Document Detail

Predictive accuracy of the Veterans Aging Cohort Study index for mortality with HIV infection: a North American cross cohort analysis.
MedLine Citation:
PMID:  23187941     Owner:  NLM     Status:  MEDLINE    
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 Affairs Healthcare System, (2) more than 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 (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-statistics and net reclassification improvement (NRI) to test discrimination varying prior ART exposure from 1 to 5 years. We then combined Veterans Affairs Healthcare System (n = 5066) and North American AIDS Cohort Collaboration 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-statistics: 0.77 vs. 0.74; NRI: 12%; P < 0.0001). NRI was highest among those with HIV-1 RNA <500 copies per milliliter (25%) and age ≥50 years (20%). Predictions were similar to observed mortality among all subgroups.
CONCLUSIONS: VACS index scores discriminate risk and translate into accurate mortality estimates over 1-5 years of exposure to ART and for diverse patient subgroups from North American.
Amy C Justice; Sharada P Modur; Janet P Tate; Keri N Althoff; Lisa P Jacobson; Kelly A Gebo; Mari M Kitahata; Michael A Horberg; John T Brooks; Kate Buchacz; Sean B Rourke; Anita Rachlis; Sonia Napravnik; Joseph Eron; James H Willig; Richard Moore; Gregory D Kirk; Ronald Bosch; Benigno Rodriguez; Robert S Hogg; Jennifer Thorne; James J Goedert; Marina Klein; John Gill; Steven Deeks; Timothy R Sterling; Kathryn Anastos; Stephen J Gange;
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  62     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-18     Completed Date:  2013-03-08     Revised Date:  2014-09-26    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  149-63     Citation Subset:  IM; X    
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MeSH Terms
Age Factors
Alanine Transaminase / blood
Anti-Retroviral Agents / therapeutic use
Aspartate Aminotransferases / blood
Biological Markers / blood*
CD4 Lymphocyte Count
Cohort Studies
Creatinine / blood
HIV Infections / drug therapy,  ethnology,  immunology,  mortality*
HIV-1 / genetics,  immunology
Hemoglobins / metabolism
Hepatitis C / blood,  mortality
Kaplan-Meier Estimate
Middle Aged
North America / epidemiology
Platelet Count
Predictive Value of Tests
RNA, Viral / blood
Risk Assessment / methods
Sex Factors
Grant Support
169621//Canadian Institutes of Health Research; 5-MO1-RR-00052/RR/NCRR NIH HHS; AHQ290-01-0012//PHS HHS; AI-69432/AI/NIAID NIH HHS; AI-69434/AI/NIAID NIH HHS; CBR-86906//Canadian Institutes of Health Research; CBR-94036//Canadian Institutes of Health Research; CDC200-2006-18797//PHS HHS; HCP-97105//Canadian Institutes of Health Research; HL100347/HL/NHLBI NIH HHS; K01 AI093197/AI/NIAID NIH HHS; K01-AI071725/AI/NIAID NIH HHS; K01-AI071754/AI/NIAID NIH HHS; K23 AG024896/AG/NIA NIH HHS; K23-AI-61-0320/AI/NIAID NIH HHS; K24-00432//PHS HHS; KRS-86251//Canadian Institutes of Health Research; N02-CP55504/CP/NCI NIH HHS; P30-AI27757/AI/NIAID NIH HHS; P30-AI27767/AI/NIAID NIH HHS; P30-AI50410/AI/NIAID NIH HHS; P30-AI54999/AI/NIAID NIH HHS; R01 AG026250/AG/NIA NIH HHS; R01-AG029154/AG/NIA NIH HHS; R01-DA04334/DA/NIDA NIH HHS; R01-DA11602/DA/NIDA NIH HHS; R01-DA12568/DA/NIDA NIH HHS; R01-HL090342/HL/NHLBI NIH HHS; R01-HL095136/HL/NHLBI NIH HHS; R01-MH54907/MH/NIMH NIH HHS; R24 AI067039/AI/NIAID NIH HHS; R24-AI067039/AI/NIAID NIH HHS; RR025747/RR/NCRR NIH HHS; T32 ES07069/ES/NIEHS NIH HHS; TGF-96118//Canadian Institutes of Health Research; U01 AI035004/AI/NIAID NIH HHS; U01 AI068634/AI/NIAID NIH HHS; U01 AI068636/AI/NIAID NIH HHS; U01 AI069918/AI/NIAID NIH HHS; U01-AA013566/AA/NIAAA NIH HHS; U01-AI069918/AI/NIAID NIH HHS; U01-AI38855/AI/NIAID NIH HHS; U01-AI38858/AI/NIAID NIH HHS; U01-AI68634/AI/NIAID NIH HHS; U01-AI68636/AI/NIAID NIH HHS; U10-AA13566/AA/NIAAA NIH HHS; UL1-RR024131/RR/NCRR NIH HHS; UO1-AI-31834/AI/NIAID NIH HHS; UO1-AI-34989/AI/NIAID NIH HHS; UO1-AI-34993/AI/NIAID NIH HHS; UO1-AI-34994/AI/NIAID NIH HHS; UO1-AI-35004/AI/NIAID NIH HHS; UO1-AI-35039/AI/NIAID NIH HHS; UO1-AI-35040/AI/NIAID NIH HHS; UO1-AI-35041/AI/NIAID NIH HHS; UO1-AI-35042/AI/NIAID NIH HHS; UO1-AI-35043/AI/NIAID NIH HHS; UO1-AI-42590/AI/NIAID NIH HHS; UO1-HD-32632/HD/NICHD NIH HHS; Z01-CP010176/CP/NCI NIH HHS; ZIA CP010214-01/CP/NCI NIH HHS
Reg. No./Substance:
0/Anti-Retroviral Agents; 0/Biological Markers; 0/Hemoglobins; 0/RNA, Viral; AYI8EX34EU/Creatinine; EC Aminotransferases; EC Transaminase

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