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

Abstract

Background: 5 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.