Association of serum albumin and aspartate transaminase with 5-year all-cause mortality in HIV/hepatitis C virus coinfection and HIV monoinfection.
Liver disease markers have been associated with mortality in HIV-infected individuals in the modern era of effective antiretroviral therapy. Our objective was to determine which markers are most predictive of mortality in HIV-monoinfected and HIV/hepatitis C virus (HCV)-coinfected persons.



We measured serum albumin, total protein, calculated globulin, aspartate transaminase (AST), and alanine transaminase in 193 HIV/HCV-coinfected and 720 HIV-monoinfected persons in the study of Fat Redistribution and Metabolic Change in HIV Infection. We evaluated associations of each marker with 5-year, all-cause mortality, adjusting for cardiovascular, HIV-related factors, inflammation, renal disease, muscle, and adiposity.



After 5 years of follow-up, overall mortality was 21% in HIV/HCV-coinfected and 12% in HIV-monoinfected participants. After multivariable adjustment, lower albumin and higher AST were independently associated with increased mortality. Lower albumin was associated with 49% increased odds of mortality overall [per 0.5 g/dl decrease, 95% confidence interval (CI): 1.2-1.9]; the association was stronger in HIV/HCV-coinfected [odds ratio (OR) = 2.1, 95% CI: 1.4-3.2] vs. HIV-monoinfected (OR = 1.3, 95% CI: 1.0-1.7; HCV-by-albumin interaction: P = 0.038). Higher AST was associated with 41% increased odds of mortality (per AST doubling; 95% CI: 1.1-1.8); associations were much stronger among HIV/HCV-coinfected (OR = 2.5, 95% CI: 1.5-4.1) than HIV-monoinfected (OR = 1.1, 95% CI: 0.8-1.5; HCV-by-AST interaction: P = 0.0042).



Lower serum albumin and higher AST appear to be important mortality risk factors in HIV/HCV-coinfection, but much less so in HIV-monoinfected individuals. The association of low albumin with mortality may reflect its role as a negative acute phase response protein. AST levels do not appear to be useful in predicting mortality in HIV-monoinfection and should be considered primarily in the context of HCV-coinfection.
aUniversity of California bVeterans Affairs Medical Center, San Francisco, California cPennington Biomedical Research Center, Baton Rouge, Louisiana dEmory University School of Medicine, Atlanta, Georgia eWashington University School of Medicine, St. Louis, Missouri, USA.
Rebecca
R
Scherzer
Steven B
SB
Heymsfield
David
D
Rimland
William G
WG
Powderly
Phyllis C
PC
Tien
Peter
P
Bacchetti
Michael G
MG
Shlipak
Carl
C
Grunfeld
D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D060085:Coinfection / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000401:mortality* / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis
D015415:Biomarkers; D012709:Serum Albumin; D001219:Aspartate Aminotransferases
FEBS Lett. 2008 Jun 11;582(13):1783-7
18474236
J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1059-64
17077199
Liver Int. 2015 Jul;35(7):1886-92
25581487
HIV Med. 2007 Jan;8(1):38-45
17305931
Eur Respir J. 1995 Sep;8(9):1548-53
8575583
AIDS Res Hum Retroviruses. 2006 Jan;22(1):14-21
16438640
Am J Kidney Dis. 2010 Nov;56(5):872-82
20709438
BMJ. 2004 Apr 24;328(7446):983
15028636
Am J Epidemiol. 2006 May 1;163(9):860-9
16524955
HIV Med. 2015 Apr;16(4):211-8
25234826
J Acquir Immune Defic Syndr. 2013 Feb 1;62(2):149-63
23187941
J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):121-31
16186728
Diabet Med. 2007 Apr;24(4):430-5
17388959
Clin Gastroenterol Hepatol. 2010 Dec;8(12 ):1002-12
20851211
J Acquir Immune Defic Syndr. 2010 Jan;53(1):102-6
19738484
Am J Kidney Dis. 2014 Oct;64(4):584-91
25059222
Ann Intern Med. 2003 Jul 15;139(2):137-47
12859163
Clin Chem Lab Med. 2010 Nov;48(11):1593-601
21034260
J Acquir Immune Defic Syndr. 2010 Nov;55(3):316-22
20581689
JPEN J Parenter Enteral Nutr. 1991 Jul-Aug;15(4):476-83
1895489
Curr HIV/AIDS Rep. 2013 Sep;10(3):226-34
23832718
Biomark Res. 2013 Feb 04;1(1):8
24252328
J Infect Dev Ctries. 2014 Nov 13;8(11):1444-50
25390056
Am J Physiol. 1998 Aug;275(2 Pt 1):E249-58
9688626
J Clin Epidemiol. 1988;41(11):1105-16
3204420
Proc Nutr Soc. 1989 Sep;48(3):347-54
2482490
J Acquir Immune Defic Syndr. 2008 Jun 1;48(2):169-76
18285711
Hepatology. 2006 May;43(5):1145-51
16628637
AIDS. 2000 May 5;14(7):863-70
10839595
Clin Infect Dis. 2001 Jul 15;33(2):240-7
11418885
AIDS Res Hum Retroviruses. 2011 Nov;27(11):1149-55
21417949
Biometrics. 2000 Sep;56(3):779-88
10985216
Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):183-91
19653438
Hepatology. 2010 Feb;51(2):373-5
20101746
AIDS. 2013 May 15;27(8):1339-43
23343914
AIDS. 2011 Jul 17;25(11):1405-14
21572308