Anchalee Avihingsanon b,h , the HIV-NAT 006/207 study team Objectives: HIV infection is associated with ectopic fat deposition, which leads to chronic inflammation and cardiometabolic dysregulation. We assessed the epicardial adipose tissue (EAT) volume and its associated factors among people with HIV (PWH).Design: A cross-sectional study.Methods: We conducted a cross-sectional study among PWH aged at least 50 years and age-matched and sex-matched HIV-negative older individuals in Bangkok, Thailand. Participants underwent a noncontrast, cardiac computed tomography (CT) scan to assess coronary artery calcium (CAC) score and EAT between March 2016 and June 2017. Multivariate linear regression analyses were used to investigate HIV-related factors, cardiac and metabolic markers associated with EAT volume.Results: Median age was 55 years [interquartile range (IQR) 52-60] and 63% were men. Median duration of antiretroviral therapy (ART) was 16 years with 97% had HIV-1 RNA less than 50 copies/ml and median CD4 þ cell count of 617 cells/ml. Median EAT volume was significantly higher in cm 3 ] than HIV-negative individuals [93 (IQR 69-117) cm 3 ], P ¼ 0.022. In adjusted model, factors associated with EAT volume included male sex (P ¼ 0.045), older age (P < 0.001), abnormal waist circumference (P < 0.001) and HOMA-IR (P ¼ 0.01). In addition, higher CAC score was independently associated with EAT volume. Higher mean EAT volume was seen in PWH with severe liver steatosis than those without steatosis (P ¼ 0.018). In adjusted PWH-only model, duration of HIV was significantly associated with higher EAT volume (P ¼ 0.028). Conclusion:In an aging cohort, PWH had higher EAT volume than HIV-negative controls. EAT was also independently associated with central fat accumulation, insulin resistance, liver steatosis and CAC score.