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BACKGROUND HIV increases risk of atherosclerosis and cardiovascular diseases (CVD). This risk maybe even higher in adult survivors of perinatal HIV infection due to prolonged exposure to HIV and its treatments. Nutritional deprivation in early life may further increase CVD risk. SETTING Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone. METHODS This study examined dyslipidemia in 18-24 year-olds with perinatally-acquired HIV with and without linear growth retardation ("stunting"). Anthropometry and lipid profiles were measured following a minimum 8-hour fast. Stunting was defined by a height-for-age z-score <2 standard deviations below the mean. Dyslipidemia was defined by non-HDL-C ≥130 mg/dL, LDL-C ≥ 100mg/dL, or HDL <40 mg/dL for males or <50 mg/dL for females. We utilized logistic regression to determine whether dyslipidemia was associated with stunting while adjusting for demographic and HIV treatment variables. RESULTS Of 107 young adults (46 males; 61 females) enrolled, 36 (33.6%) were stunted. Prevalence of dyslipidemia was 11.2%, 24.3%, and 65.4% for high non-HDL-C, high LDL-C, and low HDL-C, respectively. In univariable analysis, being stunted was associated with elevated LDL-C (OR 2.52; 95% confidence interval [CI] =1.02-6.25) but not with elevated non-HDL-C (OR=2.17; 95% CI = 0.65-7.28) nor with low HDL-C (OR=0.75; 95% CI = 0.33-1.73). The association between stunting and elevated LDL-C (OR=4.40; 95% CI = 1.49-12.98) remained significant after controlling for measured confounders. CONCLUSION Dyslipidemia was common among perinatally HIV-infected youth and those with evidence of early nutritional deprivation were more likely to have elevated LDL-C.