Abstract
Background: There is limited evidence that among HIV-infected patients haemoglobin A1c (HbA1c) values may not accurately reflect glycaemia. We assessed HbA1c discordance (observed HbA1c- expected HbA1c) and associated factors among HIV-infected participants in the Multicenter AIDS Cohort Study (MACS). Methods: Fasting glucose (FG) and HbA1c were measured at each semi-annual MACS visit since 1999. All HIVinfected and HIV-uninfected men for whom at least one FG and HbA1c pair measurement was available were evaluated. Univariate median regression determined the association between HbA1c and FG by HIV serostatus. The relationship between HbA1c and FG in HIV-uninfected men was used to determine the expected HbA1c. Generalized estimating equations determined factors associated with the Hb1Ac discordance among HIVinfected men. Clinically significant discordance was defined as observed HbA1c- expected HbA1c ≤ -0.5%. Results: Over 13 years, 1500 HIV-uninfected and 1357 HIV-infectedmen were included, with amedian of 11 visits for each participant. At an FG of 125 mg/dL, the median HbA1c among HIV-infected men was 0.21% lower than among HIV-uninfected men and the magnitude of this effect increased with FG > 126 mg/dL. Sixty-three percent of HIV-infected men had at least one visit with clinically significant HbA1c discordance, which was independently associated with: low CD4 cell count (<500 cells/mm3); a regimen containing a protease inhibitor, a non-nucleoside reverse transcriptase inhibitor or zidovudine; high mean corpuscular volume; and abnormal corpuscular haemoglobin. Conclusion: HbA1c underestimates glycaemia in HIV-infected patients and its use in patients with risk factors for HbA1c discordance may lead to under-diagnosis and to under-treatment of established diabetes mellitus.
Original language | English (US) |
---|---|
Pages (from-to) | 3360-3367 |
Number of pages | 8 |
Journal | Journal of antimicrobial chemotherapy |
Volume | 69 |
Issue number | 12 |
DOIs | |
State | Published - Dec 1 2014 |
Funding
The mechanisms underlying the underestimation of glycaemia by HbA1c among HIV-infected persons are unclear. Previous reports have suggested that HIV infection and/or its treatment is associated with a low-grade haemolysis,11 thereby leading to a shorter period of time during which haemoglobin within erythrocytes can become glycated. This hypothesis was supported by This work was supported by the National Institutes of Health (U01-AI35042, U01-AI35039, U01-AI35040, U01-AI35041, UM1-AI35043, UL1-TR000424). The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). Web site located at http://www.statepi.jhsph.edu/macs/macs.html.
Keywords
- Diabetes
- Glycosylated haemoglobin
- HIV
- HbA1c
- Mean corpuscular volume
ASJC Scopus subject areas
- Microbiology (medical)
- Pharmacology (medical)
- Infectious Diseases
- Pharmacology