HIV serostatus does not influence HbA1c levels in people living with HIV: Insights from continuous glucose monitoring

The researchers performed a comprehensive assessment of glycemia to assess if HIV serostatus influences HbA1c. They did not find strong evidence that HIV serostatus influenced HbA1c. The findings support HbA1c incorporation into routine clinical blood work in people living with HIV (PLWH).

In people living with HIV, type 2 diabetes (T2D) is reported to be common. Clinical guidelines recommend diabetes screening in PLWH, but there is no agreed method due to studies reporting that HbA1c is falsely low in PLWH. These studies were performed in the era of early HIV when participants were taking older preparations of antiretroviral therapy that are rarely used today.

Harriet Daultrey, Brighton and Sussex Medical School, Brighton, East Sussex, U.K, and colleagues aimed to investigate whether HIV serostatus influences HbA1c.

For this purpose, they conducted a prospective cohort study of PLWH and sex- and age-matched HIV-negative participants who were purposely recruited from clinics in Brighton, U.K. Each participant wore a Dexcom G6 continuous glucose monitor (CGM) for up to 10 days, had glucose measured during an oral glucose tolerance test, and fructosamine and paired HbA1c were measured.

The research team performed regression analysis to assess the impact of HIV on HbA1c and used a separate model for CGM glucose, fructosamine, and venous glucose. Additionally, predictor variables used in previous studies were included that explored HbA1c discrepancy.

The following were the key findings of the study:

• Sixty people living with HIV (90% men, 50% with T2D, mean ± SD age 57 ± 10.7 years, 100% undetectable viral load) and 48 people without HIV (92% men, 30% with T2D, mean age 57.7 ± 8.9 years) were recruited.
• HIV serostatus did not have a significant influence on HbA1c within the regression models.

To summarize, a study in the UK utilized CGM and oral glucose tolerance tests to examine the influence of HIV serostatus on HbA1c levels in PLWH compared to HIV-negative individuals.

"Despite previous concerns about HbA1c accuracy in PLWH, the findings showed no significant influence of HIV status on HbA1c levels, indicating that HbA1c remains a reliable marker for glycemic assessment in PLWH," the researchers wrote.

Reference:

Harriet Daultrey, Nick S. Oliver, Juliet Wright, Tom J. Levett, Ali Jason Chakera; What Is the Influence of HIV Serostatus on HbA1c? A Prospective Analysis Using Continuous Glucose Monitoring. Diabetes Care 2024; dc240225. https://doi.org/10.2337/dc24-0225