INTRODUCTION: With the global scale-up of antiretroviral therapy (ART) and improved life expectancy, people living with HIV (PLWH) increasingly face non-infectious comorbidities, and metabolic syndrome (MetS) is one of the most prevalent. MetS is associated with unfavorable health outcomes, including cardiovascular disease, chronic kidney disease, and metabolic dysfunction-associated fatty liver disease. However, data on the prevalence and risk factors of MetS among treatment-naïve PLWH in China are limited. The aim was to investigate the prevalence and risk factors of MetS and to understand its association with multi-organ damage. METHODS: Data on sociodemographic, physical, and clinical characteristics were collected from a completed multicenter, prospective cohort study in China. MetS was diagnosed according to criteria proposed by the China Diabetes Society. Univariate and multivariable logistic regression were applied to identify associated risk factors for MetS. The relationship with organ damage, including kidney, liver, heart, and bone health, were also been assessed. RESULTS: Among the 449 participants (median age 30 years
92.9% male), 16.9% met the criteria for MetS. Patients met MetS criteria in our study presented with low HDL-C concentration (49.8%), hypertriglyceridemia (26.1%), hypertension (23.1%), hyperglycemia (15.4%), and abdominal obesity (8.0%). Risk factors significantly associated with MetS included older age (OR 1.08
95% CI 1.02-1.15) and alcohol consumption (OR 3.63
95% CI 1.13-11.67). PLWH with MetS exhibited higher level of organ involvement, including reduced kidney function, elevated liver enzymes, and increased risks for cardiovascular events. Among them, 162 participants (36.0%) were classified as being at moderate or high risk using pooled cohort equations (PCEs). It is worth noting that in the MetS group, the dropped bone mineral density (BMD) in the spine decreased more significantly than that of the non-MetS group (P = 0.007). CONCLUSION: The incidence of MetS in ART-naïve PLWH in China is relatively high. Older age and alcohol consumption are associated with higher risk of MetS. Multiple organ damage may occur accompanied with MetS. Early identification and intervention are critical in managing MetS in PLWH.