Phase 2 · Semaglutide

NCT04019197 trial results

Effects of GLP-l Receptor Agonists on Cardiometabolic Alterations in HIV-associated Lipohypertrophy

Effects of Semaglutide on Quantity of Ectopic Fat (Total Pericardial Fat) at Week 32 Compared to Baseline (mL), 32 weeks. Semaglutide: -1.85; Placebo: 0.00.

Participants
108
Status
completed
Completed
2026-10-09
Sponsor
Case Western Reserve University

As posted on ClinicalTrials.gov (NCT04019197), updated at source Oct 27, 2026. Read again whenever the registry updates it. Registry figures can differ from a published paper, which may use another analysis.

Primary outcome

What NCT04019197 measured first

Effects of Semaglutide on Quantity of Abdominal Fat (Total, Subcutaneous, Visceral) at Week 32 Compared to Baselinecm^2 · 32 weeks · median
MeasureSemaglutiden=54Placebon=54
Total abdominal adipose tissue, cm^2-51.75(-84.10 to -2.20)6.65(-18.9 to 42.50)
Subcutaneous abdominal adipose tissue, cm^2-34.65(-64.40 to -12.40)3.90(-15.00 to 20.20)
Visceral abdominal adipose tissue, cm^2-9.45(-25.80 to 3.00)2.60(-13.60 to 19.60)
Effects of Semaglutide on Quantity of Fat (Total Body Fat, Limb Fat, Trunk Fat) at Week 32 Compared to Baselinekg · 32 weeks · median
MeasureSemaglutiden=54Placebon=54
Total Body Fat, kg-4.82(-7.25 to -2.44)0.25(-2.08 to 2.29)
Total Limb Fat, kg-1.79(-3.45 to -1.06)-0.14(-0.72 to 0.61)
Total Trunk Fat, kg-2.86(-4.47 to -1.40)0.17(-1.22 to 1.27)
Effects of Semaglutide on Quantity of Ectopic Fat (Total Pericardial Fat) at Week 32 Compared to BaselinemL · 32 weeks · median
Semaglutiden=54Placebon=54
-1.85(-17.90 to 11.00)0.00(-10.30 to 10.40)
Side effects by arm

Side effects in NCT04019197

Percent of participants affected, Adverse event data were collected for participants during the time when each participant was receiving active drug or placebo (32 weeks). Participants were evaluated weekly for possible side-effects.... The most common events the registry lists.

EventParticipants With HIV and Lipohypertrophy: Semaglutide ArmParticipants With HIV and Lipohypertrophy: Placebo Arm
Any serious event1.9%0%
Elevated Glucose46.3%72.2%
Elevated Triglycerides51.9%72.2%
Elevated Creatinine46.3%25.9%
Elevated Total Cholesterol27.8%46.3%
Nausea38.9%20.4%
Elevated Low-density Lipoprotein18.5%33.3%
Diarrhea13%31.5%
Constipation or Irregular Bowel Movements31.5%13%
Fatigue29.6%14.8%
GERD29.6%13%
Eructation or Flatulence27.8%18.5%
Headaches27.8%18.5%
Decreased Appetite or changes in food cravings/tolerance25.9%9.3%
Decreased Phosphorus24.1%18.5%
Elevated Lipase24.1%9.3%
Elevated Uric Acid22.2%24.1%
Dyspepsia22.2%3.7%
Hunger5.6%18.5%
Vomiting16.7%5.6%
Localized Musculoskeletal pain, weakness, swelling, or injury11.1%13%
Dysgeusia13%5.6%
Elevated Total Bilirubin11.1%1.9%
Elevated Alanine Transaminase9.3%11.1%
Irritability or Moodiness11.1%11.1%
Sweating7.4%11.1%
Secondary outcomes

