The Veterans Aging Cohort Study (VACS) Index and Neurocognitive Change: A Longitudinal Study.

TitleThe Veterans Aging Cohort Study (VACS) Index and Neurocognitive Change: A Longitudinal Study.
Publication TypeJournal Article
Year of Publication2016
AuthorsMarquine, MJ, Montoya, JL, Umlauf, A, Fazeli, PL, Gouaux, B, Heaton, RK, Ellis, RJ, Letendre, SL, Grant, I, Moore, DJ
Corporate AuthorsHIV Neurobehavioral Research Program Group
JournalClin Infect Dis
Date Published2016 Sep 01
KeywordsAdult, Aging, AIDS Dementia Complex, Female, Humans, Internal, Longitudinal Studies, Male, Middle Aged, Veterans

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.

Alternate JournalClin Infect Dis
PubMed ID27199461
PubMed Central IDPMC4981756
Grant ListK99 AG048762 / AG / NIA NIH HHS / United States
K23 MH105297 / MH / NIMH NIH HHS / United States
P50 DA026306 / DA / NIDA NIH HHS / United States
T32 MH019934 / MH / NIMH NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States
R24 MH059745 / MH / NIMH NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
P01 DA012065 / DA / NIDA NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States