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Is ritonavir boosting associated with gout?

S Creighton¹, R Miller, S Edwards

¹Department of Genitourinary Medicine, Camden Primary Care Trust, Mortimer Market Centre, Mortimer Market, off Capper Street, London WC1E 6AU, UK. creightonsarah@hotmail.com

International Journal of STD & AIDS

|June 14, 2005

Summary

Ritonavir, a boosted protease inhibitor, is linked to gout in HIV patients, especially those with lipodystrophy. This study highlights the importance of monitoring uric acid levels in patients on this therapy.

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Area of Science:

Infectious Diseases
Rheumatology
Pharmacology

Background:

Asymptomatic hyperuricemia is a known side effect of ritonavir therapy.
Gout, a form of inflammatory arthritis, is rarely reported in patients receiving ritonavir.

Purpose of the Study:

To investigate the association between ritonavir use and the incidence of gout in HIV-positive patients.
To identify risk factors for gout in this population.

Main Methods:

Retrospective cohort study of 1825 HIV-positive patients over two years.
Analysis of medication history, including antiretroviral therapy (ART) and ritonavir use.
Assessment for predisposing risk factors for gout and features of lipodystrophy and dyslipidemia.

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Main Results:

Eighteen patients (1%) were diagnosed with gout.
Fifteen gout patients were on ART; eight (73%) of the remaining 11 were receiving ritonavir as a boosted protease inhibitor (PI).
Ritonavir use was significantly higher in gout patients (odds ratio = 22) compared to those without gout (11%).
Seven gout patients had lipodystrophy and dyslipidemia.

Conclusions:

Gout in HIV-positive patients is associated with ritonavir-boosted PI therapy, particularly in those with pre-existing risk factors or lipodystrophy.
Clinicians should consider the risk of gout in HIV patients on ritonavir, especially those with metabolic complications.