TY - JOUR
T1 - Association of serum albumin and aspartate transaminase with 5-year all-cause mortality in HIV/ hepatitis C virus coinfection and HIV monoinfection
AU - Scherzer, Rebecca
AU - Heymsfield, Steven B.
AU - Rimland, David
AU - Powderly, William G.
AU - Tien, Phyllis C.
AU - Bacchetti, Peter
AU - Shlipak, Michael G.
AU - Grunfeld, Carl
N1 - Funding Information:
Supported by grants from the NIH (R01-DK57508, HL74814, and HL53359; K23 AI66943 and NIH center grants M01-RR00036, RR00051, RR00052, RR00054, RR00083, RR0636, RR00865, and UL1 RR024131), the Albert L. and Janet A. Schultz Supporting Foundation and with resources and the use of facilities of the Veterans Affairs Medical Center, San Francisco, California. The funding agencies had no role in the collection or analysis of the data.
Publisher Copyright:
© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - Objective: Liver disease markers have been associated with mortality in HIV-infected individuals in the modern era of effective antiretroviral therapy. Our objective was to determine which markers are most predictive of mortality in HIV-monoinfected and HIV/hepatitis C virus (HCV)-coinfected persons. Research design and methods: We measured serum albumin, total protein, calculated globulin, aspartate transaminase (AST), and alanine transaminase in 193 HIV/HCVcoinfected and 720 HIV-monoinfected persons in the study of Fat Redistribution and Metabolic Change in HIV Infection. We evaluated associations of each marker with 5-year, all-cause mortality, adjusting for cardiovascular, HIV-related factors, inflammation, renal disease, muscle, and adiposity. Results: After 5 years of follow-up, overall mortality was 21% in HIV/HCV-coinfected and 12% in HIV-monoinfected participants. After multivariable adjustment, lower albumin and higher AST were independently associated with increased mortality. Lower albumin was associated with 49% increased odds of mortality overall [per 0.5 g/dl decrease, 95% confidence interval (CI): 1.2-1.9]; the association was stronger in HIV/HCV-coinfected [odds ratio (OR)2.1, 95% CI: 1.4-3.2] vs. HIV-monoinfected (OR1.3, 95% CI: 1.0-1.7; HCV-by-albumin interaction: P0.038). Higher AST was associated with 41% increased odds of mortality (per AST doubling; 95% CI: 1.1-1.8); associations were much stronger among HIV/HCV-coinfected (OR2.5, 95% CI: 1.5-4.1) than HIV-monoinfected (OR1.1, 95% CI: 0.8-1.5; HCV-by-AST interaction: P0.0042). Conclusion: Lower serum albumin and higher AST appear to be important mortality risk factors in HIV/HCV-coinfection, but much less so in HIV-monoinfected individuals. The association of low albumin with mortality may reflect its role as a negative acute phase response protein. AST levels do not appear to be useful in predicting mortality in HIV-monoinfection and should be considered primarily in the context of HCVcoinfection.
AB - Objective: Liver disease markers have been associated with mortality in HIV-infected individuals in the modern era of effective antiretroviral therapy. Our objective was to determine which markers are most predictive of mortality in HIV-monoinfected and HIV/hepatitis C virus (HCV)-coinfected persons. Research design and methods: We measured serum albumin, total protein, calculated globulin, aspartate transaminase (AST), and alanine transaminase in 193 HIV/HCVcoinfected and 720 HIV-monoinfected persons in the study of Fat Redistribution and Metabolic Change in HIV Infection. We evaluated associations of each marker with 5-year, all-cause mortality, adjusting for cardiovascular, HIV-related factors, inflammation, renal disease, muscle, and adiposity. Results: After 5 years of follow-up, overall mortality was 21% in HIV/HCV-coinfected and 12% in HIV-monoinfected participants. After multivariable adjustment, lower albumin and higher AST were independently associated with increased mortality. Lower albumin was associated with 49% increased odds of mortality overall [per 0.5 g/dl decrease, 95% confidence interval (CI): 1.2-1.9]; the association was stronger in HIV/HCV-coinfected [odds ratio (OR)2.1, 95% CI: 1.4-3.2] vs. HIV-monoinfected (OR1.3, 95% CI: 1.0-1.7; HCV-by-albumin interaction: P0.038). Higher AST was associated with 41% increased odds of mortality (per AST doubling; 95% CI: 1.1-1.8); associations were much stronger among HIV/HCV-coinfected (OR2.5, 95% CI: 1.5-4.1) than HIV-monoinfected (OR1.1, 95% CI: 0.8-1.5; HCV-by-AST interaction: P0.0042). Conclusion: Lower serum albumin and higher AST appear to be important mortality risk factors in HIV/HCV-coinfection, but much less so in HIV-monoinfected individuals. The association of low albumin with mortality may reflect its role as a negative acute phase response protein. AST levels do not appear to be useful in predicting mortality in HIV-monoinfection and should be considered primarily in the context of HCVcoinfection.
KW - Albumin
KW - Globulin
KW - HIV infection
KW - Hepatitis C virus infection
KW - Liver enzymes
KW - Mortality
KW - Total protein
UR - http://www.scopus.com/inward/record.url?scp=84988691788&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000001278
DO - 10.1097/QAD.0000000000001278
M3 - Article
C2 - 27677166
AN - SCOPUS:84988691788
SN - 0269-9370
VL - 31
SP - 71
EP - 79
JO - AIDS
JF - AIDS
IS - 1
ER -