Background/Purpose:

The interaction between human immunodeficiency virus (HIV) disease and rheumatic disorders has been described as “an unfortunate experiment of nature” that could provide insights into the pathogenesis of both disorders . Examples of this interaction have been described for many rheumatic conditions, but limited reports have explored the association with gout. Patients with HIV infection are characteristically hypouricemic due to malnutrition and defective renal handling of uric acid ; therefore, the coexistence of gouty arthritis and HIV would be unexpected. There have been limited studies evaluating potential risk factors for the development of gout in HIV patients. Because of the scarcity of published literature,  additional data are warranted to determine risk factors for the development of gout in HIV positive patients. 

Methods:

The primary objective of this study is to determine potential risk factors for the development of gout in HIV positive patients. The study is 1:2 retrospective case-control design. Study duration was for 14 years(2001-2014) which included 72 case patients and 144 control patients . Case patients included HIV positive patients who have at least 2 medical visits during the study period, in whom a subsequent diagnosis of gout has been made. Control patients included HIV positive patients who have at least 2 medical visits during the study period, in whom there is no diagnosis of gout . A standardized data collection instrument was created in an Excel spreadsheet and the Electronic Medical Records were utilized for all data collection. The demographic, clinical and medication exposure data was obtained. SPSS, version 22 was used for statistical analysis

Results:

During the 14 year study period, we found the following risk factors in the development of gout in HIV infected patients.

Protease inhibitors (p value 0.006) that included atazanavir (p value 0.047) and saquinavir (p value 0.035). Nucleoside reverse transcriptase inhibitors (p value 0.003) that included abacavir (p value < 0.0005), lamivudine (p value <0.005) and stavudine (<0.036). Additional risk factors were comorbidities like hyperlipidemia (p value 0.016), coinfection with hepatitis B (0.024), chronic kidney disease (p value < 0.0005), alcohol abuse (p value 0.021) and  hydrochlorthiazide therapy (p value 0.042).

In the study group, the mean CD4 count was 468 and the mean uric acid level was 8.5 mg/dl at the time of diagnosis of gout in HIV patients. In the control group, the mean CD4 count was 395 and mean uric acid level was 5.4 mg/dl.

Conclusion:                                                                          

In our study, risk factors for the development of gout in HIV Patients include therapy with protease inhibitors(atazanavir and saquinavir), nucleoside reverse transcriptase inhibitors (abacavir, lamivudine and stavudine), hyperlipidemia, hydrochlorthiazide therapy, coinfection with hepatitis B, chronic kidney disease and alcohol abuse.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-the-development-of-gout-in-hiv-patients-a-retrospective-study/