NPPB and Myocardial fibrosis: Compared to HIV-uninfected controls, PWH exhibited greater myocardial fibrosis, with an absolute difference in ECVF of 1.2% (95% CI: 0.1%–2.3%). Subgroup analyses showed that this effect was more pronounced in women, with women also having higher odds of elevated NT-proBNP levels (>125 pg/ml; OR: 2.4, 95% CI: 1.0–6.0). Among all PWH, elevated NT-proBNP levels were associated with significantly higher ECV (3.4% higher; 95% CI: 1.3–5.5). These findings suggest that HIV may contribute to increased myocardial fibrosis, particularly among women.