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AIDS. 2018 Aug 24;32(13):1837-1848. doi: 10.1097/QAD.0000000000001900.

Associations between serum albumin and serious non-AIDS events among people living with HIV.

Author information

1
Department of Infectious Diseases.
2
CHIP, Department of Infectious Diseases, University of Copenhagen, Copenhagen, Denmark.
3
CHU de Bordeaux and INSERM U1219, Université de Bordeaux, Talence, France.
4
ICAP at Columbia University, New York, New York, USA.
5
Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, The Netherlands.
6
Department of Infectious diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
7
Department of Public Health, Nice University Hospital, Nice, France.
8
Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
9
The Kirby Institute, UNSW Australia, Sydney, Australia.
10
Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy.
11
Institute for Global Health, UCL, London, UK.

Abstract

OBJECTIVE:

Lower serum albumin (sAlb) has been associated with an increased risk of mortality and AIDS among people living with HIV and may be associated with the development of serious non-AIDS events (SNAEs). We evaluated the long-term association between sAlb and the risk of SNAEs.

DESIGN:

Prospective multinational cohort study.

METHODS:

D:A:D participants without SNAEs were followed from first routine sAlb value to the first of a new SNAE [cardiovascular disease (CVD), end-stage liver disease (ESLD), end-stage renal disease (ESRD), non-AIDS malignancy (NADM), death from non-AIDS cause], AIDS-death, 6 months after last visit or 1 February 2016. Poisson regression was used to determine associations between sAlb and a new SNAE, CVD, or NADM event, with adjustment for potential confounders. Models additionally tested whether the associations were modified by age, follow-up time, smoking status, CD4 and viral load.

RESULTS:

Of 16 350 participants (71.8% male, median age 44 years), 1463 developed an SNAE (371 CVD, 200 ESLD, 40 ESRD, 553 NADM, 299 deaths from other non-AIDS causes) over 80 264 person-years. Increased sAlb was associated with a decreased risk of an SNAE [adjusted rate ratio per 5 g/l: SNAE 0.79 (95% confidence interval: 0.76, 0.83); CVD 0.87 (0.80, 0.94); NADM 0.88 (0.82, 0.95)]. The association did not appear to wane with additional years of follow-up (P-interaction = 0.79) but was stronger for current smokers than for never smokers (P-interaction <0.01).

CONCLUSION:

sAlb is a durable risk factor for SNAE. Future studies are needed to determine the mechanism underlying this association and to evaluate the value of sAlb in predictive tools.

PMID:
29847331
DOI:
10.1097/QAD.0000000000001900
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