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Since the advent of effective ART in the 1990's, HIV+ people are living longer and developing chronic diseases including cardiovascular disease that is currently the cause of death in 8%–15% of HIV+ people. HIV+ people have accelerated atherosclerosis and an approximate 50%–70% increase in the risk of myocardial infarction as compared to a comparable, age-matched population. Several factors are thought to contribute to this increased CAD risk including over-representation of traditional risk factors, chronic inflammation, and vascular activation in HIV+ people. However, the importance and interaction of these factors are very poorly understood. This presentation will review the literature on this topic and discuss very recent studies showing that HIV+ people on contemporary ART with viral suppression have severely abnormal coronary endothelial function, a marker of early atherosclerosis and independent predictor of future events, before the development of heart disease. The presentation will review evidence that inflammation may contribute to accelerated atherosclerosis in HIV+ people and discuss new studies investigating contributing mechanisms and potential future therapies for reducing cardiovascular risk in HIV+ people.