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Semaglutide improves MASLD and MASH in people with HIV: The SLIM LIVER study
Jordan E Lake1, Douglas W Kitch2, Amy Kantor2
1Department of Internal Medicine, UTHealth Houston, Houston, Texas, USA.
HIV Medicine
|July 28, 2026
Summary
Semaglutide effectively treats metabolic dysfunction-associated steatotic liver disease (MASLD) in people with HIV. Serum metabolomics using OWLiver® can non-invasively monitor MASLD severity during this glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy.
Area of Science:
- Hepatology
- Metabolic Disorders
- Pharmacology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing concern, particularly in people with HIV (PWH).
- Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), shows promise for treating MASLD.
- Non-invasive methods for monitoring MASLD severity are needed, especially during treatment.
Purpose of the Study:
- To evaluate the utility of OWLiver® metabolomics for monitoring MASLD severity in PWH treated with semaglutide.
- To assess changes in MASLD severity using serum metabolomic profiling during GLP-1RA therapy.
Main Methods:
- The SLIM LIVER trial (ACTG A5371) was an open-label, phase 2b study involving PWH with MASLD.
- Participants (N=36) achieving clinical response (weight loss >2.27 kg) to semaglutide underwent serum metabolomic analysis using the OWLiver® panel.
- Analysis was conducted after 24 weeks of low-dose semaglutide treatment.
Main Results:
- Twenty-four weeks of semaglutide treatment led to significant improvements in MASLD severity.
- Serum metabolomic profiling indicated improvement across all MASLD severity categories.
- These findings suggest potential histologic improvements in MASLD.
Conclusions:
- OWLiver® metabolomics algorithms are effective for monitoring MASLD severity in patients receiving GLP-1RA therapy.
- This non-invasive approach can track treatment response in PWH with MASLD.
- Metabolomic profiling offers a valuable tool for MASLD disease management.