The Veterans Aging Cohort Study (VACS) risk index uses both HIV-related and non-HIV-related biomarkers to predict mortality in patients with HIV. The original cohort study involved multiple Veterans Affairs health center and universities.
Patient selection: HIV-positive adult
Parameters:
(1) age in years
(2) CD4 lymphocyte count per µL
(3) HIV-1 RNA in copies per mL
(4) hemoglobin
(5) FIB-4 score for hepatic fibrosis
(6) estimated GFR in mL per min per 1.73 square meter (from the MDRD)
(7) hepatitis C infection
Parameter
Finding
Points
age in years
< 50 years of age
0
50 to 64 years
12
>= 65 years
27
CD4 lymphocyte count
>= 500 per µL
0
200 to 499 per µL
6
100 to 199 per µL
10
50 to 99 per µL
28
< 50 per µL
29
HIV-1 RNA copies
< 500 copies per mL
0
500 to 100,000 copies per mL
7
> 100,000 (10^5) copies per mL
14
< 1.45
0
hemoglobin
> 14 g/dL
0
12 to 13.9
10
10 to 11.9
22
< 10
38
FIB-4 score
1.45 to 3.25
6
> 3.25
25
eGFR
> 60
0
45 to 59.9
6
30 to 44.9
8
< 30
26
hepatitis C
no
0
yes
5
total iindex =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 164
• The higher the score the all-cause mortality.
In the study of Brown et al (from the OPTIMA trial) mortality at 216 weeks (4.15 years) can be expressed as:
Score
Percent Mortality
20 to 80
(0.00625 * ((score)^2)) + (0.495 * (score)) + 2.5
60 to 120
(-0.015 * ((score)^2)) + (3.45 * (score)) - 98
> 120
100%
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