Beyond HIV: investigating key drivers of metabolic syndrome in midlife women with HIV in the INSTI era

Background The contribution of lifestyle factors compared with HIV infection and antiretroviral therapy (ART)-related determinants to Metabolic Syndrome (MetS) in Women with HIV (WWH) remains uncertain. Objectives To evaluate the prevalence and determinants of MetS in the era of Integrase Strand Transfer Inhibitors (INSTI). Design Monocentric retrospective cohort study. Methods We analyzed 297 WWH to assess the prevalence of MetS and its association with HIV-related and lifestyle factors. Results MetS was diagnosed in 80 women (26%). Those with MetS showed lower CD4 nadir, longer HIV and ART duration, and greater exposure to protease inhibitors and INSTI, but none were independently associated with MetS or its components. Notably, lifestyle-related factors showed relatively strong associations with the study outcomes: physical activity was protective (OR 0.10, 95% CI 0.02–0.44), whereas physically demanding work increased risk (OR 6.58, 95% CI 2.03–26.26). Conclusions Lifestyle-related factors appeared to show stronger associations with MetS risk compared to HIV-related variables, underscoring the importance of systematic lifestyle assessment and targeted interventions in women with HIV.