We performed a retrospective case-control study of HIV-positive patients seen from January 1996 to December 2009 to evaluate the impact of HIV suppression and exposure to specific ARVs on the incidence of CHD. Results: Cases (n = 68) were HIV-positive with evidence of CHD. Two age- and sex-matched HIV-positive controls (n = 136) without a diagnosis of CHD were assigned for each case. The cumulative incidence of CHD in the period covered by the study was 3.8 , with an incidence of 8.5 cases per 1000 patient-years of follow up. Cases had an increased likelihood of having hypertension (odds ratio (OR): 6.62, P <0.001), a family history of CHD (OR: 5.82, P <0.001), lower high-density lipoprotein levels (OR: 0.28, P = 0.025) and higher Framingham risk scores compared with controls. Following adjustment for traditional cardiovascular risk factors, the presence of CHD was significantly associated with the current use of abacavir (OR: 2.10, P = 0.03). Protease inhibitor therapy, HIV viral load and duration of known HIV infection were not predictive of CHD in our patient population. Our data add to the evidence that abacavir use is associated with CHD in HIV-positive patients in Australia.