Data characterizing risk factors and long-term outcome studies on human immunodeficiency virus (HIV)-associated pulmonary hypertension (PH) in Africa are lacking. The Pan African Pulmonary Hypertension Cohort, a multinational registry of 254 consecutive patients diagnosed with PH (97% of African descent) from 9 centers in 4 African countries was implemented. We compared baseline characteristics and 3-year survival of an HIV-infected cohort newly diagnosed with PH (PH/HIV ) to an HIV-uninfected cohort with PH (PH/HIV ). One hundred thirty-four participants with PH completed follow up (47 PH/HIV and 87 PH/HIV ; age median, 36 versus 44 years; = .0004). Cardiovascular risk factors and comorbidities were similar except for previous tuberculosis (62% versus 18%, < .0001). Six-minute walk distance (6MWD) <300 meters was common in PH/HIV ( = .0030), but PH/HIV had higher heart ( = .0160) and respiratory ( = .0374) rates. Thirty-six percent of PH/HIV and 15% of PH/HIV presented with pulmonary arterial hypertension (PAH) ( = .0084), whereas 36% of PH/HIV and 72% of PH/HIV exhibited PH due to left heart disease (PHLHD) ( = .0009). Pulmonary hypertension due to lung diseases and hypoxia (PHLD) was frequent in PH/HIV (36% versus 15%) but did not reach statistical significance. Human immunodeficiency virus-associated PAH tended to have a poorer survival rate compared with PHLHD/PHLD in HIV-infected patients. The PH/HIV patients were younger and commonly had previous tuberculosis compared to PH/HIV patients. Despite a better 6MWD at presentation, they had more signs and symptoms of early onset heart failure and a worse survival rate. Early echocardiography assessment should be performed in HIV-infected patients with history of tuberculosis who present with signs and symptoms of heart failure or posttuberculosis lung disease.