Factors associated with sarcopenia and exploratory thresholds for low muscle strength in people living with the human immunodeficiency virus

The revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria are widely used among people living with HIV (PLHIV). However, accumulating evidence suggests that conventional thresholds may underestimate sarcopenia in PLHIV and fail to capture early functional decline. This study explored handgrip strength (HGS) values ​​associated with poorer quality of life (QoL) to assist early functional screening, and identified factors associated with sarcopenia. Cross-sectional study in PLHIV on antiretroviral therapy. We collected sociodemographic, clinical, lifestyle and QoL variables; defined sarcopenia using EWGSOP2 algorithm; and evaluated HGS accuracy for discriminating poorer QoL (WHOQOL-HIV Bref median). We present exploratory HGS thresholds and factors associated with sarcopenia in adjusted models. A total of 105 PLHIV participated (mean age 44.6 ± 13.5 years; 51.4% men). The HGS thresholds with the best accuracy for poorer QoL were ≤ 33 kg for men (sensitivity: 72.0%, specificity: 65.52%, Youden’s index: 0.37, AUC: 0.66) and ≤ 26 kg for women (sensitivity: 88.0%, specificity: 53.85%, Youden’s index: 0.41, AUC: 0.70). CD4 + T-cell count ≤ 200 cells/mm³ were associated with sarcopenia in both constructs (adjusted OR ≈ 4). Poorer QoL was associated with sarcopenia when using HGS ≤ 33/26 kg thresholds (OR = 5.12; 95% CI: 2.02–12.98). Sarcopenia was associated with immunosuppression in both models. HGS thresholds of ≤ 33/26 kg may be useful for early outpatient screening of functional vulnerability in PLHIV, while conventional thresholds (< 27/16 kg) may better reflect more severe clinical settings. Findings should be interpreted as exploratory and considered alongside clinical judgment. Not applicable.