Glucagon-like peptide-1 receptor agonists in the aging population of people with HIV: emerging evidence and clinical implications

PURPOSE OF REVIEW: The increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for type 2 diabetes and obesity has generated interest in their potential role among people with HIV (PWH), who experience a high burden of cardiometabolic disease and aging-related comorbidities. This review summarizes emerging evidence on the efficacy, safety, and implementation considerations of GLP-1RAs in PWH. RECENT FINDINGS: GLP-1RAs, such as semaglutide, are associated with meaningful reductions in bodyweight, glycemia, and both visceral and hepatic fat in PWH. Emerging data suggest potential effects on behavioral outcomes such as alcohol use and smoking, although evidence in PWH remains limited. Concerns regarding lean mass loss, frailty, and bone health exist but current data are limited and generally reassuring, with functional outcomes largely preserved. HIV-specific studies have largely used lower doses of semaglutide, and evidence in older populations remains sparse. SUMMARY: GLP-1RAs are a promising option for cardiometabolic risk reduction in PWH, with important considerations around tolerability and body composition, particularly in aging and multimorbid populations. Future research should prioritize trials assessing cardiovascular, neuropsychiatric, and substance use outcomes, alongside studies of real-world effectiveness and implementation in routine clinical care. In addition, identifying subgroups most likely to benefit will be important.