The Authors Reply

We appreciate the points made by Lifson et al. (1) regarding our study (2). We agree that standard definitions, multiple reviewer adjudication, and clinical judgement on the part of reviewers are all necessary for myocardial infarction (MI) adjudication. These were key strengths of our study. We also wholeheartedly agree with Lifson et al. on the importance of reviewing the primary data and not just case report forms. In fact, we avoid case report forms entirely, and reviews are entirely based on primary data.

We agree with Lifson et al. regarding the benefits of being able to categorize events based on degree of diagnostic certainty: We used the categories of definite and probable. We would further highlight the importance of distinguishing primary spontaneous MI events from events that occur secondarily to other clinical syndromes, such as sepsis causing severe hypotension. Secondary MIs are categorized as type 2 MIs according to the universal MI definition (3). They have treatment implications distinct from those of primary MIs, and we have found them to be very common in persons with human immunodeficiency virus (approximately half of all events).

We thank Lifson et al. for sharing their “INSIGHTs” with us.