Metabolic Syndrome Prevalence Among People Living With HIV: A Single-Center Study From Türkiye

Improved survival achieved through antiretroviral therapy has redirected clinical attention in people living with HIV (PLWH) toward long-term non-AIDS-related metabolic complications. This study aimed to determine the prevalence of metabolic syndrome (MetS) among PLWH followed at our center and to examine its relationship with immunological status and antiretroviral treatment regimens.

This single-center cross-sectional study included 102 adults living with HIV who were followed at the Infectious Diseases and Clinical Microbiology Outpatient Clinic of Düzce University Faculty of Medicine between March and September 2025. Sociodemographic, clinical, anthropometric, and laboratory data were collected during routine follow-up visits. MetS was defined according to the 2005 revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Patients were stratified by CD4+ T-lymphocyte counts (<350 vs. ≥350 cells/mm³) and by NRTI and INSTI components of ART.

The study population was predominantly male (88.2%), with a mean age of 39 ± 12 years. Of the 102 participants, 5.9% had virologically suppressed HIV (RNA <50 copies/mL). The prevalence of MetS was 37.3%. MetS was significantly more frequent in patients with CD4+ T-lymphocyte counts <350 cells/mm³ (n=34) compared with those ≥350 cells/mm³ (n=68) (52.9% vs. 29.4%; p=0.021). Total cholesterol and LDL-cholesterol levels were significantly lower in patients receiving TDF-based regimens than in those receiving TAF-based regimens (TC: 145 vs. 178 mg/dL, p=0.004; LDL-C: 91 vs. 116 mg/dL, p=0.014). No significant differences in MetS prevalence or lipid parameters were observed among INSTI subgroups. Total and LDL cholesterol levels were significantly higher in patients receiving TAF/FTC/BIC compared with those receiving TDF/FTC+DTG.

The 37.3% MetS prevalence observed in this cohort exceeds the globally reported pooled average of approximately 25%, which may reflect the characteristics of the study population, ART exposure duration, or demographic factors. The association between lower CD4+ T-lymphocyte counts and higher MetS prevalence is consistent with the existing literature linking advanced immunodeficiency to adverse metabolic outcomes. Differences in lipid profiles between TDF- and TAF-based regimens, and the independent association of ART regimen with TC and LDL-C in multivariable linear regression, underscore the clinical importance of ART drug selection in the context of cardiometabolic risk management.

MetS was common among PLWH and was more prevalent in individuals with lower CD4+ T-lymphocyte counts. TDF-based regimens were associated with more favorable lipid profiles compared with TAF-based regimens. These findings highlight the importance of early MetS screening and individualized ART selection with close metabolic monitoring.