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

<b>Background</b>: <i>Cryptosporidium</i> 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 <i>Giardia duodenalis</i> assemblage and <i>Cryptosporidium</i> spp. sub-family levels. <b>Methods:</b> Stool samples from Ghanaian PLWH were tested using several real-time PCR assays targeting <i>G. duodenalis</i> at the species level and assemblages A and B to optimize diagnostic accuracy. GD60 gene-based Sanger sequencing was used for <i>Cryptosporidium</i> spp. subtyping. Results were correlated with anonymized patient data to evaluate interactions with HIV infection. <b>Results:</b> In PLWH, <i>C. hominis</i> Ib, <i>C. hominis</i> Ie, and <i>C. parvum</i> IIc were detected at similar frequencies, followed by <i>C. hominis</i> Ia, <i>C. hominis</i> Id, and <i>C. parvum</i> IIe in decreasing order. Only <i>C. parvum</i> 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. <i>C. hominis</i> Ia and Ib were associated with PLWH not receiving antiretroviral therapy; <i>C. hominis</i> Ia was linked to recently diagnosed HIV infections. No relevant associations between <i>G. duodenalis</i> assemblages and HIV infection were found. <b>Conclusions:</b> Sub-families Ia and Ib of <i>C. hominis</i> preferentially occur in individuals with severe immunosuppression, while <i>C. parvum</i> 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.