Predictive accuracy of the veterans aging cohort study index for mortality with HIV infection: A north american cross cohort analysis

Amy C. Justice, Sharada P. Modur, Janet P. Tate, Keri N. Althoff, Lisa P. Jacobson, Kelly A. Gebo, Mari M. Kitahata, Michael A. Horberg, John T. Brooks, Kate Buchacz, Sean B. Rourke, Anita Rachlis, Sonia Napravnik, Joseph Eron, James H. Willig, Richard Moore, Gregory D. Kirk, Ronald Bosch, Benigno Rodriguez, Robert S. HoggJennifer Thorne, James J. Goedert, Marina Klein, John Gill, Steven Deeks, Timothy R. Sterling, Kathryn Anastos, Stephen J. Gange

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

BACKGROUND: By supplementing an index composed of HIV biomarkers and age (restricted index) with measures of organ injury, the Veterans Aging Cohort Study (VACS) index more completely reflects risk of mortality. We compare the accuracy of the VACS and restricted indices (1) among subjects outside the Veterans Affairs Healthcare System, (2) more than 1-5 years of prior exposure to antiretroviral therapy (ART), and (3) within important patient subgroups. METHODS: We used data from 13 cohorts in the North American AIDS Cohort Collaboration (n = 10, 835) limiting analyses to HIV-infected subjects with at least 12 months exposure to ART. Variables included demographic, laboratory (CD4 count, HIV-1 RNA, hemoglobin, platelets, aspartate and alanine transaminase, creatinine, and hepatitis C status), and survival. We used C-statistics and net reclassification improvement (NRI) to test discrimination varying prior ART exposure from 1 to 5 years. We then combined Veterans Affairs Healthcare System (n = 5066) and North American AIDS Cohort Collaboration data, fit a parametric survival model, and compared predicted to observed mortality by cohort, gender, age, race, and HIV-1 RNA level. RESULTS: Mean follow-up was 3.3 years (655 deaths). Compared with the restricted index, the VACS index showed greater discrimination (C-statistics: 0.77 vs. 0.74; NRI: 12%; P < 0.0001). NRI was highest among those with HIV-1 RNA <500 copies per milliliter (25%) and age ≥50 years (20%). Predictions were similar to observed mortality among all subgroups. CONCLUSIONS: VACS index scores discriminate risk and translate into accurate mortality estimates over 1-5 years of exposure to ART and for diverse patient subgroups from North American.

Original languageEnglish (US)
Pages (from-to)149-163
Number of pages15
JournalJournal of Acquired Immune Deficiency Syndromes
Volume62
Issue number2
DOIs
StatePublished - Feb 1 2013

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Veterans
HIV Infections
Cohort Studies
Mortality
HIV-1
RNA
Acquired Immunodeficiency Syndrome
HIV
Implosive Therapy
Delivery of Health Care
Survival
CD4 Lymphocyte Count
Hepatitis C
Aspartate Aminotransferases
Alanine Transaminase
Creatinine
Hemoglobins
Therapeutics
Blood Platelets
Biomarkers

Keywords

  • aging
  • HIV
  • prognosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Predictive accuracy of the veterans aging cohort study index for mortality with HIV infection : A north american cross cohort analysis. / Justice, Amy C.; P. Modur, Sharada; Tate, Janet P.; Althoff, Keri N.; Jacobson, Lisa P.; Gebo, Kelly A.; Kitahata, Mari M.; Horberg, Michael A.; Brooks, John T.; Buchacz, Kate; Rourke, Sean B.; Rachlis, Anita; Napravnik, Sonia; Eron, Joseph; Willig, James H.; Moore, Richard; Kirk, Gregory D.; Bosch, Ronald; Rodriguez, Benigno; Hogg, Robert S.; Thorne, Jennifer; Goedert, James J.; Klein, Marina; Gill, John; Deeks, Steven; Sterling, Timothy R.; Anastos, Kathryn; Gange, Stephen J.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 62, No. 2, 01.02.2013, p. 149-163.

Research output: Contribution to journalArticle

Justice, AC, P. Modur, S, Tate, JP, Althoff, KN, Jacobson, LP, Gebo, KA, Kitahata, MM, Horberg, MA, Brooks, JT, Buchacz, K, Rourke, SB, Rachlis, A, Napravnik, S, Eron, J, Willig, JH, Moore, R, Kirk, GD, Bosch, R, Rodriguez, B, Hogg, RS, Thorne, J, Goedert, JJ, Klein, M, Gill, J, Deeks, S, Sterling, TR, Anastos, K & Gange, SJ 2013, 'Predictive accuracy of the veterans aging cohort study index for mortality with HIV infection: A north american cross cohort analysis', Journal of Acquired Immune Deficiency Syndromes, vol. 62, no. 2, pp. 149-163. https://doi.org/10.1097/QAI.0b013e31827df36c
Justice, Amy C. ; P. Modur, Sharada ; Tate, Janet P. ; Althoff, Keri N. ; Jacobson, Lisa P. ; Gebo, Kelly A. ; Kitahata, Mari M. ; Horberg, Michael A. ; Brooks, John T. ; Buchacz, Kate ; Rourke, Sean B. ; Rachlis, Anita ; Napravnik, Sonia ; Eron, Joseph ; Willig, James H. ; Moore, Richard ; Kirk, Gregory D. ; Bosch, Ronald ; Rodriguez, Benigno ; Hogg, Robert S. ; Thorne, Jennifer ; Goedert, James J. ; Klein, Marina ; Gill, John ; Deeks, Steven ; Sterling, Timothy R. ; Anastos, Kathryn ; Gange, Stephen J. / Predictive accuracy of the veterans aging cohort study index for mortality with HIV infection : A north american cross cohort analysis. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 62, No. 2. pp. 149-163.
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T1 - Predictive accuracy of the veterans aging cohort study index for mortality with HIV infection

