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Background Following ART initiation, metabolic shifts may contribute to weight gain in PLWH. While early weight gain has been linked to integrase inhibitors (INSTIs), the relative impact of long-term stable ART versus modifiable lifestyle factors remains unclear. The LIFEH study investigated lifestyle associated with overweight/obesity (OO) vs normal weight (NW) in PLWH on stable suppressive ART.Material and Methods We performed a cross-sectional analysis of LIFEH study. Adult PLWH (18–65 years) on stable ART with HIV-RNA <20 copies/mL for ≥24 months, followed at a tertiary center in Northern Italy (2023–2024), were enrolled. Individuals with metabolic/cardiovascular disease, cancer, opportunistic infections, substance abuse, or prescribed diets were excluded. Lifestyle factors were assessed using validated tools (24-hour recall diet, MediLite, IPAQ-SF, CAGE). OO was defined as BMI ≥25 kg/m 2. Multivariable logistic regression identified independent factors associated to OO.Results Among 176 participants (median age 51 years; 22% female; median HIV duration 17 years), OO prevalence was 52.8%, slightly higher than that reported in the Italian general population (43%). Thirty percent had BMI ≥25 kg/m 2 at HIV diagnosis; 39.8% of initially normal-weight individuals developed OO over time, while 83% of those overweight/obese at diagnosis remained in the same BMI category at study entry (figure 1).HIV-RNA at diagnosis was higher in OO vs NW (p=0.043), with similar current immunovirological parameters.OO vs NW participants had lower fiber intake (14 vs 17 g/day; p=0.007) and lower Mediterranean diet adherence (MediLite 10 vs 11; p=0.009). Beer and aperitif consumption were more frequent in OO (p=0.022; p=0.002). Physical activity was comparable between groups. In multivariable analysis, BMI ≥25 kg/m2 at HIV diagnosis was strongly associated with current OO (OR 7.61, 95% CI 3.27–19.6; p<0.01). Conversely, each 1-point increase in MediLite score was independently associated with lower odds of OO (OR 0.80, 95% CI 0.67–0.94; p<0.01). ART regimen (INSTI-based or dual vs triple therapy) did not increase risk of current OO.Conclusions In PLWH on long-term stable ART, overweight and obesity appear more strongly associated with modifiable lifestyle factors than with ART regimen. Integrating structured nutritional and lifestyle interventions into routine HIV care may be crucial to prevent metabolic complications.Abstract P153 Figure 1Comparison of BMI at the time of HIV diagnosis and BMI at the time of the study (currently)