High levels of gout may be linked to HAART

London researchers reported to the BHIVA conference that they had seen a high level of gout in their HIV population from 2000 onwards, especially in patients receiving boosted protease inhibitors.

Researchers from the Mortimer Market Center and University College London, found that most of these patients had dyslipidaemia and clinical features of lipodystrophy. They conclude: “As gout is known to be associated with insulin resistance, atherosclerosis and visceral fat accumulation in the HIV-negative population, this suggests that gout may be another metabolic complication of HAART.”

A retrospective analysis of 1,800 patient records was conducted. All cases of hyperuricaemi (elevated uric acid) attending the Mortimer Market Centre between 1 February 2000 and 1 February 2002 were identified from the hospital database. Notes were scrutinised using a standardised proforma, to identify predisposing factors for gout, HIV clinical history, lipodystrophy and laboratory markers.

Eighteen cases were identified, all of which had clinical manifestations of gout and elevated serum urate (mean 686, range 428–1552). Twelve patients had stage C disease and six stage B. Mean CD4 was 356 cells/mm3 (range 50–1100) and mean viral load (VL) 13,559 copies/ml (range below detection to 83,000).

Sixteen of the 18 were receiving highly active antiretroviral therapy (HAART) and had been on it for an average of 41 months (range 3–48). Eight had predisposing risk factors for gout (e.g. pyrazinamide therapy, haematological malignancy). Seven of the remaining 10 were receiving a boosted protease inhibitor (ritonavir (RTV)/saquinavir (SQV) n=5, RTV/indinavir n=1, RTV/amprenavir n=1), they had dyslipidaemia (mean triglycerides 542 mg/dl, range 373–783) and proven features of lipodystrophy. Patients with gout were significantly more likely to be taking boosted SQV than the remainder of the patients at the clinic (50% versus 10%, P<0.00001).

S Creighton, GP Kasidas, SG Edwards et al. Gout and HIV: a new facet of the fat redistribution syndrome? 9th BHIVA Conference, 24-26 April 2003, Manchester. Poster 12.

Comment

Elevated uric acid has been reported before in patients on antiretroviral combination therapy with or without lipodystrophy. This is most probably just another monocentric cohort. The prevalence is 1% or less, in which case an HIV-negative control may make sense or at least a comparison with an age-matched data subset on the prevalence of gout in London to put it into perspective.