HIV Viremia and Alterations in Hepatic and Lipid Biochemical Profiles in a Saudi Arabian Cohort

Background and Objectives: Advances in antiretroviral therapy have improved survival among people living with HIV, drawing greater attention to hepatic and metabolic comorbidities. However, associations between HIV viral burden and routine liver and lipid biochemical markers remain poorly characterized in Saudi Arabia. This study investigated these associations among people living with HIV in Saudi Arabia. Materials and Methods: We retrospectively reviewed the medical records of 84 patients with HIV attending King Khalid University Hospital, Riyadh, between 2017 and 2025. Patients were classified into high-viral-load (H-VL; HIV RNA ≥100,000 copies/mL) and low-viral-load (L-VL; <100,000 copies/mL) groups. Liver and lipid markers were compared using the Mann–Whitney U test. Associations with HIV RNA were assessed using Spearman correlations and regression models adjusted for age and sex. Receiver operating characteristic analysis evaluated discrimination between the two groups. Results: The study included 84 patients (median age, 34 years; 81.0% male), of whom 50 (59.5%) had higher HIV viral load (H-VL; ≥100,000 copies/mL). Compared with the lower-viral-load group, H-VL patients had higher AST/ALT ratios, gamma-glutamyl transferase (GGT), and triglycerides (TG), and lower albumin and high-density lipoprotein cholesterol (HDL-C). HIV viral load correlated positively with GGT (r = 0.313, p = 0.0042) and TG (r = 0.453, p = 0.0018), and inversely with albumin (r = −0.405, p = 0.0001) and HDL-C (r = −0.448, p = 0.0023). Following adjustment for age and sex, significant associations persisted for GGT (β = 0.082, q = 0.046), AST/ALT ratio (β = 0.047, q = 0.041), albumin (β = −2.346, q < 0.011), TG (β = 0.092, q = 0.022), and HDL-C (β = −0.074, q = 0.041) after false discovery rate correction. In sensitivity analyses, only albumin remained significant after additional adjustment for anemia (q = 0.011), whereas associations with AST, GGT, AST/ALT ratio, albumin, TG, and HDL-C persisted after adjustment for estimated glomerular filtration rate (all q < 0.05). HDL-C showed the highest, although moderate, discriminatory performance for H-VL (area under the curve (AUC) = 0.755), followed by TG (AUC = 0.735). Conclusions: Higher HIV viral burden was associated with elevated GGT and triglycerides and reduced albumin and HDL-C. Although several associations persisted after adjustment, residual confounding remains possible. Prospective studies incorporating comprehensive treatment and clinical data are needed to clarify these relationships.