What else it measured

Effects of Semaglutide on Liver Fat at Week 32 Compared to BaselineHounsfield unit · 32 weeks · median
Semaglutiden=54Placebon=54
1.27(-2.40 to 4.43)0.39(-1.95 to 4.23)
Effects of Semaglutide on Quantity of Lean Body Mass at Week 32 Compared to Baselinekg · 32 weeks · median
Semaglutiden=54Placebon=54
-2.94(-3.89 to -1.49)-0.17(-11.61 to 0.66)
Effects of Semaglutide on Quantity of Total Right Psoas Muscle at Week 32 Compared to Baselinecm^2 · 32 weeks · median
Semaglutiden=54Placebon=54
0.10(-1.90 to 1.00)-0.20(-2.70 to 2.10)
Effects of Semaglutide on Quality of Abdominal Fat (Total, Subcutaneous, Visceral) at Week 32 Compared to BaselineHounsfield units · 32 weeks · median
MeasureSemaglutiden=54Placebon=54
Abdominal total adipose tissue, Hounsfield unit0.40(-2.30 to 2.50)6.65(-18.90 to 42.50)
Abdominal subcutaneous adipose tissue, Hounsfield unit-34.65(-64.40 to -12.40)3.90(-15.00 to 20.20)
Abdominal visceral adipose tissue, Hounsfield unit-9.45(-25.80 to 3.00)2.60(-13.60 to 19.60)
Effects of Semaglutide on Quality of Pericardial Fat at Week 32 Compared to BaselineHounsfield units · 32 weeks · median
Semaglutiden=54Placebon=54
0.20(-0.90 to 1.10)0.00(-1.40 to 0.30)
Effects of Semaglutide on Quality of Total Right Psoas Muscle at Week 32 Compared to BaselineHounsfield units · 32 weeks · median
Semaglutiden=54Placebon=54
0.10(-1.90 to 1.00)-0.20(-2.70 to 2.10)
Effects of Semaglutide on Anthropometric Measurements (Weight) at Week 32 Compared to Baselinekg · 32 weeks · median
Semaglutiden=54Placebon=54
-7.82(-11.88 to -3.90)0.16(-2.54 to 2.59)
Effects of Semaglutide on Anthropometric Measurements (Body Mass Index) at Week 32 Compared to Baselinekg/m^2 · 32 weeks · median
Semaglutiden=54Placebon=54
-2.64(-4.00 to -1.37)-0.02(-1.05 to 0.66)
Effects of Semaglutide on Anthropometric Measurements (Waist Circumference) at Week 32 Compared to Baselinecm · 32 weeks · median
Semaglutiden=54Placebon=54
-4.50(-11.17 to -0.50)0.17(-2.33 to 2.67)
Effects of Semaglutide on Anthropometric Measurements (Waist-to-hip Ratio) at Week 32 Compared to Baselineratio · 32 weeks · median
Semaglutiden=54Placebon=54
-0.01(-0.04 to 0.02)-0.01(-0.05 to 0.02)
Effects of Semaglutide on Glucose Metabolism at Week 32 Compared to Baseline - Fasting Glucosemg/dL · 32 weeks · median
Semaglutiden=54Placebon=54
0.50(-5.00 to 7.00)0.00(-11.00 to 9.00)
Effects of Semaglutide on Glucose Metabolism at Week 32 Compared to Baseline - 2-h OGTT Glucosemg/mL · 32 weeks · median
Semaglutiden=54Placebon=54
-11.50(-41.50 to 2.00)-2.00(-16.00 to 16.00)
The trial

How NCT04019197 was run

This is a randomized, double-blinded, placebo-controlled trial designed to assess the effect of the GLP-1 receptor agonist, semaglutide, on visceral and ectopic fat, insulin resistance, inflammation markers, and the downstream effect of cardiovascular risk in people with HIV. The primary endpoints will be visceral and ectopic fat changes over the study period. The secondary endpoints will include changes in markers of inflammation, immune activation, gut integrity, and cardiovascular disease risk assessment.

  • Participants with HIV and lipohypertrophy: semaglutide arm: Participants with HIV/lipohypertrophy will receive semaglutide 0.25 mg x4 weeks, then semaglutide 0.5 mg x4 weeks, then semaglutide 1.0 mg x24 weeks, then no drug x24 weeks.
  • Participants with HIV and lipohypertrophy: placebo arm: Participants with HIV/Lipohypertrophy will receive placebo x32 weeks, then no placebo for 24 weeks.
Who could join the trial

Inclusion Criteria: 1. Male or female, aged ≥18 years. 2. HIV-1 infection as documented by any licensed ELISA test kit and confirmed by Western blot at any time prior to study entry. HIV-1 culture, HIV-1 antigen, plasma HIV-1 RNA, or a second antibody test by a method other than ELISA is acceptable as an alternative confirmatory test. 3. Body mass index ≥25 kg/m2. 4. Waist circumference and waist-to-hip ratio \>95 cm and \>0.94 cm, respectively, for men, and \>94 cm and \>0.88 cm, respectively, for women occurring in the context of HIV treatment. 5. Subjective evidence of increased abdominal girth occurring after initiation of HIV treatment. 6. HIV-1 RNA \<400 copies/mL for ≥6 months. 7. Receiving a stable antiretroviral regimen for at least the last 12 weeks prior to study entry with cumulative duration of 1 year of treatment at the time of study entry. 8. Provision of signed and dated informed consent form and is capable of reading and comprehending the informed consent. 9. Stated willingness to comply with all study procedures and availability for the duration of the study. 10. All women of child-bearing potential (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours prior to start of study medication. WOCBP is defined as any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy), who is not postmenopausal (defined as amenorrhea 12 consecutive months), or is on hormone replacement therapy (HRT) with documented plasma follicle-stimulating hormone level 35 mIU/mL. Women who are using oral, implanted, or injectable contraceptive hormones or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy or practicing abstinence or where partner is sterile (e.g., vasectomy), should be considered of child-bearing potential. 11. Female subjects who are not of reproductive potential (have reached menopause or undergone hysterectomy, bilateral oophorectomy or tubal ligation) or whose male partner has undergone successful vasectomy with resulting azoospermia or has azoospermia for any other reason, are eligible without requiring the use of contraception. Patient-reported history of menopause, sterilization, and azoospermia is considered acceptable documentation. 12. All subjects must not participate in a conception process (e.g. active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization), and if participating in sexual activity that could lead to pregnancy, the female subject/male partner must use condoms (male or female) in addition to one of the following forms of contraception while on study: either a spermicidal agent, diaphragm, cervical cap, IUD, or hormonal-based contraception. 13. Have no plans to alter antiretroviral therapy, or to undergo any weight loss program,...

Published papers

Papers from NCT04019197

Trial averages do not predict what one person will experience. Results are shown as the registry posts them, without interpretation.

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