Association Between Waist Circumference to Body Mass Index Ratio and Elevated Serum Transaminases Among Patients on Dolutegravir-based Antiretroviral Therapy in South Western Ugand

Abstract

Background: Dolutegravir (DTG)-based antiretroviral therapy (ART) has been associated with weight gain and obesity which are also linked to hepatocellular dysfunction. Despite these associations, the link between obesity indices and hepatocellular damage among people living with human immunodeficiency virus (PLWH) on DTG-based ART remains poorly understood. This study examined the association between obesity indices and elevated serum transaminases, markers of liver damage, among PLWH on DTG-based ART in Southwestern Uganda. Methods: We conducted a cross-sectional study among 212 PLWH aged 18years and above who had been on DTG based ART for ≥1 year at Municipal Health Centre IV, Southwestern Uganda. Data was collected using a semi-structured questionnaire. Anthropometric measurements were taken, and a blood sample collected from each participant for laboratory measurement of serum alanine and aspartate transaminase activity. Results: Elevated serum transaminase activity was found in 12.7% (27/212, 95% confidence interval (CI): 8.9%-18.0%) of participants. Participants with elevated transaminases had significantly higher median waist-to-hip ratio (0.88 vs 0.83, P< 0.001) and waist circumference (WC) to body mass index (BMI) ratio (3.56 vs 3.42, P=0.026) compared to those with normal activity. In multivariate analysis, only WC/BMI ratio remained significantly associated (aOR = 3.68; 95% CI: 1.11-12.16; P=0.033) with elevated serum transaminase activity. At an optimal cut-off of 3.45; sensitivity = 78%, specificity = 52%), WC/BMI had significantly predictive power, (area under the curve= 0.651; 95% CI: 0.580-0.722) for elevated serum transaminase activity. Conclusion: WC/BMI ratio is a potential predictor of elevated transaminases among PLWH on DTG-based ART in South western Uganda