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

• Type of Material: Article
• Authors: Rebecca Scherzer, University of California San Francisco; Steven B. Heymsfield, Pennington Biomedical Research Center; David Rimland, Emory University; William G. Powderly, Washington University School of Medicine; Phyllis C. Tien, University of California San Francisco; Peter Bacchetti, University of California San Francisco; Michael G. Shlipak, University of California San Francisco; Carl Grunfeld, University of California San Francisco
• Language: English
• Date: 2017-01-02
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wolters Kluwer Health, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0000000000001278
• Title of Journal or Parent Work: AIDS
• ISSN: 0269-9370
• Volume: 31
• Issue: 1
• Start Page: 71
• End Page: 79
• Grant/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.
• Keywords: COHORT; Science & Technology; THERAPY; WOMEN; INFLAMMATION; Life Sciences & Biomedicine; albumin; total protein; LIVER-DISEASE; DISEASE PROGRESSION; RISK; DESIGN; Immunology; Infectious Diseases; hepatitis C virus infection; ALANINE AMINOTRANSFERASE; liver enzymes; mortality; HIV infection; INFECTED ADULTS; globulin; Virology
• Research Categories: Health Sciences, General

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/HCV-coinfected 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 (OR = 1.3, 95% CI: 1.0–1.7; HCV-by-albumin interaction: P = 0.038). 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 (OR = 2.5, 95% CI: 1.5–4.1) than HIV-monoinfected (OR = 1.1, 95% CI: 0.8–1.5; HCV-by-AST interaction: P = 0.0042). 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 HCV-coinfection.