INTRODUCTION: The Comparative Outcomes and Service Utilization Trends (COAST) study compares health outcomes among People With HIV (PWH) and People Without HIV (PWoH) in British Columbia (BC), Canada. The cohort was recently updated to include persons diagnosed with HIV after March 31, 2013, and expanded to broaden research applications. METHODS: COAST includes PWH and a 10% random sample of the general population without HIV, all aged ≥19. Our study links an HIV registry to healthcare practitioner billing, hospital and emergency department attendance data, prescription drug dispensations, and a cancer registry. Our cohort update included new sampling strategies, adding data on emergency department visits not previously captured, and extending our follow-up period to 28 years (from 1992 to 2020). COAST now includes 17,119 PWH and 615,264 PWoH. FINDINGS TO DATE: COAST has contributed to our understanding of combination antiretroviral therapy (ART) use, health service utilization, chronic diseases, mental health and substance use disorders, and mortality among PWH in BC. Key findings include earlier age at diagnosis of certain chronic conditions, a higher incidence of mood disorders among PWH, and noteworthy shifts in causes of death among PWH on ART. The updated cohort will provide insights into the changing nature of the population living with HIV in BC and serves as a novel foundation for further research. FUTURE PLANS: To explore and extend knowledge of the evolving trends among people living and aging with HIV in BC, regular data linkage updates and the inclusion of additional datasets are scheduled every two years.