Low Aspartate Aminotransferase/Alanine Aminotransferase Ratio as an Indicator of Metabolic Syndrome Among HIV Patients on Dolutegravir Therapy in Southwestern Uganda.

Objective: This study aimed to investigate the association between the aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio and metabolic syndrome (MetS) among HIV-infected patients on dolutegravir-based antiretroviral therapy (ART).

Methods: A cross-sectional study was conducted on 377 adults on dolutegravir-based ART for at least one year. Data were collected from July 1 to August 15, 2024. Participants were systematically sampled, data were collected using a pre-tested questionnaire, anthropometric measurements were taken, and blood samples were collected for biochemical analysis. A low AST/ALT ratio was defined as ≤ 1 and MetS as the presence of at least three of the following: central obesity, fasting hyperglycemia, elevated triglycerides, low HDL-C, and hypertension (International Diabetes Federation (IDF) Consensus worldwide definition, 2006). Logistic regression was used to assess the association between low AST/ALT ratio and MetS, and receiver operating curve (ROC) analysis was conducted to evaluate its predictive performance.

Results: The median age of the participants was 44 years (interquartile range (IQR): 30-59), with 56.2% being female. The prevalence of MetS was 35.3% (133/377, 95%CI: 30.6-40.3). A significant association was found between low AST/ALT ratio and MetS (aOR: 2.19, 95% CI: 1.28-3.73, p = 0.004). Female gender (adjusted odds ratio (aOR): 3.68, 95% CI: 2.07-6.55, p < 0.001) and smoking (aOR: 3.96, 95% CI: 1.77-8.86, p < 0.001) were also significantly associated with MetS. The ALT/AST ratio had a significant predictive power for MetS (AUC = 0.583, 95% CI: 0.523-0.643).

Conclusions: The prevalence of MetS is high. A low AST/ALT ratio is significantly associated with MetS, making it a potential biomarker among HIV patients on ART.