Sarcopenic Obesity in People With HIV: Diagnostic Criteria and Classification—A Scoping Review With a Meta‐Analysis of Prevalence

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OBJECTIVES: (a) To describe studies that evaluated sarcopenic obesity (SO) in people with HIV (PWH); (b) to summarize the methods and diagnostic criteria used to define SO in PWH; and (c) to estimate the overall prevalence of SO in this population. DESIGN: Scoping review conducted according to established methodological frameworks and reported following PRISMA-ScR recommendations. SETTING AND PARTICIPANTS: Original observational studies conducted in clinical or research settings involving adults (≥ 18 years) with HIV that explicitly applied diagnostic criteria for SO were included. METHODS: Studies were identified through searches in 12 electronic databases from inception to August 2024, without language restrictions. The scoping review followed five stages: identification of the research question, identification and selection of relevant studies, data extraction, and synthesis of findings. Diagnostic approaches for SO included body composition assessed by dual-energy X-ray absorptiometry (DXA) or computed tomography (CT), anthropometric measures such as body mass index (BMI), and functional assessments including handgrip strength and the Short Physical Performance Battery (SPPB). An exploratory random-effects meta-analysis was performed to estimate the overall prevalence of SO in PWH. RESULTS: Three observational studies were included, two from Italy and one from the United States, comprising 2873 participants, predominantly male (n = 2174 [76%]). Mean age ranged from 47 to 52 years, and mean duration of HIV diagnosis and antiretroviral therapy exceeded 10 years. Seven distinct diagnostic criteria for SO were identified, with DXA being the most frequently used method. The prevalence of SO ranged from 0.76% to 20.8%, and the pooled overall prevalence was 8.18%. CONCLUSIONS AND IMPLICATIONS: SO remains insufficiently explored among PWH. The wide variability in diagnostic criteria and assessment methods contributes to inconsistent prevalence estimates, underscoring the need for standardized, population-specific diagnostic approaches.