Reduced levels of serum albumin, a major blood protein, are associated with increased mortality in individuals who have certain chronic conditions. A new study adds the human immunodeficiency virus (HIV) that causes AIDS to the list. The study focused on HIV-infected women and found that those with the lowest levels of serum albumin had a risk of death three times greater than women with the highest levels of serum albumin, even after adjusting for other markers of HIV disease progression such as CD4 cell count and HIV-1 RNA levels. In fact, 48 percent of women in the lowest serum albumin category (less than 35 g/l) died within 3 years compared with 11 percent of women in the highest category (42 g/l or less). Women with serum albumin levels of 35-40 g/l (which falls in the range considered normal) were almost twice as likely to die as women with levels of 42 g/l or higher, other factors being equal.
The magnitude of risk of death for women with serum albumin levels of less than 35 g/l was similar to that of patients with CD4 cell counts of 50-199 and viral loads of 20,000-500,000 copies/ml. Serum albumin was a better predictor of mortality in women with CD4 cell counts over 200 than under 200, suggesting that serum albumin may be a particularly good predictor in the earlier stages of HIV infection before patients have progressed to AIDS. This makes sense, given that low serum albumin, a marker for malnutrition, may reflect poor nutritional status at early stages of HIV disease before changes in body weight or other clinical markers are apparent.
These findings are based on a study of 2,056 HIV-infected women at various stages of HIV disease, who participated in the Women's Interagency HIV Study (WIHS), a multicenter prospective study of the natural history of HIV infection in women conducted in five U.S. cities. This research involved women who were enrolled in WIHS during 1994 and 1995. WIHS is cosponsored by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention. The researchers analyzed deaths during the first 3 years of followup and assessed relative risk of death by serum albumin level after adjusting for other factors indicative of disease progression.
More details are in "Serum albumin as a predictor of survival in HIV-infected women in the Women's Interagency HIV Study," by Joseph G. Feldman, Dr.P.H., David N. Burns, M.D., Stephen J. Gange, Ph.D., and others, in the May 2000 issue of AIDS 14(7), pp. 863-870.