Serum albumin as a predictor of survival in HIV-infected women in the Women's Interagency HIV study.
BACKGROUND
The level of serum albumin is associated with mortality in a wide variety of chronic diseases. However, few studies have examined the relationship between serum albumin and survival in HIV-1 infection.


OBJECTIVE
To determine whether the serum albumin level is associated with survival in HIV-1 infected women.


METHODS
Prospective cohort study. Patients were interviewed and examined at 6 month intervals.


METHODS
A North American multi-institutional cohort of HIV-infected women from five geographical areas.


METHODS
A total of 2056 HIV-infected women at various stages of disease.


METHODS
Mortality during the first 3 years of follow-up. The relative risk of death by serum albumin level was estimated using a proportional hazards ratio adjusted for CD4 cell count, HIV-1-RNA level and other relevant covariates.


RESULTS
Three year mortality for women in the lowest serum albumin category (< 35 g/l) was 48% compared with 11% in the highest category (> or = 42 g/l; P < 0.001). The adjusted relative hazard (RH) of death was 3.1 times greater for those in the lowest albumin category (P < 0.01). The excess risk associated with lower serum albumin levels remained when subjects with moderate to severe immunosuppression and abnormal kidney and liver function were excluded (P < 0.01).


CONCLUSIONS
The baseline serum albumin level is an independent predictor of mortality in HIV-1-infected women. The serum albumin level may be a useful additional marker of HIV-1 disease progression, particularly among asymptomatic women with little or no evidence of immunosuppression.
Feldman
J G
JG
Department of Preventive Medicine, State University of New York, Brooklyn 11203, USA. jfeldman@netmail.hscbklyn.edu
Burns
D N
DN
Gange
S J
SJ
Bacchetti
P
P
Cohen
M
M
Anastos
K
K
Nowicki
M
M
Delapena
R
R
Miotti
P
P
D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis
D012367:RNA, Viral; D012709:Serum Albumin