Dietary counselling and exercise training for lipid management in people living with HIV : A systematic review and meta‐analysis

Objectives Dyslipidaemia is highly prevalent among people living with human immunodeficiency virus (HIV) and contributes to increased cardiovascular risk. Although lifestyle interventions are recommended, evidence specific to people living with HIV remains limited. Previous reviews have primarily focused on dietary interventions or low‐density lipoprotein cholesterol (LDL‐C). Here, we assessed the effects of dietary counselling and exercise training on serum lipid levels in people living with HIV. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials evaluating dietary and exercise interventions in people living with HIV, predominantly with dyslipidaemia. PubMed, CENTRAL, Cumulative Index to Nursing and Allied Health Literature and Web of Science were searched up to February 28, 2026. The primary outcome was the change in LDL‐C level from baseline. Secondary outcomes included changes in total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C) and triglyceride (TG) levels. Mean differences with 95% confidence intervals were pooled. Results Seven RCTs involving 474 participants were included. Dietary counselling significantly reduced LDL‐C, TC and TG levels compared with usual care, with LDL‐C reductions ranging from approximately 6 to 13 mg/dL. Evidence from two trials suggested that exercise training may increase HDL‐C levels, with no consistent effects on LDL‐C, TC or TG levels. Differences in exercise protocols may have contributed to these findings. Conclusion Dietary counselling may improve LDL‐C, TC and TG levels, whereas limited evidence suggests that exercise training may increase HDL‐C levels in people living with HIV. Lifestyle interventions may serve as adjunctive strategies for lipid management, although further large‐scale studies are needed, particularly to evaluate the effects of exercise.