The evolving burden of liver disease in the ART era: magnitude and determinants among HIV sero-positive patients at Asella Referral and Teaching hospital, Ethiopia, 2026

As global HIV programs achieve high rates of virological suppression, non-AIDS comorbidities—particularly liver diseases—are emerging as primary threats to long-term survival. In resource-limited settings, the drivers of this "post-ART" hepatic burden are poorly understood. This study determined the prevalence and determinants of liver disease among 288 HIV sero-positive adults at a major referral center in Asella, Ethiopia, during 2025/2026. Liver disease was defined by persistent biochemical abnormalities or imaging evidence of steatosis, fibrosis, or malignancy. Despite an 87.8% viral suppression rate, the prevalence of liver disease was 27.4%, indicating a "decoupling" of virological success from physiological health. The most powerful predictor of liver injury was undernutrition (AOR = 5.00), followed by a history of tuberculosis (AOR = 3.94) and male sex (AOR = 2.7). These findings demonstrate that in the modern ART era, hepatic health is dictated more by socioeconomic status and clinical history than by HIV viral load itself. Integrated strategies prioritizing nutritional security and long-term metabolic monitoring are essential to improve patient survival.