Veterans Aging Cohort Study (VACS) 1.0 Index

VACS 1.0 Index Calculator

Age

CD4 Count (cells/µL)

HIV-1 RNA (copies/mL)

Hemoglobin (g/dL)

FIB-4

eGFR (mL/min/1.73m²)

Hepatitis C Coinfection

VACS Index: –

Awaiting input

Select all criteria to compute the score.

Estimates risk of 5-year all-cause mortality in patients with HIV and/or HCV.

Why Use

Traditional mortality estimates using only viral load or CD4 count in HIV or FIB-4 in Hepatitis C are inaccurate; the VACS Index looks adds additional markers to estimate multi-organ system involvement and more-accurately predict mortality.

When to Use

Aids in prognostication in patients with HIV or Hepatitis C. Potentially useful with goals of care planning or aggressiveness of therapy.

Formula

Addition of selected points.

Pearls / Pitfalls

The VACS Index comes from a US VA population, so most patients in both the derivation and validation cohorts were men. Half of patients had started anti-retrovirals prior to 2004, so it is unknown how the newer anti-retrovirals may affect these estimates. <5% of patients in this study were ≥65 years old so this is likely less accurate in older populations. Few patients in the study had significant renal disease: >90% had an eGFR ≥60.

Critical Actions

Because half of the patients in the study had started anti-retrovirals prior to 2004, it is unknown how newer anti-retrovirals may affect the score's estimates. Use clinical judgement when planning care or aggressiveness of therapy.

More Information

Criteria Value Points Age <50 years 0 50-64 years +12 ≥60 years +27 CD4 ≥500 cells/mm 3 0 350-499 cells/mm 3 +6 200-349 cells/mm 3 +6 100-199 cells/mm 3 +10 50-100 cells/mm 3 +28 <50 cells/mm 3 +29 HIV-1 RNA <500 copies/mL 0 500-99,999 copies/mL +7 ≥1x10& 5 copies/mL +14 Hemoglobin ≥14 g/dL 0 12-13.9 g/dL +10 10-11.9 g/dL +22 <10 g/dL +38 FIB-4 <1.45 0 1.45-3.25 +6 >3.25 +25 eGFR ≥60 mL/min 0 45-59.9 mL/min +6 30-44.9 mL/min +8 <30 mL/min +26 Hepatitis C Co-Infection No 0 Yes +5