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Author Notes:

Yuhang Qian, MHS, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, #E7142, MD 21205. Email: yqian24@jh.edu

NA-ACCORD Collaborating Cohorts and Representatives: AIDS Clinical Trials Group Longitudinal Linked Randomized Trials: Constance A. Benson and Ronald J. Bosch AIDS Link to the IntraVenous Experience: Gregory D. Kirk Emory-Grady HIV Clinical Cohort: Vincent C. Marconi and Jonathan A. Colasanti Fenway Health HIV Cohort: Kenneth H. Mayer and Chris Grasso HAART Observational Medical Evaluation and Research: Robert S. Hogg, Viviane Lima, P. Richard Harrigan, Julio SG Montaner, Benita Yip, Julia Zhu, and Kate Salters HIV Outpatient Study: Kate Buchacz and Jun Li HIV Research Network: Kelly A. Gebo and Richard D. Moore Johns Hopkins HIV Clinical Cohort: Richard D. Moore John T. Carey Special Immunology Unit Patient Care and Research Database, Case Western Reserve University: Jeffrey M. Jacobson Kaiser Permanente Mid-Atlantic States: Michael A. Horberg Kaiser Permanente Northern California: Michael J. Silverberg Longitudinal Study of Ocular Complications of AIDS: Jennifer E. Thorne MACS/WIHS Combined Cohort Study: Todd Brown, Phyllis Tien, and Gypsyamber D’Souza Maple Leaf Medical Clinic: Graham Smith, Mona Loutfy, and Meenakshi Gupta The McGill University Health Centre, Chronic Viral Illness Service Cohort: Marina B. Klein Multicenter Hemophilia Cohort Study–II: Charles Rabkin Ontario HIV Treatment Network Cohort Study: Abigail E. Kroch, Ann N, Burchell, Adrian Betts, and Joanne Lindsay Parkland/UT Southwestern Cohort: Ank E. Nijhawan Retrovirus Research Center, Universidad Central del Caribe, Bayamon Puerto Rico: Angel M. Mayor Southern Alberta Clinic Cohort: M. John Gill Study of the Consequences of the Protease Inhibitor Era: Jeffrey N. Martin Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy: Jun Li and John T. Brooks University of Alabama at Birmingham 1917 Clinic Cohort: Michael S. Saag, Michael J. Mugavero, and James H. Willig University of California at San Diego: Laura P. Bamford and Maile Y. Karris University of North Carolina at Chapel Hill HIV Clinic Cohort: Joseph J. Eron and Sonia Napravnik University of Washington HIV Cohort: Mari M. Kitahata and Heidi M. Crane Vanderbilt Comprehensive Care Clinic HIV Cohort: Timothy R. Sterling, David Haas, Peter Rebeiro, and Megan Turner Veterans Aging Cohort Study: Kathleen A. McGinnis and Amy C. Justice NA-ACCORD Study Administration: Executive Committee: Richard D. Moore, Keri N. Althoff, Stephen J. Gange, Mari M. Kitahata, Jennifer S. Lee, Michael S. Saag, Michael A. Horberg, Marina B. Klein, Rosemary G. McKaig, and Aimee M. Freeman Administrative Core: Richard D. Moore, Keri N. Althoff, and Aimee M. Freeman Data Management Core: Mari M. Kitahata, Stephen E. Van Rompaey, Heidi M. Crane, Liz Morton, Justin McReynolds, and William B. Lober Epidemiology and Biostatistics Core: Stephen J. Gange, Jennifer S. Lee, Raynell Lang, Brenna Hogan, Bin You, Elizabeth Humes, Lucas Gerace, Cameron Stewart, and Sally Coburn Disclaimer: The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC) or those of the Veterans Affairs.

The authors have no conflicts of interest to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Research Funding:

This work was supported by National Institutes of Health grants U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050409, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R01AG053100, R24AI067039, R34DA045592, U01AA013566, U01AA020790, U01AI038855, U01AI038858, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01DA036297, U01DA036935, U10EY008057, U10EY008052, U10EY008067, U01HL146192, U01HL146193, U01HL146194, U01HL146201, U01HL146202, U01HL146203, U01HL146204, U01HL146205, U01HL146208, U01HL146240, U01HL146241, U01HL146242, U01HL146245, U01HL146333, U24AA020794, U54GM133807, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR002378, Z01CP010214 and Z01CP010176; contracts CDC-200–2006–18797 and CDC-200–2015–63931 from the Centers for Disease Control and Prevention, USA; contract 90047713 from the Agency for Healthcare Research and Quality, USA; contract 90051652 from the Health Resources and Services Administration, USA; the Grady Health System; grants CBR-86906, CBR-94036, HCP-97105 and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care, and the Government of Alberta, Canada. Additional support was provided by the National Institute Of Allergy And Infectious Diseases (NIAID), National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI), Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Human Genome Research Institute (NHGRI), National Institute for Mental Health (NIMH) and National Institute on Drug Abuse (NIDA), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Nursing Research (NINR), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • HIV
  • VACS index
  • hospitalization
  • VETERANS AGING COHORT
  • HUMAN-IMMUNODEFICIENCY-VIRUS
  • UNITED-STATES
  • RISK-FACTORS
  • PREDICTS MORTALITY
  • INFECTED PERSONS
  • RATES
  • TRENDS
  • READMISSION
  • FRACTURE

Association of the VACS Index With Hospitalization Among People With HIV in the NA-ACCORD

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Journal Title:

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES

Volume:

Volume 89, Number 1

Publisher:

, Pages 9-18

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: People with HIV (PWH) have a higher hospitalization rate than the general population. The Veterans Aging Cohort Study (VACS) Index at study entry well predicts hospitalization in PWH, but it is unknown if the time-updated parameter improves hospitalization prediction. We assessed the association of parameterizations of the VACS Index 2.0 with the 5-year risk of hospitalization. Setting: PWH ≥30 years old with at least 12 months of antiretroviral therapy (ART) use and contributing hospitalization data from 2000 to 2016 in North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included. Three parameterizations of the VACS Index 2.0 were assessed and categorized by quartile: (1) "baseline"measurement at study entry; (2) time-updated measurements; and (3) cumulative scores calculated using the trapezoidal rule. Methods: Discrete-time proportional hazard models estimated the crude and adjusted associations (and 95% confidence intervals [CIs]) of the VACS Index parameterizations and all-cause hospitalizations. The Akaike information criterion (AIC) assessed the model fit with each of the VACS Index parameters. Results: Among 7289 patients, 1537 were hospitalized. Timeupdated VACS Index fitted hospitalization best with a more distinct dose-response relationship [score ,43: reference; score 43-55: aHR = 1.93 (95% CI: 1.66 to 2.23); score 55-68: aHR = 3.63 (95% CI: 3.12 to 4.23); score ≥68: aHR = 9.98 (95% CI: 8.52 to 11.69)] than study entry and cumulative VACS Index after adjusting for known risk factors. Conclusions: Time-updated VACS Index 2.0 had the strongest association with hospitalization and best fit to the data. Health care providers should consider using it when assessing hospitalization risk among PWH.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
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