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Predicting Survival Among Those Aging With HIV Infection

February 5, 2013

Even with the use of antiretroviral therapy (ART), which can lead to viral suppression and reductions in AIDS-related deaths, researchers maintain that people with HIV infection have a higher mortality rate because chronic HIV infection intensifies age-related organ system injury.

The Veterans Aging Cohort Study (VACS) Index funded by the National Institutes of Health used older indices that measured HIV biomarkers, including CD4 cell count, HIV-1 RNA levels, and patient age, to ascertain mortality risk. The newer VACS Index uses other critical factors, including the increasing role of multi-organ system injury and hepatitis C infection as well as the decreasing role of other factors such as CD4 count.

In a collaborative study by Yale University, the VA Healthcare System, and the North American Cohort Collaboration, the researchers compared the accuracy of the VACS Index with that of the newer VACS. Data reviewed were from more than 5,000 veterans and more than 10,000 non-veterans, representing 14 separate cohorts of HIV-infected persons from around the country who had at least one year of ART. The researchers followed up with patients for a little more than three years.

Researchers found the new VACS Index was much more accurate and effective than the previous index, which used CD 4 count, HIV-1 RNA, and age. Dr. Amy Justice, professor of internal medicine at Yale School of Medicine, stated that the VACS Index accurately estimated risk of mortality among persons aging with HIV infection whether they live in Canada or the United States. She also found that the index was accurate among men and women, older or younger individuals, and white people or people of color. The team has created an app for use by patients and their providers. It is available at

The study, "Predictive Accuracy of the Veterans Aging Cohort Study Index for Mortality With HIV Infection: A North American Cross Cohort Analysis," was published in the Journal of Acquired Immune Deficiency Syndromes (2013; 62 (2):149-163).

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