Prevalence and Individualized Risk Factors of and Infections Among People Living with HIV (PLHIV) with Diarrhea in Ecuador: Insights from a Single-Center Cross-Sectional Study.

: Microsporidia, particularly and , are emerging opportunistic pathogens that pose significant health risks to immunocompromised individuals, especially people living with HIV (PLHIV). Despite the global recognition of microsporidia's impact, there has been limited research on their prevalence and associated risk factors in Ecuador. This study aimed to investigate the prevalence and identify risk factors associated with microsporidia infections among PLHIV with diarrhea in Ecuador. : A cross-sectional study was conducted at the José Daniel Rodríguez Infectious Hospital in Guayaquil, Ecuador, between April 2021 and May 2022. A total of 85 PLHIV with diarrhea were included in the analysis. Fecal samples were tested for microsporidia using fast-hot Gram chromotrope staining, immunofluorescence microscopy, and transmission electron microscopy. Logistic regression was performed to assess the association between demographic, clinical, and behavioral factors and microsporidia infection. The prevalence of microsporidia infections among the study population was 18.8%. Logistic regression analysis identified significant associations with age ≥ 60 years (OR = 19.169, = 0.036), female sex (OR = 10.491, = 0.028), and non-adherence to antiretroviral therapy (OR = 8.466, = 0.077). Marginally significant associations were observed for substance use (OR = 0.262, = 0.094) and high/very high HIV viral load (≥10,000 copies/mL, OR = 0.457, = 0.094). CD4 count and marital status showed descriptive trends but were not statistically significant. This study highlights the burden of microsporidia infections among PLHIV in Ecuador and underscores the need for targeted public health interventions. Strategies should prioritize older individuals, females, and those with poor ART adherence to reduce infection risk. Future research is needed to explore additional risk factors and refine precision medicine approaches for this population.