Limited information on the effect of antiretroviral treatment (ART) on vascular function in South Africans of African descent living with human immunodeficiency virus (HIV) is available. The relationship between ART, vascular function and cardiovascular risk factors in South Africans of African ancestry with HIV was therefore studied. This cross-sectional study recruited 146 HIV-positive individuals on ART (HIVART), 163 HIV-positive individuals not on ART (HIVART) and 171 individuals without HIV (HIV) in Mthatha, Eastern Cape Province of South Africa. Flow-mediated dilation (FMD) test was performed to assess endothelial function. Anthropometry and blood pressure parameters were measured. Lipid profile, glycaemic indices, serum creatinine as well as CD4 count and viral load were assayed in blood. Urinary albumin to creatinine ratio (ACR) was determined as a marker of cardiovascular risk. Obesity and albuminuria were positively associated with HIV, and HIVART participants had significantly higher HDL cholesterol. Dyslipidaemia markers were significantly higher in hypertensive HIVART participants compared with the controls (HIVART and HIV participants). FMD was not different between HIVART participants and the controls. Moreover, HIVART participants with higher FMD showed lower total cholesterol and LDL cholesterol comparable to that of HIV and HIVART participants. A positive relationship between FMD and CD4 count was observed in HIVART participants. In conclusion, antiretroviral treatment was associated with cardiovascular risk factors, particularly dyslipidaemia, in hypertensive South Africans of African ancestry with HIV. Although, ART was not associated with endothelial dysfunction, flow-mediated dilatation was positively associated with CD4 count in HIV-positive participants on ART.