OBJECTIVES: HIV-infected patients are at an increased risk of cardiovascular diseases (CVD), resulting in the need for integration of CVD screening into HIV treatment guidelines. We evaluated different CVD screening strategies in HIV-infected patients with regard to effectiveness, costs, and cost-effectiveness. METHODS: Cost-effectiveness analysis using a microsimulation model reflecting coronary artery disease (CAD), myocardial dysfunction, and heart failure in HIV-positive men. Data sources: Patient-level data from HIV-HEART study, literature, German reimbursement data. Time horizon: Diagnostic phase, lifetime. Perspective: Societal. Interventions: No screening (SOC), ECG+BNP with echocardiography+stress-ECG if pathologic ECG or BNP (“Outpatient”), ECG+BNP+echocardiography+stress-ECG (“Cardiologist”), “Cardiologist” with coronary computed tomography angiography if pathologic echocardiography or stress-ECG (“Cardiologist +”). Outcomes: Diagnostic results, discounted quality-adjusted life expectancy (QALE) and lifetime costs, incremental cost-effectiveness ratio (ICER). RESULTS: The initial CAD prevalence in HIV-infected men aged 40 years was estimated at 5.9%. One-time “Outpatient”, “Cardiologist”, and “Cardiologist +” screenings correctly diagnosed 7, 43, and 48 out of 59 CAD patients per 1,000 patients at €46/person, €109/person, and €429/person, respectively. The expected QALE was estimated at 16.54, 16.56, 16.71, and 16.75 years for SOC, and one-time “Outpatient”, “Cardiologist”, and “Cardiologist +” screenings at mean lifetime costs per patient of €321,348, €322,279, €327,670, and €328,864, respectively. “Outpatient” and “Cardiologist” were extendedly dominated by “Cardiologist +”. The ICER of “Cardiologist +” vs. SOC was €35,791 per quality-adjusted life year (QALY). When screening frequency was varied between one and five years at one-year intervals, “Cardiologist” was extendedly dominated by “Cardiologist +”. The predicted ICERs for the non-dominated strategies as compared to SOC were €34,508, €40,489, and €49,373 per QALY for annual “Outpatient” and “Cardiologist +” at 5- and 4-year intervals, respectively. CONCLUSIONS: Our preliminary analyses suggest that integrating routine CVD screening into HIV treatment guidelines could be clinically beneficial and cost-effective.