Abstract: Cardiovascular disease is a leading cause of morbidity and mortality among people with and without HIV. Among PWoH, cannabis has been associated with cardiovascular outcomes, including coronary artery disease, myocardial infarction (MI), and stroke. However, data on subclinical changes and other cardiovascular outcomes are limited among PWH. In this study, we examined the association of cannabis use and HIV with electrocardiogram (ECG) findings—evidence of MI, other abnormalities, and normal findings. Data from study visits between 2007 and 2017 from the MACS/WIHS Combined Cohort Study (N = 3610) were used. Descriptive statistics were derived, and unadjusted and adjusted odds ratios were estimated via baseline logistic regression. Most participants were PWH (n = 2272, 63%), and 28% reported cannabis use, with no significant difference in prevalence between PWH (27%) and PWoH (28%). Overall, 59% of participants had normal ECG findings. Cannabis use was not significantly associated with evidence of ECG abnormalities in unadjusted or adjusted analyses (aOR for MI: 1.02, 95% CI: 0.82 to 1.26, P = 0.85; aOR for other abnormalities: 1.02, 95% CI: 0.80 to 1.32, P = 0.86). Abnormal findings were more common in female participants than male participants (41% vs. 35%, P = 0.0002). Among male participants, PWH had higher odds of evidence of non-MI abnormalities compared with PWoH (aOR = 1.35, 95% CI: 1.01 to 1.81, P = 0.0464). Although cannabis use was not independently associated with evidence of ECG abnormalities, sex and HIV status are important determinants. Future studies should explore the role of cannabis metabolites and usage patterns in cardiovascular outcomes among PWH.