Nearly a quarter of adults in the United States suffer from metabolic dysfunction-associated steatotic liver disease (MASLD), characterized by the accumulation of excessive fat in the liver.
According to some estimates, individuals living with HIV (human immunodeficiency virus) are more than twice as likely to develop MASLD, previously known as nonalcoholic fatty liver disease.
While no medication has been approved to treat this type of liver disease in its early stages, a recent study presented at the annual Conference on Retroviruses and Opportunistic Infections revealed promising results. The study showed that a weekly injection of semaglutide, the active ingredient in Ozempic and Wegovy, reduced the amount of fat in the liver by an average of 31 percent in individuals with HIV and MASLD.
Jordan E. Lake, MD, an author of the study and a professor of infectious diseases at McGovern Medical School at UTHealth Houston, said in a press release, “Even at the low dose of 1 milligram every week, most participants lost significant weight, and weight loss was closely associated with improvements in MASLD.”
More Than Half of Participants Experience Dramatic Improvement in Liver Disease
The study enrolled 49 adults with an average of 52 who had both HIV and MASLD, representing a diverse mix of ethnicity, race, gender, and age. Forty of these participants were on antiretroviral therapy (ART), which suppresses HIV but can lead to weight gain in some individuals.
Participants self-administered semaglutide, a medication approved under the name Ozempic for treating type 2 diabetes and used for long-term weight management, on a weekly basis. They increased their drug doses until reaching a 1 milligram (mg) dose by week four.
After 24 weeks, Dr. Lake and her team used specialized MRI scans to measure changes in liver fat content among the participants. They found, on average, a 31 percent reduction in liver fat, with 29 patients experiencing “complete resolution” of their liver disease, meaning fat dropped to 5 percent or less of overall liver content.
Although volunteers taking semaglutide experienced a loss of muscle volume, there were no significant changes in physical function observed by the researchers.
Consistent with previous studies on semaglutide, participants also showed improvements in blood sugar levels, insulin resistance, a blood triglyceride levels, all of which are crucial for heart health.
Semaglutide was generally well tolerated, with common side effects including nausea, diarrhea, vomiting, and abdominal pain.
Promising Results of Semaglutide for Individuals with HIV and Beyond
Fatty liver disease occurs when triglycerides and other fats accumulate in the liver, disrupting normal liver function. While most cases do not progress to liver damage or complications, some can lead to fibrosis, or liver scarring, and eventually result in cirrhosis or liver cancer.
This disease can often by asymptomatic, earning it the nickname of a “silent killer” as it can cause serious organ damage without any noticeable symptoms.
Among individuals living with HIV, this type of liver disease is common and likely acts synergistically with HIV to accelerate liver injury and organ dysfunction, according to the clinical trials network Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections (ACTG). Factors such as increased inflammation and oxidative stress from the virus and weight gain from medications may heighten the risk of fatty liver disease in people with HIV.
Ray Kim, MD, a professor of gastroenterology and hepatology at Stanford University specializing in chronic liver disease, sees this new study as a continuation of previous research indicating that semaglutide can effectively treat MASLD in individuals without HIV.
MASLD also affects up to 70 percent of people with diabetes, and past analyses have shown promising results in this group as well.
Dr. Kim, who was not involved in the study, said, “Promising data [on semaglutide] are emerging for patients with MASLD with and without HIV.”
He recommends those interested in the medication to discuss potential treatment options with their doctor, but cautions that it may be too expensive for some.
Novo Nordisk, the manufacturer of Ozempic, lists the drug at $935.77 per month.
Kim nots that advancements in the treatment of this liver disease extend beyond semaglutide. In fact, last week, the U.S. Food and Drug Administration (FDA) approved Rezdiffra (resmetirom) for an advanced type of fatty liver disease associated with MASLD, where liver inflammation over time can lead to scarring and dysfunction.
While this study had limitations due to its small size, the researchers plan to further investigate the specific effects semaglutide may have in people with HIV.
“Additional research will assess the secondary effects of semaglutide on systemic inflammation and metabolism and determine whether semaglutide may have unique risks or benefits for people living with HIV,” said Dr. Lake.
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