Infection with Toxoplasma gondii can promote chronic liver diseases in HIV-infected individuals

Abstract

Liver pathologies and infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) are widespread among HIV-infected patients. However, a possible contribution of toxoplasmosis to the development of various forms of liver diseases in HIV-infected individuals has not yet been determined. This research is a retrospective cohort study. Medical cards of 907 HIV-positive patients, including 119 individuals who died, were studied. The patients were divided into two groups: 531 patients were seropositive to T. gondii and 376 seronegative. General liver pathology was more widespread among patients seropositive to T. gondii than in seronegative patients (63.1 ± 2.1% and 51.9 ± 2.6%, respectively, p < 0.001). The association of seropositive to T. gondii with general liver pathology is weak both in the whole cohort (Pearson's contingency coefficient C = 0.112), and among the deceased patients (C = 0.228). Chronic HBV-HCV coinfection was more common in the seropositive than in seronegative individuals as it was found both in entire cohorts (26.0 ± 1.9% and 18.6 ± 2.0%, respectively, p = 0.010) and in died patients (31.0 ± 5.5% and 14.6 ± 5.1%, respectively, p = 0.041). Toxoplasma gondii had a weak role in distributing of HBV-HCV coinfection between cohorts (C = 0.187). In both cohorts in patients with chronic hepatitis, regardless of its etiology, there was no significant difference in alanine transaminase activity (ALT). Cirrhosis of the liver occurred 4.5 times more often in deceased seropositive patients than in the entire seropositive cohort (23.9 ± 5.1 and 5.3 ± 2.0, respectively, p = 0.0006) whereas it no significantly increased in seronegative cohort (10.4 ± 4.4 against 4.8 ± 1.1, p > 0.05). In them T. gondii is weakly involved in cirrhosis formation (C = 0.168). Thus, in HIV-infected patients, T. gondii is a weak nonspecific adjunct that supports chronic liver inflammation and progression of cirrhosis, regardless of etiology, but does not influence the degree of hepatitis activity. The increased prevalence of HBV-HCV coinfection in patients seropositive for T. gondii may be related to their risk factor behaviour associated with uncontrolled blood contacts.

Histopathological, Immunohistochemical and Biochemical Studies of Murine Hepatosplenic Tissues Affected by Chronic Toxoplasmosis

“…The liver is well equipped with an army of well-primed transitional efficient cells and highly specialized, permanently resident, innate immune effectors in the form of Kupffer cells, hepatic stellate cells, and endothelial cells [ 45 , 47 ]. This natural function can be interrupted by infections such as T. gondii that affect liver cells either independently or through the mechanism of upregulating pro-inflammatory cytokines, especially INF- γ , TNF- α , and IL-12 [ 48 ]. In T. gondii chronically infected mice, the reticuloendothelial cells' function in different tissues is also greatly altered by the infection [ 49 ] with subsequent induction of apoptosis following parasitic infiltration with tachyzoites of T. gondii inside the normal cells [ 50 ].…”

The role of Nrf2 signaling in parasitic diseases and its therapeutic potential

“…The liver is one of the most important organs attacked and damaged by T. gondii . It can cause hepatomegaly, hepatitis, and cirrhosis in an infected liver [ [86] , [87] , [88] ]. The main mechanism of the liver damage in toxoplasmosis is inflammatory responses.…”

HIV Infection Predisposes to Increased Chances of HBV Infection: Current Understanding of the Mechanisms Favoring HBV Infection at Each Clinical Stage of HIV Infection

“…The overtly symptomatic stage of HIV illness denotes the late stage of HIV disease (AIDS) in which patients (i) have a CD4+ T-cell count of less than 200 cells/mm 3 and (ii) are vulnerable to additional opportunistic infections (OIs) (167) (such as infections by Mycobacterium avium complex, Mycobacterium tuberculosis, Pneumocystis jirovecii, Cytomegalovirus, Toxoplasma gondii, and Candida species) or the occurrence of aggressive forms of Kaposi's sarcoma or B-cell lymphoma (32). Unfortunately, numerous OIs are known to be associated with liver injury, which is a vital facilitator for HBV invasion of the liver (168)(169)(170)(171)(172)(173). The liver is frequently affected by opportunistic infections, most commonly in infections by mycobacteria and Cytomegalovirus (174).…”