697 – Tirzepatide Use in People With HIV Shows Effectiveness for Weight Loss and Diabetes Control

Background

There is limited real-world evidence about the effectiveness of tirzepatide, a newer dual glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 receptor agonist (GLP-1RA), among people with HIV (PWH) in routine clinical care. We investigated changes in body weight and diabetes control in PWH starting therapy with tirzepatide while in care.

Methods

We examined PWH who initiated tirzepatide between 6/2022 and 2/2025 in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. We assessed changes in percentage of body weight and glycated hemoglobin (A1c) among new users of tirzepatide using a longitudinal quasi-experimental pre-post study design. Both outcomes were estimated using multivariable linear mixed models of the trajectory of the outcome, and adjusted for age, sex, race/ethnicity, and diabetes status to improve precision. We assessed for effect measure modification with analyses stratified by sex, diabetes status, and obesity (body mass index BMI ≥30 kg/m²) at the time of tirzepatide initiation. In sensitivity analyses, we compared results to PWH initiating semaglutide (the most common GLP-1RA in CNICS) during the same timeframe.

Results

There were 743 PWH who initiated tirzepatide during the study period, from 9 CNICS sites. The mean age was 53 years, 28% were female, mean BMI was 35 kg/m², and 95% were virally suppressed (<200 copies/mL). At tirzepatide initiation, obesity was present in 84% of PWH and 62% had diabetes. There was a mean drop in body weight of 5.9% (95% CI: -6.9, -5.0) and of A1c of -0.58% (95% CI: -0.75, -0.41) over the first year of therapy in adjusted analyses. The only effect measure modification observed was by sex and A1c (interaction p-value: <0.01), with men showing more improvement in A1c, -0.66% (95% CI: -0.87, -0.46) compared to women -0.15% (95% CI: -0.23, -0.07). Over the same time period, PWH taking semaglutide showed similar body weight -4.1% (95% CI: -4.6, -3.5), and A1c -0.47% (95% CI: -0.58, -0.36) reductions using the same study design (Table). 

Conclusions

CNICS provides real-world evidence that tirzepatide is an effective treatment option for the treatment of obesity in PWH. There is also evidence of improved diabetes control among PWH, although evidence of effect measure modification among women needs to be further studied.

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