Discrimination of the Veterans Aging Cohort Study Index 2.0 for Predicting Cause-specific Mortality Among Persons With HIV in Europe and North America.

Background

Predicting cause-specific mortality among people with HIV (PWH) could facilitate targeted care to improve survival. We assessed discrimination of the Veterans Aging Cohort Study (VACS) Index 2.0 in predicting cause-specific mortality among PWH on antiretroviral therapy (ART).

Methods

Using Antiretroviral Therapy Cohort Collaboration data for PWH who initiated ART between 2000 and 2018, VACS Index 2.0 scores (higher scores indicate worse prognosis) were calculated around a randomly selected visit date at least 1 year after ART initiation. Missingness in VACS Index 2.0 variables was addressed through multiple imputation. Cox models estimated associations between VACS Index 2.0 and causes of death, with discrimination evaluated using Harrell's C-statistic. Absolute mortality risk was modelled using flexible parametric survival models.

Results

Of 59 741 PWH (mean age: 43 years; 80% male), the mean VACS Index 2.0 at baseline was 41 (range: 0-129). For 2425 deaths over 168 162 person-years follow-up (median: 2.6 years/person), AIDS (n = 455) and non-AIDS-defining cancers (n = 452) were the most common causes. Predicted 5-year mortality for PWH with a mean VACS Index 2.0 score of 38 at baseline was 1% and approximately doubled for every 10-unit increase. The 5-year all-cause mortality C-statistic was .83. Discrimination with the VACS Index 2.0 was highest for deaths resulting from AIDS (0.91), liver-related (0.91), respiratory-related (0.89), non-AIDS infections (0.87), and non-AIDS-defining cancers (0.83), and lowest for suicides/accidental deaths (0.65).

Conclusions

For deaths among PWH, discrimination with the VACS Index 2.0 was highest for deaths with measurable physiological causes and was lowest for suicide/accidental deaths.

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Déclaration de conflit d'intérêts

Potential conflicts of interest. A.v.S. has received grants unrelated to this study and paid to his institution from ECDC. H.C. has received research grant funding from ViiV, NIH, and AHRQ paid to their institution, and has sat on the NIH Office of AIDS Research Advisory Council. N.P. has received grants unrelated to this study and paid to his institution from Gilead Sciences Hellas and ECDC. M.C.'s institution received research grants and expert opinion fees from Gilead, MSD, and Viiv. P.D. reports consulting fees from Gilead, Merck, Janssen and Cilag, ViiV Healthcare, Roche, and Theratechnologies; and payment or honoraria for lectures from Gilead, Merck, Janssen, ViiV Healthcare, and Roche. I.J. has received teaching fees from ViiV, fees for evaluating scientific projects and participating in expert panels from Gilead, and fees for statistical analyses from GESIDA. M.J.G. has received honoraria in the past 3 years from ad hoc membership of national HIV advisory boards, Merck, Gilead, and ViiV. J.B. reports honoraria for advice or public speaking from Gilead, GSK, Janssen, MSD, and ViiV Healthcare; and grants from Gilead, MSD, and ViiV Healthcare. C.W. reports honoraria for advice or public speaking from Abbott, Gilead, Janssen, MSD, Pfizer, and ViiV Healthcare. P.R., through his institution, has received scientific grant support for investigator-initiated studies from Gilead Sciences, Janssen Pharmaceuticals Inc, Merck & Co, and ViiV Healthcare, and has served on scientific advisory boards for Gilead Sciences, ViiV Healthcare, and Merck & Co honoraria for which were all paid to his institution. All other authors report no potential conflicts.