People living with HIV (PLWHIV) are at a higher risk of developing coronary artery disease (CAD). We aimed to assess the factors associated with CAD among PLWHIV in Colombia. We conducted a retrospective cohort study based on adults newly diagnosed with HIV, reported to the Colombian HIV/AIDS registry from 2018 to 2021. Baseline demographic and clinical characteristics were compared by age (<50 and ≥ 50 years). Our main outcome was the presence of CAD. Logistic regression models were used to assess the association between traditional and HIV-related factors with CAD. These associations were also evaluated in stratified models by age. Effect measures were odds ratios (OR) and their 95% confidence intervals. Among 36,483 PLWHIV, the frequency of CAD was 0.53% (n = 196). There was a high prevalence of impaired fasting glucose/diabetes mellitus (12.62%), overweight/obesity (27.79%), elevated LDL-c (86.69%), and hypertriglyceridemia (72.76%). Factors associated with CAD included male gender (OR: 2.01, 95% CI: 1.12–3.58), age ≥50 years (OR: 4.96, 95% CI: 3.29–7.45), lipoatrophy or lipodystrophy (OR 5.12, 95% CI: 1.12–23.33), AIDS-defining conditions (OR: 1.83, 95% CI: 1.07–3.12), obesity (OR: 2.95, 95% CI: 1.69–5.10), diabetes mellitus (OR: 2.50, 95% CI: 1.25–4.97), and renal impairment (OR: 3.15, 95% CI: 1.83–5.42). Traditional CAD risk factors are common in PLWHIV. There were traditional and disease-specific factors associated with increased odds of CAD. These findings may aid clinicians and decision-makers in reducing the impact of CAD in PLWHIV.