Beyond HIV: Lifestyle as a Key Driver of Metabolic Syndrome in Midlife Women with HIV in the INSTIs 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 (WoWH) remains uncertain. Objective: To evaluate the prevalence and determinants of MetS in the era of Integrase Strand Transfer Inhibitors (INSTIs). Design : Monocentric retrospective cohort study. Methods : We analyzed 297 WoWH to assess the prevalence of MetS and associated 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 INSTIs, but none were independently associated with MetS or its components. Lifestyle emerged as the major determinant: physical activity was protective (OR 0.10, 95% CI 0.02–0.44), while physically demanding work increased risk (OR 6.58, 95% CI 2.03–26.26). Family dyslipidemia (OR 5.06, 95% CI 1.67–17.51) and former injection drug use (OR 11.72, 95% CI 1.23–134.03) raised risk. Conclusions : Lifestyle factors outweighed HIV-related variables in MetS risk, highlighting the need for systematic lifestyle assessment and intervention in WoWH.