Estimating Prognosis in HIV-Infected Patients with Other Chronic Diseases

An easy calculation yielded a good predictor of hospitalization.

The prognosis of patients on effective antiretroviral therapy remains unclear, particularly when they have other serious medical conditions. A predictive index constructed from common laboratory values has proven successful in predicting all-cause mortality among HIV-infected veterans. Now, researchers have evaluated the usefulness of the same index in predicting serious morbidity as reflected by hospital admissions.

Each of the 3410 HIV-infected patients enrolled between 2002 and 2008 in the large, prospective Veterans Aging Cohort Study had a "VACS Index" score calculated from baseline values for age, CD4-cell count, viral load, hemoglobin, creatinine, liver enzymes, and hepatitis C serostatus. Virtually all the participants were men, and 67% were black. During the 2 years after enrollment, 1141 participants were hospitalized, 203 (18%) of them in a medical intensive care unit.

Abnormalities in each individual component of the VACS Index correlated with the likelihood of hospitalization, and the composite score was a strong predictor: Among those in the highest VACS score quartile, >40% were hospitalized within 1 year after enrollment, and 60% within 2 years. In addition to VACS score, other independent predictors of hospitalization included a diagnosis of chronic obstructive pulmonary disease, hypertension, or diabetes; hazardous alcohol use; current smoking; and a history of AIDS-defining events.

CITATION(S):

Akgün KM et al. Risk factors for hospitalization and medical intensive care unit (MICU) admission among HIV-infected veterans. J Acquir Immune Defic Syndr 2013 Jan 1; 62:52.