Work

Comparative effectiveness of GLP-1 receptor agonists, SGLT2 inhibitors, DPP-4 inhibitors, and sulfonylureas on weight change among people with HIV: a real-world longitudinal cohort study

Year: 2026

Type: article

Abstract: Obesity is common among people with HIV (PWH), yet evidence on weight loss with newer antidiabetic medications in this population is limited. We compared bodyweight change associated with glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium–glucose cotransporter-2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sulfonylureas among PWH. We conducted an active-comparator new-user cohort study using data from 9 U.S. sites in the Centers for AIDS Research Network of Integrated Clinical Systems. PWH initiating GLP-1RA, SGLT2 inhibitors, DPP-4 inhibitors, or sulfonylureas between 2013 and 2023 were included. The primary outcome was percent bodyweight change at 1 year, assessed using covariate-adjusted linear mixed models under an on-treatment approach. Secondary outcomes included absolute weight change (kg) and time to ≥ 5% and ≥ 10% loss, evaluated using adjusted Cox models. Weight trajectories up to 3 years were also examined. Among 1,572 PWH, GLP-1RA use was associated with the greatest mean percent weight loss at 1 year (–4.44%; 95% CI − 5.51 to − 3.36), followed by SGLT2 inhibitors (–1.00%; 95% CI − 2.25 to 0.24). DPP-4 inhibitors and sulfonylureas showed minimal change. Compared with sulfonylureas, GLP-1RA and SGLT2 inhibitor use was associated with a higher likelihood of achieving ≥ 5% and ≥ 10% weight loss. GLP-1RA–associated weight loss was greater among PWH without diabetes and those with higher body mass index, with semaglutide being associated with the largest reductions. Weight loss with GLP-1RA was nonlinear, with greater early reductions. GLP-1RA were associated with the greatest weight loss among PWH, supporting their use in a population with high cardiometabolic risk.

Source: BMC Medicine

DOI: 10.1186/s12916-026-05219-7