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Serum albumin and its association with mortality, morbidity, and CD4 T-cell reconstitution among Tanzanians initiating antiretroviral therapy.

J Infect Dis. 2013 Jan 14;

Authors: Sudfeld CR, Isanaka S, Aboud S, Mugusi FM, Wang M, Chalamilla GE, Fawzi WW


Background. Prospective studies of serum albumin as a low-cost predictor of HIV progression are needed for individuals initiating ART in resource-limited settings.Methods. Serum albumin was measured at ART initiation for 2,145 adults enrolled in a trial of multivitamins in Tanzania. Participants were prospectively followed for mortality, morbidity, and anthropometric outcomes at monthly visits (median follow-up=21.2 months). Proportional hazard models were utilized to analyze mortality, morbidity, and nutritional outcomes; while generalized estimating equations were used for CD4 T-cell counts.Results. Individuals with hypoalbuminemia (<35&emsp14;g/L) at ART initiation had 4.52 (95% CI: 3.37-6.07; p<0.001) times the hazard of death as compared to individuals with concentrations ≥35&emsp14;g/L, after multivariate adjustment. Hypoalbuminemia was also independently associated with incidence of pulmonary tuberculosis (p<0.001), severe anemia (p<0.001), wasting (p=0.002), and >10% weight loss (p=0.012). Secondary analyses suggest serum albumin concentrations <38&emsp14;g/L are associated with increased mortality and incident pulmonary TB. There was no association of serum albumin with change in CD4 T-cell count (p=0.121).Conclusions. Serum albumin can identify adults initiating ART at high risk for mortality and selected morbidities. Future research is needed to identify and manage conditions reducing serum albumin.

PMID: 23319741 [PubMed - as supplied by publisher]