each sample individually. Pooled qualitative screening and deconvolution testing had a higher cost savings of $30,147 for one PCR round and $25,535 for two PCR rounds compared to quantitative testing each sample individually. Both pooled qualitative PCR methods had positive and negative predictive values ≥90%, but the pooled one-round PCR method had a sensitivity of 64%. Conclusions Given the high rate of undiagnosed ART failure and drug resistance in this cohort, it is clear that virologic monitoring is urgently needed in this population. Here, we compared alternative methods of virologic monitoring to standard viral load testing of individual samples and found these methods to be cost saving and accurate. The test characteristics of each method will likely need to be considered for each local population before it is adopted.