Cardio-metabolic syndrome (CMS), is a cluster of biochemical and anthropometric abnormalities that have high predictive ability for the development of atherosclerotic cardiovascular disease. The advent of combination antiretroviral therapy(cART) has transformed the dynamics of HIV/AIDS from an acute infection to a chronic lifelong disease. However, this has predisposed people living with HIV (PLWHIV) to cardio-metabolic effects of the disease. Although available reports suggest increasing trends of CMS among PLWHIV, evidence of CMS in adolescents living with HIV (ALHIV), who account for a significant burden of HIV infection, is very limited in scope and methodological rigor. Aim: This study therefore, aimed to determine the prevalence and risk factors associated with CMS in adolescents living with HIV and apparently healthy controls, using the modified International Diabetes Federation (IDF) criteria. Methods: This study was cross-sectional in design and conducted over eight (8) months at the Lagos University Teaching Hospital (LUTH). A total of 182 adolescents aged 10-19 years comprising 91 HIV positive and 91 HIV negative controls who gave informed assent and consent, were recruited into the study. Anthropometric measurements (weight, height, and waist circumference) including blood pressure were taken. Blood samples were collected for fasting glucose, high density lipoprotein and triglyceride assays and analyzed using standard procedures. Cardio-metabolic syndrome was defined based on the modified International Diabetes Federation (IDF) criteria, which consist of obesity, dyslipidemias, hyperglycemia, and hypertension. Proportions of CMS, components of CMS, and plausible risk factors (age at diagnosis of HIV, viral load, duration of cART and type of cART) were also determined. Statistical package for social sciences (SPSS) software version 26 was used for analysis. Statistical association was considered significant if the p-value was <0.05.