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

作者：Ronit Andreas^*; Hatleberg Camilla I; Ryom Lene; Bonnet Fabrice; El Sadr Wafaa; Reiss Peter; Weber Rainer; Pradier Christian; De Wit Stephane; Law Matthew; Monforte Antonella d'Arminio; Lundgren Jens; Mocroft Amanda; Phillips Andrew N; Sabin Caroline A

来源：AIDS, 2018, 32(13): 1837-1848.

DOI：10.1097/QAD.0000000000001900

• albumin
• biomarker
• cancer
• cardiovascular disease
• non-AIDS comorbidity
• smoking

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 16350 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 80264 person-years. Increased sAlb was associated with a decreased risk of an SNAE [adjusted rate ratio per 5g/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.

• 出版日期2018-8-24