Serum Albumin Level Compared to CD4+ Count as a Marker of Immunosuppression in HIV/AIDS Patients: An Observational Cross- Sectional Study from South India

Background Monitoring of immunosuppression in HIV patients is essential, especially in resource-limited settings. CD4 + T-cell count, though standard, is costly and technically demanding. Serum albumin, an inexpensive and routinely measured parameter, may reflect immunosuppressive status. This study evaluates the correlation between serum albumin and CD4 + count and its relationship with markers of inflammation and opportunistic infections in HIV/AIDS patients. Methods This observational cross-sectional study was conducted at Kasturba Hospital, Manipal, between June 2023 and April 2025. A total of 107 adult patients diagnosed with HIV were enrolled. Comprehensive demographic, clinical, and laboratory data were collected. Pearson correlation analysis was performed to examine the association between CD4 + T-cell counts and serum albumin levels, absolute lymphocyte count (ALC), albumin-to-globulin (A:G) ratio, and neutrophil-to-lymphocyte ratio (NLR). Additionally, Independent sample t-tests were applied to compare serum albumin levels between patients with and without opportunistic infections. Subsequently, Logistic regression analysis was used for analysis. Results CD4 count showed a positive correlation with serum albumin (r = 0.296, p = 0.002), A:G ratio (r = 0.437, p < 0.001), and ALC (r = 0.634, p < 0.001), and a negative correlation with NLR (r = − 0.354, p < 0.001). Albumin levels were significantly lower in patients with opportunistic infections (3.48 ± 0.64 g/dL) compared to those without (4.01 ± 0.68 g/dL; p < 0.001). Logistic regression indicated that each 1 g/dL rise in serum albumin reduced the odds of opportunistic infections by 70% (OR = 0.30; 95% CI: 0.17–0.56; p < 0.001). Conclusions Serum albumin demonstrates a strong positive association with CD4 + counts and an inverse relationship with systemic inflammation and opportunistic infections. Its ease of measurement, cost-effectiveness, and wide availability position it as a valuable surrogate marker for assessing immunosuppression in HIV/AIDS patients, especially in settings with limited access to advanced diagnostics. Trial Registration Registered prospectively with the Clinical Trials Registry - India (CTRI) on 03 July 2023 (CTRI/2023/07/054614).