Background:
Limited real-world evidence on effectiveness of semaglutide for weight loss among people with HIV (PWH) exists. We aimed to investigate weight change in a cohort of PWH initiating semaglutide use.
Methods:
Adult PWH who initiated semaglutide between 2018 and 2022 and had ≥2 weight measurements from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort were assessed for within-person (1) bodyweight change in kg at 1 year and (2) percent bodyweight change using linear mixed model adjusted for age, sex, race/ethnicity, CNICS site, diabetes status, CD4 cell count, HIV viral load (VL), and time. We also investigated whether the effect of semaglutide on weight change varied by baseline BMI category, diabetes status, and semaglutide dose.
Results:
During the study period 222 PWH initiated semaglutide. Mean follow up was 1.1 years. Approximately 75% were male. At baseline mean age was 53 years (standard deviation [SD]: 10), average weight was 108 kg (SD: 23), mean BMI was 35.5 kg/m2, mean HbA1c was 7.7% and 77% had clinically recognized diabetes. At baseline, 97% were on ART and 89% were virally suppressed (VL< 50 copies/mL). The majority, 87 (69.6%) received low doses of subcutaneously injected semaglutide (0.25, 0.5, and 1 mg), while 24 (19.2%) received high doses of subcutaneously injected semaglutide (1.7, 2, and 2.4 mg). In linear mixed models, treatment with semaglutide was associated with an average weight loss of 6.5 kg at 1 year (95% CI -7.7, -5.2) and with a percent bodyweight reduction of 5.7% (-6.9 to -4.6) at 1 year. Reductions in weight among PWH were -4.1 (-7.9, -0.2) kg (p =0.04) with normal BMI, −4.6 (−6.9, −2.3) kg (p< 0.001) in overweight, −5.4 (−7.3, −3.4) kg (p< 0.001) in obesity class 1, −7.6 (−9.5, −5.7) kg (p< 0.001) in obesity class 2, and −8.8 (−10.9, −6.7) kg (p< 0.001) in obesity class 3. There was a significant difference in weight loss between PWH with obesity class 3 (reference) and PWH with normal BMI, overweight, and obesity class 1 (p for interaction <0.05). No significant differences in weight loss by diabetes status or semaglutide dose were observed.
Conclusions:
Among PWH, semaglutide was associated with significant weight loss, with more substantial weight loss observed in individuals with higher BMI. These findings are highly relevant given high proportions of diabetes, overweight, and obesity among PWH.
