Background and aims According to the report from the World Health Organization (WHO), 1.8 million individuals become HIV infected every year. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. In this study, we aim to measure the prevalence and risk factors for LEAD among HIV infected patients. Methods A cross-sectional study was conducted among 1250 HIV-infected outpatients in Burundi. Inclusion criteria were as follows: age ≥ 20 years, positive HIV status, and currently receiving ART. Clinical data were extracted from Centre records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. We measured their ankle-brachial index (ABI) and LEAD was diagnosed by ABI≤0.9. Results The prevalence of LEAD was 14.72 % (CI 95%: 13.2-22.1). The mean age was 42, 8±7, 4 years, and 81.6% were female. On multivariable analysis, factors associated with LEAD were diabetes (OR= 1.7; 95% CI: 1.09–2.79), obesity (OR=2.5, 95% CI: 1.27–5.02) and stage IV HIV clinical infection (OR=4.7, 95% CI: 2.29–9.85). Conclusions This is the first study performed on a large HIV population in East Africa reporting high LEAD prevalence. It underlines the influence of advanced HIV disease on peripheral atherosclerosis and the need for LEAD screening in adults living with HIV.