Highlights

• In this study of middle-aged adults in rural Uganda, we found no difference in the prevalence of abnormal or ischemic electrocardiograms between persons with human immunodeficiency virus (HIV) on stable antiretroviral therapy and HIV-negative comparators.
• Women were more than twice as likely than men to have evidence of myocardial ischemia on electrocardiography, independent of HIV serostatus. This difference persisted after adjustment.
• Additional research is warranted to better evaluate sex-based differences in cardiovascular risk and to further characterize the contributions of HIV cardiovascular disease in this population.