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Semaglutide Trims Muscle Volume but Physical Function Not Lost
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CROI 2024 (Conference on Retroviruses and Opportunistic Infections), March 3-6, 2024, Denver
Mark Mascolini
Low-dose semaglutide, the GLP-1 receptor agonist that suppresses appetite and lowers weight, significantly decreased psoas muscle volume through 24 weeks in the SLIM LIVER trial of people with HIV infection and metabolic-associated steatotic liver disease (MASLD) [1]. But standard physical function measures like chair rise and gait speed did not change or improved slightly with semaglutide.
The SLIM LIVER study enrolled people with HIV who had an MRI-detected 5% or greater gain in intrahepatic triglycerides, waist circumference 95 cm or greater in men and 94 cm or greater in women, and at least one criterion for insulin resistance or diabetes. Participants got open-label subcutaneous semaglutide for 24 weeks, with dose escalation up to 1.0 mg/week by week 4. Because muscle loss usually occurs with weight loss, SLIM LIVER investigators tracked muscle and fat changes, as well as standard measures of physical function, through 24 weeks. (The psoas muscle connects the lower spine and the pelvis.)
Of the 49 trial participants evaluated, 31 were men and 18 women, 59% white, 33% black, and 39% Hispanic. Age averaged 50 years, body mass index 36.5 kg/m2, weight 103.1 kg, and waist circumference 114.7 cm.
Overall psoas muscle volume fell by 9.3% through 24 weeks (P < 0.001) and weight loss averaged 7.8 kg. Psoas volume loss proved significantly greater in people older than 60 than in 40- to 60-year-olds or people younger than 40 (-22.8% vs -7.9% vs -2.4%). Muscle loss did not differ by sex. Psoas muscle fat content did not change significantly during the 24 weeks.
Drops in psoas muscle volume correlated with declines in intrahepatic triglycerides (rho = +0.32, P = 0.028), body mass index (rho = +0.31, P = 0.038), and the diabetes marker HbA1C (rho = +0.39, P = 0.007). Psoas absolute volume loss was associated with drops in fasting triglycerides (rho = +0.33, P = 0.027).
Despite psoas muscle volume loss during 24 weeks of the trial, chair rise time and one measure of gait speed did not change significantly. Change from baseline in 5x chair rise fell an average 0.66 sec (P = 0.077), 10x chair rise time dwindled 1.27 sec (P = 0.069), and gait speed improved nonsignificantly (+0.05, P = 0.078). Whereas 63% of trial participants had slow gait speed (less than 1 meter per second) at baseline, 46% had a slow gait at week 24, a significant improvement (P = 0.029). These small shifts in muscle function did not correlate with changes in overall weight or body mass index.
SLIM LIVER investigators proposed that "the observed average improvement in muscle function suggests a beneficial effect of semaglutide on overall muscle quality."
Reference
1. Ditzenberger GL, Lake JE, Kitch DW, et al. Effects of semaglutide on muscle structure and function in the SLIM liver study. CROI 2024 (Conference on Retroviruses and Opportunistic Infections), March 3-6, 2024, Denver. Abstract 799.
CROI:Effects of Semaglutide on Muscle Structure and Function in the SLIM Liver Study - (03/12/24)
Semaglutide at CROI 2024
the use of semagltude is found to cause muscle loss in PWH in these studies, as well as worsening already existing or causing facial & limb fat loss/lipoatrphy, this this becomes a concern for WPWH aging were muscle & fat changes or loss can be impactful.
• CROI: Impact of Semaglutide on Weight Change Among People with HIV: A Stratified Analysis by Baseline BMI - (03/11/24)
CROI: Effects of Semaglutide on Muscle Structure and Function in the SLIM Liver Study - (03/12/24)
• CROI: Semaglutide Lowers Some Inflammation Markers in HIV Lipohypertrophy - (03/12/24)
CROI: Effects of Semaglutide on Inflammation and Immune Activation in HIV-Associated Lipohypertrophy....people with severe lipoatrophy were excluded from study, so were diabetics & CVD - (03/11/24)
• CROI: Effects of Semaglutide on Muscle Structure and Function in the SLIM Liver Study - (03/12/24)
• CROI: Semaglutide Lowers Some Inflammation Markers in HIV Lipohypertrophy - (03/12/24)
• CROI: Low-Dose Semaglutide Cuts Weight, Triglycerides, and Glucose in HIV MASLD Group - (03/12/24)
• CROI: Race/Ethnicity and Risk of NAFLD and Clinically Significant Fibrosis in Persons Living with HIV - (03/12/24)
• CROI: NAFLD and Advanced Fibrosis Are Common in Adults With HIV and Associated With Unique Histology - (03/12/24)
CROI: Weight Loss 5.7% at 1 Year With Semaglutide in HIV - Mark Mascolini (03/11/24)
100 NATAP CROI Reports
Conference on Retroviruses
and Opportunistic Infections Virtual
Mar 3 -, Mar 6, 2024
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