Racial Inequity in Prescription of Semaglutide Among Eligible People With HIV

OBJECTIVE To evaluate semaglutide use among people with HIV (PWH) with medical indications by race and ethnicity. RESEARCH DESIGN AND METHODS We identified PWH in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort at nine sites eligible for semaglutide therapy between 2019 and 2023. Semaglutide eligibility was based on BMI ≥30 or HbA1c ≥6.5. We evaluated differences in semaglutide receipt among eligible PWH by race and ethnicity using relative risk regression adjusted for demographic characteristics. RESULTS Among 11,617 eligible PWH, 774 (6.7%) received semaglutide (92% eligible by BMI ≥30, 62% by HbA1c ≥6.5, and 54% by both criteria). Eligible Black PWH were 20% less likely to receive semaglutide versus White PWH (prevalence ratio PR 0.80, 95% CI 0.67–0.95). The lower rate of semaglutide for Black (PR 0.66, 95% CI 0.53–0.83) and Hispanic PWH (PR 0.70, 95% CI 0.53–0.93) was more pronounced among those with higher HbA1c (≥8.0). CONCLUSIONS We describe inequitable semaglutide use among PWH, with lower initiation rates in eligible Black PWH.