title: Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretroviral therapy era: relationships with gender.
abstract: OBJECTIVE
  The aims of the study were to describe gender differences in haemoglobin and albumin and to investigate the prognostic value of these measurements in relation to highly active antiretroviral therapy (HAART).
  
  
  METHODS
  Anaemia was defined as haemoglobin <13.5 g/dL for men and <11.5 g/dL for women. Albumin <35 g/L was defined as hypoalbuminaemia. Proportional hazards models were used to describe relationships between these markers and HIV progression and death.
  
  
  RESULTS
  A total of 291 patients had pre-HAART and 1-year measurements. Mean haemoglobin and albumin levels pre-HAART were lower in women than in men (haemoglobin: 11.2 vs 13.2 g/dL, respectively, P<0.0001; albumin: 37.4 vs 40.2 g/L, respectively, P<0.0001), and a higher proportion of women were anaemic and hypoalbuminaemic compared with men. Despite a rise in both markers in the first year on HAART, mean haemoglobin levels remained lower by 2.08 g/dL (P<0.0001) and albumin by 2.88 g/L (P<0.0001) in women. In the 495 patients included in this analysis, haemoglobin and albumin levels were both significantly related to short-term risk of AIDS and death independently of CD4 count [hazards ratio (HR)=0.73/g/dL higher haemoglobin, 95% confidence interval (CI) 0.55-0.82, P<0.0001 and HR=0.87/g/L higher albumin, 95% CI 0.83-0.91, P<0.0001]. The prognostic value did not differ by gender.
  
  
  CONCLUSIONS
  Women were more likely to be anaemic and/or hypoalbuminaemic pre-HAART, but post-HAART increases were similar to those in men. Both haemoglobin and albumin were strong independent prognostic factors for risk of AIDS and death, regardless of gender.
authors.affiliation: Department of Thoracic Medicine, Royal Free Centre for HIV Medicine, Royal Free & University College Medical School & Royal Free Hospital, Rowland Hill Street, London, UK. s.shah@pcps.ucl.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Shah
authors.forename: C J
authors.initials: CJ
authors.lastname: Smith
authors.forename: F
authors.initials: F
authors.lastname: Lampe
authors.forename: M
authors.initials: M
authors.lastname: Youle
authors.forename: M A
authors.initials: MA
authors.lastname: Johnson
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000821:virology; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D015497:HIV-1; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000821:virology; D008131:London; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin