Study finds racial gap in semaglutide prescribing among people with HIV

A study published September 19 in the journal Diabetes Care found that most people with HIV who qualified for semaglutide did not receive it, and that eligible Black patients were significantly less likely to get the drug than White patients ^[1][2].

The analysis looked at 11,617 people with HIV in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, drawn from nine US sites, between 2019 and 2023 ^[2]. Researchers defined eligibility for semaglutide as a body mass index (BMI) of 30 or higher, an HbA1c of 6.5 or higher, or both ^[2]. HbA1c is a blood test that reflects average blood sugar over roughly the previous three months.

Of those 11,617 eligible patients, 774 — 6.7 percent — received semaglutide ^[2]. Among the eligible group, 92 percent qualified by BMI of 30 or higher, 62 percent by HbA1c of 6.5 or higher, and 54 percent met both criteria ^[2]. Semaglutide is sold as Ozempic and Rybelsus for type 2 diabetes and as Wegovy for chronic weight management.

Eligible Black patients were 20 percent less likely to receive semaglutide than eligible White patients, with a prevalence ratio of 0.80 and a 95 percent confidence interval of 0.67 to 0.95 ^[2]. The difference was larger among patients whose HbA1c was 8.0 or higher: in that group, Black patients had a prevalence ratio of 0.66 (95 percent confidence interval 0.53 to 0.83) and Hispanic patients had a prevalence ratio of 0.70 (95 percent confidence interval 0.53 to 0.93) ^[2]. A prevalence ratio below 1.0 means a group received the drug less often than the comparison group.

The models were adjusted for demographic characteristics, and a figure showing prescription rates by race was adjusted for age, sex, study site and maximum BMI ^[1][2]. The authors reported no potential conflicts of interest ^[2]. The report appears in the October 2025 issue of Diabetes Care, volume 48, issue 10, pages 1761 to 1765 ^[1].

Why it matters for patients

The study measures who got a prescription, not why. It does not report data on insurance coverage, out-of-pocket cost, pharmacy access, patient preference or clinician decision-making, so the reasons behind the gap have not been established ^[2]. The authors describe the findings as inequitable semaglutide use and lower initiation rates among eligible Black patients with HIV, without identifying a cause ^[2].

It also is not known whether the same pattern appears with other GLP-1 medications, such as tirzepatide (Mounjaro and Zepbound) or orforglipron. That has not been reported.

The findings come from a research cohort at nine US sites, so they describe those patients rather than everyone with HIV in the United States ^[2]. Even so, the eligibility rules used in the study — BMI of 30 or higher or HbA1c of 6.5 or higher — are measures that appear in routine lab results and clinic notes, which means many patients can see whether they fall into the group the study examined ^[2].

More than nine out of ten eligible patients in this cohort, across all racial and ethnic groups, never received semaglutide during the four-year study window ^[2]. Whether that reflects supply limits, prescribing patterns, coverage rules or other factors is not addressed in the analysis.

The study was a brief report based on existing cohort records rather than a trial, and the authors did not report follow-up research or planned interventions ^[1][2].