Sabin Caroline A, Griffioen Anja, Yee Thynn Thynn, Emery Vincent C, Herrero-Martinez Esteban, Phillips Andrew N, Lee Christine A
Department of Primary Care and Population Sciences, Royal Free Centre for HIV Medicine, Royal Free and University College Medical School, London, UK.
Lancet. 2002 Nov 16;360(9345):1546-51. doi: 10.1016/S0140-6736(02)11519-4.
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.
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 Cox's regression models to assess the independent prognostic value of these markers for AIDS and death.
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.
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.
血清白蛋白浓度低与HIV-1感染者的短期生存相关。然而，很少有研究者评估血清白蛋白浓度低的个体是否会延缓艾滋病进展或长期生存。我们旨在评估HIV-1和丙型肝炎病毒感染的血友病患者的肝功能指标与艾滋病进展及死亡之间的关系。
我们对英国伦敦皇家自由医院血友病中心登记的111例患者进行了肝功能指标测量，并每3个月进行一次CD4细胞计数。自1996年起，每年测量HIV RNA浓度，之后每3 - 6个月测量一次。我们使用Cox回归模型评估这些指标对艾滋病和死亡的独立预后价值。
作为固定协变量，HIV-1血清转化后不久测得的白蛋白浓度与15年内艾滋病风险（相对风险0.91 [95%可信区间0.84 - 1.00]，p = 0.04）和死亡风险（0.89 [0.82 - 0.96]）相关。这些发现独立于CD4细胞计数和HIV-1 RNA浓度。作为时间更新协变量，在调整CD4细胞计数和HIV-1 RNA浓度后，白蛋白与艾滋病进展无关（0.96 [0.90 - 1.01]，p = 0.13），但在短期内与死亡密切相关（0.88 [0.84 - 0.93]，p < 0.0001）。
HIV-1感染者白蛋白浓度低可能预示预后不良，因此在感染的任何阶段都应引起关注。
