Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) such as semaglutide are used to lower serum glucose levels and reduce weight. In animal studies, GLP-1 RA reduce alcohol use, though non-trial human data is limited particularly among people with HIV (PWH).
Methods
We examined change in alcohol use among PWH who reported alcohol use and received semaglutide for weight or glucose control in routine clinical care at 8 sites across the U.S. between 4/2018-3/2024 in the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Change in alcohol use was assessed with linear mixed models of AUDIT-C scores prior to and after initiating semaglutide adjusted for age, sex, race/ethnicity, and time. We stratified models by PWH with at-risk alcohol use, defined as AUDIT-C scores of >3 for women and >4 for men and low alcohol use, defined as scores of 1-2 and 1-3 among women and men, respectively.
Results
334 PWH reporting alcohol use received semaglutide. Median number of alcohol assessments after semaglutide was 2 [interquartile range: IQR 1,3] with last follow-up alcohol assessment a median of 422 [IQR 184,682] days after starting semaglutide. The mean age was 54 years, 24% were female, 42% were White, 31% Black, and 22% Hispanic/Latine. Among 98 PWH with at-risk alcohol use at baseline, median AUDIT-C score was 5 (IQR 4,6), vs. 2 (IQR 1,2) among 236 PWH reporting low alcohol use. Median baseline BMI was 33 (IQR 30,38) among those with at-risk alcohol use and 34 (IQR 31,38) among those with low alcohol use. In adjusted analyses, among PWH with baseline at-risk alcohol use, mean AUDIT-C scores decreased by 1.2 points (95% CI: -1.7, -0.7) after initiating semaglutide while there was no change in AUDIT-C score among those with lower baseline alcohol use (see Table).
Conclusions
PWH with at-risk alcohol use receiving semaglutide for weight or glucose management in routine clinical care report decreases in alcohol use as measured by AUDIT-C score providing support for testing semaglutide in future studies of PWH with alcohol use disorder.
Table or Figure
