Prevalence of and Factors Associated with Sarcopenic Obesity in People Living with HIV

Objective:To determine the prevalence and identify factors associated with sarcopenic obesity (SO) among people living with HIV (PLWH). Material and Methods:A cross-sectional study was conducted between September 2024 and May 2025 among 312 PLWH aged 20–79 years attending Siriraj Hospital. All participants had been diagnosed with HIV for at least 12 months. Sarcopenia was assessed using handgrip strength and the five-time chair stand test, while body composition was evaluated by bioelectrical impedance analysis. Results:The prevalence of SO was 7.3% (95% CI: 4.87–10.81%). While no significant associations were found in initial multivariable analyses, dose–response analysis revealed relationships between cumulative exposure to specific antiretroviral therapy (ART) and SO. A significant trend was observed with protease inhibitors (PIs). Stavudine (d4T) exposure was significantly associated with SO in the highest quartile, suggesting a threshold effect. Abacavir (ABC) also showed a strong association, particularly at the third quartile, with a significant dose–response trend. Conclusions:The findings suggest that certain ART regimens, especially prolonged exposure to PIs, stavudine, and abacavir, may contribute to the development of SO in PLWH. These insights underscore the importance of individualized ART management and the need for further longitudinal studies to understand the long-term metabolic impact of ART.