Male-specific association of HIV infection with lower risk of hyperuricemia is mediated by lower BMI and AGR.

OBJECTIVE

HIV infection may affect uric acid (UA) metabolism, but no large-scale population-based studies have investigated whether and how HIV infection affects incidence of hyperuricemia.

DESIGN

Prospective, observational, noninterventional study.

METHODS

We included 1836 people with HIV (PWH) who had normal UA level at baseline assessment and 1836 age-, sex-, and baseline UA level-matched people without HIV (PWoH) from the Comparative HIV and Aging Research in Taizhou (CHART) cohort. Hyperuricemia was defined as a serum UA level ≥7 mg/dl, following Chinese clinical guidelines. Logistic regression models were used to examine the association and potential effect modifiers. A generalized linear model (GLM) and bootstrap method were employed to assess the mediation effect.

RESULTS

The three-year cumulative incidence of hyperuricemia was significantly lower in PWH than in PWoH overall [11.6% vs. 16.4%; adjusted odds ratio (aOR) = 0.67; 95% confidence interval (CI): 0.55, 0.82], and significantly lower in male PWH than in male PWoH (13.1% vs. 19.4%; aOR = 0.64, 95% CI: 0.52, 0.79) but comparable between female PWH and female PWoH (6.2% vs. 6.1%, aOR = 0.97, 95% CI: 0.55, 1.72). A significant additive interaction between sex and HIV infection was observed, with a relative excess risk due to interaction (RERI) of -1.18 (95% CI :  -2.87, -0.13). Among males, lower BMI and albumin to globulin ratio (AGR) mediated 36% and 12% of the association between HIV infection and lower risk of hyperuricemia, respectively.

CONCLUSIONS

HIV infection was associated with a lower risk of hyperuricemia in men but not women, partially mediated by lower BMI and AGR, suggesting distinct metabolic and inflammatory profiles in male PWH.