Prevalence and determinants of hepatitis B, hepatitis C, and liver injury among people living with HIV on antiretroviral therapy in the Upper East Region of Ghana

Background Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infections remain an important public health challenge among people living with HIV (PLHIV), with their heaviest toll borne in sub-Saharan Africa. These infections accelerate liver disease progression, complicate antiretroviral therapy (ART) management, and contribute to morbidity and mortality. This study assessed the prevalence of HBV and HCV and liver injury among PLHIV on ART in the Upper East Region of Ghana. Methods In a cross-sectional survey, a total of 294 PLHIV receiving ART at three treatment sites were recruited. Sociodemographic and clinical data were obtained using a structured questionnaire after informed consent. Participants were screened for HBV and HCV serological markers, and liver function was evaluated biochemically. Results The overall prevalence of viral hepatitis was 13.3%, with HBV (9.2%) more common than HCV (4.1%). HBV infection was significantly higher in males than females (17.5% vs. 7.4%; p = 0.025) and more common among participants with tertiary education (21.4%) relative to those without formal education (4.5%; p = 0.022). Urban residents showed higher but not statistically significant HBV prevalence than rural participants (14.9% vs. 7.3%; p = 0.050). HCV prevalence showed no significant sociodemographic associations. The prevalence of liver injury was 17.5%. Being a male was independently associated with liver injury (adjusted odds ratio [aOR]: 4.35; 95% CI: 1.81–10.47; p = 0.001). Older age was also a predictor: compared to participants aged 20–30 years, those aged 31–40 (aOR: 13.31; 95% CI: 1.37-129.76; p = 0.026), 41–50 (aOR: 20.01; 95% CI: 1.90-210.33; p = 0.013), and > 50 years (aOR: 15.62; 95% CI: 1.41-172.51; p = 0.025) had markedly increased odds. Longer ART duration was protective: individuals on ART for > 10 years had reduced odds of liver injury compared to those on ART for 1–5 years (aOR: 0.39; 95% CI: 0.16–0.97; p = 0.042). Conclusion The findings show that HBV is more prevalent than HCV among PLHIV on ART in the Upper East Region of Ghana, with infection patterns influenced by sex, education, and area of residence. Liver injury affects nearly one in five PLHIV in this setting, with male sex and older age as strong independent risk factors, and longer duration on ART is associated with lower risk. These findings highlight the need for targeted viral hepatitis and liver function monitoring and integration of hepatitis management into HIV care, particularly among older men and patients in the early years of ART in this population. Clinical trial number : Not applicable