# Assessment of Cryptosporidium spp. Sub-Families and Giardia duodenalis Assemblages A and B in Ghanaian HIV Patients, Including Socio-Economic, Clinical, and Immunological Associations

## TL;DR

This study examines Cryptosporidium and Giardia infections in Ghanaian HIV patients, finding links between specific parasite sub-types and immune status.

## Contribution

The study identifies specific Cryptosporidium sub-families associated with HIV immunosuppression levels and clarifies Giardia's lack of direct HIV link in Ghana.

## Key findings

- Cryptosporidium sub-families Ia and Ib are linked to severe immunosuppression in HIV patients.
- C. parvum IIc is found in HIV patients with higher CD4+ T cell counts.
- Giardia duodenalis assemblages show no significant association with HIV infection status.

## Abstract

Background: Cryptosporidium spp. cause opportunistic infections in immunosuppressed individuals, such as people living with HIV (PLWH). However, the association between giardiasis and HIV infection remains uncertain. This study assessed co-infections in Ghanaian PLWH and HIV-negative individuals, analyzing socio-economic, clinical, and immunological implications, including the Giardia duodenalis assemblage and Cryptosporidium spp. sub-family levels. Methods: Stool samples from Ghanaian PLWH were tested using several real-time PCR assays targeting G. duodenalis at the species level and assemblages A and B to optimize diagnostic accuracy. GD60 gene-based Sanger sequencing was used for Cryptosporidium spp. subtyping. Results were correlated with anonymized patient data to evaluate interactions with HIV infection. Results: In PLWH, C. hominis Ib, C. hominis Ie, and C. parvum IIc were detected at similar frequencies, followed by C. hominis Ia, C. hominis Id, and C. parvum IIe in decreasing order. Only C. parvum IIc was repeatedly observed in individuals with CD4+ T cell counts above 200/µL, while other sub-families occurred preferentially in those with lower counts. C. hominis Ia and Ib were associated with PLWH not receiving antiretroviral therapy; C. hominis Ia was linked to recently diagnosed HIV infections. No relevant associations between G. duodenalis assemblages and HIV infection were found. Conclusions: Sub-families Ia and Ib of C. hominis preferentially occur in individuals with severe immunosuppression, while C. parvum IIc is also detectable in individuals with better immune function. The prevalence of giardiasis in Ghana appears to be influenced by factors other than HIV-induced immunosuppression.