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As part of stroke prevention, especially with vascular symptoms, carotid endarterectomy or carotid stenting are often performed. With apparent increased strokes in adults with HIV, a question arises about the frequency and age of such surgical procedures. Using a very large sample of hospital admissions from the Healthcare Cost and Utilization Project, the age, sex, other demographics, comorbidities, and other related variables were collected from medical records on adults with HIV (HIV+) and without HIV (HIV-) over a 10-year period (2004-2014). Age for the procedures for HIV+ persons was 59 years and 70 years for HIV- persons, which was significant. Male sex, black race, and symptomatic carotid atherosclerotic disease were also more common. In addition over time mean age, frequency of comorbidities and percent with symptomatic disease increased in the HIV+ population. With multivariable analysis, the surgical procedures still occurred about 9 years earlier in HIV+ persons. Although the reasons for the age difference are unclear, the authors emphasize the importance of addressing risks and promoting improved health in order to reduce the impact of carotid disease on strokes in HIV+ adults.