Combination Antiretroviral Therapy (CART) is the mainstay in the treatment of HIV infection. However, long-term CART causes fat redistribution, insulin resistance, and dyslipidaemia in patients living with HIV (PLWH). There is limited data from India that have studied these features exclusively in males. In this cross- sectional, observational study, male PLWH (n = 29; mean age: 45.5 years) treated on CART for a decade and above were recruited by purposive sampling method. Anthropometry and skinfold thickness were measured. Body composition analysis was done by DXA. Surrogate indices of insulin resistance (HOMA-IR, HOMA-Beta, and FG-IR) and insulin sensitivity (Mcauley index and QUICKI) were calculated. At end of the study period, Zidovudine-based ART accounted for 54.57% while Stavudine and Tenofovir based ART accounted for 28.37% and 17.05% respectively. Male PLWH on CART for more than a decade featured increased body weight, higher body fat percentage, total body fat mass higher abdominal adiposity and increased fat mass in upper limbs alongside, Furthemore, reduced beta cell function, impaired glucose tolerance, insulin resistance and lower testosterone levels were observed. The proportion of PLWH with diabetes, prediabetes and non-diabetic individuals were (20.6% n = 6), (34.5%; n = 10) and (44.8%: n = 13) respectively.