Albumin levels associated with poor prognosis in men coinfected with HIV and HCV

Low serum concentrations of the protein albumin at the time of HIV seroconversion are associated with poor prognosis in men coinfected with HIV and hepatitis C, according to a study published in the 15 November edition of The Lancet.

What’s more, low albumin levels are also associated with an increased risk of dying in the long-term even when traditional prognostic markers such as CD4 and CD8 counts were taken into account.

Investigators at the Royal Free Haemophilia Centre in London examined the medical records of 111 male patients coinfected with HIV and hepatitis C. The men had been infected with HIV by infected blood products between 1979 and 1985, with most men infected with hepatitis C on average five and a half years earlier. Stored serum samples allowed investigators to estimate the date of HIV seroconversion for every man. All patients were seen every three months for check-ups when blood tests were performed. These included various liver function tests, including analysis of albumin levels as well as CD4 and other immune measurements.

To see which test results were predictive of disease progression to an AIDS defining illness and/or death, the records of each person were reviewed from the time of HIV seroconversion to 31st August 2000. Investigators were keen to see which test results were indicative of both long-term prognosis and the likelihood of developing AIDS or dying within three months.

On average people were followed-up for an average of 13.5 years. During follow-up, 58 men (52%) developed AIDS and 68 (61%) died, 18 from liver related causes. When test results from the study population were controlled for age at HIV seroconversion and HIV treatment history, analysis showed that low baseline concentration of albumin was strongly associated with an increased risk of progressing to AIDS and dying in the longer-term, independent of other possible risk factors including CD4 and CD8 counts. However, as regards the short-term risk of dying within three months of seroconversion only CD4 and CD8 counts were significant.

Furthermore, coinfection with hepatitis C was not found to be associated with an increased risk of low baseline albumin levels and of quicker progression to AIDS and death. Nor were albumin levels found to be related to the liver-related deaths that occurred in the cohort. Indeed the investigators stress that low albumin levels were associated with poor prognosis “at a very early stage of HIV-1 infection, at a time when patients had only been infected with hepatitis C for an average of 5.7 years and most had not had significant damage to the liver.”

The investigators conclude that “the most likely explanation for our findings is that lowered concentrations of albumin are the result of a normal systemic response to a chronic inflammatory disorder.”