Introduction: Human immunodeficiency virus disease (HIV) is a worldwide health problem. It is estimated that 38.6 million people are infected with HIV globally. It has remained endemic in the African continent for close to 20 years and is a long term developmental challenge in Africa which bears 69 % of the HIV/AIDS global burden. The introduction of highly active antiretroviral therapy (HAART) has caused dramatic improvement in prognosis of HIV disease. Consequently, this has resulted in substantial reduction in Acquired Immune Deficiency Syndrome (AIDS) related morbidity and mortality. In contrast, this has been accompanied by an upsurge in liver- related morbidity and mortality. Studies have shown that deaths resulting from liver diseases rank second to AIDS-related mortality. Liver cirrhosis and hepatocellular carcinoma are the leading causes. Others are steatohepatitis secondary to fatty liver disease. Studies on liver diseases in HIV patients have been done predominantly in those who are coinfected with hepatitis B virus/hepatitis C virus (HBV/HCV). These have shown high coinfection rates in the western countries. On the other hand, Sub-Saharan Africa has lower rates of HIV coinfection with HBV and HCV. Therefore, HIV-monoinfected patients are the majority, yet, there is scarcity of data on liver diseases in these patients. This study aimed to estimate the prevalence of hepatic steatosis and the factors associated with hepatic steatosis in HIV monoinfected patients of African descent at Aga Khan University Hospital Nairobi. Objectives: Primary objective - To determine the prevalence of hepatic steatosis in HIV monoinfected patients of African descent on grey scale ultrasonography Secondary objectives – To determine factors associated with hepatic steatosis in HIV monoinfected patients of African descent on grey scale ultrasonography. Methods: This was a prospective cross-sectional study done between April 2015 and November 2015 through consecutive enrolment of 109 eligible HIV monoinfected patients of African descent at Aga Khan University hospital Nairobi (AKUH, N). The study was carried out in AKUH, N HIV clinic and radiology department. Results: Hepatic steatosis was diagnosed in 11% of the 109 patients (95% CI 5.5 - 17.4%). Male patients had a significantly higher prevalence of hepatic steatosis (19.3%) compared to the females (1.9%), AOR 15.4 (95% CI 1.7-138.0), p=0.014. Patients on HAART had a significantly lower prevalence of hepatic steatosis (6.5%) compared to those patients who were HAART naïve (37.5%), AOR 0.1 (95% CI 0.0-0.4), p=0.001. Other patient characteristics such as alcohol consumption, viral load, BMI and hyperlipidemia were not