Jg. Feldman et al., Serum albumin as a predictor of survival in HIV-infected women in the Women's Interagency HIV Study, AIDS, 14(7), 2000, pp. 863-870
Background: The level of serum albumin is associated with mortality in a wi
de variety of chronic diseases. However, few studies have examined the rela
tionship between serum albumin and survival in HIV-1 infection.
Objectives: To determine whether the serum albumin level is associated with
survival in HIV-1 infected women.
Design: Prospective cohort study. Patients were interviewed and examined at
6 month intervals.
Setting: A North American multi-institutional cohort of HIV-infected women
from five geographical areas.
Participants: A total of 2056 HIV-infected women at various stages of disea
se.
Measurements: Mortality during the first 3 years of follow-up. The relative
risk of death by serum albumin level was estimated using a proportional ha
zards ratio adjusted for CD4 cell count, HIV-1-RNA level and other relevant
covariates.
Result: Three year mortality for women in the lowest serum albumin category
(< 35/l) was 48% compared with 11% in the highest category (greater than o
r equal to 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 subje
cts with moderate to severe immunosuppression and abnormal kidney and liver
function were excluded (P < 0.01).
Conclusion: The baseline serum albumin level is an independent predictor of
mortality in HIV-l-infected women. The serum albumin level may be a useful
additional marker of HIV-1 disease progression, particularly among asympto
matic women with little or no evidence of immunosuppression. (C) 2000 Lippi
ncott Williams & Wilkins.