Association of serum albumin and aspartate transaminase with 5-year all-cause mortality in HIV/ hepatitis C virus coinfection and HIV monoinfection

Rebecca Scherzer, Steven B. Heymsfield, David Rimland, William G. Powderly, Phyllis C. Tien, Peter Bacchetti, Michael G. Shlipak, Carl Grunfeld

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)71-79
Number of pages9
JournalAIDS
Volume31
Issue number1
DOIs
StatePublished - 2017

Keywords

  • Albumin
  • Globulin
  • HIV infection
  • Hepatitis C virus infection
  • Liver enzymes
  • Mortality
  • Total protein

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