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A1C Underestimates Glycemia in HIV Infection

Kim, Peter S., Woods, Christian, Georgoff, Patrick, Crum, Dana, Rosenberg, Alice, Smith, Margo, Hadigan, Colleen
Diabetes care 2009 v.32 no.9 pp. 1591-1593
RNA, RNA-directed DNA polymerase, adults, blood glucose, cross-sectional studies, fasting, glucose, hemoglobin, hyperglycemia, multivariate analysis, noninsulin-dependent diabetes mellitus, patients, sociodemographic characteristics
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.