In a recent unveiling at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI), a study illuminated the potential of semaglutide, a medication frequently prescribed for type 2 diabetes and obesity, within the realm of individuals afflicted with HIV and Metabolic dysfunction-associated steatotic liver disease (MASLD).  Diabetes treatment Ozempic and popular weight loss drug Wegovy by Novo Nordisk have been known to contain semaglutide as an active ingredient.  This investigation, spearheaded by the National Institute of Allergy and Infectious Diseases (NIAID) and executed by the global clinical trials network ACTG, represents the inaugural exploration into semaglutide’s impact on MASLD among HIV-positive patients. MASLD, previously denoted as non-alcoholic fatty liver disease, is characterized by the accumulation of liver fat independent of alcohol consumption or viral hepatitis. Over time, this malady can precipitate inflammation, cellular degradation, and an array of cardiovascular and hepatic disorders.  Semaglutide, acknowledged for its efficacy in diabetes management and weight reduction, was administered to a cohort of participants aged 18 and older, whose HIV viral load had been effectively suppressed by antiretroviral therapy (ART). The study cohort exhibited a diverse composition, spanning various ethnicities, races, genders, and age brackets. Of the 49 individuals scrutinized, 82% were on ART regimens incorporating integrase strand transfer inhibitors, renowned for their potency in HIV suppression albeit linked with weight gain in certain instances. Participants embarked on a regimen of self-administered semaglutide injections on a weekly basis, progressively augmenting the dosage until reaching 1 milligram by the fourth week, all while undergoing routine safety surveillance.  Following a 24-week period, the research team scrutinized alterations in liver fat content utilizing specialized MRI methodologies. The outcomes proved auspicious, delineating an average reduction of 31% in liver fat, with 29% of participants achieving complete remission of MASLD, defined as diminishing liver fat to 5% or less of total liver volume. Furthermore, participants experienced notable weight loss, decreased fasting blood glucose levels, and diminished fasting triglyceride concentrations, aligning with antecedent findings observed in non-HIV cohorts. Moreover, a secondary examination unveiled a decline in psoas muscle volume sans any discernible modifications in physical functionality. Overall, the tolerability profile of semaglutide was commendable, with gastrointestinal adversities such as nausea, diarrhea, vomiting, and abdominal discomfort constituting the most commonly reported side effects.  Remarkably, two participants encountered more substantial adverse reactions plausibly attributed to semaglutide, yet managed to persist in the study, with all participants successfully completing the entire 24-week therapeutic regimen as initially prescribed.
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