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 (PWH), particularly in tropical regions with poor sanitation. We conducted a cross-sectional study in 315 PWH from Iquitos, Peru, between October 2023 and May 2024, to assess their prevalence and risk factors. Stool samples were examined using Lugol’s iodine, modified Ziehl–Neelsen (MZN) staining, and immunochromatography (ICT). The mean age was 41 years, with a median CD4+ count of 431 cells/µL; 12.4% were in the AIDS stage, and 21.5% had a detectable viral load. 51.4% of the participants tested positive for any intestinal protozoa. The overall Cryptosporidium spp. prevalence (by combining MZN and ICT results) was 25.7%. The overall Giardia spp. and Entamoeba spp. prevalences (by combining Lugol’s iodine and ICT results) were 2.9% and 1.9%, respectively. Blastocystis spp. was frequently isolated, though its pathogenicity remains uncertain. 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 fecal–oral exposure, underscoring the need for public health education, routine diagnosis, and treatment in similar settings.