Page 52 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 23 of 26 Guideline

What to do: Review supportive and palliative care planning:
• Review current treatment and medication so that the patient receives optimal care.
• Consider referral for specialist assessment if symptoms or needs are complex and difficult to manage.
• Agree to current and future care goals and a care plan with the patient and his or her family.
• Plan ahead if the patient is at risk of loss of capacity.
• Record, communicate and coordinate the care plan.

Source: The Support and Palliative Care Indicator Tools (SPICT ) [homepage on the Internet]. University of Edinburgh, SPICT ; 2015.[cited 03
TM
TM
Nov 2019] Available from: http://www.spict.org.uk

Appendix 5: The established Veterans Aging Cohort Study index scoring scheme

The VACS Index utilises age, routine laboratory markers such as CD4 count, HIV-1 RNA, haemoglobin, platelets, AST and ALT, creatinine and
markers of liver impairment (viz. FIB-4 and HCV status).

TABLE 1-A5: A Restricted VACS index. The risk of mortality of PLWHIV on at least
12 months of ART increases with a rising VACS score. (Max. vacs score= 164). 30
Component Level VACS index points assigned
Age (years) < 50 0
50–64 12
≥ 65 27
CD4 count (cell/mm ) 3 ≥ 500 0
350–499 6
200–349 6
100–199 10
50–99 28
< 50 29
Viral load (copies/mL) < 500 0
500-log1 × 10 5 7
≥ log1 × 10 5 14
Haemoglobin (g/dL) ≥ 14 0
12–13.9 10
10–11.9 22
< 10 38
FIB-4† < 1.45 0
1.45–3.25 6
> 3.25 25
eGFR (mL/min) ‡ ≥ 60 0
45–59.9 6
30–44.9 8
< 30 26
Hepatitis C co-infection Yes 5
No 0
Source: Tate JP, Justice AC, Hughes MD, et al. The VACS index: An internationally generalizable
risk index for mortality after one year of antiretroviral therapy. AIDS. 2013;27(4):563–572.
https://doi.org/10.1097/QAD.0b013e32835b8c7f
VACS, Veterans Aging Cohort Study.
†, FIB-4 = age (year) × AST/ platelet in 100/L × √ALT.
‡, eGFR = 186.3 × (creatinine) -1.154 × (age) -0.203 × (0.742 for women) × (1.21 for black
individuals).

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