Sherman, Amy CWalsh, Stephen RAnyebe, Victor Anyebe2026-05-0720262026-05-072026Anyebe, Victor Anyebe. 2026. Project 1 Title: Body Mass Index and the Risk of HIV Acquisition in Transgender Women and Men who have sex with Men: A Secondary Analysis; Project 2 Title: Global Prevalence of Metabolic Syndrome in Adolescents Living with HIV by Protease inhibitor Exposure: A Systematic review and Meta-analysis . Masters Thesis, Harvard Medical School.32698531https://dash.harvard.edu/handle/1/42736937Paper 1 Abstract: Objective: The objective of this study was to explore the association between BMI and the risk of HIV acquisition in transgender women and men who have sex with men using secondary data. Design/Methods: We conducted a secondary analysis of the randomized controlled trial HVTN 505. We analyzed BMI at baseline both as a continuous variable and categorical variable categorized as normal/underweight (BMI .9), overweight (BMI 25 -29.9) and obese (BMI ≥30). We assessed Behavioral risk using a standardized baseline risk score. A logistics regression model estimated the association between HIV and BMI category adjusting for age, race, behavioral risk score, and vaccination status. STATA MP/19.5 was used. Results: The cohort (mean age 31.4 ± 9.0 years; 98% male) had a mean BMI of 26.5 ± 5.7 kg/m2 and a distribution of 46.5% normal, 30.8% overweight, and 22.6% obese. HIV acquisition occurred in 4% (n=102). In unadjusted analysis, high BMI (kg/m2) as a continuous variable was associated with lower odds of HIV acquisition (OR 0.93, 95% CI 0.89–0.98, p=0.002); this means that for every 5 kg/m2 increase in baseline BMI, the odds of HIV acquisition decreased by 30%(OR 0.70; 95% CI 0.56 – 0.90, p=0.002). This persisted after adjusting for age, race, behavioral risk score and vaccine treatment assignment (aOR 0.73, 95% CI 0.59–0.95, p=0.017). When analyzed categorically, overweight (OR 0.58, 95% CI 0.37–0.93, p=0.026) and obese (OR 0.33, 95% CI 0.18–0.64, p=0.001) participants had lower odds of HIV acquisition versus normal BMI. After adjustment, obesity was still associated with lower odds of HIV acquisition (aOR 0.38, 95% CI 0.18–0.73, p=0.004), while overweight was nonsignificant (aOR 0.66, 95% CI 0.40–1.07, p=0.098). The Kruskal Wallis test showed that there was no significant difference in behavioral risk across the BMI categories. Conclusions: The study shows a significant association between BMI measured at baseline and the risk of HIV acquisition. Further studies are warranted by researchers to determine how BMI may impact the risk of HIV acquisition. Paper 2 Abstract Background: Metabolic syndrome (MetS) increases cardiovascular disease risk in people living with HIV, yet its global burden among adolescents living with HIV (ALWH) remains poorly characterized. Protease inhibitors (PIs), though no longer first line, remain widely used in second line treatment especially in resource limited settings where most HIV infected adolescents reside. We aimed to quantify the global prevalence of MetS in ALWH and examine its association with PI based antiretroviral therapy (ART) exposure. Methods: We systematically searched PubMed, Embase, and Web of Science for observational studies reporting MetS prevalence in adolescents aged 10-19 years living with HIV. Pooled prevalence was estimated using a random effects model with Freeman-Tukey double arcsine transformation. Subgroup analyses were performed by PI exposure level (high versus low, dichotomized at median 43% PI exposure), age group, and diagnostic criteria (International Diabetes Foundation (IDF) versus National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III). Heterogeneity was assessed using Q statistics, I2, and sensitivity analyses tested effect estimates for robustness. Results: Six cross-sectional studies comprising 1,252 participants from Africa, Europe, Asia and the United States were included. The global pooled prevalence of MetS was 6% (95% CI: 1% -14%), with significant heterogeneity (I2 =94.2%). Among high PI exposure cohorts (>43% on PI based regimens), pooled prevalence was 10% (95% CI: 4% - 17%; I2=70.9%), compared to 4% (95% CI: 0% - 17%; I2=97.4%) in low PI exposure groups. Subgroup analyses by late adolescence (14%; 95% CI: 9% -20%; I2=49.5%) and NCEP ATP III criteria (3%; 95% CI: 1% - 4%; I2=0%) reduced heterogeneity substantially. Leave-one-out sensitivity analysis confirmed estimate stability (range: 5% - 9%). Egger’s test suggested low publication bias (p=0.89), however, this was underpowered because of few studies assessed. Conclusion: The global prevalence of MetS in ALWH is 6%, with a nearly 2.5-fold higher burden among those with high PI exposure (10% versus 4%). These findings support evolving ART strategies beyond viral suppression toward metabolic risk mitigation, particularly in resource limited settings where PIs remain common. Additionally, standardized adolescent specific diagnostic criteria are urgently needed.application/pdfenAdolescents Living with HIVHIV AcquisitionMen who have sex with menMetabolic syndromeObesityprotease inhibitorsPublic healthLGBTQ studiesEpidemiologyThesis or Dissertation2026-05-070000-0002-0157-6402