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% |
Purpose: To evaluate an HIV-positive adult using the Veterans Aging Cohort Study (VACS) index.
Specialty: Infectious Diseases
Objective: other testing
ICD-10: B20-B24,