This study was a hospital based cross- sectional study which was conducted to assess the prevalence of intestinal parasites among HIV/AIDS patients at southwest district of Ethiopia. Accordingly, the overall prevalence of intestinal parasites was 35.1% which was higher than study findings in different parts of Ethiopia in which the average prevalence of intestinal parasites among HIV/AIDS patients was 18.2% [20–23]. However, this finding is lower than a finding in Nekemte (73.3%) , Gondar (45.3%) , Ethiopia. As compared with other developing countries, this finding is higher than a study finding in Mozambique (26.4%) , India (27.6%)  and Colombia (29.2%) ; however, lowers than study findings in Nigeria (68.2%) , Gabon (42.6%) , Cameroon (57.5%)  and Kenya (50.9%) . The observed variations may be explained by the difference in geographic location, the difference in sample size, awareness and hygienic practices of the population in the preventions of intestinal parasite infections and moreover the variation in immune status of the study participants. In addition, the observed variations may be influenced by study period in which nowadays there is a better awareness of the patients about intestinal parasite infection and their cause.
In this study, the prevalence of intestinal parasite among ART and ART naïve group was (31.5%) and (45.8%) which was in line with study finding in Northern Ethiopia, Dessie and Gondar, in which the higher proportion of intestinal parasite were observed in ART naïve group [21, 25]. This higher prevalence in ART naïve group might be explained by the immune status of the study participants. In fact, ART improving the quality of life and reducing the occurrence of opportunistic infection due to immuno suppression. In addition, ART patients might be followed through laboratory screening for intestinal parasites and may get deworming and better awareness in adopting prevention and treatment measures against intestinal parasites.
Although there is no statistical significant difference in the overall detected parasitic species between ART and ART naïve group, Entamoeba histolytica/dispar and Giardia lamblia was the most predominant parasites detected both in ART and ART naïve groups in this study. However, the prevalence of Cryptosporidium spps in ART and ART naïve groups was 1.4% and 4.2%, respectively. This finding is in line with other study finding in Ethiopia [17, 21, 25] and Colombia , in which higher predominance of non-opportunistic intestinal parasites were reported. The higher proportion of non-opportunistic intestinal parasites indicates that, ART may also be contributed to the reduction of opportunistic intestinal parasites infections.
In this study, intestinal parasitic infections occurrence was significantly higher in patients with CD4 count <200 cell/mm3, which is in line with other study findings [20–25, 33]. Unlike others, in our study the occurrence of intestinal parasitic infections was also significantly higher in patients with CD4 count 200-500 cell/mm3. However, other study in Ethiopia reported that CD4 count <500cell/µl was significantly associated with opportunistic intestinal parasitic infections . In fact, immuno-deficient patients are more vulnerable in acquiring intestinal parasites and are unable to clear the infection once it is established [33, 35].
In this study, being WHO stage II and III were also significantly associated with intestinal parasitic infection. The occurrence higher intestinal parasitic infection in patients with WHO stage III was in line with other study finding [21, 36]. Similarly, in this study, viral load ≥150 copies/ml was also significantly associated with intestinal parasitic infection, which also is reported in other study . The higher the viral load, may be related with low level of CD4 count and advanced WHO stage, which leads to the quicker a person’s immune system will be damaged, increasing their chances of catching infections that the body would normally fight off very easily. Some studies reported that, baseline CD4 count of 500cells/µl or more was significantly associated with viral load reductions or suppression [37- 39].
In this study, environmental and hygienic practices of study participants like drinking untreated water, consuming raw food and eating unwashed raw vegetables were found to be significantly associated with intestinal parasitic infections. Significant association of consuming raw unwashed raw vegetables and drinking untreated water with intestinal parasitosis is also reported in other studies in Ethiopia [17, 23, 40]. Therefore, a combination of public health and clinical strategies is required in the prevention and control of intestinal parasites. The efforts should be focused not only on the treatment of infected individuals but also on the other contributing risk factors.
In this study, only saline and iodine wet mount, formol-ether concentration and modified Ziehl-Neelsen staining method was used for the detection of intestinal parasites. Thus the added yield of intestinal parasites may be an underestimate as we have not used water-ether sedimentation method for Microsporidia and other methods like molecular techniques and immuno flouscent techniques which are sensitive for parasites. In addition, patients may be got deworming and/or diagnosed for parasites and treated as well before.