Prevalence of elevated liver enzymes and its associated factors among people living with HIV on dolutegravir-based ART at Debre Markos Comprehensive Specialized Hospital, Ethiopia

Abstract

Elevated liver enzymes remain a clinically important adverse effect of antiretroviral therapy (ART) in people living with HIV (PLHIV). Although dolutegravir (DTG)–based ART is recommended as first-line therapy in Ethiopia, evidence on the burden and factors associated with elevated liver enzymes among PLHIV receiving these regimens remains limited. To assess the prevalence and factors associated with elevated liver enzymes among PLHIV receiving DTG-based ART at Debre Markos Comprehensive Specialized Hospital (DMCSH) in Northwest Ethiopia. An institutional-based cross-sectional study was conducted among 417 PLHIV who had been receiving a DTG-based regimen for at least six months at the ART clinic of DMCSH between March 1, 2024, and June 30, 2024. Socio-demographic and behavioral data were collected using a semi-structured questionnaire, anthropometric measurements were obtained, and clinical data were extracted from medical records using a standardized checklist. Data were entered into Epidata version 4.6 and analyzed using SPSS version 26. Binary and multivariable logistic regression analyses were conducted to identify factors associated with elevated liver enzymes. Variables with a p-value < 0.05 in the final model were considered statistically significant. The overall prevalence of elevated liver enzymes was 21.1% (95% CI: 17.4–25.5). Of these, 17.3% were classified as Grade 1 elevations, whereas only 3.8% were classified as Grade 2 or Grade 3 elevations. Age ≥ 60 years (AOR = 3.1, 95% CI: 1.08–8.94, p = 0.036), alcohol consumption (AOR = 1.98, 95% CI: 1.27–4.02; p = 0.036), cluster of differentiation 4-positive T-cell count (CD4 + T-cell count) < 500 cell/mm 3 (AOR = 1.84, 95% CI = 1.08–3.85, p = 0.024), and isoniazid (INH) prophylaxis (AOR = 2.04, 95% CI = 1.17–3.58; p = 0.012) were significantly associated with elevated liver enzymes. Elevated liver enzymes were relatively common among PLHIV receiving DTG-based ART; however, the majority of cases were classified as Grade 1 elevations. Age ≥ 60 years, alcohol consumption, CD4 + T-cell count < 500 cell/mm 3 , and INH prophylaxis were independently associated with elevated liver enzymes. These findings suggest that increased clinical vigilance and consideration of liver enzyme monitoring may be beneficial for patients with these associated factors, particularly when clinically indicated.