About VACS

Veterans Aging Cohort Study (VACS):

Contact Details:

Principal Investigator: Amy C. Justice, MD, PhD

Administrative Coordinator: Angela Consorte, phone 203 932 5711 ext 5309

Cohort Description and Enrollment:

Funded by the National Institute of Medicine (NIH), primarily the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the National Heart, Lung, and Blood Institute, (NHLBI), VACS consists of two ongoing cohorts. The first, assembled from national VA data alone and beginning in 1997, is a “virtual cohort” of >40,000 HIV- positive veterans and a two to one (>80,000) age/race/site matched sample of uninfected controls, used to understand the overall impact of HIV, HIV treatment, and comorbid conditions on morbidity and mortality. At the end of each fiscal year, this cohort is updated to include veterans with new diagnoses of HIV infection and matched controls receiving care in the same fiscal year.

The virtual cohort (VACS VC) is complemented by a prospectively-consented, “living” cohort of veterans with and without HIV infection, currently in care at eight VA medical centers around the country (VACS 8). This in-depth cohort allows us to “get behind” gross associations with outcome, to better understand the likely complex and overlapping etiologies resulting in differences outcome and patient utilization. As in the virtual cohort, enrollment is ongoing. As new veterans present for care with HIV infection they will be offered enrollment, and an age/race/site matched control will be offered enrollment from the general-medicine clinic.

Since 2002, VACS 8 has consented and enrolled >7,000 patients (half HIV-positive, half HIV-negative controls) in Atlanta, Baltimore, the Bronx, Houston, Los Angeles, Manhattan/Brooklyn, Pittsburgh, and Washington, D.C. In addition to having access to complete medical-record information (including pharmacy fills, laboratory data, pathology data, radiology data, and progress notes) and administrative data (including utilization and diagnostic codes), VACS draws from several additional sources of data: (1) patient and provider surveys (quality of life, symptoms, adherence, alcohol use, drug use, health habits) at the time of the visit; (2) telephone interviews providing in-depth data on alcohol use and medication adherence; (3) banked serum, plasma, and blood pellets for future hypothesis testing; (4) The National VA Cancer Registry; (5)The QUERI Myocardial Infarction Registry; (6) The National Death Index Cause of Death File;and (7) Medicaid and Medicare Files for outside utilization.

In depth descriptions of both samples have been published (references below) and can also be found on our website.  VACS welcomes proposals for analyses and sub-studies (forms available on our website).

Data Quality:

Data is closely monitored and has been externally validated for a number of critical variables (see references below).

Population Characteristics:  

Predominantly male, with a majority of the HIV infected sample reporting heterosexual exposure (88%) and a large minority reporting at least some homosexual exposure (48%). Past IV drug use is relatively common (19%) and 45% of HIV infected are co-infected with hepatitis C.  Controls are matched for age, race, and year of active use of VA healthcare.

Important/Recent Publications (from over 150 publications):

Freiberg MS, Chang CC, Skanderson M, McGinnis K, Kuller LH, Kraemer KL, Rimland D, Goetz MB, Butt AA, Rodriguez Barradas MC, et al. The risk of incident coronary heart disease among veterans with and without HIV and hepatitis C. Circ.Cardiovasc.Qual.Outcomes. 2011 Jul 1;4(4):425-32

Crothers K, Huang L, Goulet JL, Goetz MB, Brown ST, Rodriguez-Barradas MC, Oursler KK, Rimland D, Gibert CL, Butt AA, et al. HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era. Am.J.Respir.Crit Care Med. 2011 Feb 1;183(3):388-95

Oursler KK, Goulet JL, Crystal S, Justice AC, Crothers K, Butt AA, Rodriguez-Barradas MC, Favors K, Leaf D, Katzel LI, et al. Association of age and comorbidity with physical function in HIV-infected and uninfected patients: results from the Veterans Aging Cohort Study. AIDS Patient.Care STDS. 2011 Jan;25(1):13-20

Lo RV, III, Lim JK, Goetz MB, Tate J, Bathulapalli H, Klein MB, Rimland D, Rodriguez-Barradas MC, Butt AA, Gibert CL, et al. Validity of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events in the Veterans Aging Cohort Study. Pharmacoepidemiol.Drug Saf. 2011 Jul;20(7):689-99

Butt AA, Chang CC, Kuller L, Goetz MB, Leaf D, Rimland D, Gibert CL, Oursler KK, Rodriguez-Barradas MC, Lim J, et al. Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease. Arch.Intern.Med. 2011 Apr 25;171(8):737-43

Womack JA, Goulet JL, Gibert C, Brandt C, Chang CC, Gulanski B, Fraenkel L, Mattocks K, Rimland D, Rodriguez-Barradas MC, et al. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS.One. 2011 Feb 16;6(2):e17217

Park LS, Tate JP, Justice AC, Lo RV, III, Lim JK, Brau N, Brown ST, Butt AA, Gibert C, Goetz MB, et al. FIB-4 Index Is Associated with Hepatocellular Carcinoma Risk in HIV-Infected Patients. Cancer Epidemiol.Biomarkers Prev. 2011 Nov 22;

Vanasse GJ, Jeong JY, Tate J, Bathulapalli H, Anderson D, Steen H, Fleming M, Mattocks K, Telenti A, Fellay J, et al. A polymorphism in the leptin gene promoter is associated with anemia in patients with HIV disease. Blood. 2011 Nov 17;118(20):5401-8

Sullivan LE, Goulet JL, Justice AC, Fiellin DA. Alcohol consumption and depressive symptoms over time: a longitudinal study of patients with and without HIV infection. Drug Alcohol Depend. 2011 Sep 1;117(2-3):158-63

Tetrault JM, Tate JP, McGinnis KA, Goulet JL, Sullivan LE, Bryant K, Justice AC, Fiellin DA. Hepatic Safety and Antiretroviral Effectiveness in HIV-Infected Patients Receiving Naltrexone. Alcohol Clin.Exp.Res. 2011 Jul 28;10-0277

McGinnis KA, Brandt CA, Skanderson M, Justice AC, Shahrir S, Butt AA, Brown ST, Freiberg MS, Gibert CL, Goetz MB, et al. Validating Smoking Data From the Veteran's Affairs Health Factors Dataset, an Electronic Data Source. Nicotine.Tob.Res. 2011 Dec;13(12):1233-9

Fultz SL, Skanderson M, Mole LA, Gandhi N, Bryant K, Crystal S, Justice AC. Development and verification of a "virtual" cohort using the National VA Health Information System. Med Care. 2006 Aug;44(8 Suppl 2):S25-30. PubMed PMID: 16849965. 

Justice AC, Dombrowski E, Conigliaro J, Fultz SL, Gibson D, Madenwald T, Goulet J, Simberkoff M, Butt AA, Rimland D, Rodriguez-Barradas MC, Gibert CL,Oursler KA, Brown S, Leaf DA, Goetz MB, Bryant K. Veterans Aging Cohort Study (VACS): Overview and description. Med Care. 2006 Aug;44(8 Suppl 2):S13-24. PubMed PMID: 16849964.