Antiretroviral drugs are the cornerstone of HIV/AIDS management, and they may be associated with insulin resistance and dyslipidemia, but those are not the only factors likely involved in the increased CVD risk seen in HIV-infected patients. Traditional risk factors, such as increased rates of smoking, may be increased in these patients; HIV itself may affect traditional risk factors, including lipid profiles; and/or there may be increased underlying inflammation or endothelial dysfunction. How HIV affects the heart and vasculature as a whole in the presence of antiretroviral therapy (ART) is not fully known, but left ventricular (LV) dysfunction is clinically common, and pulmonary arterial hypertension can occur in 1 of every 200 HIV-positive adults, most often in patients without advanced HIV disease. In contrast to primary pulmonary hypertension (PPH), in which there is a female predominance, males are more affected by pulmonary arterial hypertension (PAH) associated with HIV infection (HIV-PAH). Although HIV-PAH shares several clinical and pathological features with PPH, it has decreased 1-year survival rates (51%) compared to rates in a National Institutes of Health registry for PPH (68%) (14). Patients with HIV-PAH have worse survival than do HIV-infected patients without PAH and often die from conditions related to the pulmonary hypertension, not the HIV infection per se. Therefore, prompt diagnosis and initiation of specific therapy such as a prostacyclin (epoprostenol) or the dual endothelin receptor antagonist bosentan is crucial (15). Isolated diastolic dysfunction may be an early sign of CVD in both the general population and HIV-infected patients. A recent, albeit small, study reported an unexpectedly high prevalence of diastolic dysfunction (37%) in a cohort of young (median age 38 years), asymptomatic HIV-infected patients at otherwise low risk for CVD (16). Consequently, although there are currently no recommendations for routine screening echocardiograms of this population, these data suggest such additional evaluations may be warranted for particular patients.