Serum Albumin Is a Powerful Predictor of Survival Among HIV-1–Infected Women

Publisher Website
Google Scholar
Abstract
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. Prospective cohort study of 1941 women enrolled at six sites in the Women's Interagency HIV Study. 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 42 g/L. The RH of serum albumin <35 g/L in women with CD4+ lymphocyte counts ≥200 cells/μL 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 42 g/L) than were other factors. 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.