Markers of HIV-1 disease progression in individuals with haemophilia coinfected with hepatitis C virus: a longitudinal study

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Lancet 2002 Nov 16;360(9345):1546-51

Markers of HIV-1 disease progression in individuals with haemophilia coinfected

with hepatitis C virus: a longitudinal study.

Sabin CA, Griffioen A, Yee TT, Emery VC, Herrero-ez E, AN, Lee CA

Department of Primary Care and Population Sciences, Royal Free Centre for HIV

Medicine, Royal Free and University College Medical School, London, UK.

c.sabin@...

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BACKGROUND: Low serum albumin concentration is associated with short-term

survival in individuals with HIV-1. However, few investigators have assessed

whether individuals with a low serum albumin concentration have delayed

progression to AIDS, or survive in the long term. We aimed to assess the

relation between markers of liver function and progression to AIDS and death in

individuals with haemophilia infected with HIV-1 and hepatitis C virus. METHODS:

We measured markers of liver function and took CD4 counts every 3 months in 111

patients registered at the Royal Free Hospital Haemophilia Centre, London, UK.

HIV RNA concentrations were measured yearly and then every 3-6 months from 1996.

We used 's regression models to assess the independent prognostic value of

these markers for AIDS and death. FINDINGS: As a fixed covariate, albumin

concentrations measured shortly after HIV-1 seroconversion were associated with

risk of AIDS (relative hazard 0.91 [95% CI 0.84-1.00], p=0.04) and death (0.89

[0.82-0.96], p=0.004) over a 15-year period. These findings were independent of

the CD4 count and HIV-1 RNA concentration. As a time-updated covariate, after

adjustment for CD4 count and HIV-1 RNA concentrations, albumin was not

associated with progression to AIDS (0.96 [0.90-1.01], p=0.13), but was strongly

associated with death (0.88 [0.84-0.93], p<0.0001) in the short term.

INTERPRETATION: Low concentrations of albumin in individuals infected with HIV-1

could indicate a poor outlook and should therefore prompt concern at any stage

of infection.

PMID: 12443592, UI: 22331300