Diarrhoea remains a significant concern among HIV-positive individuals, impacting their quality of life and treatment outcomes. This study aims to determine the prevalence and associated risk factors of diarrhoea among HIV-positive patients in Southern Nigeria. A prospective case-control study was conducted at a tertiary healthcare facility from February to November 2023. HIV-positive patients (n=450) and age-sex matched HIV-negative controls (n=450) were enrolled. Data on socio-demographics, medical history, and hygiene practices were collected using self-administered questionnaires. Stool samples were examined for parasites, and CD4+ T cell counts were determined. Statistical analysis was performed using SPSS version 20.0.The prevalence of diarrhoea was significantly higher among HIV-positive patients compared to controls (49.55% vs. 28.89%, p=0.001). Factors associated with diarrhoea in HIV-positive patients included smoking history (p=0.000*), duration of HIV infection (p=0.000*),  and frequency of alcohol consumption (p=0.039*). Hygiene practices such as hand washing after defecation (p=0.000*) and availability of toilet facilities at home (p=0.000*) were significantly associated with diarrhoea in both HIV-positive patients and control subjects. Parasitic infections were more prevalent in HIV-positive patients with diarrhoea compared to control subjects (p=0.000*). Diarrhoea is highly prevalent among HIV-positive patients in Southern Nigeria, with smoking, alcohol consumption, and poor hygiene practices contributing to its occurrence. Interventions targeting these modifiable risk factors and improving hygiene practices are essential for reducing diarrhoeal burden in this population.

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