Limited data are available on dyslipidemia in HIV-infected patients in resource-limited settings (RLS). We performed a cross-sectional analysis in ART-naïve, non-fasting HIV-infected patients in Tanzania between November 2004-June 2008. Robust linear regression modeling was performed. Lipid parameters were assessed in 12,513 patients (65% women; median (IQR) age, 36 (30–42) years; CD4 count, 143 (51–290) cells/mm3). Low HDL was prevalent in 67% and increased TG in 28%. High triglyceride and low HDL levels were associated with low CD4 counts (P<0.001). In this ART-naïve Tanzanian population, dyslipidemia was highly prevalent and associated with advanced disease. The impact of ART on these changes requires further exploration.