Glycated Hemoglobin A_1c as Screening for Diabetes Mellitus in HIV-Infected Individuals

Abstract

The American Diabetes Association now recommends hemoglobin A 1c (HbA 1c ) screening for the diagnosis of diabetes. It has been reported that HbA 1c levels underestimate glycemic levels in HIV-infected persons. We examined the performance of HbA 1c as a screening test for diabetes in a group of HIV-infected people without diabetes. We conducted a retrospective cross-sectional cohort study among HIV-infected patients determining the sensitivity and specificity of HbA 1c as a screening test compared to fasting blood glucose (FBG). The effect of treatment regimen on the relationship between HbA 1c and FBG was assessed by multiple linear regressions. Twenty-two of the 395 patients included in the study were newly diagnosed with diabetes based on FBG ‡ 126 mg/dL. Using a cutoff of HbA 1c ‡ 6.5%, HbA 1c had a sensitivity of 40.9% and specificity of 97.5% for identification of incident diabetes. At an HbA 1c level of 5.8% the product of sensitivity and specificity was maximized, with values of 88.8% and 77.5% respectively. Higher mean cell volume (MCV) values ( p = 0.02) and current use of a non-nucleoside reverse transcriptase inhibitors (NNRTIs; p = 0.02) significantly increased the slope, while PI use significantly decreased the slope ( p < 0.001), of the linear regression of HbA 1c compared to FBG. Tenofovir use did not significantly alter the slope or y-intercept of the line. Among HIV-infected nondiabetic patients, HbA 1c is insensitive, although highly specific for diagnosing diabetes. Current antiretroviral (ART) use has significant and variable influence on the relationship between HbA 1c and FBG. The use of HbA 1c in conjunction with FBG may be the best modality to screen for diabetes.

Soluble Levels of Receptor for Advanced Glycation Endproducts (RAGE) and Progression of Atherosclerosis in Individuals Infected with Human Immunodeficiency Virus: ACTG NWCS 332

“…Although glycation differences have been suggested in HIV-infected compared to -uninfected individuals (27–29), in this small subgroup of 80 A5078 study subjects, we did not find evidence that plasma levels of either form of sRAGE studied here were modulated by HIV status. However, we did find progression of CIMT associated with lower baseline esRAGE levels among those with HIV infection, which is consistent with a previous report in HIV-uninfected, diabetic individuals (30).…”

Diabetes Mellitus Type 2 and Abnormal Glucose Metabolism in the Setting of Human Immunodeficiency Virus

“…al. (20) compared elevated fasting blood glucose with HgbA1c. Using fasting blood glucose as the gold standard, investigators found that the sensitivity of HgbA1c was poor at 40.9%, but specificity high at 97.5%; peak sensitivity and specificity was found at a HgbA1c cutoff of 5.8%.…”

Maternal and neonatal outcomes following a diabetic pregnancy within the context ofHIV

“…The lower HbA1C in the HIV‐infected population was unexpected, as this group had higher rates of anemia, which results in higher HbA1C if caused by iron deficiency anemia . However, this relationship is complex, since the cause of anemia in our cohort was unknown and HbA1C has previously been found to underreport hyperglycemia in HIV‐positive patients . On the other hand, the observation that first visit mean blood glucose (MBG) was also lower in our HIV‐infected group tends to affirm better control in this group.…”

“…32 However, this relationship is complex, since the cause of anemia in our cohort was unknown and HbA1C has previously been found to underreport hyperglycemia in HIVpositive patients. 33 On the other hand, the observation that first visit mean blood glucose (MBG) was also lower in our HIV-infected group F I G U R E 1 Neonatal outcomes in metformin monotherapy and glibenclamide-exposed groups vs insulin monotherapy in participants with T2DM and GDM. T2DM, type 2 diabetes; GDM, gestational diabetes; LBW, low birth weight; PNM, perinatal mortality.…”