Bagenda, Charles NkubiNantongo, CarolMugisa, Michael JuniorAinebyoona, BlendarOyuru, AmosNzaramba, DanielTumusiime, JaziraLubwama, ConradMusinguzi, BensonOsuwat, Lawrence ObadoSsenkumba, BrianOmolo, Ronald Ouma2026-02-092026-02-092026-02-03Bagenda, C. N., Nantongo, C., Mugisa, M. J., Ainebyoona, B., Oyuru, A., Nzaramba, D., ... & Omolo, R. O. (2026). Association between high serum alanine aminotransferase to high density lipoprotein cholesterol ratio and metabolic syndrome among people living with HIV on dolutegravir-based ART in South-Western Uganda. Journal of the International Association of Providers of AIDS Care (JIAPAC), 25, 23259582261420274.2325-9582https://dir.muni.ac.ug/handle/20.500.12260/912This study advances Uganda’s National Development Plan IV by facilitating early detection and prevention of non-communicable diseases (NCDs) among people living with HIV through routine, low-cost clinical markers. This approach strengthens integrated HIV-NCD care delivery and reduces long-term healthcare system expenditures. Furthermore, this research contributes to the Sustainable Development Goals, particularly SDG 3 (good health and well-being), by promoting timely identification of metabolic syndrome and improving long-term health outcomes for individuals receiving antiretroviral therapy.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.enALT-to-HDL-C ratiometabolic syndromeinsulin resistancedolutegravir-based ARTArticle