article · Tropical Medicine and Infectious Disease
Co-infection with neurocysticercosis and HIV is frequent in sub-Saharan Africa, but standard serological tests face uncertain accuracy in immunosuppressed individuals. A cross-sectional diagnostic study in two endemic Tanzanian districts evaluated cysticercosis antigen ELISA and Western Blot IgG in 101 people living with HIV, using cerebral computed tomography for definitive diagnosis. Overall prevalence of neurocysticercosis was 23 percent. Western Blot IgG showed higher sensitivity and specificity than antigen ELISA, although its sensitivity dropped slightly among individuals with CD4 counts below 500. Combining the tools showed distinct trade-offs: parallel testing substantially improved sensitivity and negative predictive value, whereas sequential testing reduced assay strip usage by 70 percent and elevated specificity to 95 percent at the expense of sensitivity. These findings indicate how diagnostic workflows can be tailored depending on local resources and clinical priorities.
Neurocysticercosis is a serious parasitic brain infection that often co-occurs with HIV in endemic areas. Diagnosing it typically requires expensive brain scans that are scarce in low-resource settings. Determining how existing blood tests perform, individually or in combination, helps healthcare providers choose the best screening strategies to detect infections accurately while managing limited diagnostic supplies.
This research provides applied clinical evidence for healthcare facilities, diagnostic laboratories, and public health programmes in resource-limited, endemic regions. The findings define operational diagnostic algorithms using existing, commercialised testing tools. Because the work evaluates established assays rather than developing a new product, it is immediately actionable for informing clinical guidelines and test procurement strategies in settings with constrained imaging and reagent capacity.
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Background: Neurocysticercosis (NCC) and HIV co-infection frequently occur in sub-Saharan Africa, yet the accuracy of available serological tests for NCC in immunosuppressed patients is uncertain. Methodology: We performed a cross-sectional diagnostic study on 101 people living with HIV from two endemic districts in Tanzania. Participants provided serum for cysticercosis antigen ELISA and Western Blot IgG; any positive result prompted neuroimaging investigation with cerebral computed tomography. NCC was diagnosed according to the 2017 revised Del Brutto criteria based on cCT according to Del Brutto criteria modified to exclude serology. Sensitivity, specificity, and area under the receiver–operating–characteristic curve (AUC) were calculated and adjusted for CD4 count and HIV stage. Two algorithms were compared: parallel testing (“either-test-positive”) and sequential screening (Ag ELISA screen, western blot IgG confirm). Results: NCC prevalence was 23%. Western Blot IgG outperformed Ag ELISA (sensitivity 57% vs. 30%; specificity 87% vs. 86%; AUC 0.73 vs. 0.57). Western blot IgG sensitivity declined to 54% when CD4 < 500 cells µL−1, while Ag ELISA remained low. Western blot IgG positivity independently predicted NCC (adjusted odds ratio 4.1, 95% CI 1.4–11.9); Ag ELISA did not. When we counted a positive if either test was positive (parallel rule), sensitivity rose to 78% and NPV to 87%. When we ran Ag ELISA only if IgG was negative (sequential rule), we saved 70% of IgG strips, kept specificity at 95%, and PPV at 69%, but sensitivity fell to 39%. Conclusions: Western blot IgG is the most reliable single serological test for NCC in PLHIV. Parallel testing increased sensitivity and NPV and may suit better primary-level facilities without routine imaging. Sequential testing achieved high specificity, PPV, and conserved test kits, making it ideal for centers with limited reagents or scanner access. Tiered use of these assays can streamline NCC diagnosis in T. solium endemic, resource-limited settings.
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DOI: 10.3390/tropicalmed10090246
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