Key result
High ALT-to-HDL-C ratio is linked to ~4.6-fold higher metabolic syndrome odds in treated HIV patients.
Why the study?
Is a higher ALT-to-HDL-C ratio associated with metabolic syndrome in people living with HIV on dolutegravir-based ART?
Cross-Sectional (n=377)
No
Is a higher ALT-to-HDL-C ratio associated with metabolic syndrome in people living with HIV on dolutegravir-based ART?
A higher ALT-to-HDL-C ratio is strongly associated with metabolic syndrome in people living with HIV on dolutegravir-based ART, suggesting its potential utility as a biomarker.
Background Serum Alanine aminotransferase to High density lipoprotein cholesterol ratio (ALT-to-HDL-C ratio) has been identified as a significant predictor of non-alcoholic fatty liver disease, a hepatic manifestation of metabolic syndrome. This study investigated the association between serum aminotransferases to high-density lipoprotein cholesterol ratios and metabolic syndrome (MetS) among people living with HIV (PLWH) on Dolutegravir (DTG)-based antiretroviral therapy (ART) in South Western Uganda. Methods We conducted a secondary analysis study from June 15, 2025 to August 20, 2025 using a dataset generated from hospital-based cross-sectional study that investigated an association between aspartate aminotransferase to alanine aminotransferase ratio and MetS among 377 PLWH who were on DTG-based ART at Ruhoko Health Centre IV, South Western Uganda. Results The prevalence of MetS was 44.6%(168/377); 95% CI: 39.6 - 49.6 and significantly increased from the lowest to the highest ALT-to-HDL-C ratio tertiles (30.2% vs 47.7% vs 56.1%, p < 0.001). In the adjusted model, higher ALT-to-HDL-C ratio was significantly associated with MetS. Individuals in the second tertile had 2.35-fold higher odds (aOR 2.35, 95% CI: 1.26–4.41, p = 0.008), and those in the third tertile had over fourfold higher odds (aOR 4.65, 95% CI: 2.25–9.61, p < 0.001) of MetS compared to the lowest tertile. ALT-to-HDL-C ratio at an optimal cutoff of 0.33 had a significant ability (AUC=0.820, 95%CI: 0.782 - 0.861) to differentiate between participants with MetS from those without MetS at a sensitivity of 92% and specificity of 54%. Conclusion Higher ALT-to-HDL-C ratio is potentially associated with MetS. Since both ALT and HDL-C are routine measurements in HIV Care, this warrants further studies on the potential of ALT-to-HDL-C ratio as a biomarker for MetS.
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Bagenda et al. (2026) conducted a cross-sectional in Metabolic syndrome in people living with HIV (n=377). High ALT-to-HDL-C ratio vs. Lowest ALT-to-HDL-C ratio tertile was evaluated on Metabolic syndrome (MetS) (aOR 4.65, 95% CI 2.25-9.61, p=< 0.001). A high ALT-to-HDL-C ratio was significantly associated with metabolic syndrome in HIV patients on dolutegravir-based ART (highest vs lowest tertile aOR 4.65; 95% CI 2.25-9.61; p<0.001).
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