HIV infection and anaemia do not affect HbA1c for the detection of diabetes in black South Africans - evidence from the Durban Diabetes Study

Thomas R Hird, Uttara Partap, Pravi Moodley, Fraser J Pirie, Tonya M Esterhuizen, Brian O'Leary, Mark I McCarthy, Elizabeth H Young, Manjinder S Sandhu, Ayesha A Motala

Research output: Contribution to journalArticlepeer-review

3 Citations (SciVal)


Objective: South Africa has a high burden of HIV infection and anaemia. These conditions may cause HbA 1c to over- or underestimate glycaemia; however, this has not been comprehensively investigated in African populations. We assessed the association of anaemia, HIV infection and antiretroviral therapy (ART) with HbA 1c, and implications for the detection and diagnosis of diabetes, in a black South African population. Research design and methods: In this population-based cross-sectional study in eThekwini municipality (Durban), South Africa, we assessed HbA 1c and conducted oral glucose tolerance tests (OGTTs), HIV diagnostic tests and full blood count measurements among 1067 participants without a history of diabetes diagnosis. Linear regression was used to examine differences in HbA 1c by anaemia (comparator: no anaemia), or HIV and ART (comparator: no HIV) status. HbA 1c-based diabetes prevalence was compared with OGTT-based prevalence among individuals with anaemia and with untreated and ART-treated HIV. Results: In adjusted analyses, normocytic and microcytic anaemia were associated with higher HbA 1c compared with no anaemia, whereas macrocytic anaemia and ART-treated HIV were associated with lower HbA 1c compared with no anaemia and no HIV, respectively. However, magnitudes of association were small (range: (Formula presented.) = −3.4 mmol/mol or −0.31%, p < 0.001 [macrocytic anaemia] to (Formula presented.) = 2.1 mmol/mol or 0.19%, p < 0.001 [microcytic anaemia]). There was no significant difference in diabetes prevalence based on HbA 1c or OGTT among individuals with anaemia (2.9% vs. 3.3%, p = 0.69), untreated HIV (1.6% vs. 1.6% p = 1.00) or ART-treated HIV (2.9% vs. 1.2%, p = 0.08). Conclusions: Our results suggest that anaemia and HIV status appear unlikely to materially affect the utility of HbA 1c for diabetes detection and diagnosis in this population. Further studies are needed to examine these associations in sub-Saharan African populations.

Original languageEnglish
Article numbere14605
JournalDiabetic Medicine
Issue number11
Early online date24 May 2021
Publication statusPublished - 30 Nov 2021


  • AIDS
  • Africa
  • HIV
  • South Africa
  • anaemia
  • anti-HIV agents
  • glucose tolerance test
  • glycated haemoglobin A

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


Dive into the research topics of 'HIV infection and anaemia do not affect HbA1c for the detection of diabetes in black South Africans - evidence from the Durban Diabetes Study'. Together they form a unique fingerprint.

Cite this