The National Institutes of Health (NIH) reported that semaglutide may safely and effectively reduce the severity of metabolic dysfunction–associated steatotic liver disease in patients with human immunodeficiency virus (HIV). Researchers explained that the liver disease is not linked to alcohol consumption and is characterized by a buildup of fat in the liver—which can lead to inflammation, cellular damage, cardiovascular disease, and liver transplantation. In a phase IIb pilot study presented by Lake et al at the 2024 Conference on Retroviruses and Opportunistic Infections, researchers examined the outcomes of 49 patients aged 18 years and older with metabolic dysfunction–associated steatotic liver disease and HIV—82% (n = 40) of whom were receiving antiretroviral therapy with integrase strand transfer inhibitors. The patients involved in the study received increasing doses of self-injected semaglutide weekly until they reached 1 mg at week 4, after which they participated in regular safety-monitoring visits. After a follow-up of 24 weeks, the researchers discovered that semaglutide reduced liver fat by 31% and that 29% of the patients experienced complete resolution of their metabolic dysfunction–associated steatotic liver disease. Further, semaglutide helped the patients lose weight as well as lower their fasting blood glucose and fasting triglycerides. An additional analysis demonstrated that the volume of the psoas muscle decreased without significant change in physical function in patients receiving the agent. The most common adverse events in patients taking semaglutide were nausea, diarrhea, vomiting, and abdominal pain. The researchers hope their new findings may help inform treatment decision-making and improve quality of life in patients with metabolic dysfunction–associated steatotic liver disease and HIV.