title: G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic.
abstract: Because human immunodeficiency virus (HIV)-infected patients receive prophylaxis with oxidative drugs, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience hemolysis. However, G6PD deficiency has not been studied in the Dominican Republic, where many individuals have African ancestry. Our objective was to determine the prevalence of G6PD deficiency in Dominican HIV-infected patients and to attempt to develop a cost-effective algorithm for identifying such individuals. To this end, histories, chart reviews, and G6PD testing were performed for 238 consecutive HIV-infected adult clinic patients. The overall prevalence of G6PD deficiency (8.8%) was similar in males (9.3%) and females (8.5%), and higher in Haitians (18%) than Dominicans (6.4%; P = 0.01). By logistic regression, three clinical variables predicted G6PD status: maternal country of birth (P = 0.01) and a history of hemolysis (P = 0.01) or severe anemia (P = 0.03). Using these criteria, an algorithm was developed, in which a patient subset was identified that would benefit most from G6PD screening, yielding a sensitivity of 94.7% and a specificity of 97.2%, increasing the pretest probability (8.8-15.1%), and halving the number of patients needing testing. This algorithm may provide a cost-effective strategy for improving care in resource-limited settings.
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York julia.xu@dm.duke.edu.
authors.forename: Julia Z
authors.initials: JZ
authors.lastname: Xu
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Francis
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Leonel E
authors.initials: LE
authors.lastname: Lerebours Nadal
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Maryam
authors.initials: M
authors.lastname: Shirazi
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Jobanputra
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Eldad A
authors.initials: EA
authors.lastname: Hod
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jhang
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Brie A
authors.initials: BA
authors.lastname: Stotler
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Spitalnik
authors.affiliation: Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Nicholas
mesh_terms: D000328:Adult; D000465:Algorithms; D003362:Cost-Benefit Analysis; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D005952:Glucose-6-Phosphatase / Q000097:blood / Q000235:genetics; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications; D006205:Haiti / Q000208:ethnology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
chemical_list: D005952:Glucose-6-Phosphatase