Body mass index (BMI)—a ratio of weight to height—may be a poor measure of cardiovascular disease (CVD) risk for people with HIV, underscoring the importance of more comprehensive screening. Weight gain is a known predictor of CVD, and excess visceral fat within the abdomen—indicated by a large waist circumference—is more harmful than subcutaneous fat under the skin. Researchers looked at associations between BMI, excess visceral abdominal fat (EVAF) according to CT scans and CVD risk in 170 people with viral suppression on antiretroviral therapy. As expected, people with obesity (BMI above 30) were most likely to have excess visceral fat. But EVAF was also seen in 47% of those classified as overweight (BMI 25 to 29.9) and even in 43% of those classified as normal weight (BMI of 20 to 24.9). People with more visceral abdominal fat had higher 10-year cardiovascular risk scores than those without EVAF regardless of BMI. CT scans are expensive and not readily available from primary care providers, but waist measurement is a feasible alternative.