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    Patent Pending

    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
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    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.

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    Next Steps
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    Creator Insights

    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.

    Formula

    Addition of selected points.

    Facts & Figures

    Criteria Value Points
    Age <50 years 0
    50 - 64 years +12
    ≥ 60 years +27
    CD4 ≥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
    HIV-1 RNA < 500 copies/mL 0
    500 - 99,999 copies/mL +7
    ≥ 1x10&5 copies/mL +14
    Hemoglobin ≥ 14 g/dL 0
    12 - 13.9 g/dL +10
    10 - 11.9 g/dL +22
    <10 g/dL +38
    FIB-4 < 1.45 0
    1.45 - 3.25 +6
    > 3.25 +25
    eGFR ≥ 60 mL/min 0
    45 - 59.9 mL/min +6
    30 - 44.9 mL/min +8
    < 30 mL/min +26
    Hepatitis C Co-Infection No 0
    Yes +5
    Dr. Amy Justice

    About the Creator

    Amy Justice, MD, PhD, is a professor of general medicine and public health policy at Yale University. She also practices at the VA Connecticut Healthcare System. As principal investigator of the Veterans Aging Cohort Study (VACS), she researches the impact of aging, substance abuse and other issues on the quality of life and survival of HIV-infected people. Dr. Justice has demonstrated her expertise on outcomes in chronic HIV infection through numerous panels and published papers and has presented on HIV and aging at the White House Office of National AIDS Policy.

    To view Dr. Amy Justice's publications, visit PubMed