Background and study aim: The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The United Nations (UN) estimates that Sudan has the highest rate of HIV infection in North Africa and the Middle East. The aim of this study was to describe the effects of AIDS in liver and biliary tract and evaluate the clinical utility of hepatic and biliary tract sonography in AIDS patients in Khartoum state, Sudan. Patient and Methods: This prospective study was conducted at Omdurman, Elshaab and Bashayer Teaching Hospitals, in Khartoum State, Sudan. It spanned a period of 3 years from January 2009 to January 2012, involving 300 HIV positive Sudanese patients (198; 66% males and 102; 34% females) and aged 6 to 60 years; mean age of 46 ± 6.4 years. Samples proved to have AIDS by enzyme immuno assay test (EIA) and also confirmed by Western blot (protein immunoblot) blood test. Sonography was performed using Toshiba Just Vision 200, Aloka SSD 500 and Siemens Antares fitted with 3.5 MHz convex transducers. Results: In AIDS patients, ultrasound findings in liver included wide spectrum of abnormalities like hepatomegally (88; 29.3%), portal hypertension (49; 16.3%), periportal fibrosis (20; 6.7%), fatty fibrotic changes (42; 14%), jaundice (18; 6%), extra hepatic ducts dilatation (24; 8%), cholecystitis (33; 11%), cholelithiasis (24; 8%) and Kaposi sarcoma (18; 6%). Conclusion: Abdominal ultrasound is a simple and cost effective tool and can be used as a baseline imaging modality in AIDS infected patients. Liver enlargement and gall bladder wall thickening are common effects develop due to AIDS infection in population at Khartoum state, Sudan.