Predictors of clinical severity , immunological failure and magnitude of intestinal parasitic infections among HIV Patients on ART in Mekelle General Hospital, Tigray, Ethiopia.

Abstract

Background: Untreated intestinal parasitic co-infections appeared to hasten the progression of HIV-1 disease. However, there had been few studies to ascertain the interference and their induced severity of intestinal parasitic infections among on ART HIV/AIDS patients in resource-limited settings such as Ethiopia, where HIV/AIDS management largely depended on CD4+ T cells counts, viral load, and WHO clinical staging. Objective: To assess predictors of clinical severity, immunological failure and magnitude of intestinal parasitic infections in HIV Patients on ART in Mekelle General Hospital, Tigray, Ethiopia. Methods: A health facility based cross-sectional study was carried out from December 2024 to March 2025 among adult HIV/AIDS patients on ART. Data on socio-demographic, clinical and risk factors were gathered using a pre-tested structured questionnaire. Intestinal parasite were detected using direct microscopic examination, the formal ether concentration methods, and the Modified Ziehl–Neelsen technique, CD4 cell quantification was performed using the BD FACS Count System, while viral load measurement was conducted with the 2000rt Abbott machine. Multivariable logistic regression analysis determined the association between predictors and outcomes. P-value ≤ 0.05 was considered statistically significant. Results: The prevalence of intestinal parasites among HIV/AIDS patients was found to be 31.5% (100/318), of these 92.0 % (92/100) protozoans and 8.0% (8/100) helminthes. Among the identified parasites, Entamoeba histolytica/dispar had the highest prevalence 13.8% (44/318), followed by Giardia lamblia 10.4% (33/318) and Isospora belli was detected in 3.5% (11/318). The overall magnitude of clinical severity and immunological failure were 33.3% (106/318) among on ART patients, of these 26.7% (85/318) clinical severity and 29.3% (93/318) immunological failure. Among these, 72.3% (64 /85) had disclosed their HIV status, while 69.4% (59/85) demonstrated fair or poor adherence to antiretroviral therapy (ART). The prevalence of clinical and immunological failure among patients with parasitic infections was 53% (53/100). Significant association was observed between parasite infection and CD4+ T cell counts below 200/µl (AOR: 3.4, 95% CI: 1.5-8.5, p=0.005) as well as viral load levels equal to or greater than 1000 copies/ml (AOR: 3.2, 95% CI: 1.7-5.9, p=0.000). Several factors were associated with an increased likelihood of clinical severity and immunological failure, including smoking habits, occupational status, low BMI and an ambulatory or bedridden functional status at the last ART visit. Conclusions: The prevalence of intestinal parasites was higher among HIV patients on ART of these, E. histolytica, G.lambelia and Isospora belli were the leading causes of clinical severity and immunological failure on those individuals who were their CD4 count less than 200 cells/mm3, viral load greater than 1000 copies/µl. The overall severity of clinical conditions and immunological failure was significantly high among patients on ART who had smoking habits, occupational status, low body mass index, and an ambulatory or bedridden functional status.