Background: Persistent vascular inflammation has been implicated as an important cause for a higher prevalence of cardiovascular disease (CVD) in HIV-infected adults. In several populations at high risk for CVD, vascular 18Fluorodeoxyglucose ( 18FDG) uptake quantified using 3D-positron emission-computed tomography (PET-CT) has been used as a molecular level biomarker for the presence of metabolically active proinflammatory macrophages in rupture-prone early atherosclerotic plaques. We hypothesized that 18FDG PET-CT imaging would detect arterial inflammation and early atherosclerosis in HIV-infected adults with modest CVD risk. Methods. We studied 9 HIV-infected participants with fully suppressed HIV viremia on antiretroviral therapy (8 men, median age 52yrs, median BMI 29kg/m 2, median CD4 count 655 cells/L, 33% current smokers) and 5 HIV-negative participants (4 men, median age 44yrs, median BMI 25kg/m 2, no current smokers). Mean Framingham Risk Scores were higher for HIV-infected persons (9% vs. 2%, p<0.01). 18FDG (370MBq) was administered intravenously. 3D-PET-CT images were obtained 3.5hrs later. 18FDG uptake into both carotid arteries and the aorta was compared between the two groups. Results: Right and left carotid 18FDG uptake was greater (P<0.03) in the HIV group (1.77 0.26, 1.33 0.09 target to background ratio (TBR)) than the control group (1.050.10, 1.030.05 TBR). 18FDG uptake in the aorta was greater in HIV (1.50 0.16 TBR) vs control group (1.240.05 TBR), but did not reach statistical significance (P=0.18). Conclusions: Carotid artery 18FDG PET-CT imaging detected differences in vascular inflammation and early atherosclerosis between HIV-infected adults with CVD risk factors and healthy HIV-seronegative controls. These findings confirm the utility of this molecular level imaging approach for detecting and quantifying glucose uptake into inflammatory macrophages present in metabolically active, rupture-prone atherosclerotic plaques in HIV infected adults; a population with increased CVD risk. © 2012 Yarasheski et al.; licensee BioMed Central Ltd.