The Clinical Features and Immunological Signature of Cyclospora cayetanensis Co-Infection among People Living with HIV in Ghana

Abstract

Background: There is a paucity of information on the contemporary burden, disease patterns, and immunological profile of people living with HIV who are co-infected with C. cayetanensis in the post-antiretroviral therapy era. Methods: For this cross-sectional study, stool samples of 640 HIV-positive and 83 HIV-negative individuals in Ghana were tested for C. cayetanensis. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and immunological parameters were assessed. Results: The prevalence of C. cayetanensis was 8.75% (n = 56) in HIV-positive and 1.20% (n = 1) in HIV-negative participants (p = 0.015). Within the group of HIV-positive participants, the prevalence reached 13.6% in patients with CD4+ T cell counts below 200 cells/µl. Frequencies of the clinical manifestations of weight loss and diarrheal disease were significantly higher in patients with C. cayetanensis compared to those without co-infection (36.36% vs. 22.59%, p = 0.034 and 20.00% vs. 4.90%, p < 0.001, respectively). The expression of markers of immune activation and exhaustion of T lymphocyte sub-populations was significantly elevated in patients colonized with C. cayetanensis. Conclusions: In the modern post-combined antiretroviral therapy (cART) era, the acquisition of C. cayetanensis among PLWH in Ghana is driven largely by the immunosuppression profile characterized by high expression of markers of immune activation and immune exhaustion.

Perspectives on the drug discovery of intestinal protozoan parasites

“…The clinical outcomes of cyclosporiasis are multifactorial and influenced by various factors, including the age and immune status of the host [91]. It is a significant challenge, especially for vulnerable populations such as immunosuppressed individuals, children, and the elderly that are more susceptible to severe forms of the disease, including extraintestinal complications like biliary disease, Guillain-Barré syndrome, reactive arthritis syndrome, and ocular inflammation [92].…”

Cyclospora cayetanensis: A Perspective (2020–2023) with Emphasis on Epidemiology and Detection Methods

“…Recent studies have shown high prevalence in poor rural communities in Venezuela (9.9%; 73/732) by microscopy [ 22 , 23 ], in indigenous people living in a remote region of tropical Colombia (11.8%; 16/136) by real-time PCR [ 24 ], and in HIV-positive individuals in Ghana (8.7%; 56/640) by real-time PCR [ 25 ]. On the other hand, lower prevalence of cyclosporiasis has recently been reported in several studies conducted in developing countries.…”

“…Immunosuppressed patients are more prone and vulnerable to infection by parasites in general and to C. cayetanensis in particular. A significantly higher prevalence in HIV-positive individuals 8.7% (56/640) than in HIV-negative individuals 1.2% (1/83) was reported in Ghana [ 25 ]. The prevalence reached 13.6% in patients with CD4+ T cell counts below 200 cells/µL.…”