Despite these limitations, the estimated incidence of myocardial infarction in our cohort would have been 1.75 cases per 1000 patient-years, which is not different from that reported in major cohorts such as the French Hospital Database on HIV ANRS Cohort CO4 (1.24 cases per 1000 patient-years) [4], although it is lower than that for the D:A:D study (3.3 cases per 1000 person-years) [6]. In addition, 42% of the HIV+/ACS group

in our study were women, a percentage that is twice as high as that reported in a recent meta-analysis [41]. As a consequence of the retrospective nature of our analysis, all HIV-infected patients who experienced myocardial infarction in our cohort were not necessarily included in this study. In fact, all 14 patients excluded because of the unavailability of data were men. Nevertheless, Cytoskeletal Signaling inhibitor our study was designed to control for age and gender, so see more no biases from these variables should

be expected. As in any other retrospective study, we had no information available on a number of variables of potential interest for ACS in both HIV-positive and HIV-negative participants. One of these was the use of cocaine, as this factor has been recently associated with the risk of ACS in our area [42], particularly in persons younger than 30 years (25%) relative to those aged 45–50 years (5.5%). In our study, the mean age of participants was 53 years, and 11% of the HIV+/ACS group admitted the use of cocaine. This prevalence

was higher than that in the HIV+/noACS group (3%) (P = 0.0591), but we had no data on cocaine use in non-HIV-infected persons. Because HIV-positive patients commonly had regular follow-up data, some variables were available in HIV-positive but not HIV-negative participants. Our study also has some notable strengths. It is the first study, to our knowledge, to assess the PARs of common traditional cardiovascular risk factors in the HIV-positive population. We compared, as accurately as possible, the PARs of those factors between HIV-positive and HIV-negative adults, matching for age and gender in both HIV-positive and HIV-negative participants, and the known duration of HIV infection in HIV-positive Mannose-binding protein-associated serine protease participants and calendar date of ACS diagnosis in HIV-negative participants. Moreover, we took particular care to use similar working definitions of risk factors and outcomes in both HIV-positive and HIV-negative populations. In conclusion, in our study, the contribution of smoking to ACS in HIV-positive adults was almost twice that in HIV-negative adults, and the contribution of smoking in the HIV-positive population was greater than those of diabetes and hypertension. If our results are confirmed, a substantial reduction in the incidence of ACS in HIV-positive adults should be expected if the contribution of smoking can be eliminated.