Predictive Accuracy of the Veterans Aging Cohort Study Index for Mortality With HIV Infection

Abstract

Background By supplementing an index composed of HIV biomarkers and age (Restricted Index) with measures of organ injury, the Veterans Aging Cohort Study (VACS) Index more completely reflects risk of mortality. We compare the accuracy of the VACS and Restricted Indices 1) among subjects outside the Veterans Healthcare System (VA), 2) over 1–5 years of prior exposure to antiretroviral therapy (ART), and 3) within important patient subgroups. Methods We used data from 13 cohorts in the North American AIDS Cohort Collaboration (NA-ACCORD, n=10, 835) limiting analyses to HIV-infected subjects with at least 12 months exposure to ART. Variables included demographic, laboratory (CD4 count, HIV-1 RNA, hemoglobin, platelets, aspartate and alanine transaminase, creatinine and hepatitis C status), and survival. We used C statistic and net reclassification improvement (NRI) to test discrimination varying prior ART exposure from 1–5 years. We then combined VA (n=5,066) and NA-ACCORD data, fit a parametric survival model, and compared predicted to observed mortality by cohort, gender, age, race, and HIV-1 RNA level. Results Mean follow-up was 3.3 years (655 deaths). Compared with the Restricted Index, the VACS Index showed greater discrimination (C statistic: 0.77 vs. 0.74; NRI 12%; p<0.0001). NRI was highest among those with HIV-1 RNA<500 copies/ml (25%) and age ≥50 years (20%). Predictions were similar to observed mortality among all subgroups. Conclusion VACS Index scores discriminate risk and translate into accurate mortality estimates over 1–5 years of exposures to ART and for diverse patient subgroups from North American

The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality

“…As previously described, [21][22][23][24]28 VACS is a prospective cohort of HIV-infected patients matched (1:2) by age, sex, race, and VA site of care to uninfected controls. 29 VACS is HIPAA compliant and has received approval from the review boards for the VA Connecticut Healthcare System and the Yale School of Medicine; the requirement for informed consent was waived.…”

“…As a measure of overall severity of illness, we used the VACS Index, which incorporates age, HIV-1 RNA viral load, CD4 count, hemoglobin, FIB-4, estimated glomerular filtration rate, and hepatitis C virus. The VACS Index is a validated prognostic measure, 28,29,[37][38][39][40] which is predictive of morbidity and mortality in both HIVinfected and uninfected patients (in calculating the index, the assumption is made that uninfected patients have a CD4 count > 500 cells/μL and viral load < 20 copies/ml). 29,41 Higher scores are indicative of higher all-cause mortality risk.…”

Markers of chronic obstructive pulmonary disease are associated with mortality in people living with HIV

“…The median VACS Index was 29 in PLWH compared to [18][19][20][21][22][23][24][25][26][27] in the uninfected (p<0.001). There was a trend towards higher pack years of smoking in PLWH.…”

“…The VACS Index was developed in Veterans and externally validated, and predicts mortality in PLWH and uninfected persons. [24,[27][28][29] The VACS Index incorporates age, CD4, viral load, hepatitis C serostatus, hemoglobin, glomerular filtration rate (eGFR) and the Fibrosis- and Nutrition Examination Survey (NHANES) III data. [30][31][32][33][34] COPD was defined as airflow obstruction (FEV1/FVC<0.7), [35] and alternatively as FEV1/FVC below lower limit of normal (LLN, <5 th percentile).…”

The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality

“…We examined these aims using the Veterans Aging Cohort Study (VACS): a well-established, validated sample of HIV+ veterans demographically matched to HIV-veterans engaged in care Justice, Dombrowski, et al, 2006;Justice, Erdos, et al, 2006;Lo Re et al, 2011;Justice et al, 2013). This is a robust sample for exploring mortality outcomes associated with LtOT-the mortality rate in both HIV+ patients and veterans is high.…”