Purpose: To determine the effects of exercise on metabolic and morphological outcomes among people with HIV using a systematic search strategy of randomized, controlled trials (RCTs). Methods: Two independent reviewers assessed studies using a predetermined protocol. Results: Nine RCTs (469 participants, 41% females) of moderate quality were included. Compared to nonexercising controls, aerobic exercise (AE) resulted in decreased body mass index (weighted mean difference [WMD] -1.31; 95% CI, -2.59, -0.03; n=186), triceps skinfold thickness of subcutaneous fat (WMD -1.83 mm; 95% CI,-2.36, -1.30; n=144), total body fat (%) (standardised mean difference [SMD],-0.37; 95% CI, -0.74, -0.01; n=118), waist circumference (SMD -0.74 mm, 95% CI, -1.08, -0.39; n=142), and waist:hip ratio (SMD -0.94; 95% CI, -1.30, -0.58; n=142). Progressive resistive exercise (PRE) resulted in increased body weight (5.09 kg; 95% CI, 2.13, 8.05; n=46) and arm and thigh girth (SMD 1.08 cm; 95% CI, 0.35, 1.82; n=46). Few studies examined blood lipids, glucose, and bone density. Conclusions: Few RCTs exist and their quality varies. AE decreases adiposity and may improve certain lipid subsets. PRE increases body weight and limb girth. No additional effects of combining AE and PRE are evident. Larger, higher quality trials are needed to understand the effects of exercise on metabolic outcomes (eg, lipids, glucose, bone density) relevant to persons with chronic, treated HIV. © 2010 Thomas Land Publishers, Inc.