Background:
Despite widespread antiretroviral therapy (ART) coverage, people living with HIV (PLWH) may exhibit residual systemic inflammation and hepatic abnormalities not fully captured by routine virologic markers. While HIV infection and ART have been implicated in persistent inflammation and liver dysfunction, few studies in sub-Saharan Africa have simultaneously evaluated inflammatory markers, transaminases, and serum albumin in treated populations. We compared inflammatory and hepatic biomarkers between HIV-positive adults receiving ART and HIV-negative controls, and assessed associations with viral suppression and ART duration among PLWH.
Methods:
This cross-sectional study enrolled 171 adults (100 HIV-positive on ART and 71 HIV-negative registered blood donors). Serum C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin were measured. Sex-specific thresholds were applied for ALT and AST, while albumin was analyzed as a continuous variable following assessment of its distribution. Between-group comparisons used Mann–Whitney U and chi-square tests. Among HIV-positive participants, multivariable linear and logistic regression models examined associations of viral suppression and ART duration with biomarkers, adjusting for age and sex.
Results:
HIV-positive participants were older and more frequently female than HIV-negative controls. Age (p < 0.001) and CRP distributions (p = 0.029) differed by HIV status. Median ART duration among PLWH was 9.0 years. Viral suppression and ART duration were not independently associated with CRP, ALT, or AST. Female sex was independently associated with higher odds of elevated ALT (OR ≈ 3). Serum albumin did not differ by HIV status. Among PLWH, unsuppressed viral load was independently associated with lower albumin concentrations (β = −0.65 g/dL, p = 0.049).
Conclusion:
In this treated HIV population, systemic inflammation and hepatic enzyme abnormalities were poorly explained by viral suppression or ART duration. Sex-specific ALT elevation and lower albumin among unsuppressed individuals highlight residual biological heterogeneity and support integrating albumin assessment and sex-sensitive monitoring in treated HIV care.