Initiating semaglutide therapy reduces tobacco cigarette smoking intensity among people with HIV

Smoking remains a major public health issue in people with HIV (PWH). Given the recent uptake of semaglutide for weight management and/or diabetes treatment in PWH and emerging evidence of antiaddictive properties, we studied changes in tobacco cigarette smoking among PWH initiating semaglutide in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort.

We conducted a prepost within-person study examining changes in tobacco cigarette intensity (cigarettes/day) among PWH who reported currently smoking tobacco cigarettes at the time of semaglutide initiation between 04/2018-11/2025 across 10 CNICS sites. Smoking intensity was collected via the CNICS clinical assessment of patient reported instruments administered during routine clinical visits. We used linear mixed models adjusted for age, sex, race/ethnicity, and time to estimate the average change in smoking intensity level following initiation of semaglutide.

There were 123 PWH who reported current smoking at the time of semaglutide initiation, with an average of 10.5 cigarettes/day. The mean age was 51 years, 24% were female, and 95% were virally suppressed (<200 copies/mL). Most (93%) had a standard indication for semaglutide therapy, including 77% of PWH with a body mass index ≥30 kg/m2 and 61% with diabetes at baseline. We found a reduction of -2.5 (95% confidence interval: -3.7 to -1.3) cigarettes smoked per day among PWH after semaglutide initiation.

New use of the GLP-1 medication semaglutide in PWH who smoked resulted in a mean decrease of 2.5 cigarettes per day representing a 24% drop in total smoking intensity, and 21% reported not smoking at the end of follow-up.