Obesity, hypertension, and hyperuricemia among people living with HIV in Ghana: a cross-sectional study

Abstract Hyperuricemia is highly prevalent among people living with HIV (PLHIV), yet the influence of obesity and hypertension on hyperuricemia remains poorly characterized in sub-Saharan Africa. This study aimed to quantify the association between obesity and hyperuricemia and to assess the potential effect modification by hypertension among PLHIV in Ghana. We conducted a cross-sectional study among PLHIV receiving care at Korle-Bu Teaching Hospital, Accra, Ghana, from May to June 2022. A total of 423 participants aged 19–80 years (mean ± SD: 49.32 ± 10.60 years) were enrolled, with the majority being female (79.2%). Poisson regression analysis was used to estimate the adjusted prevalence ratios (aPRs) of hyperuricemia associated with obesity, with hypertension evaluated as a potential effect modifier. The prevalence of hyperuricemia was 45.91%(95%CI: 41.16–50.74), obesity 26.78%(95% CI: 22.69–31.31), and hypertension 35.93%(95% CI: 31.5–40.6). Hyperuricemia was most prevalent among individuals with both obesity and hypertension (55.32%; 95%CI: 41.01–68.79%). While no additive interaction was observed, a significant multiplicative interaction was detected (ratio of prevalence ratios = 1.38; 95% CI: 1.17–1.96), indicating that when non-hypertensive PLHIV reach obesity, the adjusted prevalence ratio for hyperuricemia due to obesity jumps by an additional 38% as compared to PLHIV who already have hypertension. Obesity and hypertension independently associated with higher prevalence of hyperuricemia among PLHIV in Ghana. Notably, the effect of obesity on hyperuricemia was significantly amplified in the absence of hypertension, demonstrating a positive multiplicative interaction between these conditions. Given the substantial burden of obesity, hypertension, and hyperuricemia in this population, routine screening and integrated cardiometabolic risk management should be prioritized in HIV care to enable early identification and targeted intervention.