ABTRACT Many sources have highlighted the high incidence of premature cardiovascular events in HIV infected patients. This raises the suspicion of an accelerated aging of the vascular system in this disease characterized by chronic systemic subliminal inflammation and immune dysregulation. Unfortunately all currently available risk assessment algorithms based on traditional risk factors, and even those containing more HIV-specific factors, fail to accurately predict risk in a large proportion of patients. In the general population several models have implemented imaging data to refine risk assessment, and the concept of vascular aging has been of value in improving the performance of these algorithms. It is expected that HIV patients may benefit from a similar approach as it becomes clearer that vascular imaging provides valuable prognostic information in this patient category.