PhD student University of Manitoba Winnipeg, Canada
Background: With recent improvements in antiretroviral therapy (ART), obesity has become more common in people with HIV (PWH), especially among those with metabolic disease like type 2 diabetes. Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved in many countries for the treatment of type 2 diabetes and recently in the US for obesity as well. In the general population, randomized clinical trials (RCTs) have reported significant weight loss with semaglutide, however, there is limited real-world evidence about the effectiveness of semaglutide for weight loss among PWH.
Objectives: We aimed to investigate weight change in a US cohort of PWH who initiated semaglutide treatment.
Methods: We conducted an observational study using data from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. We identified adult PWH who initiated semaglutide between 2018 and 2022, using their first prescription date as baseline, and with ≥2 weight measurements: one within 12 months before baseline (median 3 days, IQR: 0-27 days) and one after initiation of semaglutide treatment (median 35 days, IQR: 18-77 days). The primary outcome of interest was within-person bodyweight change (kg/year) estimated using a linear mixed model adjusted for age, sex, race/ethnicity, CNICS site, diabetes status, CD4 cell count, and HIV viral load (VL).
Results: In total, 222 new users of semaglutide met inclusion criteria for this analysis. Mean follow up was 1.1 years. Approximately 75% of new semaglutide users were male, mean age at baseline was 53 years (standard deviation [SD]: 10), average weight at/prior to baseline was 108 kg (SD: 23), and mean body mass index was 35.5 kg/m2. Mean hemoglobin A1c was 7.7% and 77% had clinically recognized diabetes at baseline. At/prior to semaglutide initiation, 54% were on metformin, 39% were on insulin, and 15% were on a Sodium-glucose Cotransporter-2 (SGLT2) Inhibitor. At baseline, 89% were virally suppressed (VL < 50 copies/mL) and 97% were on ART. In the adjusted mixed model analysis, treatment with semaglutide was associated with significant weight loss: 6.42 kg per 1 year (95% CI: -7.67 to -5.18).
Conclusions: Semaglutide was associated with significant weight loss in this cohort of PWH. These results are comparable with the results of RCTs and observational studies from the general population, suggesting that semaglutide may be as effective for both weight loss and diabetes control among PWH. This study was limited by short follow up time, therefore, larger studies with longer follow up time are warranted.
