Patients with HIV infection may benefit from GLP-1 receptor agonists

Glucagon-like peptide-1 (GLP-1) receptor agonists are associated with weight loss, lower BMI, and improved HbA_1C levels among patients with HIV infection, according to study results published in Clinical Infectious Diseases.

Researchers conducted a retrospective, single-center cohort study to explore whether patients with HIV infection experience weight loss or changes in BMI and HbA_1C levels following the initiation of GLP-1 receptor agonists. Data for this analysis were obtained from adult patients who were prescribed GLP-1 receptor agonists for diabetes, weight loss, or both for at least 3 months between February 2021 and February 2023. The primary outcome was change in weight, calculated as the difference between baseline and the most recent clinic measurement prior to cessation of GLP-1 receptor agonist use. Secondary outcomes included changes in BMI and HbA_1C levels from baseline.

Variables were compared in patients with and without weight loss greater than 5% via Pearson chi-squared and student t-testing or Mann-Whitney U testing, depending on the variable. Stepwise multivariable logistic regression was used to identify variables associated with weight loss greater than 5%, and a supplementary analysis was conducted using multivariable linear regression.

A total of 225 patients (median age, 56 years; White, 48.9%; women, 17.8%; median weight, 100.4 kg; median BMI, 34 kg/m²; median HbA_1C, 6.4%) were included in the final analysis. The mean duration of GLP-1 receptor agonist use was 13 months, and 43.1% of patients received therapy for more than 12 months. Most patients had at least 1 metabolic comorbidity (hypertension, 65.3%; hyperlipidemia, 63.1%; type 2 diabetes, 56.9%). Overall, the most commonly prescribed agent was injectable semaglutide (51.6%), followed by dulaglutide (30.7%) and oral semaglutide (7.6%).

Overall, GLP-1 receptor agonist use was associated with a mean weight loss of 5.4 kg and a mean BMI reduction of 1.8 kg/m², with 99 (44%) patients experiencing greater than 5% weight loss. Patients (n=180) with a BMI greater than 30 kg/m² at baseline experienced higher mean weight loss (6.2 kg) and were more likely to experience a weight loss of at least 5% (49.4%) when compared with the total cohort.

Regardless of initial BMI, patients (n=128) with type 2 diabetes reported a mean weight loss of 3.8 kg, with 39.1% experiencing weight loss of 5% and greater. Further analysis of patients with type 2 diabetes showed mean HbA_1C levels of 8.1% at baseline, which subsequently reduced by a mean of 0.9% following treatment initiation. The researchers noted higher mean weight loss among patients (n=97) without type 2 diabetes (7.3 kg), with 50.5% experiencing weight loss of 5% and greater.

Compared with GLP-1 receptor agonist use for longer than 12 months, patients who received therapy for fewer than 6 months experienced less weight loss and smaller changes in BMI (mean, 3.6 vs 5.9 kg and 1.2 vs 3.6 kg/m², respectively). Moreover, patients who received therapy for more than 12 months vs fewer than 6 months were more likely to experience weight loss greater than 5% (51% vs 32%, respectively).

Mean weight loss of at least 5% was positively associated with higher BMI at baseline (odds ratio [OR], 1.10; 95% CI, 1.03-1.16) and tirzepative use (OR, 5.46; 95% CI, 1.44-20.76) and negatively associated with dulagutide use (OR, 0.44; 95% CI, 0.22-0.85) and treatment for 6 or fewer months (OR, 0.32; 95% CI, 0.15-0.67).

Study limitations include the retrospective design, the inability to assess tolerability to different GLP-1 receptor agonist agents and the effect of individual agents on overall weight loss, and the lack of sufficient data to evaluate the effect of lifestyle modifications on HBA_1c levels.

“Additional prospective data are needed to better understand the risk of lipoatrophy and other potentially negative weight and metabolic effects associated with GLP-1RA [receptor agonist] therapy,” the researchers concluded.

Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

References:

Nguyen Q, Wooten D, Lee D, et al. GLP-1 receptor agonists promote weight loss among people with HIV. Clin Infect Dis. Published online March 19, 2024. doi:10.1093/cid/ciae151