Abstract Body: Combination antiretroviral therapy (cART) has extended life expectancy in people living with HIV (PLWH), shifting the primary cause of death to cardiovascular disease (CVD). Hypertension affects over 65% of PLWH. However, the mechanisms underlying HIV-associated hypertension remain poorly understood. In PLWH on cART, T cells persist as viral reservoirs, secreting viral proteins that circulate and localize in the central nervous system (CNS). Here, we used theTg26 mouse model, clinically relevant to cART-controlled PLWH, to test the hypothesis that HIV-derived proteins elevate blood pressure (BP) and induce sympatho-activation through blood-brain barrier disruption, microglial activation, and neuroinflammation. Telemetry-based BP measurements revealed a hypertensive phenotype in male and female Tg26 mice (male: WT=112.3 ±1.3 vs. Tg26=121.9 ±4.0 mmHg; female: WT=110.6 ±3.01 vs. Tg26=120.3 ±6.9 mmHg). Tg26 mice displayed increased sympathetic contribution to BP, indicated by a larger BP decrease following ganglionic blockade compared to WT, with no changes in heart rate responses to muscarinic and β-adrenergic receptor blockade, suggesting increased neurogenic BP regulation. Tg26 mice also showed increased aortic vasoconstriction to phenylephrine (P<0.05). LC/MS analysis revealed no significant differences in circulating catecholamine and metabolites between WT and Tg26 mice (n=5). MRI-based brain perfusion measurements also showed no significant differences, indicating an alteration in brain perfusion is not responsible for increased sympathetic activation. Inhibiting T-cell activation using abatacept, a CTLA-4-Ig fusion protein, significantly reduced BP, sympatho-activation, and phenylephrine-induced vasoconstriction in Tg26 mice (n=5, p<0.05). We analyzed the brains of Tg26 mice to investigate how T cells promote hypertension and sympatho-activation. Quantitative PCR confirmed viral protein expression in brain tissues and microglia of Tg26 mice, associated with increased markers of neuroinflammation, microglia activation, and T-cell infiltration (fold change>1.5, n=6, p<0.05). Tg26 mice also showed increased expression of NADPH oxidases and matrix metalloproteinase. However, there were no changes in the expression of tight junction proteins. Our data suggest that the expression of HIV-derived proteins in Tg26 mice induces central inflammation and T cell infiltration, leading to sympatho-activation through T cell-dependent mechanisms.