The burden of sarcopenia in people living with HIV: a systematic review and meta-analysis across WHO regions

BACKGROUND: Sarcopenia, characterized by progressive loss of skeletal muscle mass and function, represents an underrecognized comorbidity in people living with human immunodeficiency virus, and comprehensive prevalence data across WHO regions remain lacking. OBJECTIVE: To estimate the prevalence of sarcopenia across WHO regions among people living with human immunodeficiency virus (HIV) and to identify demographic, clinical, and methodological factors associated with variations in reported prevalence. METHODS: We searched PubMed, Embase, Scopus, and Web of Science for observational studies published from 2000 onwards that reported the prevalence of sarcopenia in people living with human immunodeficiency virus. Prevalence estimates were pooled using a random-effects meta-analysis. Subgroup analyses examined variations by geographic region, diagnostic criteria, demographic characteristics, and virus-related factors. Publication bias was assessed using Egger’s and Begg’s tests. RESULTS: Across 34 studies involving 7,216 participants in 15 countries, the pooled prevalence of sarcopenia was 16% (95% confidence interval: 12-21%). Substantial heterogeneity (93.6%) was observed. Prevalence estimates varied substantially by diagnostic criteria, ranging from 8% (EWGSOP2 2019) to 28% (Baumgartner criteria), highlighting the importance of standardised diagnostic approaches in future research. Geographic variation was evident, with Romania reporting the highest prevalence (34%). Meta-regression identified body mass index status as a significant moderator of variability in prevalence, and age above 50 years was associated with higher sarcopenia prevalence [odds ratio: 1.97 (1.30-2.98)]. No publication bias was detected. Sensitivity analysis demonstrated robustness. Evidence certainty was moderate. CONCLUSIONS: Sarcopenia affects approximately one in six people living with HIV across the represented WHO regions, with considerable variation across diagnostic approaches and populations. While diagnostic harmonisation is needed to enable consistent epidemiological surveillance, clinical management of sarcopenia in PLHIV must adopt a personalised, risk-stratified approach that accounts for the considerable heterogeneity across individuals in age, body composition, ART history, and socioeconomic context. REGISTRATION: CRD 420,251,063,820. CLINICAL TRIAL NUMBER: Not applicable

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Older adults (>50 years)
  • General HIV+ population
• Co-morbidities
  • Age related disorders
• Health Systems
  • Governance arrangements