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    Veterans Aging Cohort Study (VACS) Index

    Estimates risk of 5-year all-cause mortality in patients with HIV and/or HCV.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Aids in prognostication in patients with HIV or Hepatitis C. Potentially useful with goals of care planning or aggressiveness of therapy.

    • The VACS Index comes from a US VA population, so most patients in both the derivation and validation cohorts were men.
    • Half of patients had started anti-retrovirals prior to 2004, so it is unknown how the newer anti-retrovirals may affect these estimates.
    • <5% of patients in this study were ≥65 years old so this is likely less accurate in older populations.
    • Few patients in the study had significant renal disease: >90% had an eGFR ≥60.

    Traditional mortality estimates using only viral load or CD4 count in HIV or FIB-4 in Hepatitis C are inaccurate; the VACS Index looks adds additional markers to estimate multi-organ system involvement and more-accurately predict mortality.

    < 50 years
    0
    50 - 64 years
    +12
    ≥ 65 years
    +27
    ≥ 500 cells/mm³
    0
    350 - 499 cells/mm³
    +6
    200 - 349 cells/mm³
    +6
    100 - 199 cells/mm³
    +10
    50 - 100 cells/mm³
    +28
    < 50 cells/mm³
    +29
    < 500 copies/mL
    0
    500 - 99,999 copies/mL
    +7
    ≥ 1x10⁵ copies/mL
    +14
    ≥ 14 g/dL
    0
    12 - 13.9 g/dL
    +10
    10 - 11.9 g/dL
    +22
    <10 g/dL
    +38
    < 1.45
    0
    1.45 - 3.25
    +6
    > 3.25
    +25
    ≥ 60 mL/min
    0
    45 - 59.9 mL/min
    +6
    30 - 44.9 mL/min
    +8
    < 30 mL/min
    +26
    No
    0
    Yes
    +5

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    Critical Actions

    Because half of the patients in the study had started anti-retrovirals prior to 2004, it is unknown how newer anti-retrovirals may affect the score's estimates. Use clinical judgement when planning care or aggressiveness of therapy.

    About the Creator
    Dr. Amy Justice
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