G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic

• Published in: The American journal of tropical medicine and hygiene Vol. 93; no. 4; pp. 722 - 729
• Main Authors: Xu, Julia Z., Francis, Richard O., Lerebours Nadal, Leonel E., Shirazi, Maryam, Jobanputra, Vaidehi, Hod, Eldad A., Jhang, Jeffrey S., Stotler, Brie A., Spitalnik, Steven L., Nicholas, Stephen W.
• Format: Journal Article
• Language: English
• Published: United States The American Society of Tropical Medicine and Hygiene 01.10.2015
• Subjects: Adult; Algorithms; Cost-Benefit Analysis; Dominican Republic - epidemiology; Female; Glucose-6-Phosphatase - blood; Glucose-6-Phosphatase - genetics; Glucosephosphate Dehydrogenase Deficiency - complications; Glucosephosphate Dehydrogenase Deficiency - diagnosis; Glucosephosphate Dehydrogenase Deficiency - epidemiology; Haiti - ethnology; HIV Infections - complications; Humans; Logistic Models; Male; Prevalence; Risk Factors; Sensitivity and Specificity; Sex Factors; Dominican Republic; Haiti; Africa
• ISSN: 0002-9637; 1476-1645; 1476-1645
• DOI: 10.4269/ajtmh.14-0295

Because human immunodeficiency virus (HIV)-infected patients receive prophylaxis with oxidative drugs, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience hemolysis. However, G6PD deficiency has not been studied in the Dominican Republic, where many individuals have African ancestry. Our objective was to determine the prevalence of G6PD deficiency in Dominican HIV-infected patients and to attempt to develop a cost-effective algorithm for identifying such individuals. To this end, histories, chart reviews, and G6PD testing were performed for 238 consecutive HIV-infected adult clinic patients. The overall prevalence of G6PD deficiency (8.8%) was similar in males (9.3%) and females (8.5%), and higher in Haitians (18%) than Dominicans (6.4%; P = 0.01). By logistic regression, three clinical variables predicted G6PD status: maternal country of birth ( P = 0.01) and a history of hemolysis ( P = 0.01) or severe anemia ( P = 0.03). Using these criteria, an algorithm was developed, in which a patient subset was identified that would benefit most from G6PD screening, yielding a sensitivity of 94.7% and a specificity of 97.2%, increasing the pretest probability (8.8–15.1%), and halving the number of patients needing testing. This algorithm may provide a cost-effective strategy for improving care in resource-limited settings.