Objectives: To assess utility of serum albumin as surrogate  marker  for predicting the severity and         progression of HIV/AIDS and  for monitoring response to therapy.Methods: The importance of serum albumin measurement in assessing HIV/AIDS disease progression and in monitoring the response to antiretroviral therapy using CD4 cell count and body weight as parameters was examined in 100 consecutive HIV–infected, therapy–naive individuals who were recruited for antiretroviral therapy at the Gandhi  Hospital. The regimen included  Tenofovir,Lamivudine,Efavirenze. Pretreatment serum albumin levels, CD4 counts noted.After initiation of ART , patients were followed with serum albumin levels at monthly intervals and CD4 counts at end of 6 months and one year. Response to therapy assessed using  change in CD4 counts . Results: We found significant positive correlation between raise in CD4 and Serum albumin after initiation of ART.Patients whose CD4 count improved after initiation of ART, also had increase in serum albumin, weight gain , less mortality. There were significant positive correlations between pretreatment albumin and both pretreatment CD4 cell count and pretreatment weight.Conclusions: In developing countries where many patients may not be able to afford to pay for CD4 cell counts and viral load tests, which are the traditional markers for HIV disease, serum albumin would be a very useful surrogate test for predicting severity of HIV infection and for clinical monitoring of response to antiretroviral therapy