Populations living with HIV who access effective antiretroviral therapies are ageing and thus facing chronic disease-related comorbidities. Cardiovascular disease is now a leading cause of morbidity and mortality in the HIV population as in the general population. The increased incidence of cardiovascular complications experienced by the HIV population is due to physiological aging and consequently the increased risk of hypertension, diabetes, and renal failure. Whether HIV itself is an additive and independent risk factor for cardiovascular disease (CVD) remains a central question. If and how HIV impacts the ageing process is an important and related question. The purpose of the present review is to highlight the risk of CVD in the ageing HIV population, particularly concerning atherosclerotic CVD (ASCVD) and heart failure, and to address effective CVD prevention in an aging HIV population at risk of poly-pharmacy.