A1C Underestimates Glycemia in HIV Infection

  1. Peter S. Kim, MD1,2,
  2. Christian Woods, MD1,
  3. Patrick Georgoff, BS3,
  4. Dana Crum, MD3,
  5. Alice Rosenberg, RN2,
  6. Margo Smith, MD1 and
  7. Colleen Hadigan, MD, MPH2
  1. 1Department of Infectious Diseases, Washington Hospital Center, Washington, DC;
  2. 2National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;
  3. 3University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
  1. Corresponding author: Colleen Hadigan, hadiganc{at}niaid.nih.gov.


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.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received January 29, 2009.
    • Accepted May 29, 2009.
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  1. Diabetes Care vol. 32 no. 9 1591-1593
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