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. 2009 Sep;32(9):1591-3.
doi: 10.2337/dc09-0177. Epub 2009 Jun 5.

A1C underestimates glycemia in HIV infection

Peter S Kim  1 , Christian Woods, Patrick Georgoff, Dana Crum, Alice Rosenberg, Margo Smith, Colleen Hadigan
Affiliations

A1C underestimates glycemia in HIV infection

Peter S Kim et al. Diabetes Care. 2009 Sep.

Abstract

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

Research design and 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.

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