Globally, 37 million people are living with the HIV virus.1 Since the year 2000, the number of individuals with access to antiretroviral therapy (ART) has significantly increased from 700,000 to over 16 million.1,2 Wide-spread ART use has halved the HIV-related mortality rate, from an estimated 2 million deaths in 2005 to 1 million in 2016.1,2 During the same time period though, cardiovascular disease mortality rates more than doubled in people living with HIV (PLWH).3 Hypertension, the leading risk factor for mortality worldwide, is a growing problem in HIV-infected adults.4–11 HIV-infected adults on ART have a higher prevalence of hypertension when compared with HIV-uninfected individuals.4–6,12–15 A recent meta-analysis of data from around the globe demonstrated that 35% of all HIV-infected adults on ART have hypertension, compared to an estimated 30% of HIV-uninfected adults.6 Among ART-experienced individuals older than 50 years, more than 50% have hypertension.6 In addition, HIV-infected adults with hypertension have a higher risk of cardiovascular events and all-cause mortality than HIV-uninfected adults with hypertension or HIV-infected adults with normal blood pressure.8,13,16–18 A prospective cohort study of over 80,000 HIV-infected and uninfected American veterans followed over a median six-year period, for example, found that HIV-infected adults with hypertension had a 2-fold higher risk of incident acute myocardial infarction as compared with HIV-uninfected adults with hypertension.17 Although the epidemiologic problem of hypertension in HIV-infected adults is well defined,6,7,9 fewer studies have evaluated the pathophysiologic mechanisms leading to hypertension in PLWH. Traditional cardiovascular risk factors explain some, but not all, of the increased hypertension risk among HIV-infected adults.14,19,20 A number of virologic- and treatment-related factors have been implicated, among them chronic inflammation, immune reconstitution, and lipodystrophy, all of which uniquely influence common downstream pathways such as the sympathetic and renin-angiotensin-aldosterone systems.21–25 Therefore, in this review we explore the mechanisms of hypertension in HIV infection. Understanding the mechanisms of hypertension in HIV-infected adults is important for two reasons. First, increased knowledge of the mechanisms of hypertension in HIV-infected adults will be critical to public health efforts to prevent hypertension, cardiovascular disease and premature mortality in HIV-infected adults. Second, the study of HIV-specific pathophysiology of hypertension may reveal important immunologic and inflammatory mechanisms of hypertension in the general population. Our review is not intended to be a comprehensive analysis of the numerous mechanisms of hypertension. Instead, we have focused on those mechanisms which might be particularly important in HIV-infected adults. An enhanced understanding of these processes may thereby aid in the development of new preventative and therapeutic interventions for hypertension in HIV-infected adults and for the general population.