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GLP1 RAs for Weight Management in HIV
Metabolic Modulation in HIV: Utilizing GLP-1 Receptor Agonists for Weight Management 

Released: March 05, 2026

Grace A. McComsey
Grace A. McComsey, MD, FIDSA
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Key Takeaways
  • People living with HIV who experience significant weight gain on ART are strong candidates for GLP-1 RA therapy, particularly those with 1 or more weight-related comorbidities and who have not benefited from multiple attempts at lifestyle modifications.
  • Evidence for GLP-1 RA therapy in people living with HIV is still limited, but one published randomized controlled study and a few observational studies report that they do help decrease total and visceral fat.
  • Improved weight management with GLP-1 RA therapy may also lead to better mental health, reduction or cessation of excessive alcohol consumption, and better ART adherence.

Identifying People Living With HIV Who Would Benefit From GLP-1 Therapy
In my practice, I recommend GLP-1 therapy for people living with HIV who experience significant weight gain on antiretroviral therapy (ART), particularly those who have comorbidities, such as hypertension or dyslipidemia. Patients with diabetes are especially good candidates for GLP-1 receptor agonists (RAs), given their proven efficacy in improving glycemic control.

More broadly, I believe GLP-1 RAs should be strongly considered for people who have multiple comorbidities, including additional metabolic conditions. 

However, I do not recommend GLP-1 RA therapy in place of lifestyle interventions or without first attempting to control weight gain with nonpharmaceutical methods. Some people benefit significantly from lifestyle intervention and can manage their weight that way. Those people are not necessarily the strongest candidates for GLP-1 RAs. However, if a person has done their best, has attempted multiple lifestyle interventions, and is repeatedly telling me that there is nothing more they can do, I think that is when it is time to move on to pharmacologic interventions.

Evidence for Use of GLP-1 RAs in People Living With HIV
Despite the proven efficacy and safety of GLP-1 RAs for managing weight and type 2 diabetes in the general population, the data on GLP-1 RAs in people living with HIV is still limited. To date, there is one published randomized controlled study and some observational studies showing that they do help decrease total and visceral fat.

However, there is still concern that these agents could cause decreases in muscle that could be detrimental for people living with HIV, who are already at risk for sarcopenia as a consequence of chronic inflammation and accelerated aging. So when prescribing GLP-1 RAs for people living with HIV, I believe we should be vigilant about monitoring whether the GLP-1 RA is affecting their muscle composition. 

When I prescribe GLP-1 RAs to people living with HIV, I stress the importance of exercise, both to address the issue of muscle loss and to promote healthy lifestyle changes. In fact, I often find that when people lose weight, they will actually start to exercise more, which is a great combination.

Weight Management and Mental Health
I believe the psychosocial aspects of GLP-1 in HIV care are very important. I think GLP-1 RA therapy can help people feel better about their quality of life through improved weight management. At a healthier weight, people can exercise more, and I often find that they start eating better.

If a person drinks a lot of alcohol, GLP-1 RAs can even help with excessive alcohol consumption, because in addition to improved appetite control, these agents also reduce the desire to drink. So, alcohol cessation or reduction also helps improve physical and mental health.

Getting on GLP-1 RA therapy can even help with ART adherence. In the past, I think there was a widespread misconception among patients that antiretrovirals were specifically causing weight gain, which caused a lot of people to not take their medication.

Now we know that is not true of all antiretrovirals. There are some that are associated with more weight gain than others, and some that are weight neutral. A lot of weight gain is caused by HIV itself, the chronic inflammation that comes from HIV infection. I think the availability of medications to support weight loss and enable people to exercise and adopt healthier eating habits is a huge advance in the field of HIV.

Your Thoughts
How do you approach weight management in your practice? How does your approach to weight management differ when caring for people living with HIV? Leave a comment to join the discussion!

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