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

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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 1 February 2016. Poisson regression was used to determine associations between sAlb and a new SNAE, CVD, or 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), 1463 developed an 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 per 5 g/l: SNAE 0.79 (95% confidence interval: 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
Original languageEnglish
Pages (from-to)1837-1848
Number of pages12
Issue number13
Publication statusPublished - Aug 2018


  • Albumin
  • Biomarker
  • Cancer
  • Cardiovascular disease
  • Non-AIDS comorbidity
  • Smoking
  • CD4 antigen
  • serum albumin
  • human serum albumin
  • adult
  • age
  • albumin blood level
  • Article
  • cardiovascular disease
  • cohort analysis
  • end stage liver disease
  • end stage renal disease
  • female
  • follow up
  • human
  • Human immunodeficiency virus infected patient
  • Human immunodeficiency virus infection
  • major clinical study
  • male
  • multicenter study
  • priority journal
  • prospective study
  • serious non aids event
  • smoking
  • virus load
  • chronic kidney failure
  • clinical trial
  • complication
  • neoplasm
  • risk assessment
  • survival analysis
  • Adult
  • Cardiovascular Diseases
  • End Stage Liver Disease
  • Female
  • Follow-Up Studies
  • HIV Infections
  • Humans
  • Kidney Failure, Chronic
  • Male
  • Neoplasms
  • Prospective Studies
  • Risk Assessment
  • Serum Albumin, Human
  • Survival Analysis


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