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Objectives: We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all‐cause mortality as a secondary outcome, after hospitalization for ACS among HIV‐infected and HIV‐uninfected individuals. Methods: We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV‐infected and HIV‐uninfected adults discharged after ACS hospitalization [types: ST‐elevation myocardial infarction (STEMI), non‐STEMI, or unstable angina] during 1996–2010. We compared the outcomes of ACS recurrence and all‐cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV‐uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors. Results: Among 226 HIV‐infected and 86 321 HIV‐uninfected individuals with ACS, HIV‐infected individuals had a similar risk of ACS recurrence compared with HIV‐uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76‐1.54]. HIV infection was independently associated with all‐cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81–3.52). In CD4‐stratified models, post‐ACS mortality was higher for HIV‐infected individuals with CD4 counts of 201–499 cells/μL (HR 2.64; 95% CI 1.66–4.20) and < 200 cells/μL (HR 5.41; 95% CI 3.14–9.34), but not those with CD4 counts ≥ 500 cells/μL (HR 0.67; 95% CI 0.22–2.08), compared with HIV‐uninfected individuals (P trend < 0.001). Conclusions: HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All‐cause mortality was higher among HIV‐infected compared with HIV‐uninfected individuals, but there was no excess mortality risk among HIV‐infected individuals with high CD4 counts. [ABSTRACT FROM AUTHOR]