Highly active antiretroviral therapy has led to significant declines in infection-related mortality in HIV-infected patients. Cardiovascular disease has emerged as a leading cause of morbidity and mortality in this population, and is likely related to both an increased prevalence of traditional cardiovascular risk factors and HIV-specific factors associated with antiretroviral therapy, chronic inflammation, and direct viral effects. Accurate clinical assessment of cardiovascular risk in HIV-infected patients is a critical challenge now facing practitioners. Multiple modes of noninvasive vascular imaging are available to enhance the ability to identify patients at high cardiovascular risk, and may ultimately assist in targeting use of intensive medical therapy to reduce cardiac events in this population. This review will examine several of these noninvasive tests and is intended to aid practitioners making cardiovascular risk assessments in HIV patients.