Opportunistic parasite infections are common health problem among HIV/AIDS patients in the study area. Therefore, early detection and treatment of these parasites are important to improve the quality of life of HIV/AIDS patients.

Background Immune hemolytic anemia commonly affects human immune deficiency infected individuals. Among anemic HIV patients in Africa, the burden of IHA due to autoantibody was ranged from 2.34 to 3.06 due to drug was 43.4%. IHA due to autoimmune is potentially a fatal complication of HIV which accompanies the greatest percent from acquired hemolytic anemia. Objective The main aim of this study was to determine the magnitude and associated factors of immune hemolytic anemia among human immuno deficiency virus infected adults at university of Gondar comprehensive specialized hospital north west Ethiopia from March to April 2021. Methods An institution-based cross-sectional study was conducted on 358 human immunodeficiency virus-infected adults selected by systematic random sampling at the University of Gondar comprehensive specialized hospital from March to April 2021. Data for socio-demography, dietary and clinical data were collected by structured pretested questionnaire. Five ml of venous blood was drawn from each participant and analyzed by Unicel DHX 800 hematology analyzer, blood film examination and antihuman globulin test were performed to diagnosis of immune hemolytic anemia. Data was entered into Epidata version 4.6 and analyzed by STATA version 14. Descriptive statistics were computed and firth penalized logistic regression was used to identify predictors. P value less than 0.005 interpreted as significant. Result The overall prevalence of immune hemolytic anemia was 2.8% (10 of 358 participants). Of these 5 were males and 7 were in the 31 to 50 year age group. Among individuals with immune hemolytic anemia, 40% mild and 60% moderate anemia. The factors that showed association were family history of anemia (AOR 8.30 at 95% CI 1.56, 44.12), not eating meat (AOR 7.39 at 95% CI 1.25, 45.0), and high viral load 6.94 at 95% CI (1.13, 42.6). Conclusion and recommendation Immune hemolytic anemia is less frequent condition in human immunodeficiency virus infected adults, and moderate anemia was common in this population. The prevalence was increased with a high viral load, a family history of anemia, and not eating meat. In these patients, early detection and treatment of immune hemolytic anemia is necessary.