# The Epidemiology and Determinants of Opportunistic Intestinal Parasites Among HIV-Positive Patients Attending Care and Treatment Centers in Northcentral Ethiopia

## TL;DR

This study found that nearly 18% of HIV-positive patients in Ethiopia had opportunistic intestinal parasites, with factors like low CD4+ count and poor hygiene increasing the risk.

## Contribution

The study identifies key determinants of opportunistic intestinal parasites among HIV-positive patients in Ethiopia, emphasizing the role of CD4+ count and hygiene practices.

## Key findings

- The overall prevalence of opportunistic intestinal parasites was 17.9% among HIV-positive patients.
- Cryptosporidium species were the most commonly identified parasites, followed by Cystoisospora belli and Cyclospora cayetenensis.
- Factors like CD4+ count, ART adherence, and hygiene practices significantly influenced the presence of parasites.

## Abstract

Background: Opportunistic intestinal parasites (OIPs) cause significant morbidity and mortality among HIV-positive people due to the decline of CD4+ T-cells. In Ethiopia, the burden of this infection is high due to poor personal and environmental hygiene. The present study is aimed at finding the epidemiology and determinants of OIPs in human immunodeficiency virus-infected patients attending antiretroviral therapy (ART) at Debre Tabor General Hospital.

Methods: A hospital-based cross-sectional study was conducted among 384 systematically selected patients attending the Debre Tabor General Hospital ART Clinic from December 2019 to February 2020. For parasitological examinations, wet mount, formol–ether sedimentation, and modified Ziehl–Neelsen staining methods were used. CD4 count was reviewed from medical records. Data were entered and analyzed using SPSS Version 23. Logistic regression was utilized to analyze the relationship between factors linked with OIPIs. Variables with p < 0.05 were considered to be statistically significant.

Results: The overall prevalence of OIPs was 17.9%. The most commonly identified parasites were Cryptosporidium species (8.59%), followed by Cystoisospora belli (6.77%) and Cyclospora cayetenensis (2.60%). Residence (AOR = 0.197; 95% CI = 0.053–0.734), CD4+ count (AOR = 49.08; 95% CI = 9.440–228.777), ART adherence (AOR = 7.427; 95% CI = 2.488–22.172), diarrhea (AOR = 7.063; 95% CI = 1.882–26.512), fingernail trimming (AOR = 3.665; 95% CI = 1.040–12.918), hand washing habit after toilet (AOR = 10.409; 95% CI = 1.398–77.497), and drinking water source (AOR = 14.721; 95% CI = 3.349–64.71) were determinants for OIPs.

Conclusion: The study indicated that the coinfection rate of OIPs is high among ART patients. It was also found that urban residence, poor ART adherence, individuals with diarrhea, irregular trimming of the fingernail, a lack of hand washing habits after the toilet, drinking unsafe water, and having a CD4+ count < 200 cells/μL predicted the presence of OIPs.