Participants

The VACS is a prospective, multisite cohort of HIV-infected and age-, race/ethnicity-, and clinical site–matched uninfected adults enrolled in the same calendar year in the US Department of Veterans Affairs (VA) system. Participants in VACS have been continually selected for inclusion since 1998 by using an existing validated algorithm from the VA national electronic medical record system.^13,14 For the selected participants, data are extracted from several sources. Demographic, clinical, laboratory, and pharmacy data are obtained from the immunology case registry, the National Pharmacy Benefits Management database, the Decision Support System, the National Patient Care Database, and the VA electronic medical record health factor data set. Cardiovascular disease data are obtained from Medicare, Medicaid, and VA fee-for-service data and from the Ischemic Heart Disease–Quality Enhancement Research Initiative.¹⁵ Death data are obtained from the VA vital status file, the Social Security Administration death master file, the Beneficiary Identification and Records Locator Subsystem, and the Veterans Health Administration Medical Statistical Analysis Systems inpatient data sets.³ Finally, cause of death data are obtained from the National Death Index. The University of Pittsburgh, Yale University, and West Haven VA Medical Center institutional review boards approved this study; we obtained a waiver of consent from West Haven VA Medical Center and the Yale School of Medicine to minimize a loss of privacy and to facilitate this low-risk research given the large sample of HIV-infected veterans. The current analysis was conducted from January 2015 to November 2015.

For the present report, we selected all adults with HIV enrolled in the VACS (N = 27 350), defined as at least 1 inpatient or 2 outpatient International Classification of Diseases, Ninth Revision (ICD-9) codes for HIV in the VA Immunology Case Registry.¹³ The baseline enrollment date was the participant’s first clinic visit on or after April 1, 2003. As described in our earlier work,³ all veterans with prevalent CVD (n = 1206) were excluded using ICD-9 code data from Medicare, Medicaid, and VA fee-for-service files during the baseline period (1998 to the participant’s baseline enrollment date). Our final sample included 26 144 HIV-infected adults, who were followed up from their baseline enrollment date to either an AMI event, death, or the last follow-up date on December 31, 2009.