by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

May 7, 2024

Featured Literature:

Lake JE, Kitch DW, Kantor A, et al.  The effect of open-label semaglutide on metabolic dysfunction-associated steatotic liver disease in people with HIV.  Ann Intern Med.  2024 Apr 30.  doi: 10.7326/M23-3354.  PMID: 38684100. 

The SLIM LIVER team investigated whether semaglutide taken as 1mg weekly was associated with changes in liver fat and cardiometabolic parameters among adult PWH with central adiposity, insulin resistance/prediabetes, and steatotic liver disease.  Among 49 virologically suppressed participants (57% cismen, 37% ciswomen, and 5% transwomen) with median BMI of 35 kg/m2 and median waist circumference of 114 cm, reductions in intrahepatic triglycerides (IHTG) were observed over 24 weeks.  29% of participants had complete resolution of metabolic dysfunction-associated steatotic liver disease and 58% had a relative reduction in IHTG of at least 30%.  Participants also experienced reductions in weight, BMI, and waist circumference as well as improvements in glucose regulation markers and fasting triglyceride concentrations.  The most common adverse event was grade 1 gastrointestinal symptoms.

Author’s Commentary:

The glucose and weight benefits of GLP-1 agonists have been well established, and given the elevated prevalence of HIV associated metabolic disorders, studies such as the SLIM LIVER trial will be increasingly important to better understand specific safety and clinical outcomes for people with HIV.  Data from this pilot study are very encouraging; longer follow-up times and information on additional clinical end points will further add to our understanding of the impact of these pharmacotherapies.  Additionally, sub-analyses by ART may be helpful (82% of participants in this sample were on INSTI-based combinations at baseline) to determine whether the effect of semaglutide differs by varying ART exposure. 

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