Semaglutide Minimizes MASLD Severity in Patients with HIV

On Tuesday, March 5, 2024, the NIH issued a release linking semaglutide use with a decreased severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in HIV-positive patients, noting a 31% reduction in liver fat.

The study was conducted in Brazil by Advanced Clinical Therapeutics Globally (ACTG) with funding from the National Institute of Allergy and Infectious Diseases (NIAID), a part of the NIH, and the McGovern Medical School at the University of Texas Health, Houston.

Researchers recruited participants 18 and older who had MASLD and HIV; however, all participants had to have an undetectable viral load that had been suppressed by antiretroviral therapy.

Before the study, all participants were assessed for inter-hepatic triglyceride (IHTG) levels, central adiposity, insulin resistance or pre-diabetes, and hepatic steatosis.

The 49 participants were given semaglutide to self-inject weekly, starting with a 0.25 mg dose. The dose was increased to 0.5 mg by the second week and 1.0 mg by the fourth week. Patients remained on the 1.0 mg weekly dose for the rest of the study.

Once the 24-week study was complete, researchers assessed liver fat content using magnetic resonance imaging-proton density fat fraction (MRI-PDFF). Using this tool, the researchers identified a 31% average reduction in liver fat among patients with HIV.

Additionally, the investigators found that 29% of participants had complete resolution of MASLD, which was characterized by a reduction of liver fat, comprising 5% or less of the total liver content. The participants also reported secondary effects, including weight loss, reductions in blood glucose, and reduced fasting triglyceride levels.

The data from the study was also analyzed independently to assess the psoas muscle volume, which was reduced without significant changes to physical function.

Across the participants, the drug was well-tolerated, and minimal adverse events were reported. Most commonly, patients reported nausea, diarrhea, vomiting, and abdominal pain. Only two patients reported more severe adverse side effects; however, they could still complete the study.

“These findings suggest that semaglutide is a safe and effective therapy for MASLD in people with HIV. The study may help inform healthcare decisions by people in consultation with their providers as part of an approach to healthier aging with HIV over the life span. According to the investigators, additional research is underway to understand whether people with HIV experience any unique immunologic or inflammatory pathway changes while taking semaglutide therapy,” concluded the NIH release.