BACKGROUND: Hyperuricaemia is a risk factor for gout and independently predicts hypertension, diabetes, and chronic kidney disease development. While elevated uric acid levels occur in HIV patients, and weight gain is linked to dolutegravir-based therapy, data on the obesity-hyperuricaemia relationship in this population remain limited. OBJECTIVE: The objective of our study was to evaluate the association between obesity and hyperuricaemia among HIV-positive patients on antiretroviral therapy in South-Western Uganda. METHODS: Between April 2024 and June 2024, this study conducted a secondary analysis of data on uric acid level and factors associated with obesity from a 2023 cross-sectional study of HIV-positive participants. We used logistic regression to assess the factors associated with hyperuricaemia, and receiver operating characteristic curve analysis to assess the predictive performance of body mass index for hyperuricaemia. RESULTS: Among 328 participants, hyperuricaemia prevalence was 23.48% (95% confidence interval [CI]: 19.19-28.39%) higher in male participants (31.6%) than female participants (20.0%, CONCLUSION: Our findings indicate a relationship between hyperuricaemia and obesity in HIV patients on antiretroviral therapy in Uganda. Nationwide studies using primary data are needed to better understand this relationship's epidemiological spread. WHAT THIS STUDY ADDS: This study is the first to link obesity with hyperuricaemia among HIV-positive Ugandans on antiretroviral therapy, highlighting obesity as a key metabolic complication of HIV treatment.