Rationale: The prevalence of HIV-associated pulmonary arterial hypertension has not been evaluated since introduction of combined highly active anti-retroviral treatments. Objective: To establish the current prevalence of pulmonary arterial hypertension in a large HIV-positive population. Methods: Prospective study conducted in 7,648 consecutive HIV-positive adults in 14 HIV clinics in France. Pulmonary arterial hypertension was identified through screening with a predefined algorithm. Patients with dyspnea unexplained by other causes underwent transthoracic Doppler echocardiography. Pulmonary arterial hypertension was suspected if peak velocity of tricuspid regurgitation was >2.5 m/s and was confirmed by right heart catheterization. Measurements and main results: Pulmonary arterial hypertension was diagnosed if mean pulmonary artery pressure was 25 mmHg at rest (with pulmonary capillary wedge pressure 15 mmHg) or 30 mmHg on exercise. 739 patients had dyspnea, of whom 312 had exclusion criteria, and 150 refused to participate. Among the remaining 277, 30 had known pulmonary arterial hypertension and 247 had unexplained dyspnea and underwent echocardiography; pulmonary arterial hypertension was suspected in 18 and confirmed in 5 to give a total of 35 cases. The prevalence was thus 0.46% [95% CI 0.32%-0.64%]. All new cases had relatively milder pulmonary arterial hypertension. Conclusions: The prevalence of HIV-associated pulmonary arterial hypertension is about the same as in the early 1990s. Given the current good long-term prognosis of HIV patients, the severity of pulmonary arterial hypertension in HIV-infected patients and the absence of predictive factors, careful screening for pulmonary arterial hypertension is warranted for patients with unexplained dyspnea.