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Title
Impact of GLP-1 receptor agonists on body weight in patients with type 2 diabetes and HIV
Presenter
Marisa Brizzi
Authors
A. Lloyd1, M. Brizzi1, M. Lyons1, L. Rotert2, C. Fichtenbaum2
Institutions
1UC Health, Department of Pharmacy, Cincinnati, United States, 2University of Cincinnati College of Medicine, Division of Infectious Diseases, Department of Clinical Medicine, Cincinnati, United States

BACKGROUND: Integrase strand transfer inhibitor- (INSTI-) based regimens have been associated with clinically significant weight gain in patients with HIV (PWH). The mechanism of which is poorly understood but has been associated with INSTIs interference with estrogen-mediated metabolic pathways, impact on hormones regulating glucose and lipid metabolism, suppression of the melanocortin stimulating system, and reduction in insulin sensitivity. Additionally, glucagon-like peptide-1 (GLP-1) may be depleted during HIV infection and may play a role in weight gain, however the impact of GLP-1 receptor agonists (GLP-1 RAs) on weight in PWH is unknown. We evaluated the impact of GLP-1 RA on metabolic outcomes in patients with type-2 diabetes (T2DM) and HIV (DM+HIV) compared to T2DM without HIV (DM).
METHODS: Retrospective cohort analysis of metabolic outcomes in DM+HIV compared to DM receiving GLP-1 RAs and receiving care at UC Health outpatient clinics from 08.31.2017 to 08.31.2022. Metabolic outcomes were assessed by matching patients 2:1 by gender, race/ethnicity, GLP-1 RA, and dose.
RESULTS: In this analysis, 15 persons were included in the DM+HIV group compared to 30 persons in the DM group. The mean age was 57 years (±8.5 years), 13% identified female, 52% were Black, 48% were White, and 46% had GLP-1 RA dose titrated up during the study period. The mean change in weight was -10.4 (±12.47) kg in the DM+HIV group compared to -1.73 (±8.45) kg in the DM group (P = 0.0085). The mean percentage difference in weight was -8% (±9.96%) in the DM+HIV group compared to -1.47% (±6.8%) in the DM group (P = 0.013). The rate of patients achieving =5% weight loss was 60% (9/15) in the DM+HIV group compared to 33% (10/30) in the DM group (P = 0.1158). The mean percentage difference in hemoglobin A1c was -1.3% (±2.39%) in the DM+HIV group compared to -0.49% (±2%) in the DM group (P = 0.2415).
CONCLUSIONS: In this cohort, PWH and T2DM had significantly greater weight loss compared to people with T2DM alone. A larger study comparing metabolic outcomes in DM+HIV compared to DM receiving GLP-1 RAs is underway to confirm these results.

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