Serum albumin is a powerful predictor of survival among HIV-1-infected women

Background: 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. Design: Prospective cohort study of 1941 women enrolled at six sites in the Women's Interagency HIV Study. Results: 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 <35 g/L compared with patients with serum albumin >42 g/L. The RH of serum albumin <35 g/L in women with CD4(+) lymphocyte counts greater than or equal to200 cells/muL 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/mm(3). 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 <35 g/L versus >42 g/L) than were other factors. Conclusion: 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.