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

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The 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.


To determine whether the serum albumin level is associated with survival in HIV-1 infected women.


Prospective cohort study. Patients were interviewed and examined at 6 month intervals.


A North American multi-institutional cohort of HIV-infected women from five geographical areas.


A total of 2056 HIV-infected women at various stages of disease.


Mortality 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.


Three 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).


The 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.

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