Metabolic syndrome (MS) has become a growing concern among people living with HIV (PLHIV) due to chronic inflammation, aging, and the metabolic effects of antiretroviral therapy (ART). The current preferred regimen in Brazil consists of tenofovir (TDF), lamivudine (3TC), and dolutegravir (DTG). With advances in HIV management, dual therapy regimens have gained attention, particularly 3TC plus DTG. This substitution is often made due to adverse effects associated with TDF, such as renal dysfunction and bone loss, although TDF is associated with more favorable lipid profiles in some studies. Other ART components, such as protease inhibitors (PIs), are linked to adverse metabolic outcomes, including dyslipidemia and hypertension.

To compare the prevalence of MS and its components among PLHIV receiving different ART regimens.

A cross-sectional study was conducted among adult HIV-positive patients attending outpatient follow-up and receiving ART. Anthropometric, laboratory, and clinical data were collected from medical records between May 2024 and February 2025. Patients were classified according to the International Diabetes Federation criteria for MS and stratified by treatment regimen.

A total of 35 patients were using dual therapy containing a PI, 19 were on 3TC + DTG, 15 on TDF + 3TC + darunavir/ritonavir (DRV/r), and 62 on the preferred regimen (TDF + 3TC + DTG). The highest MS prevalence was observed in patients on dual PI-based therapy (60%), though without statistical significance. Hypertension prevalence was significantly higher (p = 0.011) in the PI-dual therapy group (60%) and lowest in the TDF + 3TC + DRV/r group (26.6%). Hypertriglyceridemia also showed significant variation (p = 0.010), being more frequent in PI-dual therapy (74.2%) and less common in the preferred regimen (40.3%). No significant differences were found for other MS components.

Dual therapy including a PI was associated with higher prevalence of hypertension and hypertriglyceridemia. Despite virological efficacy, such regimens may negatively impact metabolic health, warranting caution in patients with cardiovascular risk. These findings emphasize the importance of screening for MS in PLHIV and highlight the need for longitudinal studies to assess the long-term metabolic impact of dual therapy.