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Introduction: Human immunodeficiency virus (HIV) infection has become a chronic condition due to antiretroviral therapy (ART), which has increased life expectancy but is also associated with a higher burden of cardiovascular disease (CVD) in people living with HIV (PLHIV). Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk biomarker; however, its role in PLHIV remains unclear. This study evaluated the relationship between Lp(a) and cardiovascular risk and explored its association with subclinical coronary artery disease. Materials and Methods: Cross-sectional study included PLHIV aged ≥40 years on stable ART with sustained viral suppression. Individuals with prior cardiovascular events or type 1/advanced type 2 diabetes were excluded. Lp(a) levels and clinical data were collected. Cardiovascular risk was estimated using validated clinical scores; participants with ≥10% risk underwent coronary computed tomography angiography (CTA) to assess coronary anatomy. Results: A total of 69 patients were included (81% male; mean age 54 years). The mean Lp(a) level was 66.7 nmol/L; 29% had ≥75 nmol/L and 23% ≥125 nmol/L. A non-significant inverse correlation was observed between Lp(a) levels and ART duration (r = –0.209; p = 0.08). Among those with elevated Lp(a), a higher proportion had vulnerable plaques on CTA, although this was not statistically significant. Conclusions: In this cohort of virologically suppressed PLHIV, an inverse trend was observed between ART duration and Lp(a) levels. In the subgroup of moderate-to-high cardiovascular risk, the prevalence of coronary plaque vulnerability features was higher among those with elevated Lp(a), highlighting a possible link between Lp(a) and subclinical atherosclerosis in this population.