Determinants of Metabolic Syndrome in People Living with Human Immunodeficiency Virus in Africa: A Systematic Review and Meta-analysis

Emmanuel Agada David¹Olatunde Ayodeji Olayanju^2*Kamaldeen Olalekan Sanusi³Philemon Paul Mshelia⁴Oluseun Iyabode Mabadeje⁵IBUCHUKWU NKEONYENASOYA ORABUEZE⁶Chioma Kunle-ope⁷Ifeyinwa Ezenwosu⁸Kasimu Mamuda⁹Adeoti Gbemisola Adeniran¹⁰Saheed Olatunbosun Akiode¹¹sonnen Atinge¹²Oluchukwu Perpetual Okeke¹³Olunike Abodunrin¹⁴Folahanmi Akinsolu¹⁵Olajide Odunayo Sobande¹³

• ¹Gombe State University, Gombe, Nigeria
• ²Babcock University Benjamin S Carson Snr School of Medicine, Ilishan-Remo, Nigeria
• ³Al-Hikmah University, Ilorin, Nigeria
• ⁴Abubakar Tafawa Balewa University, Bauchi, Nigeria
• ⁵Southwestern University, Okun-owa, Nigeria
• ⁶College of Medicine, University of Nigeria Ituku-Ozala Campus, Enugu,, Enugu, Nigeria
• ⁷Centre for Tuberculosis Research, Nigeria Institute of Medical Research, Lagos, Nigeria
• ⁸Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozala, Enugu,, Nigeria
• ⁹National Tuberculosis and Leprosy Training Center, Zaria, Nigeria
• ¹⁰University of Medical Sciences, Ondo, Nigeria
• ¹¹Biotechnology Advanced Research Centre, Sheda Science and Technology Complex, Abuja, Nigeria
• ¹²Federal University, Wukari, Nigeria
• ¹³Nigerian Institute of Medical Research Foundation, Lagos, Nigeria
• ¹⁴Department of Research, Capacity Building and Implementation, Alabastron Initiative, Lagos, Nigeria
• ¹⁵Lead City University, Ibadan, Nigeria

Background: Metabolic syndrome (MetS) among people living with HIV (PLHIV) is an emerging concern in Africa, but its underlying causes remain unclear. This study is a systematic review and meta-analysis of observational studies published between January 2000 and June 2025 to synthesize evidence on the determinants of MetS among PLHIV in Africa. Methods: PubMed, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for studies reporting determinants of MetS among PLHIV in Africa. Two reviewers independently screened and extracted data, and the risk of bias was assessed with the Newcastle-Ottawa Scale. Results: Thirty-six studies were included, while 23 were meta-analyzed. Female sex was strongly associated with MetS (Pooled odds ratios (PORs) = 2.86, 95% CI: 1.74–4.72), as was alcohol consumption (POR = 1.46, 95% CI: 1.04– 2.03) and elevated BMI (>25 kg/m²) (POR = 4.27, 95% CI: 1.83–9.33). HIV-positive status showed significant effect (OR = 1.04, 95% CI: 1.01–1.09), while smoking (POR = 0.88, 95% CI: 0.48–2.70) and physical activity (POR = 0.98, 95% CI: 0.35–2.80) were not significantly associated. Substantial heterogeneity was observed for BMI, smoking, and physical activity. Conclusion: Female sex, alcohol consumption, and elevated BMI emerged as consistent determinants of MetS among PLHIV in Africa. These findings highlight the importance of proactively integrating, context-specific strategies for metabolic risk management into HIV care to address the rising burden of cardiometabolic disease in the region.