Prevalence of Intestinal Protozoa Among Patients Living with HIV in the Peruvian Amazon

Intestinal protozoa are a common cause of morbidity in people living with HIV (PLWH), particularly in tropical regions with poor sanitation. We conducted a cross-sectional study in 315 PLWH from Iquitos, Peru, between October/2023-May/2024, to assess their prevalence and risk factors. Stool samples were examined using Lugol’s iodine, modi-fied Ziehl Neelsen (MZN) staining, and immunochromatography (ICT). Epidemiologi-cal and clinical data were collected. The mean age was 41 years, with a median CD4+ count of 431 cells/µL; 12.4% were in AIDS stage (CD4+ < 200) and 21.5% had a detectable viral load. 51.4% of participants tested positive for any intestinal protozoa. Pathogenic protozoa prevalence was 25.7% for Cryptosporidium spp., 2.9% for Giardia spp., and 1.9% for Entamoeba spp. Diagnostic agreement was almost perfect between Lugol and ICT for Giardia and Entamoeba (κ = 0.87; p < 0.001 and κ = 0.91; p < 0.001, respectively), but only slight between MZN and ICT. Homosexual practices were identified as a significant risk factor for pathogenic protozoa infection (AOR 2.52; 95% CI: 1.04–6.12). In conclusion, the high prevalence of protozoa infection reflects ongoing exposure to fecal–oral transmission, underscoring the need for public health education, routine diagnosis, and treatment in similar settings.