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Author Notes:

Ionut Bebu, PhD, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, Phone: 301-816-8416; ibebu@idcrp.org.

All authors contributed to the content of the manuscript and concurred with the decision to submit it for publication.

The investigators would like to thank our patients for their enormous contributions over the years.

In addition to authors listed above, the IDCRP HIV Working Group includes: Susan Banks, RN; William Bradley, MS; Helen Chun, MD; Nancy Crum-Cianflone, MD, MPH; Cathy Decker, MD; Conner Eggleston; LTC Tomas Ferguson; COL Susan Fraser, MD; MAJ Joshua Hartzell, MD; MAJ Joshua Hawley; LTC Gunther Hsue; Arthur Johnson, MD; COL Mark Kortepeter, MD, MPH; Tahaniyat Lalani, MD; Robbin Lockhart, MS; Scott Merritt; LTC Robert O’Connell, MD; Sheila Peel, PhD; Michael Polis, MD; John Powers, MD; MAJ Roseanne Ressner, MD; COL(ret) Edmund Tramont; LT Tyler Warkentien; Timothy Whitman, MD; and COL Michael Zapor, MD.

Authors reported no conflicts of interest.

The authors have no financial interest in this work.


Research Funding:

Support for this work (IDCRP-000) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences.

This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • HIV
  • military
  • early diagnosis
  • VACS index
  • validation
  • CARE

The VACS Index Predicts Mortality in a Young, Healthy HIV Population Starting Highly Active Antiretroviral Therapy

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Journal Title:

Journal of Acquired Immune Deficiency Syndromes


Volume 65, Number 2


, Pages 226-230

Type of Work:

Article | Post-print: After Peer Review


Background: The Veterans Aging Cohort Study (VACS) index is a weighted combination of age and 8 clinical variables. It has been well correlated with all-cause mortality among HIV-infected patients. The US Military HIV Natural History Study (NHS) cohort provides a different validation population profile, being younger and healthier. A significant portion of the US HIV population is similarly composed; so, evaluation of the VACS index in this population is of great interest. Methods: NHS subjects have medical history and laboratory data collected at 6-month visits. We performed an external validation of the VACS index in the NHS evaluating correlation, discrimination, and calibration for all-cause mortality after highly active antiretroviral therapy initiation (HI). We then tested whether combining longitudinal VACS index values at different time points improves prediction of mortality. Results: The VACS index at 1 year after HI was well correlated with all-cause mortality (Harrell c statistic 0.78), provided good discrimination (log-rank P < 0.05), and was marginally well calibrated using Brier score. Accounting for VACS index at HI and 6 months after HI significantly improved a standard model, including only the VACS index at 1 year after HI (net reclassification improvement = 25.2%, 95% CI: 10.9% to 48.9%). Conclusions: The VACS index was well correlated and provided good discrimination with respect to all-cause mortality among highly active antiretroviral therapy initiating subjects in the NHS. Moderate overprediction of mortality in this young, healthy population suggests minor recalibration that could improve fit among similar patients. Considering VACS index at HI and 6 months improved outcome prediction and allowed earlier risk assessment.

Copyright information:

Copyright © 2013 by Lippincott Williams and Wilkins.

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