T2 - A north american cross cohort analysis

AU - Justice, Amy C.

AU - P. Modur, Sharada

AU - Tate, Janet P.

AU - Althoff, Keri N.

AU - Jacobson, Lisa P.

AU - Gebo, Kelly A.

AU - Kitahata, Mari M.

AU - Horberg, Michael A.

AU - Brooks, John T.

AU - Buchacz, Kate

AU - Rourke, Sean B.

AU - Rachlis, Anita

AU - Napravnik, Sonia

AU - Eron, Joseph

AU - Willig, James H.

AU - Moore, Richard

AU - Kirk, Gregory D.

AU - Bosch, Ronald

AU - Rodriguez, Benigno

AU - Hogg, Robert S.

AU - Thorne, Jennifer

AU - Goedert, James J.

AU - Klein, Marina

AU - Gill, John

AU - Deeks, Steven

AU - Sterling, Timothy R.

AU - Anastos, Kathryn

AU - Gange, Stephen J.

PY - 2013/2/1

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N2 - BACKGROUND: By supplementing an index composed of HIV biomarkers and age (restricted index) with measures of organ injury, the Veterans Aging Cohort Study (VACS) index more completely reflects risk of mortality. We compare the accuracy of the VACS and restricted indices (1) among subjects outside the Veterans Affairs Healthcare System, (2) more than 1-5 years of prior exposure to antiretroviral therapy (ART), and (3) within important patient subgroups. METHODS: We used data from 13 cohorts in the North American AIDS Cohort Collaboration (n = 10, 835) limiting analyses to HIV-infected subjects with at least 12 months exposure to ART. Variables included demographic, laboratory (CD4 count, HIV-1 RNA, hemoglobin, platelets, aspartate and alanine transaminase, creatinine, and hepatitis C status), and survival. We used C-statistics and net reclassification improvement (NRI) to test discrimination varying prior ART exposure from 1 to 5 years. We then combined Veterans Affairs Healthcare System (n = 5066) and North American AIDS Cohort Collaboration data, fit a parametric survival model, and compared predicted to observed mortality by cohort, gender, age, race, and HIV-1 RNA level. RESULTS: Mean follow-up was 3.3 years (655 deaths). Compared with the restricted index, the VACS index showed greater discrimination (C-statistics: 0.77 vs. 0.74; NRI: 12%; P < 0.0001). NRI was highest among those with HIV-1 RNA <500 copies per milliliter (25%) and age ≥50 years (20%). Predictions were similar to observed mortality among all subgroups. CONCLUSIONS: VACS index scores discriminate risk and translate into accurate mortality estimates over 1-5 years of exposure to ART and for diverse patient subgroups from North American.

AB - BACKGROUND: By supplementing an index composed of HIV biomarkers and age (restricted index) with measures of organ injury, the Veterans Aging Cohort Study (VACS) index more completely reflects risk of mortality. We compare the accuracy of the VACS and restricted indices (1) among subjects outside the Veterans Affairs Healthcare System, (2) more than 1-5 years of prior exposure to antiretroviral therapy (ART), and (3) within important patient subgroups. METHODS: We used data from 13 cohorts in the North American AIDS Cohort Collaboration (n = 10, 835) limiting analyses to HIV-infected subjects with at least 12 months exposure to ART. Variables included demographic, laboratory (CD4 count, HIV-1 RNA, hemoglobin, platelets, aspartate and alanine transaminase, creatinine, and hepatitis C status), and survival. We used C-statistics and net reclassification improvement (NRI) to test discrimination varying prior ART exposure from 1 to 5 years. We then combined Veterans Affairs Healthcare System (n = 5066) and North American AIDS Cohort Collaboration data, fit a parametric survival model, and compared predicted to observed mortality by cohort, gender, age, race, and HIV-1 RNA level. RESULTS: Mean follow-up was 3.3 years (655 deaths). Compared with the restricted index, the VACS index showed greater discrimination (C-statistics: 0.77 vs. 0.74; NRI: 12%; P < 0.0001). NRI was highest among those with HIV-1 RNA <500 copies per milliliter (25%) and age ≥50 years (20%). Predictions were similar to observed mortality among all subgroups. CONCLUSIONS: VACS index scores discriminate risk and translate into accurate mortality estimates over 1-5 years of exposure to ART and for diverse patient subgroups from North American.

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