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GLP-1 receptor agonists promote weight
loss among people with HIV
One Quarter of PWH Lose More
Than 5% of Weight With GLP-1 Agonists
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IDWeek 2023, October 11-15, 2023, Boston
Mark Mascolini
About one quarter of 225 overweight and obese people with HIV (PWH) lost more than 5% of weight during treatment with a GLP-1 receptor agonist (GLP-1RA) in a retrospective analysis [1]. Higher baseline body mass index (BMI) and longer GLP-1RA treatment predicted more than 5% weight loss in multivariable analysis.
Weight gain remains a concern in PWH taking today's antiretroviral regimens, noted University of California San Diego (UCSD) researchers who conducted this study. Second-generation integrase inhibitors (dolutegravir and bictegravir) along with tenofovir alafenamide (TAF) have taken heat for weight gain in some studies, though other work, including another study presented at IDWeek 2023 [2], found that switching from efavirenz or tenofovir disoproxil fumarate (TDF) to an integrase inhibitor regimen raised odds of weight gain.
The UCSD team noted several challenges to using GLP-1RA for weight loss: no guidance on length of therapy or when to stop; no advice on managing side effects or dose titration; expense of modification and spotty insurance coverage; and determining which group should have priority access to GLP-1RA, people with diabetes or people trying only to lose weight. Data on GLP-1RA for weight loss in PWH remain scarce, the research team noted.
To learn more about GLP-1RA in PWH, the UCSD investigators conducted a retrospective study of adults seen at the university clinic and prescribed a GLP-1RA from February 2021 to February 2023. The 225 study participants averaged 54.3 years in age, 17.8% were assigned female at birth, 49.3% were white, 29.3% mixed race, and 15.3% black. Comorbidities seen in high proportions of the study group were hypertension in 65%, hyperlipidemia in 63%, diabetes in 57%, and nonalcoholic fatty liver disease (NAFLD) in 24%. Clinicians prescribed semaglutide (Ozempic) most (31.6%), followed closely by dulaglutide (Trulicity) (30.7%), followed more distantly by another semaglutide (Wegovy) (20.9%).
During GLP-1RA therapy, average weight dropped 5.4 kg, BMI fell 1.8 kg/m2, and hemoglobin A1C slid 0.6%. Fifty-three of 225 study participants (23.5%) lost more than 5% of pretreatment weight. Multivariable analysis linked three factors to more than 5% weight loss in this study group:
- Higher pretreatment BMI (odds ratio [OR] 1.07, 95% confidence interval [CA] 1.02 to 1.3)
- Longer GLP-1RA therapy (OR 1.04 per month, 95% CI 1.01 to 1.07)
- Use of dulaglutide vs other GLP-1A lowered odds of losing more than 5% of weight (OR 0.33, 95% CI 0.17 to 0.66)
A subgroup of 97 people with HIV but without diabetes averaged 51.5 years in age, 20.6% were assigned female at birth, their most-prescribed regimen (in 47.4%) coupled dolutegravir or bictegravir with two nucleoside/nucleotide inhibitors (NRTIs), and the most-prescribed GLP-1RA agent was semaglutide (35% Wegovy and 35% Ozempic). During treatment average weight dropped 7.3 kg and BMI 2.3 kg/m(2). Half of the people in this subgroup, 50.5%, lost more than 5% of weight.
A second subgroup of 180 people with BMI above 30 kg/m2 (indicating obesity) averaged 53.2 years in age, 20.6% were assigned female at birth, and the most prescribed antiretroviral combination was dolutegravir or bictegravir plus 2 NRTIs. Weight fell an average 5.9 kg during therapy, while BMI waned 2 kg/m(2). Virtually half, 49.4%, shed more than 5% of weight, and 23% improved from the obese BMI category to overweight.
The investigators noted that they could not factor in the potential impact of TDF, which is tied to weight loss. Neither could they assess the effect of lifestyle changes on outcomes or explore how tolerability of different GLP-1RAs affects changing regimens.
More will be learned about semaglutide in PWH now enrolling in the University College Dublin's SWIFT trial, which randomizes people to semaglutide plus lifestyle interventions versus lifestyle interventions alone [3].
References
1. Nguyen QP, Wooten D, Duren K, et al. GLP-1 receptor agonists promote weight loss among people with HIV. IDWeek 2023, October 11-15, 2023, Boston.
2. Cutshaw MK, Harding M, Davenport CA, Okeke NL. Determinants associated with weight gain among persons with HIV who switch to integrase strand transfer inhibitors (INSTI). IDWeek 2023, October 11-15, 2023, Boston. (Reviewed separately by NATAP.)
3. ClinicalTrials.gov. Semaglutide's efficacy in achieving weight loss for those with HIV (SWIFT). ClinicalTrials.gov ID NCT04174755. https://clinicaltrials.gov/study/NCT04174755
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