With improved and highly active antiretroviral therapy (HAART) the average life span of HIV infected individuals has increased tremendously. HIV infections can now be managed with HAART for years making it a chronic disease much in line with others like diabetes or high blood pressure. However the increasing use of HAART therapy for HIV management has also revealed a growing concern for the side effects associated with this treatment regimen. The two groups of drugs currently at the forefront of HAART therapy namely Nucleoside Reverse Transcriptase inhibitors (NRTI) and Protease inhibitors (PI) are known to induce toxicities that lead to cardiovascular complications. While NRTIs are known to directly affect cardiac cells via their effect on mitochondria; the PIs have more indirect effects through alteration of lipid metabolism leading to dyslipidemia, a predisposing factor for atherosclerosis and heart disease. In this review, we provide a summary of the mechanism of cardiovascular complications that are associated with HIV infection as well as long term treatment with HAART.