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Objectives: We evaluated whether ophthalmic artery resistance index (OARI) is related to intima media thickness (IMT) of common carotid artery. Our hypothesis was that OARI could be an index of occlusive carotid artery disease and an early predictor of atherosclerosis in HIV-1 infected patients receiving highly active antiretroviral therapy (HAART). Methods: We enrolled 88 consecutive HIV-1-infected patients in a cross sectional study. All patients were receiving HAART for more than twelve months. OARI and IMT was measured by ultrasonography, using a 7.5 mHz linear probe. Multiple regression analysis was used to assess the independent association between the carotid IMT and OARI adjusting for various risk factors. The most discriminant cutoffs were calculated by receiver operating characteristic (ROC) curves. Results: For all patients OARI correlated well with carotid IMT (r = +0.56, p< 0.0001). Using the average IMT as the dependent variables in regression analysis, OARI was the independent factor associated with carotid IMT. ROC curves indicated that the most discriminant OARI value for predicting a clinically significant increase of IMT was >0.74 (sensitivity 86.7%, specificity 82.2%, AUC 0.87, p=0.0001). Conclusions: Our data indicate that ultrasonographic OARI measure- ment may have a potential to be a marker of increased endothelial damage and it could be used as an early predictor of IMT increase in HIV- 1-infected patients. As a consequence, a periodic screening for vascular resistance indexes should be considered mandatory in HIV-1-infected patients receiving HAART and it could identify patients at major risk to develop cardiovascular disease.