Methods: We conducted a nested study within in the SATURN-HIV trial in which 147 HIV+ adults on stable antiretroviral therapy (ART), were virally suppressed, and had a LDL-cholesterol level <130mg/dL were randomized to 10 mg daily rosuvastatin or placebo. Measures of serum albumin, carotid intima media thickness (IMT, surrogate marker of atherosclerosis), inflammation, T-cell and monocyte immune activation were assessed at baseline, 24, 48 and 96 weeks later. Spearman correlations and linear mixed effects models with random intercept and slope were conducted to assess associations with albumin.
Results: Mean age was 45 years, 80% were male, 69% were African American and 46% were receiving protease inhibitors. Mean serum albumin was not significantly different between the groups at any time points (4.05-4.08 g/dL in statin arm vs 4.01-4.11 g/dL in placebo arm, p=0.08-0.35). Low serum albumin significantly correlated with elevated levels of interleukin 6 (IL6), d-dimer, fibrinogen and high sensitivity C reactive protein (hsCRP) at all time points (p≤0.04). Low serum albumin also correlated with higher inflammatory monocytes (CD14+CD16+) at week 24 and week 96 (p≤0.03) but not with markers of T cell activation at any time point (p≥0.10). Lower baseline albumin significantly predicted larger changes in IMT (p=0.03), IL6, d-dimer, tumor necrosis factor α receptor 1, fibrinogen and hsCRP (p≤0.02) over 96 weeks. After adjusting for age, gender, smoking, body mass index, vascular cell adhesion molecule and creatinine clearance, every 1 g/dL decrease in albumin remained associated with a 0.5 mm increase in IMT over 96 weeks (p=0.05).
Conclusion: Lower serum albumin in controlled HIV is associated with higher markers of chronic inflammation, hypercoagulation and monocyte activation, which could explain the prior observation that albumin predicts non-AIDS events in HIV. Our findings suggest that serum albumin may predict progression of carotid atherosclerosis independent of traditional risk factors.
A. Sattar, None
N. Funderburg, None
G. A McComsey, Gilead: Consultant , Consulting fee and Research support . Merck: Consultant , Consulting fee and Research support . Viiv: Consultant , Consulting fee and Research support . Roche: Research Contractor , Research support . Astellas: Research Contractor , Research support .