Serum Albumin as a Prognostic Marker for Serious Non-AIDS Endpoints in the Strategic Timing of Antiretroviral Treatment (START) Study

Andreas Ronit, Shweta Sharma, Jason V. Baker, Rosie Mngqibisa, Tristan Delory, Luis Caldeira, Nicaise Ndembi, Jens D. Lundgren, Andrew N. Phillips

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background. Serum albumin may be used to stratify human immunodeficiency virus (HIV)-infected persons with high CD4 count according to their risk of serious non-AIDS endpoints. Methods. Cox proportional hazards models were used to analyze the risk of serious non-AIDS events in the Strategic Timing of Antiretroviral Treatment (START) study (NCT00867048) with serum albumin as a fixed and time-updated predictor. Models with exclusion of events during initial follow-up years were built to assess the ability of serum albumin to predict beyond shorter periods of time. Secondarily, we considered hospitalizations and AIDS events. Results. Among 4576 participants, 71 developed a serious non-AIDS event, 788 were hospitalized, and 63 experienced an AIDS event. After adjusting for a range of variables associated with hypoalbuminemia, higher baseline serum albumin (per 1 g/dL) was associated with a decreased risk of serious non-AIDS events (hazard ratio, 0.37 [95% confidence interval, .20-.71]; P = .002). Similar results were obtained in a time-updated model, after controlling for interleukin 6, and after excluding initial follow-up years. Serum albumin was independently associated with hospitalization but not with risk of AIDS. Conclusions. A low serum albumin level is a predictor for short-A nd long-term serious non-AIDS events, and may be a useful marker of risk of noncommunicable diseases, particularly in resource-limited settings.

Original languageEnglish (US)
Pages (from-to)405-412
Number of pages8
JournalJournal of Infectious Diseases
Issue number3
StatePublished - Jan 17 2018

Bibliographical note

Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases; National Institutes of Health Clinical Center; National Cancer Institute; National Heart, Lung, and Blood Institute; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Mental Health; National Institute of Neurological Disorders and Stroke; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (France); National Health and Medical Research Council (Australia); National Research Foundation (Denmark); Bundesministerium für Bildung und Forschung (Germany); European AIDS Treatment Network; Medical Research Council, National Institute for Health Research, and National Health Service (United Kingdom); and University of Minnesota. National Institute of Health grant numbers for START: UM1-AI068641 and UM1-AI120197. Antiretroviral drugs were donated to the central drug repository by AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline/ViiV Healthcare, Janssen Scientific Affairs, and Merck.

Publisher Copyright:
© 2017 The Author(s).


  • HIV
  • albumin
  • biomarker
  • non-AIDS comorbidity
  • non-communicable disease


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