G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic

Julia Z. Xu Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Richard O. Francis Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Leonel E. Lerebours Nadal Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Maryam Shirazi Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Vaidehi Jobanputra Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Eldad A. Hod Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Jeffrey S. Jhang Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Brie A. Stotler Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Steven L. Spitalnik Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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Stephen W. Nicholas Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York

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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.

Author Notes

* Address correspondence to Julia Z. Xu, Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Box 3182, Durham, NC 27710. E-mail: julia.xu@dm.duke.edu

Financial support: Julia Z. Xu received funding from the Columbia University Doris Duke Charitable Foundation Clinical Research Fellowship 2012–2013 and received funding from an award from the American Society of Hematology (HONORS Award), as well as the Department of Pathology and Cell Biology at Columbia University. Jeffrey S. Jhang received compensation in the past from Aaronson Rappaport Feinstein and Deutsch LLP for expert testimony. Steven L. Spitalnik is currently receiving a grant (R01 HL115557) from the National Institutes of Health and funding from the American Society of Hematology (HONORS Award), and has an unrelated pending patent application regarding iron chelation and RBC transfusions.

Disclosure: Some of these data were presented previously at the 2013 annual meeting of the Academy Clinical Laboratory Physicians and Scientists in Atlanta, GA, June 6–8, 2013, and the 2013 annual meeting of the American Society of Hematology in New Orleans, LA, December 7–10, 2013.

Authors' addresses: Julia Z. Xu, Department of Medicine, Duke University Medical Center, Durham, NC, E-mail: julia.xu@dm.duke.edu. Richard O. Francis, Maryam Shirazi, Vaidehi Jobanputra, Eldad A. Hod, Brie A. Stotler, and Steven L. Spitalnik, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, E-mails: rof3@cumc.columbia.edu, ms4105@cumc.columbia.edu, vj2004@cumc.columbia.edu, eh2217@cumc.columbia.edu, bs2277@cumc.columbia.edu, and ss2479@cumc.columbia.edu. Jeffrey S. Jhang, Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, E-mail: jeffrey.jhang@mountsinai.org. Leonel E. Lerebours Nadal, Clínica de Familia La Romana, República Dominicana, E-mail: leonel.lereboursnadal@gmail.com. Stephen W. Nicholas, IFAP Global Health Program, Columbia University Medical Center, New York, NY, E-mail: swn2@cumc.columbia.edu.

Reprint requests: Stephen W. Nicholas, IFAP Global Health Program, Columbia University Medical Center, 630 West 168th Street, Box 41, Room P and S 1-416, New York, NY 10032, E-mail: swn2@cumc.columbia.edu, Tel: 212-305-3595, Fax: 212-305-3601.

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