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

November 21, 2023

Featured Literature:

Haidar L, Crane HM, Nance RM, et al.  Weight loss associated with semaglutide treatment among people with HIV.  AIDS.  2023 Nov 17.  doi: 10.1097/QAD.0000000000003791.  PMID: 37976053

Investigators from the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort conducted an observational, longitudinal examination of adult PWH to describe weight changes after semaglutide initiation.  222 new semaglutide users at eight academically affiliated study sites across the U.S. (study period 2018-2022) contributed data.  Outcomes of interest were within-person bodyweight change, percentage bodyweight change, and hemoglobin A1c percent change at 1 year.  Almost three-quarters of patients were male, with mean baseline age of 53 years.  Average baseline weight was 108 kg (mean BMI: 35.5 kg/m2).  Mean HbA1c was 7.7% and 77% had diabetes at baseline.  89% had VL < 50 copies/mL at baseline, with 97% on ART (82% were receiving an INSTI-based regimen).  87/125 received low-dose and 24/125 received high-dose injectable semaglutide, and 14/125 received oral doses.  Multivariate modeling indicated that semaglutide treatment was associated with significant bodyweight and percent bodyweight loss at 1 year (6.47 kg and 5.72%, respectively).  Body weight changes among PWH on INSTIs were -6.49 kg vs. -6.38 for people not on INSTIs, with no significant difference between these two subgroups.  Semaglutide was also associated with significant A1c reduction at 1 year: 1.07%.

Author’s Commentary:

This brief report, one of the first describing short-term clinical outcomes among PWH initiating semaglutide, affirms it is an effective pharmacologic intervention for weight loss and diabetes management among PWH.  Body weight changes observed among this cohort were comparable to results from trials involving people without HIV.  Although limitations include lack of information on semaglutide adherence, ARV adjustments during the observation period, and/or intensive lifestyle modifications adopted by participants, findings indicate that semaglutide at various doses leads to weight loss and A1c reduction.  Larger studies including longer follow-up time and incorporation of additional data points such as other clinical outcomes of interest (e.g., CVD and CKD) will help further establish the role of semaglutide in HIV care.      

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