A1C underestimates glycemia in HIV infection.
OBJECTIVE
The objective of this study was to determine the relationship between A1C and glycemia in HIV infection.


METHODS
We completed a prospective cross-sectional study of 100 HIV-infected adults with type 2 diabetes (77%) or fasting hyperglycemia (23%) with measured glucose, A1C, mean corpuscular volume (MCV), and fructosamine. A total of 200 HIV-uninfected type 2 diabetic subjects matched for key demographic characteristics served as control subjects.


RESULTS
Relative to the control subjects, A1C underestimated glucose by 29 +/- 4 mg/dl in the HIV-infected subjects. Current nucleoside reverse transcriptase inhibitors (NRTIs), higher MCV and hemoglobin, and lower HIV RNA and haptoglobin were associated with greater A1C-glucose discordance. However, only MCV and current NTRI use, in particular abacavir, remained significant predictors in multivariate analyses. Fructosamine more closely reflected glycemia in the HIV-infected subjects.


CONCLUSIONS
A1C underestimates glycemia in HIV-infected patients and is related to NRTI use. Use of abacavir and increased MCV were key correlates in multivariate analyses. Fructosamine may be more appropriate in this setting.
Kim
Peter S
PS
Department of Infectious Diseases, Washington Hospital Center, Washington, DC, USA.
Woods
Christian
C
Georgoff
Patrick
P
Crum
Dana
D
Rosenberg
Alice
A
Smith
Margo
M
Hadigan
Colleen
C
D001786:Blood Glucose / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D015658:HIV Infections / Q000097:blood* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin