Background: Non-calcified coronary artery plaque (NCAP) might be an important predictor of cardiovascular events; however, few studies have directly measured NCAP in HIV-infected individuals. Methods: We completed a prospective cross-sectional evaluation of NCAP and coronary calcium scores using computed tomography angiography in HIV-infected patients (n=26) without known coronary artery disease (CAD), but who had one or more CAD risk factor(s), and compared them with controls matched on age, race, sex, body mass index and Framingham Risk Score (n=26). Results: There was no difference in coronary calcium scores (114 ±218 versus 124 ±298; P=0.89) or NCAP volume (65 ±86 mm 3 versus 63 ±82 mm 3; P=0.38) between HIV-infected patients and controls, respectively. Among HIV-infected patients, lower CD4 + T-cell count was associated with increased NCAP volume (r=-0.52, P=0.006). The CD4 + T-cell count remained a significant predictor of NCAP in a multivariate analysis that adjusted for age and duration of antiretroviral therapy. Conclusions: Plaque burden is similar between HIVinfected and uninfected individuals when matched on traditional CAD risk factors; however, immune function might mediate the development of atherosclerosis in HIV infection.