Background <p>People living with HIV (PLWH) have a markedly increased risk of cardiovascular disease (CVD), including cardiomyopathy, due to a complex interplay of chronic inflammation, viral persistence, and antiretroviral therapy (ART) effects. Echocardiography and cardiac magnetic resonance (CMR) are key imaging tools for detecting subclinical myocardial damage, yet their comparative effectiveness and optimal use in this population remain unclear.</p> Objective <p>To systematically evaluate the effectiveness and diagnostic accuracy of echocardiography and CMR for the early detection, structural characterization, and monitoring of cardiomyopathy in PLWH, and to explore how clinical, therapeutic, and geographic factors influence imaging findings.</p> Methods <p>This protocol follows the PRISMA-P guidelines and is registered in PROSPERO (CRD420251023451). We will include observational studies and clinical trials involving adults (≥ 18&#xa0;years) with confirmed HIV infection who underwent echocardiography or CMR. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment using validated tools. Narrative and quantitative syntheses will be conducted, with subgroup and meta-regression analyses by ART regimen, CD4 count, and geographic region. The certainty of evidence will be rated using GRADE.</p> Expected impact <p>This review aims to generate evidence and information useful for defining rational protocols and guidelines for the use of echocardiography and CMR in the care of PLWH. By consolidating evidence on the applicability of these resources for the timely diagnosis and monitoring of cardiomyopathies in PLWH, it will provide elements for establishing individual care pathways and for improving the efficiency and coverage of respective healthcare. It is thus expected to benefit individuals and, also, health programs aimed at PLWH.</p> Systematic review registration <p>PROSPERO CRD420251023451.</p>