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Weight Loss 5.7% at 1 Year With Semaglutide in HIV
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CROI 2024 (Conference on Retroviruses and Opportunistic Infections), March 3-6, 2024, Denver
Mark Mascolini
In a 10-site US cohort of more than 200 overweight people with HIV and sometimes diabetes, weight loss averaged 5.7% after 1 year of the GLP-1 receptor agonist semaglutide [1]. Weight loss was greater among people with higher body mass index (BMI) when starting the once-weekly injected drug.
Licensed in the US to treat obesity and type 2 diabetes, semaglutide has attracted the attention of HIV clinicians with many patients facing these problems. Yet few reports describe real-world experience on semaglutide in people with HIV. To fill that gap, researchers from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) conducted this 2018-2022 observational study.
Participants were people with HIV who took injectable or oral semaglutide and had their weight measured at least twice. Stephanie Ruderman (University of Washington, Seattle) and CNICS colleagues used linear mixed models adjusted for age, sex, race/ethnicity, CNICS site, diabetes status, CD4 count, HIV viral load, and time to determine (1) body weight change and (2) percent body weight change 1 year after starting semaglutide.
One quarter of the 222 participants were female, age averaged 53 years, and follow-up averaged 1.1 years. About half of participants (48%) were white, 35% black, and 15% Hispanic. While 77% of participants had diabetes, 89% had an undetectable viral load. For people with dosing information, 87 of 111 got low doses of subcutaneous semaglutide weekly (0.25, 0.5, 1 mg), while 24 people got high subcutaneous doses (1.7, 2, 2.4 mg).
The researchers found no significant interaction with diabetes status or dose and weight loss over time. Weight fell an average 6.18 kg in people with diabetes and 8.57 kg in those without diabetes (P < 0.001 for both within-group changes, P = 0.12 for interaction between groups). People getting low-dose semaglutide averaged an 8.95 kg weight loss, while those on high-dose semaglutide averaged a 12.06 kg drop (P < 0.001 for both within-group changes, P = 0.27 for interaction between groups). Overall percent weight drop measured 5.7% after 1 year of semaglutide.
People with higher BMI lost more weight than people with lower BMI: -8.8 kg with BMI for 50 people at or above 40 kg/m2, -7.6 kg for 60 people at 35.0 to 39.9 kg/m2, -5.4 kg for 65 people at 30 to 34.9 kg/m2, -4.6 kg for 36 people at 25 to 29.9 kg/m2, and -4.1 kg for 11 people at 18.5 to 24.9 kg/m2. Weight loss in the highest BMI group was significantly greater than loss in the three lowest BMI groups listed above (P < 0.05).
The CNICS investigators observed that their study is limited by its small sample, especially when considering dose groups. They also noted their inability to assess adherence or treatment gaps caused by inconsistent semaglutide supply. Because of the drug's popularity, reports of injectable semaglutide shortages in the US, Canada, and Europe are common [2].
people with HIV: a stratified analysis by baseline BMI. CROI 2024 (Conference on Retroviruses and Opportunistic
References
1. Haidar L, Crane HM, Nance RM, et al. Impact of semaglutide on weight change among Infections), March 3-6, 2024, Denver. Abstract 797.
2. Neale T. Injectable semaglutide shortage forces physicians to pivot. tctMD. February 5, 2024. https://www.tctmd.com/news/injectable-semaglutide-shortage-forces-physicians-pivot
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