The veterans aging cohort study index is an effective tool to assess baseline frailty status in a contemporary cohort of HIV-infected persons

The Veterans Aging Cohort Study (VACS) Index has previously been used to identify frail HIV-infected persons. However, data demonstrating the independent association between the VACS Index and baseline frailty status is lacking. Furthermore, the ability of the VACS Index to also reflect transitions in frailty status over time is unknown. We used data from the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study) to determine independent association of baseline frailty status with the VACS Index. We also evaluated VACS Index changes with frailty status transitions over time. We included 303 participants (median age 48 years, 76% men, 57% non-Hispanic white, 91% with plasma HIV RNA < 400 copies/ml, and median CD4 + cell count 595 cells/ml) with baseline and follow-up frailty assessments and used the Fried’s criteria to define frailty status. There were 184 (61%) nonfrail, 112 (37%) prefrail, and seven (2%) frail participants at baseline. Prefrail/frail participants had significantly higher median VACS Index scores compared with nonfrail participants (18 versus 10, p < 0.001). In multivariable analysis, prefrailty/frailty was independently associated with a higher VACS Index score (odds ratio 1.025, p = 0.019). After a median follow-up of 12 months, participants who remained prefrail/frail compared to those who remained nonfrail continued to have higher median VACS Index scores. The VACS Index score did not significantly change with transitions in frailty status over time. Our study highlights the potential utility of the VACS Index in frailty assessment within the clinical setting. Frailty is a clinical syndrome resulting from dysregulation of multiple physiologic systems that leads to low endurance, poor strength, low physical activity, increased hospitalization, and mortality. Studies derived from the Multicenter AIDS Cohort Study (MACS) have shown that frailty occurs at a much younger age among HIV-infected persons compared with demographically matched HIVuninfected individuals. Among the aging HIV-infected population, in whom frailty prevalence has been estimated to range from 2% to 20% the role of chronic inflammation in the multifactorial pathogenesis of this syndrome is increasingly recognized. Frailty has previously been shown to be independently associated with low CD4 + cell count, higher plasma HIV RNA, longer duration of HIV infection, previous history of opportunistic infections, and depression. The Veterans Aging Cohort Study (VACS) Index is a multivariable risk assessment tool that has been shown to accurately predict 5-year all-cause mortality risk among HIV-infected persons. It has also been shown to predict morbidity, including hospitalizations and medical intensive care unit admissions, and correlate with HIV-related chronic inflammation. Because frailty and the VACS Index predict the same outcomes, the VACS Index has been used in two recent studies as a surrogate marker to identify frail HIVinfected persons. Another study has also shown that the median VACS Index scores of frail HIV-infected persons were significantly higher compared to nonfrail individuals. Despite these data, the association of the VACS Index with frailty independent of other frailty predictors has not yet been demonstrated. Furthermore, it is unknown whether Washington University School of Medicine, St. Louis, Missouri. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. University of Minnesota, Hennepin County Medical Center, Minneapolis, Minnesota. Miriam Hospital, Providence, Rhode Island. Denver Infectious Disease Consultants, Denver, Colorado. AIDS RESEARCH AND HUMAN RETROVIRUSES Volume 31, Number 3, 2015 a Mary Ann Liebert, Inc. DOI: 10.1089/aid.2014. 0225