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Increased Adiposity and Dyslipidemia in Young Men Living with HIV Compared to Matched PrEP Users: A Cross-Sectional

Felice Cinque1,2, Arianna Liparoti1,3, Stefania Varchetta3

  • 1Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Advances in Therapy
|May 5, 2026
PubMed

Insights

People living with HIV (PLWH) on antiretroviral therapy (ART) show greater adiposity and dyslipidemia compared to men on pre-exposure prophylaxis (PrEP). Higher physical activity in PLWH is linked to improved insulin sensitivity.

Area of Science:

  • Metabolic health
  • Cardiovascular health
  • HIV research

Background:

  • Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are crucial for managing HIV.
  • Metabolic and cardiovascular complications are significant concerns for individuals on ART.
  • Comparing metabolic profiles of PLWH on ART and PrEP users is essential for understanding treatment-related effects.

Purpose of the Study:

  • To compare anthropometric, metabolic, cardiovascular, and liver parameters in people living with HIV (PLWH) on ART versus men on PrEP.
  • To investigate lifestyle factors, including physical activity and diet, in both groups.
  • To identify potential markers of metabolic dysfunction and associations with HIV status.

Main Methods:

  • A single-center, cross-sectional study of males aged 18-50 years on ART or PrEP for at least 6 months.
  • Assessment of lifestyle factors, anthropometric measurements (BMI, waist circumference, bioimpedance), and blood parameters (lipids, glucose, hepatic enzymes, adipokines).
  • Evaluation of hepatic steatosis and fibrosis using FibroScan®, with statistical analysis including chi-squared, t tests, Mann-Whitney, and logistic regression.

Main Results:

  • PLWH (n=53) exhibited significantly higher BMI, waist circumference, fat mass, triglycerides, total cholesterol, and LDL cholesterol compared to PrEP users (n=29).
  • PrEP users reported higher vigorous-intensity physical activity; no dietary differences were observed.
  • Leptin levels were higher in PLWH, and LDL cholesterol was independently associated with HIV status.

Conclusions:

  • People living with HIV on ART demonstrate increased adiposity and dyslipidemia compared to PrEP users.
  • Leptin may serve as a marker for metabolic dysfunction in PLWH.
  • Higher physical activity in PLWH is associated with improved insulin sensitivity, highlighting the importance of exercise in managing HIV-related metabolic issues.
Abstract

Keywords:
HIVLeptinMetabolismPhysical activityPrEP

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