Prevalence of metabolic syndrome and classification performance of triglyceride‐glucose ‐derived indices in people living with HIV in Spain

Objectives Estimate the prevalence and predominant phenotypic patterns of metabolic syndrome (MetS) in people living with HIV receiving contemporary antiretroviral therapy (ART) in southeastern Spain, identify independently associated factors and evaluate the classification performance and clinical utility of triglyceride‐glucose (TyG)‐derived indices relative to a multivariable logistic regression (MLR) model. Methods Cross‐sectional study of 287 people living with HIV on stable ART for ≥6 months. MetS was defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP‐ATP III) criteria. MLR identified factors independently associated with MetS. Receiver operating characteristic (ROC), DeLong pairwise comparisons and decision curve analysis (DCA) compared the TyG, TyG‐waist circumference (TyG‐WC) and TyG‐waist‐to‐height ratio (TyG‐WHtR) against the MLR model. Results MetS prevalence was 30.3% (95% CI 25.1%–36.0%), with hyperglycaemia, hypertension and increased waist circumference (G‐B‐W) as the predominant three‐component cluster (16.1%, adjusted residual 3.67). Independently associated factors were body mass index (BMI) (aOR 1.44; 95% CI 1.28–1.64; p < 0.001), age >50 years (aOR 5.02; 95% CI 1.94–13.03; p = 0.001) and lower CD4 nadir (aOR 0.997; 95% CI 0.995–1.000; p = 0.032); neither ART regimen nor prior protease inhibitor (PI) exposure was associated. AUCs were 0.876 for MLR, 0.864 for TyG, 0.901 for TyG‐WC and 0.912 for TyG‐WHtR (all p < 0.001) without significant pairwise differences. DCA showed net benefit for TyG‐WHtR comparable to the MLR model. Conclusions MetS affects nearly one‐third of people living with HIV on contemporary ART in southeastern Spain, driven primarily by BMI, advanced age and lower nadir CD4, with a predominant G‐B‐W phenotype. TyG‐WHtR offers classification performance comparable to a full multivariable model using routine parameters, supporting its use as a low‐burden MetS screening tool in HIV care.