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. 2022 Jan 1;89(1):9-18.
doi: 10.1097/QAI.0000000000002812.

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

Yuhang Qian  1 , Richard D Moore  2 , Sally B Coburn  1 , Thibaut Davy-Mendez  3   4 , Kathleen M Akgün  5   6 , Kathleen A McGinnis  7 , Michael J Silverberg  8 , Jonathan A Colasanti  9 , Edward R Cachay  10 , Michael A Horberg  11 , Charles S Rabkin  12 , Jeffrey M Jacobson  13 , M John Gill  14 , Angel M Mayor  15 , Gregory D Kirk  1   2 , Kelly A Gebo  1   2 , Ank E Nijhawan  16 , Keri N Althoff  1
Affiliations

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

Yuhang Qian et al. J Acquir Immune Defic Syndr. .

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. Time-updated 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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Crude and adjusted hazard ratios (HRs) and 95% confidence interval (CIs) of VACS Index scores for the risk of hospitalization by sex. A. Unadjusted results by sex, black circles denote male and red diamonds denote female. B. Adjusted results by sex, black circles denote male and red diamonds denote female. Adjusting variables include race/ethnicity, smoking, HIV acquisition risk factor, depression, and calendar year. All the HRs and 95% CIs are presented on a log2 scale.
Figure 1.
Figure 1.
Crude and adjusted hazard ratios (HRs) and 95% confidence interval (CIs) of VACS Index scores for the risk of hospitalization by sex. A. Unadjusted results by sex, black circles denote male and red diamonds denote female. B. Adjusted results by sex, black circles denote male and red diamonds denote female. Adjusting variables include race/ethnicity, smoking, HIV acquisition risk factor, depression, and calendar year. All the HRs and 95% CIs are presented on a log2 scale.
Figure 2.
Figure 2.
Crude and adjusted hazard ratios (HRs) and 95% confidence interval (CIs) of VACS Index scores for the risk of hospitalization by race/ethnicity. A. Unadjusted results by race/ethnicity, black circles denote white, red diamonds denote Black, and green triangles denote Hispanic. B. Adjusted results by race/ethnicity, black circles denote white, red diamonds denote Black, and green triangles denote Hispanic. Adjusting variables include sex, smoking, HIV acquisition risk factor, depression, and calendar year. All the HRs and 95% CIs are presented on a log2 scale.
Figure 2.
Figure 2.
Crude and adjusted hazard ratios (HRs) and 95% confidence interval (CIs) of VACS Index scores for the risk of hospitalization by race/ethnicity. A. Unadjusted results by race/ethnicity, black circles denote white, red diamonds denote Black, and green triangles denote Hispanic. B. Adjusted results by race/ethnicity, black circles denote white, red diamonds denote Black, and green triangles denote Hispanic. Adjusting variables include sex, smoking, HIV acquisition risk factor, depression, and calendar year. All the HRs and 95% CIs are presented on a log2 scale.
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