Coronary heart disease rates are expected to be higher as the human immunodefi ciency virus (HIV) population ages. Controversy still exists as to whether HIV infection per se or its treatment increases the rate of coronary heart disease. Highly active antiretroviral therapy (HAART) has been associated with the occurrence of cardiovascular events in HIV-infected patients ( 1, 2 ). However, in the Strategies for Managment of Antiretroviral Therapy (SMART) trial, the episodic use of HAART was associated with an increased risk of CVD when compared with continuous HAART use ( 3 ). It is now well-established that atherosclerosis Abstract The capacity of HDL to remove cholesterol from macrophages is inversely associated with the severity of angiographic coronary artery disease . The effect of human immunodefi ciency virus (HIV) infection or its treatment on the ability of HDL particles to stimulate cholesterol effl ux from human macrophages has never been studied. We evaluated the capacity of whole plasma and isolated HDL particles from HIV-infected subjects (n = 231) and uninfected controls (n = 200), as well as in a subset of 41 HIV subjects receiving highly active antiretroviral therapy (HAART) to mediate cholesterol effl ux from human macrophages. Plasma cholesterol effl ux capacity was reduced ( ؊ 12%; P = 0.001) in HIV patients as compared with controls. HIV infection reduced by 27% ( P < 0.05) the capacity of HDL subfractions to promote cholesterol effl ux from macrophages. We observed a reduced ABCA1-dependent effl ux capacity of plasma ( ؊ 27%; P < 0.0001) from HIV-infected subjects as a result of a reduction in the effl ux capacity of HDL3 particles. HAART administration restored the capacity of plasma from HIV patients to stimulate cholesterol effl ux from human macrophages (9.4%; P = 0.04). During HIV infection, the capacity of whole plasma to remove cholesterol from macrophages is reduced, thus potentially contributing to the increased coronary heart disease in the HIV population. HAART administration restored the removal of cholesterol from macrophages by increasing HDL functionality. -El Khoury, P., M. Ghislain,