Introduction The history of HIV/AIDS in Romania is different compared to the rest of the world. Here, the vast majority of HIV-positive patients have been infected since infancy and have been receiving HAART treatment for at least ten years. This situation is a unique environment to check for long-term cardiac involvement in HIV-positive patients with a long evolution of the infection. Methods A group of 40 HIV-positive patients were randomly selected to undergo an echocardiogram to check for cardiac involvement. Data collection took place at the National Institute for Infectious Diseases "Prof.Dr. Matei Balş" in Bucharest, Romania, from September 2011 to February 2012. Patients were examined and compared based on cardiovascular risk factors and disease risk factors described in field literature, including: age, gender, blood pressure, lipid profile, glucose, HbA1c, lifestyle habits, time from infection, duration of treatment and drug class use. Results The median age of patients was 23, with a mean time from infection of 20.85 years and a duration of treatment of 15.9 years. Out of the 40 patients included in the study, 15 (37.5%) had cardiac involvement such as hyperkinetic syndrome, hypertrophy, atheroma, pulmonary hypertension or overlapping syndromes. The main risk factors were: male gender (OR 3.187, 90%CI 1.038-9.779), high cholesterol (>200 mg/dL) or smoking (OR 2.538, 90%CI 0.789-8.163), with a high risk for cardiac involvement in patients that were smokers and also had high levels of cholesterol (OR 5.75, 90%CI 1.263-26.169). Conclusion An important aspect of this study is that both major risk factors identified are modifiable to an extent, and while cholesterol levels can be controlled with lipid-lowering medication, smoking can be stopped with or without replacement therapy. We need to stress on the importance of smoke-reducing policies and, particularly, encouraging young patients to not start smoking.