Iating Antiretroviral TherapyChristopher R. Sudfeld,1 Sheila Isanaka,2 Said Aboud,5 Ferdinand M. Mugusi,6 Molin Wang,3 Guerino E. Chalamilla,4,7 and Wafaie W. Fawzi1,2,Department of Epidemiology, 2Department of Nutrition, 3Department of Biostatistics, and 4Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts; and 5Department of Microbiology and Immunology and 6Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, and 7Management and Development for Health, Dar es Salaam, TanzaniaBackground. Prospective studies of serum albumin concentration measurement as a low-cost predictor of human immunodeficiency virus (HIV) disease progression are needed for individuals initiating antiretroviral therapy (ART) in resource-limited settings. Methods. Serum albumin concentration was measured at ART initiation for 2145 adults in Tanzania who were enrolled in a trial examining the effect of multivitamins on HIV disease progression. Participants were prospectively followed for mortality, morbidity, and anthropometric outcomes at monthly visits (median follow-up duration, 21.2 months). Proportional hazard models were used to analyze mortality, morbidity, and nutritional outcomes, while generalized estimating equations were used to analyze CD4+ T-cell counts. Results. Individuals with hypoalbuminemia (defined as a serum albumin concentration of 35 g/L) at ART initiation had a hazard of death that was 4.52 times (95 confidence interval, 3.37.07; P .001) that of individuals with serum albumin concentrations of 35 g/L, after multivariate adjustment. Hypoalbuminemia was also independently associated with the incidence of pulmonary tuberculosis (P .001), severe anemia (P .001), wasting (P = .002), and 10 weight loss (P = .012). Secondary analyses suggested that serum albumin concentrations of 38 g/L were associated with increased mortality and incident pulmonary tuberculosis. There was no association between serum albumin concentration and changes in CD4+ T-cell counts (P = .121). Conclusions. Serum albumin concentrations can identify adults initiating ART who are at high risk for mortality and selected morbidities. Future research is needed to identify and manage conditions that reduce the serum albumin concentration. Keywords. albumin; HIV; tuberculosis; nutrition; mortality.Clinical management of patients with human immunodeficiency virus (HIV) infection often relies on markers of disease progression, primarily CD4+ T-cell count and HIV load, to guide treatment plans [1].Received 17 September 2012; accepted 15 November 2012; electronically published 14 January 2013. Correspondence: Christopher Sudfeld, ScM, 665 Huntington Ave, Bldg 1, Room 1102, Boston, MA 02115 (csudfeld@hsph.Evobrutinib harvard.EI1 edu).PMID:24238102 The Journal of Infectious Diseases 2013;207:1370 The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup. DOI: 10.1093/infdis/jitBoth CD4+ T-cell count and HIV load are routinely monitored in developed countries. However, in many resource-limited settings, routine viral load assessment is not in the national guidelines because of the high cost of testing and other logistical difficulties [2]. Accordingly, low-cost markers of HIV disease severity may improve HIV treatment in resource-limited settings. Serum albumin is a plasma protein produced by the liver that.
