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BACKGROUND Relatively little is known about the frequency and factors associated with miscarriage among women living with HIV. OBJECTIVE To evaluate factors associated with miscarriage among women enrolled in the Women's Interagency HIV Study (WIHS). STUDY DESIGN We conducted an analysis of longitudinal data collected from October 1, 1994 to September 30, 2017. Women who attended at least two WIHS visits and reported pregnancy during follow-up were included. Miscarriage was defined as spontaneous loss of pregnancy before 20 weeks of gestation based upon self-report assessed at biannual visits. We modeled the association between demographic, behavioral, and clinical covariates and miscarriage (versus live birth) for women overall and stratified by HIV status using mixed model logistic regression. RESULTS Similar proportions of women living with and at without HIV experienced miscarriage (37% and 39%, respectively, p=0.638). In adjusted analyses, smoking tobacco (adjusted odds ratio, aOR=2.0), alcohol use (aOR=4.0), and marijuana use (aOR=2.0) were associated with miscarriage. Among women living with HIV, low HIV viral load (<4 log10 copies/mL) (aOR=0.5) and protease inhibitor (PI) (aOR=0.4) versus non-use of combination antiretroviral therapy (cART) use were protective against miscarriage. CONCLUSIONS We did not find increased odds of miscarriage among women living with HIV compared to uninfected women, however poorly controlled HIV-infection was associated with increased miscarriage risk. Higher miscarriage risk among women exposed to tobacco, alcohol, and marijuana highlight potentially modifiable behaviors. Given previous concern about ART and adverse pregnancy outcomes, the novel protective association between PIs compared to non-cART and miscarriage in this study is reassuring.