Serum albumin as a predictor of survival in HIV-infected women in the Women's Interagency HIV Study*

BackgroundThe level of serum albumin is associated with mortality in a wide variety of chronic diseases. However, few studies have examined the relationship between serum albumin and survival in HIV-1 infection. ObjectivesTo determine whether the serum albumin level is associated with survival in HIV-1 infected women. DesignProspective cohort study. Patients were interviewed and examined at 6 month intervals. SettingA North American multi-institutional cohort of HIV-infected women from five geographical areas. ParticipantsA total of 2056 HIV-infected women at various stages of disease. MeasurementsMortality during the first 3 years of follow-up. The relative risk of death by serum albumin level was estimated using a proportional hazards ratio adjusted for CD4 cell count, HIV-1-RNA level and other relevant covariates. ResultThree year mortality for women in the lowest serum albumin category (< 35 /l) was 48% compared with 11% in the highest category (⩾ 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 subjects with moderate to severe immunosuppression and abnormal kidney and liver function were excluded (P < 0.01). ConclusionThe baseline serum albumin level is an independent predictor of mortality in HIV-1-infected women. The serum albumin level may be a useful additional marker of HIV-1 disease progression, particularly among asymptomatic women with little or no evidence of immunosuppression.