Metabolic Syndrome in Adults with HIV on Antiretroviral Therapy: Risk Factors and a Predictive Model

BACKGROUND: Metabolic syndrome (MetS) is common among people living with HIV, especially those receiving long-term antiretroviral therapy (ART). This study aimed to identify risk factors for MetS in adults with HIV receiving ART and to develop a predictive nomogram. METHODS: This cross-sectional study included 1,135 adults with HIV receiving ART at Tangdu Hospital, Xi'an, China, between January 2022 and January 2025. MetS was defined using modified NCEP ATP III criteria. Sociodemographic, lifestyle, clinical, and laboratory data were collected. Logistic regression and LASSO-penalized regression were used to identify predictors. A nomogram was developed and internally validated. RESULTS: The mean age was 39.49 ± 10.10 years, 54.4% of participants were male, and the mean BMI was 24.23 ± 3.72 kg/m². Overall, 315 participants (27.8%) met the criteria for MetS. Compared with those without MetS, participants with MetS were older, had higher BMI, and had longer ART duration (all P < 0.001). Current smoking, regular alcohol use, physical inactivity, and poor fruit/vegetable intake were more common in the MetS group (all P < 0.001). The final nomogram included age, smoking status, alcohol consumption, physical activity, dietary habits, BMI group, ART duration, ART regimen class, and viral suppression. It showed good discrimination, with an AUC of 0.898 in the training cohort and 0.881 in the validation cohort. CONCLUSIONS: MetS was common among adults with HIV receiving ART. The nomogram may support individualized metabolic risk stratification and help identify adults with HIV who may benefit from closer metabolic monitoring and targeted lifestyle assessment.