Unexpected viral rebound with GLP-1 weight loss drugs in HIV study

A retrospective study reported high recent use of GLP-1 receptor agonists in people living with HIV at a UK centre, with results unexpectedly including viral rebound in 18%. [1]

The study identified 65 participants from the pharmacy database at the University Hospitals of Leicester HIV service between January 2024 and March 2026, based on prescribed or disclosed use of GLP-1 agonists.

This represented almost 4% of the HIV clinic. Half the people using GLP-1 RAs were women, with mean age overall of 51 (range: 26-75) and the average duration of HIV infection was 15 years.

Roughly two-thirds (41/65) accessed treatment privately vs one-third with NHS prescriptions, with tirzepatide most commonly used (50/65) followed by semaglutide (13/65) and dulaglutide and liraglutide being used by one person each.

Mean baseline weight in the 60/65 people with paired weight in their notes was 108 kg (range 66 to 205 kg) with mean weight loss of 10.6 kg (roughly 10% body weight, range 2% to 29%).

In 39/65 with paired results, mean HbA1c dropped from 7.3% (range: 4.9 to 15%) to 6.3% (range: 4.9 to 10%). The mean drop was greater in people with diabetes (n=22), falling from 8.8% (range: 6 to15) to 6.8% (range: 5.4 to 10.0).

However, 12 people (18%) had detectable viral loads during GLP-1 RA use including 8/12 with minor blips <100 c/mL, 2/12 with higher rebound (to 437 and 825 c/mL) who both resuppressed, one rebound to 315 c/mL was intensified with TDF and one case of viral failure (using liraglutide) at 1260 c/mL with drug resistance.

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Although these new drugs can very effectively reduce weight and lower HbA1c, the limited research into the use by people living with HIV raises several cautions.

These include practical issues related to sustainability of access (as in the US), dosing (including with intermittent access), risk of poor nutrition or low exercise, regaining weight (as fat) if treatment is stopped, loss of lean muscle (not replaced if treatment is stopped) and worsening lipoatrophy.

These concerns, together with reports of viral blips and rebound, show the importance of medical support and management especially when treatments are being accessed privately online.

The 4% of people living with HIV in Leicester accessing GLP-1 RA treatment is likely an underestimate because it required active disclosure.

Nazareth J et al. Descriptive review of GLP-1 agonist use in PLWH at a single NHS Trust in Leicester UK. 6th Joint BHIVA/BASHH Conference, 27–29 April 2026, Liverpool. Poster abstract A190. HIV Medicine 27(Suppl. 1). doi: DOI: 10.1111/hiv.70233.
https://onlinelibrary.wiley.com/toc/14681293/2026/27/S1