In an analysis of data from patients receiving routine clinical care in Fibrotic Liver Disease Consortium health systems, we found that the prevalence of PBC increased from 2004 through 2014, despite steady incidence. Patient demographic and clinical characteristics, as well as UDCA treatment, affected mortality.

Importance The Universal Definition of Myocardial Infarction divides myocardial infarctions into different types. Type 1 myocardial infarctions result spontaneously from atherosclerotic plaque instability, whereas Type 2 myocardial infarctions occur in the setting of oxygen demand/supply mismatch such as with severe hypotension. Type 2 myocardial infarctions are uncommon in the general population but the frequency of Type 2 myocardial infarctions in HIV-infected individuals is unknown. Objective To characterize myocardial infarctions including type; identify causes for Type 2 myocardial infarctions, and compare demographic and clinical characteristics among HIV-infected individuals with Type 1 vs. Type 2 myocardial infarctions. Setting/Design Longitudinal HIV clinical care cohort at 6 U.S. sites. Events Potential myocardial infarctions from 1996–2014 were identified in the centralized data repository using diagnoses and cardiac biomarkers. Sites assembled de-identified packets including physician notes, ECGs, procedure and clinical laboratory results. Two physician experts adjudicated each event, categorizing each definite/probable myocardial infarction as a Type 1 or Type 2 myocardial infarction, and identifying Type 2 myocardial infarction causes. Results Among 571 definite/probable myocardial infarctions, 288 (50%) were Type 2; sepsis and recent cocaine/crack use were the most common causes (35% and 14% of Type 2 myocardial infarctions, respectively). Individuals with Type 2 myocardial infarctions were younger on average and had lower CD4 cell counts, lipid levels, and Framingham risk scores than those with Type 1 myocardial infarctions. Limitations Missing events or ascertainment bias is always a concern although we used both diagnoses and biomarkers to minimize this as much as possible. In addition, although we used a standardized approach with multiple expert adjudicators, distinguishing MI type with certainty can be difficult and there may be some misclassification of type. Conclusions/Relevance Approximately half of myocardial infarctions among HIV-infected individuals were Type 2. Type 2 myocardial infarctions were caused by heterogeneous clinical conditions including sepsis and cocaine/crack use. Demographic characteristics and cardiovascular risk factors among those with Type 1 and Type 2 myocardial infarctions differed, suggesting the need to specifically consider type among HIV-infected individuals to further understand myocardial infarction outcomes and to guide prevention and treatment.

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We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26%) were definite/probable MIs. Almost as many secondary (48%) as primary (52%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78% had elevated troponin concentrations (positive predictive value = 57%, 95% confidence interval: 52, 62); however, only 44% had clinical diagnoses of MI (positive predictive value = 45%, 95% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.