Effects of semaglutide on subclinical cardiovascular health in people with HIV
- Design
- Randomized trial · 108 participants · Mixed outcome
- Match to healthy normal-weight adults aged 55–75
- Different populationINDIRECT: all participants had HIV with lipohypertrophy and BMI >25 kg/m2 with increased waist circumference; median age 53 years, below the target range.
- Could weight loss explain it?
- PossiblyThe parent trial reported improved weight, visceral fat, blood pressure, glucose and lipids with semaglutide; this analysis was only sex-adjusted and did not separate those changes from the ASCVD-risk and hsCRP results. Weight loss is not quantified, so possibly rather than likely.
- Study tier
- Study tier 3LOW: a prespecified secondary analysis of a small randomized trial with biomarker and modelled-risk outcomes.
- Assessment
- Version 3 · Two independent AI reviews agreed · Nov 7, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
One hundred eight adults with HIV, central fat build-up and a BMI above 25 took part in this secondary analysis of a 32-week placebo-controlled trial. Semaglutide did not change measures of artery stiffness, blood-vessel function or coronary calcium, but it lowered a calculated 10-year heart-disease risk score by 32.6% and the inflammation marker hsCRP by 23.4% compared with placebo. These are markers and risk estimates, not heart attacks or strokes.
01Findings
What the study reported
- Drugs
- Semaglutide
- Comparator
- placebo
- Treatment duration
- 32 weeks
- Primary outcome
- subclinical cardiovascular health: arterial stiffness (PWV), endothelial function (endoPAT) and coronary artery calcium
- Effect
- No significant effect on PWV, CAC score, reactive hyperemia index, augmentation index or REE; VO2 downward trend (β -43 ml/min; P = 0.087); 10-year ASCVD risk -32.6%; P = 0.026 and hsCRP -23.4%; P = 0.02 vs placebo
- 95% confidence interval
- Not extracted
- P value
- P = 0.026 (10-year ASCVD risk); P = 0.02 (hsCRP)
- Follow-up
- 32 weeks
- Adverse events
- not reported in abstract
- Limitations
- Prespecified secondary analysis of a small, 32-week phase 2b trial in people with HIV and lipohypertrophy; no confidence intervals are reported, and the authors call for longer and larger studies.
Who was studied
- Mean age
- median 53 years
- Sex distribution
- 60% male
- Bmi min
- >25 kg/m2
- Obesity status
- overweight or obesity required (BMI >25 kg/m2 with increased waist circumference/waist-to-hip ratio)
- Diabetes status
- excluded (without known diabetes)
- Cvd status
- not reported in abstract
- Ckd status
- not reported in abstract
- Baseline condition
- HIV with lipohypertrophy
- Sample size
- 108
- Inclusion exclusion
- virologically suppressed adults with HIV on stable antiretroviral therapy, no known diabetes, BMI >25 kg/m2 and increased waist circumference/waist-to-hip ratio
Study quality details
- Study design
- Randomized controlled trial
- Sample size
- 108
- Randomization
- yes
- Blinding
- double-blind
- Comparator
- placebo
- Follow up duration
- 32 weeks
- Outcome type
- mixed
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- INDIRECT
- Statistical precision
- no CI reported; P values only
- Risk of bias
- not assessed
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- not reported in abstract
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[DESIGN AND OBJECTIVE] Lipohypertrophy, characterized by central adipose tissue accumulation, is common in people with HIV (PWH) and contributes to cardiometabolic risk. In a recent randomized, double-blind, placebo-controlled phase 2b trial, semaglutide significantly improved weight, total fat, visceral adiposity, blood pressure, glucose metabolism, and lipids over 32 weeks in PWH with lipohypertrophy. This prespecified secondary analysis evaluated semaglutide's effects on subclinical cardiovascular health. [METHODS] Virologically suppressed adults with HIV without known diabetes, receiving stable antiretroviral therapy, with body mass index >25 kg/m2 and increased waist circumference/waist-to-hip ratio were enrolled. Participants were randomized 1 : 1 to semaglutide or placebo for 32 weeks. Pulse wave velocity (PWV) and endothelial peripheral arterial tonometry (endoPAT) assessed arterial stiffness and endothelial function, and coronary artery calcium (CAC) score assessed calcified coronary atherosclerosis. Indirect calorimetry measured resting energy expenditure (REE) and oxygen consumption (VO2). 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated. Analyses followed intention-to-treat principles using sex-adjusted multiplicative regression. [RESULTS] One hundred eight participants (n = 54 semaglutide) were enrolled (median age 53 years; 60% male; 65% non-White; 35% smokers). Semaglutide had no significant effect on PWV, CAC score, reactive hyperemia index, augmentation index, or REE. VO2 showed a downward trend (β -43 ml/min; P = 0.087). At week 32, significant reductions were observed in 10-year ASCVD risk (-32.6%; P = 0.026) and hsCRP (-23.4%; P = 0.02) in the semaglutide group relative to placebo. [CONCLUSION] Semaglutide did not improve subclinical vascular markers over 32 weeks but significantly improved overall cardiometabolic health and cardiovascular disease risk. Longer and larger studies of GLP-1 RAs are indicated in HIV to further assess their effects on long-term cardiovascular disease outcomes. [TRIAL REGISTRATION] NCT04019197.
Where this record came from
| Source | Retrieved | Identifier |
|---|---|---|
| pubmed | Sep 20, 2026 | 42752515 first ingestion |
| pubmed | Sep 27, 2026 | 42752515 duplicate matched on doi |
| owner-review | Nov 6, 2026 | reviewed_by set to Carrie Schluter (2026-11-05) on the owner's own confirmation. The assessment is unchanged and still the auto-classifier's, so its extracted values stay withheld under the 2026-10-18 decision. |