The present study investigated the socio-demographic characteristics and prevalence of IPs among individuals living with HIV/AIDS in East and West Gojam Zones, Amhara region, Ethiopia. The findings of this study provide important insights into the factors associated with IP infections in this specific geographic area.

The socio-demographic characteristics of the study population revealed that most participants were urban residents (52%), aged between 21 and 40 (54.2%), and 38.2% couldn’t read and write, while 31.8% had completed high school. This finding is consistent with previous reports in different parts of Ethiopia. The higher rates of HIV/AIDS in urban areas due to factors such as increased mobility, higher population density, and greater access to healthcare services, and the global HIV/AIDS epidemiology reported that young adults are often at higher risk of HIV infection due to behavioral factors, including engaging in risky sexual behaviors and substance abuse. Low educational attainment is often associated with limited health literacy, which can hinder individuals' ability to understand and adopt preventive measures against parasitic infections (18,19,20,21,22,23).

The overall prevalence of IPs among people living with HIV/AIDS attending the study areas was 19.3%. This finding is consistent with some previous studies conducted in Amhara region, Ethiopia, which have reported a high burden of IP infections among HIV-positive individuals (19, 24). However, our finding was much lower than the expected prevalence obtained from the systematic review and meta-analysis research in Ethiopia (39.15%) (14). This might be due to in the study area people living with HIV/AIDS have a strong adherence to ART drugs, counseling, improved knowledge through health education, and good sanitation practices. The prevalence of specific parasites in this study revealed that hookworms were the most prevalent (33.3%), followed by E. histolytica (17%). These findings are consistent with the literature, as hookworm infection is known to be highly prevalent in Ethiopia, particularly in rural areas with poor sanitation and hygiene practices (25).

The association analysis between intestinal parasitosis and socio-demographic and other risk factors revealed several important findings. Female participants had a higher likelihood of being infected with intestinal parasites compared to males. This finding is consistent with previous studies in Ethiopia, which have reported a higher prevalence of intestinal parasites among females living with HIV/AIDS (26). This might be due to biological factors like immunosuppression and gastrointestinal changes, socially limited access to healthcare, stigma, and discrimination associated with HIV/AIDS, poor nutritional status, and cultural like menstrual hygiene practices and traditional practices (herbal medicine usage) differences in hygiene practices, may contribute to this gender disparity. The presence of a latrine/toilet was found to be a significant protective factor against intestinal parasitic infections. Participants who did not have access to a latrine were 1.2 times more likely to acquire such infections compared to those who had access. This finding highlights the importance of proper sanitation and hygiene practices in preventing parasitic infections, particularly in resource-limited settings like East and West Gojam Zones. Lack of access to adequate sanitation facilities increases the risk of fecal–oral transmission of parasites (27, 28).

Furthermore, the viral load level and the WHO stage of HIV/AIDS were significantly associated with intestinal parasitosis. Individuals with a viral load count between 20 and 1000 cps/ml were more likely to develop parasitic infections compared to those with undetectable viral load counts. This finding suggests that individuals with higher viral loads may have compromised immune systems, making them more susceptible to opportunistic infections, including intestinal parasites (23, 29). Additionally, patients in WHO stage 4 of HIV/AIDS had a higher likelihood of being infected with parasitic infections compared to those in stage 1. Advanced HIV/AIDS disease progression weakens the immune system, increasing vulnerability to various infections, including parasitic infections (30).

Individuals with a CD4 count below 200 cell/mm3, indicating advanced HIV/AIDS progression, had a significantly higher likelihood of being infected with intestinal parasites. In this study, the adjusted odds ratio was 5.7 (95% CI 2.77–11.7). Even individuals with a CD4 count between 200 and 500 cells/mm3 showed an increased risk of parasitic infections compared to those with higher CD4 counts, with an adjusted odds ratio of 4.6 (95% CI 1.80–11.7, p-value = 0.001). Walking barefoot was also significantly associated with a higher risk of parasitic infections, with an adjusted odds ratio of 6.6 (95% CI 2.7–16.4, p-value = 0.001). These findings emphasize the importance of monitoring CD4 counts, promoting preventive measures, and improving hygiene practices, including the use of footwear, to reduce the burden of intestinal parasitic infections among individuals living with HIV/AIDS.

The findings of this study have important implications for public health interventions in East and West Gojam Zones, Amhara region, Ethiopia. Targeted interventions should focus on improving health literacy and promoting proper sanitation and hygiene practices among individuals living with HIV/AIDS. Efforts to increase awareness about the importance of regular screening and appropriate treatment for intestinal parasitic infections are crucial. Integration of interventions targeting both HIV/AIDS and parasitic infections is recommended to improve the overall health outcomes of individuals living with HIV/AIDS. This can include providing comprehensive healthcare services that address both HIV/AIDS management and the prevention and treatment of parasitic infections. The strength of this study was used different parasitological diagnostic modalities to detect IPs in people living with HIV/AIDS, however, there was a delayance in sample transportation to the reference laboratory which performed formol-ether concentration technique and modified acid-fast staining, this issue could affect the prevalence of IPs among the participants.