THE EVOLVING BURDEN OF LIVER DISEASE IN THE ART ERA: MAGNITUDE AND DETERMINANTS AMONG HIV SERO-POSITIVE PATIENTS AT ASELLA REFERRAL AND TEACHING HOSPITAL, ETHIOPIA, 2026

Abstract

ABSTRACT Background: Liver disease remains a significant cause of morbidity and mortality among people living with human immunodeficiency virus, even in the era of widespread antiretroviral therapy. Multiple factors, including demography, clinical status, and treatment related effects, may contribute to liver disease in this population. However, data from resource limited settings like Ethiopia remains limited. Objective; To determine the magnitude of liver disease and associated factors among human immunodeficiency virus sero-positive patients on follow up at Asella referral and teaching hospital, Arsi Zone, Ethiopia. Methods: An institution-based cross-sectional study was conducted from October to December, 2025. Data on socio-demographic, behavioral, and clinical characteristics were gathered using a structured questionnaire and a thorough review of medical records. Liver disease was defined based on biochemical criteria. Data were entered and analyzed using SPSS version 27. Variables with a P-value < 0.25 in the bivariate analysis were entered into the multivariate model, and statistical significance was declared at a p-value < 0.05. Results: A total of 288 participants were included in the final analysis, with a mean age of 45.6 years. Females represented 61.1% (n=176) of the cohort. The overall prevalence of liver disease was 27.4% (95% CI: 0.222 – 0.326). In multivariable logistic regression analysis, male sex was significantly associated with higher odds of liver disease (AOR = 2.698; 95% CI: 1.340 - 5.431). Participants with a history of tuberculosis had nearly four-fold increased odds of liver disease (AOR = 3.944; 95% CI: 2.044 - 7.611), while under nutrition was the strongest predictor of hepatic injury (AOR = 4.996; 95% CI: 2.373 - 10.518). Other factors, including age, viral load, CD4 count, and ART regimen, were not significantly associated with liver disease. Conclusion: This study identified a high prevalence of liver disease (27.4%) among adults living with HIV in Asella. Male sex, under nutrition, and a history of tuberculosis were identified as the key determinants of hepatic complications. These findings suggest that liver health monitoring and nutritional support should be prioritized for these specific high-risk subgroups to improve long-term clinical outcomes. Key Words; Liver disease, HIV patients, Hepatotoxicity, ART, Viral hepatitis, Ethiopia