VACS Risk Index Refinement and further validation Janet Tate VACS Scientific Meeting Washington DC April 9, 2010

Composite biomarkers

Remove non-standardized elements

Initial development Validation in ART-CC Development cART 1999-2002 Internal validation, cART 1997-1998 No restriction on detectable viral load Validation in ART-CC The Antiretroviral Cohort Collaboration

Validation in ART-CC Baseline = first cART date 1 January 1997 to 31 December 2005 Exclude if HIV RNA < 500 Baseline labs < 6 months before cART date Complete cases only (thus far) Not adjusted for gender Not adjusted for year Used all cohorts that had any of target labs One marker at a time, then in combination

ART-CC* = 9 cohorts Member cohorts with any of target labs

Cohort characteristics

Heterogeneity

Correlation

CD4 and age are attenuated Hemoglobin Fib4

Hemoglobin <10, men and women

Hemoglobin <10, men only

FIB 4 1.45 to 3.25

FIB 4 > 3.25

eGFR <30

Anemia and liver disease 153 deaths

Anemia, liver disease, renal disease 77 deaths

Thank you for your attention. Questions?

Cox Model  Risk Score Log hazard ratio x a constant point value for each parameter is a positive integer discriminates between levels of a given parameter 0 to 100 scale

Mortality vs Risk Score

Mortality vs Risk Score VACS 1863 deaths ART-CC* 77 deaths