Increased Hb A2 Values in an HIV-1-Infected Patient Receiving Antiretroviral Drugs: A Pitfall for Thalassemia Antenatal Diagnosis

We report a human immunodeficiency virus-1 (HIV-1)-infected couple, where the woman in the 11th week of gestation, carried a Hb E trait. She and her spouse were referred to the hemoglobinopathy counselors. Her spouse's blood was subsequently tested and showed an increased Hb A₂ value. However, his red cell indices and osmotic fragility test were different from those found in β-thalassemia (β-thal) carriers. The β-thal genes were investigated further and no mutations were observed. Therefore, it is unlikely that he is a β-thal carrier and the increased Hb A₂ value is a result of receiving antiretroviral drugs. As antenatal thalassemia screening becomes more widespread, measuring the Hb A₂ values should be taken in all HIV-1-infected couples before the initiation of antiretroviral drugs to rule out misdiagnosis of β-thal. However, if these tests are not available, the results of the red cell indices and osmotic fragility test should be considered as they may provide great value for β-thal investigations.