The Impact of Ethnicity/Race on the Association Between the Veterans Aging Cohort Study (VACS) Index & Neurocognitive Function among HIV-Infected Persons

The Veterans Aging Cohort Study (VACS) Index was developed as a risk index for health outcomes in HIV, and it has been consistently associated with mortality. It shows a significant, yet relatively weak, association with neurocognitive impairment, and little is known about its utility among ethnic/racial minority groups. 

We examined whether the association between the VACS Index and neurocognition differed by ethnic/racial group. Participants included 674 HIV-infected individuals (369 non-Hispanic whites, 111 non-Hispanic blacks, and 194 Hispanics). 

Neurocognitive function was assessed via a comprehensive battery. Scaled scores for each neurocognitive test were averaged to calculate domain and global neurocognitive scores. Models adjusting for demographics and HIV disease characteristics not included in the VACS Index showed that higher VACS Index scores (indicating poorer health) were significantly associated with worse global neurocognition among non-Hispanic whites. This association was comparable in non-Hispanic blacks, but nonsignificant among Hispanics (with similar results for English and Spanish speaking). 

We obtained comparable findings in analyses adjusting for other covariates (psychiatric and medical comorbidities and lifestyle factors). Analyses of individual neurocognitive domains showed similar results in learning and delayed recall. For other domains, there was an effect of the VACS Index and no significant interactions with race/ethnicity. Different components of the VACS Index were associated with global neurocognition by race/ethnicity. 

In conclusion, the association between the VACS Index and neurocognitive function differs by ethnic/racial group. Identifying key indicators of HIV-associated neurocognitive impairment by ethnic/racial group might play an important role in furthering our understanding of the biomarkers of neuroAIDS.

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By:   Marquine MJ1, Sakamoto M2, Dufour C3, Rooney A2, Fazeli P4, Umlauf A2, Gouaux B2, Franklin D2, Ellis R5, Letendre S3, Cherner M2, Heaton RK2, Grant I2,Moore DJ2; HNRP Group.

• 1Department of Psychiatry, University of California, San Diego, CA, USA. mmarquine@ucsd.edu.
• 2Department of Psychiatry, University of California, San Diego, CA, USA.
• 3Department of Medicine, University of California, San Diego, CA, USA.
• 4Psychology Department, University of Alabama, Birmingham, CA, USA.
• 5Department of Neurosciences, University of California, San Diego, CA, USA. 

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