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

2. Composite biomarkers

3. Remove non-standardized elements

4. Initial development Validation in ART-CC
Development cART
Internal validation, cART
No restriction on detectable viral load
Validation in ART-CC
The Antiretroviral Cohort Collaboration

5. 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

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

7. Cohort characteristics

8. Heterogeneity

9. Correlation

10. CD4 and age are attenuated
Hemoglobin
Fib4

11. Hemoglobin <10, men and women

12. Hemoglobin <10, men only

13. FIB to 3.25

14. FIB 4 > 3.25

15. eGFR <30

16. Anemia and liver disease
153 deaths

17. Anemia, liver disease, renal disease
77 deaths

18. Thank you for your attention. Questions?

19. 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

20. Mortality vs Risk Score

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