Increased haemoglobin A2 percentage in HIV infection: disease or treatment?

Abstract

An elevated haemoglobin A2 percentage has been reported in HIV-infected patients, possibly attributable to therapy. In cross-sectional and cohort studies we have established that A2 is often elevated in untreated patients; a further rise during treatment is attributable specifically to zidovudine. The haemoglobin A2 may be high enough to lead to a misdiagnosis of beta thalassemia trait if there is a lack of awareness of this unexpected effect of HIV infection and its treatment.

A Comparison of Hemoglobin A2 Levels in Untreated and Treated Groups of HIV Patients on ART Including Zidovudine

“…In the present study, thyroid functions test was within normal limits in both study and control groups. Wilkinson et al observed that incidence of increased Hb A 2 value was significantly high in patients treated with zidovudine containing HAART than in those treated with non-zidovudine HAART and normal volunteers [4]. In the present study all patients on zidovudine containing ART had raised Hb A 2 value than control group.…”

The role of haemoglobin A2testing in the diagnosis of thalassaemias and related haemoglobinopathies

“…Increased levels have been reported in the absence of β thalassaemia trait in a few significant cases of hyperthyroidism (values over 4%),14 in HIV-infected patients treated with antiretroviral therapy, 15 16 by Piero Giordano (personal communication), and in the presence of megaloblastic anaemia 17…”

Significant haemoglobinopathies: guidelines for screening and diagnosis

“… • Re‐analyse FBC • Repeat Hb A 2 • Consider B12/folate deficiency, drugs, liver disease/alcohol or HIV infection (Alperin et al , 1977; Galacteros et al , 1993; Howard et al , 2005; Wilkinson et al , 2007). …”