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In the general population, metabolic health often declines as BMI increases. However, some obese individuals maintain metabolic health. HIV and antiretroviral therapy have been associated with metabolic disturbances. We hypothesized that HIV-infected (HIV+) men on suppressive antiretroviral therapy experience less metabolic health than HIV-uninfected (HIV−) men across all BMI categories.In a cross-sectional analysis of 1018 HIV+ and 1092 HIV− men enrolled in the multicenter AIDS cohort study, Poisson regression with robust variance determined associations between HIV serostatus and metabolic health prevalence (defined as meeting ≤2 of 5 National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome criteria), adjusting for age, race, BMI category, smoking, and hepatitis C virus infection status.HIV+ men were younger (54 vs. 59 years) and had lower median BMI (25 vs. 27 kg/m2). Nonobese HIV+ men had lower metabolic health prevalence than HIV− men (BMI ≤25 kg/m2: 80 vs. 94%, P < 0.001; BMI 25–29 kg/m2: 64 vs. 71%, P = 0.05), but metabolic health prevalence among obese men did not differ by HIV serostatus (BMI 30–34 kg/m2: 35 vs. 39%, P = 0.48; BMI ≥35 kg/m2: 27 vs. 25%, P = 0.79). In the adjusted model, nonobese HIV+ men were less likely to demonstrate metabolic health than nonobese HIV− men. Among HIV+ men, per year darunavir, zidovudine, and stavudine use were associated with lower metabolic health likelihood.Metabolically healthy obesity prevalence does not differ by HIV serostatus. However, among nonobese men, HIV infection is associated with lower metabolic health prevalence, with associations between lack of metabolic health and darunavir and thymidine analog nucleoside reverse transcriptase inhibitor exposure observed.