Serum albumin is a powerful predictor of survival among HIV-1-infected women.
BACKGROUND
We previously reported that single measurements of albumin strongly predict survival in HIV-1-infected women independent of disease-specific markers. We now extend this to the use of serial measurements and single albumin values prior to initiation of highly active antiretroviral therapy.


METHODS
Prospective cohort study of 1941 women enrolled at six sites in the Women's Interagency HIV Study.


RESULTS
Albumin fell 0.44 g/L/y in 1627 women who survived and at a faster rate in 397 who died (1.54 g/L/y; p <.01). In a time-dependent model adjusting for disease markers, the relative hazard (RH) was fivefold higher in patients with serum albumin <35 g/L compared with patients with serum albumin >42 g/L. The RH of serum albumin <35 g/L in women with CD4+ lymphocyte counts > or =200 cells/micro L was 8.2 [95% CI: 4.2-15.8]) versus only 3.8 [95% CI: 2.4-6.1] in those with counts <200 cells/mm3. In a fixed-covariate Cox analysis of patients who started HAART during the study, albumin prior to HAART was associated with a higher RH (7.0 for albumin <35 g/L versus >42 g/L) than were other factors.


CONCLUSIONS
Serum albumin is a strong independent predictor of mortality in HIV-1-infected women after adjustment for known disease markers and may be useful for clinical monitoring.
Feldman
Joseph G
JG
State University of New York Health Science Center at Brooklyn, Brooklyn, New York 11203, USA. Joseph.Feldman@Downstate.edu
Gange
Stephen J
SJ
Bacchetti
Peter
P
Cohen
Mardge
M
Young
Mary
M
Squires
Katheleen E
KE
Williams
Carolyn
C
Goldwasser
Philip
P
Anastos
Kathryn
K
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D006801:Humans; D012367:RNA, Viral / Q000097:blood; D012306:Risk; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis; D013997:Time Factors
D012367:RNA, Viral; D012709:Serum Albumin