Association Between High Serum Aspartate Transaminase to Alanine Transaminase Ratio and Probable HIV Dementia Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy: A Cross-Sectional Study from Central Uganda
Charles Nkubi Bagenda, Carol Nantongo, Michael Junior Mugisa, Vincent Olwoch, Fauziya Naziiwa, Christier Masereka, Bright Bagambe, Godfrey Somikwo, Fred Sempijja, Jazira Tumusiime, Deusdedit TusubiraBackground
Probable HIV dementia (PHD) remains a significant complication among people living with HIV(PLWH), particularly in resource-limited settings where access to comprehensive neurocognitive assessment is limited . This study investigated the association between AST-to-ALT ratio and PHD among PLWH on Dolutegravir-based antiretroviral therapy (DTG-based ART).
Methods
We conducted a secondary analysis using a dataset generated from hospital-based cross-sectional study that consecutively recruited 235 PLWH on DTG-based ART at St. Francis Nsambya Hospital in Kampala, Central Uganda. PHD was defined as International HIV Dementia Scale score ≤10.
Results
PHD prevalence was 22.1% (52/235; 95% CI: 17.3–27.9) and increased across AST-to-ALT ratio tertiles (13%, 23%, and 31%; p=0.023). Participants in the second and third tertiles had higher odds of PHD (aOR=2.85, 95% CI: 1.13–7.15; p=0.026 and aOR=4.28, 95% CI: 1.75–10.45; p=0.001). Each 0.5-unit increase in the AST-to-ALT ratio increased the odds of PHD by 40% (aOR=1.40, 95% CI: 1.02–1.92; p=0.036). An AST-to-ALT ratio cutoff of 1.26 showed modest discrimination for PHD (AUC=0.622), with 73% sensitivity, 51% and specificity, 29%.
Conclusion
A higher AST-to-ALT ratio is a potentially useful screening predictor for PHD in PLWH on DTG-based ART in resource limited settings, pending validation in larger prospective studies.