Prevalence of Intestinal Parasitic Infections in HIV-Positive Patients with Acute Diarrhoea: A Cross-sectional Study

Prevalence of Intestinal Parasitic Infections in HIV-Positive Patients with Acute Diarrhoea

Abstract

Intestinal parasitic infections are one of the primary determinants of morbidity and mortality in people with HIV, especially in resource-limited environments. Objective: To determine the prevalence of intestinal parasitic infections in HIV-positive patients presenting with acute diarrhoea. Methods: This cross-sectional study was conducted at Allama Iqbal Teaching Hospital, Dera Ghazi Khan, from October 2025 to February 2026. A total of 153 HIV-seropositive patients (18–60 years) with acute diarrhoea and CD4 count <200 cells/mm³ were enrolled, and their stool specimens were examined by direct wet-mount microscopy with normal saline and Lugol’s iodine, modified acid-fast (Kinyoun) staining for coccidian parasites, and formal-ether concentration. Data were analysed using SPSS version 25.0. Results: Of 153 patients (mean age 34.8±9.6 years; 74.5% male), intestinal parasitic infection was detected in 68 (44.4%; 95% CI 36.8–52.4). Cryptosporidium spp. was the most prevalent organism (30.1%), followed by Entamoeba histolytica (13.1%), Cystoisospora belli (11.8%) and Blastocystis spp. (9.8%). Infection rates were significantly higher in patients with CD4 <50 cells/mm³ (100%) versus 101–200 cells/mm³ (31.8%) (χ²=19.94, p<0.001), and in WHO clinical Stage IV (75.6%) versus Stage I (14.3%) (χ²=30.57, p<0.001). In multivariable logistic regression, each one-cell/mm³ increase in CD4 count was associated with lower odds of infection (aOR 0.968, 95% CI 0.955–0.982, p<0.001). Conclusions: Intestinal parasitic infections are frequent in HIV-positive patients with acute diarrhoea, with Cryptosporidium species being the most common. Lower CD4 count and advanced WHO clinical stage were the only variables independently associated with infection.