Infectious Disease · Medical Literature
Sarcopenic Obesity in People With HIV: Diagnostic Criteria and Classification-A Scoping Review With a Meta-Analysis of Prevalence.
Abstract
(a) To describe studies that evaluated sarcopenic obesity (SO) in people with HIV (PWH); (b) to summarize the methods and diagnostic criteria used to define SO in PWH; and (c) to estimate the overall prevalence of SO in this population. Scoping review conducted according to established methodological frameworks and reported following PRISMA-ScR recommendations. Original observational studies conducted in clinical or research settings involving adults (≥ 18 years) with HIV that explicitly applied diagnostic criteria for SO were included. Studies were identified through searches in 12 electronic databases from inception to August 2024, without language restrictions. The scoping review followed five stages: identification of the research question, identification and selection of relevant studies, data extraction, and synthesis of findings. Diagnostic approaches for SO included body composition assessed by dual-energy X-ray absorptiometry (DXA) or computed tomography (CT), anthropometric measures such as body mass index (BMI), and functional assessments including handgrip strength and the Short Physical Performance Battery (SPPB). An exploratory random-effects meta-analysis was performed to estimate the overall prevalence of SO in PWH. Three observational studies were included, two from Italy and one from the United States, comprising 2873 participants, predominantly male (n = 2174 [76%]). Mean age ranged from 47 to 52 years, and mean duration of HIV diagnosis and antiretroviral therapy exceeded 10 years. Seven distinct diagnostic criteria for SO were identified, with DXA being the most frequently used method. The prevalence of SO ranged from 0.76% to 20.8%, and the pooled overall prevalence was 8.18%. SO remains insufficiently explored among PWH. The wide variability in diagnostic criteria and assessment methods contributes to inconsistent prevalence estimates, underscoring the need for standardized, population-specific diagnostic approaches.
Clinical relevance
What diagnostic criteria are currently used to define sarcopenic obesity (SO) in people with HIV (PWH), and what is the estimated pooled prevalence of SO in this population? __SNAPSHOT__ {"studyDesign":"Scoping review with exploratory random-effects meta-analysis of prevalence, conducted according to established methodological frameworks and reported following PRISMA-ScR recommendations","setting":"Clinical and research settings; databases searched from inception to August 2024 across 12 electronic databases without language restriction","sampleSize":"Meta-analysis subset: n=2,873 participants (235 identified SO cases) across 7 included studies; total number of studies in the broader scoping review not reported in the available abstract/record","population":"Adults ≥18 years of age with confirmed HIV infection, enrolled in original observational studies that explicitly applied diagnostic criteria for sarcopenic obesity","intervention":"Diagnostic classification and characterization of sarcopenic obesity using various methods including DXA, CT-based body composition assessment, anthropometric indices (BMI), and functional measures (handgrip strength, Short Physical Performance Battery [SPPB])","comparator":"Not applicable (single-population prevalence review; no HIV-negative comparator arm in the scoping review)","primaryOutcome":"Overall prevalence of sarcopenic obesity in PWH; secondary aims included cataloguing and summarizing the diagnostic criteria and classification methods applied across studies","followUp":"Not reported (cross-sectional prevalence data; study-level follow-up durations not specified in available record)","fundingSource":"Not reported"}
Key findings
When prevalence estimates were pooled using a random-effects model, the overall prevalence of SO in PWH was 8.18% (95% CI: 4.02%–15.9%), representing 235 cases among 2,873 participants. Heterogeneity was extreme: I² = 98.44%, Q = 385.56 (df = 6), Tau² = 1.00, indicating that the pooled estimate must be interpreted with considerable caution. Study-level prevalence estimates varied markedly by diagnostic criteria applied, ranging from 0.76% (low ASMI + high BMI) to 20.8% (low ASMI + high VAT). No single criterion was uniformly adopted across studies. Adverse event data and NNT/NNH are not applicable to this study design and were not reported. No comparative effect sizes (odds ratios, hazard ratios) for outcomes of SO versus non-SO in PWH were reported within the meta-analysis component of this review.
Practice implications
This scoping review establishes that sarcopenic obesity is an identifiable and measurable condition in PWH, with a pooled prevalence of approximately 8%, but the extreme statistical heterogeneity (I²=98.44%) renders the pooled estimate descriptively informative rather than a reliable epidemiological parameter. The review clearly demonstrates that no standardized, HIV-specific diagnostic criteria for SO currently exist, and that most studies in PWH rely solely on anthropometric indices (BMI) and body composition measures (ALMI, ALM/W, TSMI, VAT, body fat percentage) without incorporating functional parameters such as handgrip strength or SPPB—despite guidelines for the general population recommending their inclusion. Diagnostic thresholds derived from HIV-negative populations may have limited validity in PWH due to HIV-specific alterations in fat distribution, lipodystrophy, and ART-associated weight gain. The wide prevalence range (0.76%–20.8%) across studies reflects methodological and definitional heterogeneity rather than true epidemiological variation. Findings apply to adults with HIV engaged in clinical or research settings; individuals with advanced immunosuppression, pediatric patients, and those not yet engaged in care are not adequately represented. This review does not establish causal relationships, does not adjudicate which diagnostic method is superior, and does not provide outcome data linking SO to specific clinical endpoints in PWH. Practice should not change on the basis of this review alone; rather, it serves as a call for consensus guideline development and prospective studies using standardized, HIV-validated criteria. LIMITATION NOTE: This summary is based on abstract-level and open-access full-text data only; findings from the complete manuscript may include additional nuances not captured here. __LIMITATIONS__ Extreme between-study heterogeneity (I²=98.44%) severely limits the interpretability of the pooled prevalence estimate of 8.18%,No standardized diagnostic criteria for SO in PWH exist, and the diversity of definitions (DXA vs. CT, BMI vs. body fat percentage vs. VAT, with or without functional measures) precludes meaningful direct comparisons across studies,Scoping review methodology is designed to map evidence, not to formally synthesize or critically appraise study quality; risk-of-bias assessment is not a standard component,The meta-analysis component was described by the authors as 'exploratory,' appropriately tempering the weight placed on the pooled estimate,Diagnostic thresholds used in included studies were derived from HIV-negative reference populations, introducing potential misclassification in PWH with lipodystrophy or ART-related body composition changes,The number of studies contributing to the meta-analysis was small (n=7), limiting the precision and generalizability of the pooled estimate,Potential publication bias was not formally assessed or reported in the available record,Sex, age, ART regimen, geographic region, CD4 count, and viral load as potential moderators of SO prevalence were not adequately addressed in the available data,Absence of HIV-uninfected comparator groups prevents estimation of excess SO burden attributable to HIV or ART,Funding source was not reported, precluding assessment of potential sponsorship bias __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This scoping review with meta-analysis identifies a pooled SO prevalence of approximately 8% in PWH, but extreme heterogeneity (I²=98.44%) driven by non-standardized diagnostic criteria renders this estimate unreliable for direct clinical application. No HIV-specific guidelines for SO diagnosis currently exist, and most published studies omit functional assessments recommended in general-population frameworks. Clinicians caring for PWH should be aware of SO as an undercharacterized comorbidity and advocate for prospective studies using validated, HIV-adapted diagnostic criteria.