GLP-1 Receptor Agonists to Decrease Ethanol and CVD Risk in HIV

Inclusion Criteria: * Ages 18-89 * Prior diagnosis of HIV-1 * Affiliated with Vanderbilt Comprehensive Care Clinic * On current ART regimen for at least 90 days prior to study entry with no missed doses for at least 7 consecutive days. * Most recent absolute CD4 count ≥ 300 cells/mm3 and drawn within 12 months of study enrollment * BMI ≥ 23 (calculated at screening) * Self-report of consuming alcohol in past 90 days * AUDIT-C ≥ 3 (male)/ ≥ 2 (female) * Has an established stable address at which they can receive mail and can be reached for the next 6 months * Willing and able to complete study procedures and follow-ups Exclusion Criteria: * Known allergy to semaglutide * Currently taking GLP-1 RA (in the past 3 months) * History of diabetes defined by diagnosis in Problems List in medical record * History of pancreatitis * History of gastroparesis * Gallbladder disease (in the past 3 months) * History of medullary thyroid carcinoma * Family history of medullary thyroid carcinoma * History of multiple endocrine neoplasia syndrome type 2 * Family history of multiple endocrine neoplasia syndrome type 2 * Cognitive inability to consent * Barrier to speaking, hearing, reading, or writing English * Pregnant or breastfeeding, or planning to become pregnant in the next 6 months * Too ill to complete study procedures