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The Veterans Aging Cohort Study (VACS) Index and Neurocognitive Change: A Longitudinal Study
- Marquine, María J;
- Montoya, Jessica L;
- Umlauf, Anya;
- Fazeli, Pariya L;
- Gouaux, Ben;
- Heaton, Robert K;
- Ellis, Ronald J;
- Letendre, Scott L;
- Grant, Igor;
- Moore, David J;
- Group, for the HIV Neurobehavioral Research Program;
- Heaton, Robert K;
- Grant, Igor;
- Atkinson, J Hampton;
- Ellis, Ronald J;
- Letendre, Scott;
- Marcotte, Thomas D;
- Marquie-Beck, Jennifer;
- Sherman, Melanie;
- Ellis, Ronald J;
- Letendre, Scott;
- McCutchan, J Allen;
- Best, Brookie;
- Schrier, Rachel;
- Rosario, Debra;
- Heaton, Robert K;
- Atkinson, J Hampton;
- Woods, Steven Paul;
- Marcotte, Thomas D;
- Cherner, Mariana;
- Moore, David J;
- Dawson, Matthew;
- Fennema-Notestine, Christine;
- Buchsbaum, Monte S;
- Hesselink, John;
- Archibald, Sarah L;
- Brown, Gregory;
- Buxton, Richard;
- Dale, Anders;
- Liu, Thomas;
- Masliah, Eliezer;
- Achim, Cristian;
- Smith, David M;
- Richman, Douglas;
- McCutchan, J Allen;
- Cherner, Mariana;
- Achim, Cristian;
- Lipton, Stuart;
- Atkinson, J Hampton;
- Marquie-Beck, Jennifer;
- Gamst, Anthony C;
- Cushman, Clint;
- Abramson, Ian;
- Vaida, Florin;
- Deutsch, Reena;
- Umlauf, Anya
- et al.
Published Web Location
https://doi.org/10.1093/cid/ciw328Abstract
Background
The Veterans Aging Cohort Study (VACS) Index, a composite marker of disease severity among human immunodeficiency virus (HIV)-infected persons, has been associated with concurrent risk for neurocognitive impairment (NCI). The present study examined whether the VACS Index predicts longitudinal neurocognitive change.Methods
Participants included 655 HIV-infected persons followed for up to 6 years in cohort studies at the University of California, San Diego, HIV Neurobehavioral Research Program (mean age at baseline, 42.5 years; 83% male; 60% white; AIDS in 67%; median current CD4(+) T-cell count, 346/μL; 61% receiving antiretroviral therapy). The VACS Index was calculated through standard methods. Participants completed a comprehensive neurocognitive battery. Neurocognitive status was plotted over time using demographically and practice-adjusted global and domain T scores. NCI was defined by global deficit scores derived from T scores.Results
Baseline VACS Index scores were not predictive of changes in global T scores during the follow-up period (P = .14). However, in time-dependent analyses adjusting for covariates, higher VACS Index scores were significantly associated with worse global and domain neurocognitive performance (Ps < .01), as well as increased risk for developing NCI in a subgroup of persons who were neurocognitively normal at baseline (hazard ratio [HR], 1.17; P < .001). We categorized VACS Index scores by quartiles and found that the upper-quartile group was significantly more likely to develop NCI than the lower quartile (HR, 2.16; P < .01) and middle groups (HR, 1.76; P < .01).Conclusions
Changes in VACS Index scores correspond to changes in neurocognitive function. HIV-infected persons with high VACS Index scores are at increased risk for decline and incident NCI. The VACS Index shows promise as a tool for identifying HIV-infected persons at risk for NCI.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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