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


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 01/02/2016. Poisson regression was used to determine associations between sAlb and a new i) SNAE, ii) CVD or iii) 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) 1,463 developed a 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 (aRR) per 5 g/L: SNAE 0.79 [95%CI: 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). CONCLUSIONS 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.

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 01/02/2016. Poisson regression was used to determine associations between sAlb and a new i) SNAE, ii) CVD or iii) 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) 1,463 developed a 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 (aRR) per 5 g/L: SNAE 0.79 [95%CI: 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). CONCLUSIONS 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.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Immunology, Immunology and Allergy, Infectious Diseases
Language:English
Date:28 May 2018
Deposited On:06 Jun 2018 15:24
Last Modified:19 Aug 2018 15:52
Publisher:Lippincott Williams & Wilkins
ISSN:0269-9370
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/QAD.0000000000001900
PubMed ID:29847331

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