The inflammation-reducing effects of GLP-1 receptor agonists may yield cognitive function benefits for some people living with HIV, according to short-term results from a small U.S. study. While the findings are preliminary—they’re not enough to warrant expanding our use cases for semaglutide and related drugs—they do offer promising avenues for further research and progress in an area of great concern for many of our patients as they age with HIV.
Highlighted Study Population and Methods
In this phase 2b study, 108 adults living with HIV (median age 53 years, 65% non-white, 40% female) were randomized 1:1 to receive once-weekly semaglutide or placebo for 32 weeks.
Inclusion criteria included receipt of a stable antiretroviral regimen for ≥12 weeks, HIV-1 RNA <400 copies/mL for at least six months before entry, and a body mass index (BMI) ≥ 25 kg/m² with an observed increase in abdominal girth occurring after antiretroviral therapy initiation.
The primary outcome was change in cognitive function at 32 weeks, assessed using the Cognivue computer-based test measuring various cognitive domains.
Secondary outcomes included changes in body composition (visceral adipose tissue, subcutaneous fat, total fat) and the inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and soluble CD163.
Key Findings
At 32 weeks, compared with placebo:
The semaglutide arm showed significant improvements in three cognitive domains: visuospatial, naming/language, and delayed recall (p = 0.01, 0.05, 0.04 respectively).
After adjusting for sex and absolute CD4 count, only the visuospatial domain remained statistically significant (p = 0.05).
Effect on visuospatial score persisted after controlling for changes in the inflammatory biomarkers hs-CRP and soluble CD163 (p = 0.04).
Change in total or central adiposity was not associated with cognitive improvement.
The authors concluded that the cognitive benefit (particularly visuospatial) appears to be mediated by reduction in inflammation rather than reductions in adiposity.
Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodyPro.
Source : TheBodyPro
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