Published: 2017-01-02

Study of serum albumin as surrogate marker of immune suppression in patients living with HIV and AIDS

Shiv Shankar Sharma, Yogendra Jamra, Sanjay Hawaldar, Ankit Meshram


Background: HIV/AIDS being a life long illness requires regular monitoring. CD4+cell counts and HIV RNA levels have been widely accepted as the most reliable indicators of HIV disease progression but these tests are not readily available and costly too. This study examines that whether Serum albumin levels can be used as a surrogate marker for HIV disease monitoring as an alternate to CD4 cell count and HIV viral load measurements in low resource set-up.

Methods: This prospective observational study was conducted at a tertiary care hospital in Central India. We studied a total of 100 PLHIV (patients living with HIV and AIDS). Correlation of CD4 count was done with serum albumin levels at baseline and at follow-up visits.

Results: Several studies have suggested that albumin could serve as a useful marker of HIV disease progression in resource-limited settings. In the present study, the baseline and follow up values of albumin and CD4 counts were obtained. It was found to have a strong positive correlation amongst them with low CD4 cell counts being associated with lower serum albumin concentrations.

Conclusions: The results of this study suggest that serum albumin levels have potential to be used as a surrogate low-cost prognostic marker for HIV disease monitoring in resource-limited settings where frequent estimation of CD4 cell count and HIV viral load is not possible.


HIV, Serum albumin, CD4 cell

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Sashindran VK, Chauhan R. Antiretroviral therapy: shifting sands. Med J Armed Forces India. 2016;72:54-60.

Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infect Dis Soc America. Clin Infect Dis. 2014;58(1):e1-34.

Centers for disease control and prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41(17):1-19.

World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children; 2007.

Kannangai R, Kandathil AJ, Ebenezer DL, Mathai E, Prakash AJ, Abraham OC et al. Usefulness of alternate prognostic serum and plasma markers for antiretroviral therapy for human immunodeficiency virus type 1 infection. Clin Vacc Immunol. 2013;20:154.

Olawumi HO, Olatunji PO. The value of serum albumin in pre-treatment assessment and monitoring of therapy in HIV/AIDS patients. HIV Med. 2006;7(6):351-5.

Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50(6):693-703.

Mehta SH, Astemborski J, Sterling TR, Thomas DL, Vlahov D. Serum albumin as a prognostic indicator for HIV disease progression. AIDS Res Hum Retrovir. 2006;22(1):14-21.

Shah S, Smith CJ, Lampe F, Youle M, Johnson MA, Phillips AN et al. Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretroviral therapy era: relationships with gender. HIV Med. 2007;8(1):38-45.

Ghate M, Deshpande S, Tripathy S, Thakur A, Rishud A, Bollinger R et al. Incidence of common opportunistic infection in HIV-infected individuals in Pune, India; analysis by stages of immunosuppression represented by CD4 counts. Intern J Infect Dis. 2009;13:e1-8.

Steinbrook R. Tuberculosis and HIV in India. N Engl J Med. 2007;3:1198-9.

Boniphace I, Omari M, Fred RS, Ferdinand M, Marcel T. HIV/AIDS clinical manifestations and their implication for patient clinical staging in resource limited settings in Tanzania. The Open AIDS J. 2011;5:9-16.

Babu SK, Babu CR, Jyothi NB, Sunita K. A retrospective study on status of CD4 counts and effect of ART in patients attending VCTC of MGM Hospital, Warangal, Andhra Pradesh, India. IJOSR J Nurs Health Sci. 2014;3(6):25-35.

Olawuni HO, Olatunji PO. The value of serum albumin in pre-treatment assessment and monitoring of therapy in HIV/AIDS patients. HIV Med. 2006;7:351-5.

Alvarez-Uria G, Midde M, Pakam R, and Praveen Naik K. Diagnostic and prognostic value of serum albumin for tuberculosis in HIV infected patients eligible for antiretroviral therapy: data from an HIV cohort study in India. Bioimpacts. 2013;3(3):123-8.