The introduction of HAART (highly active antiretroviral therapy) has made a tremendous impact on the management of human immunodeficiency virus infection/acquired immunodeficiency syndrome. However, its use is associated with important complications, which resemble those of the metabolic syndrome in the general population (dyslipidemia, insulin resistance, impaired glucose tolerance, lipodystrophy). As a result, vascular risk is likely to increase, as suggested by surrogate measures such as carotid intima/media thickening and endothelial dysfunction. Large prospective cohort studies have confirmed that vascular risk rises for each year of HAART treatment. Until metabolically neutral drugs are introduced, it is important to treat vascular risk factors in this at-risk population. This represents an important challenge to the physician given the often severe metabolic problems and the potential for drug interactions...