Cardiovascular manifestations of HIV infection have been observed for more than 15 years and finally prospective data substantiates this association.1 Studies published over the past 2–3 years have tracked the incidence and course of HIV infection in relation to cardiac illness in both children and adults (table 1). These recent studies show that subclinical echocardiographic abnormalities independently predict adverse outcomes and identify high risk groups to target for early intervention and treatment.

The introduction of highly active antiretroviral therapy (HAART) regimens has significantly modified the course of HIV disease, with longer survival rates and improvement of life quality in HIV infected subjects expected. However, early data raised concerns about HAART being associated with an increase in both peripheral and coronary arterial diseases.

Importantly, the studies listed in table 1 were performed in the era before HAART. Understanding the effects of HAART on the cardiovascular system is only possible by understanding the effects of HIV co-infections first. HAART is only available to a minority of HIV infected individuals worldwide and studies before HAART remain globally applicable. UNAIDS estimates that 36.1 million people were living with HIV infection at the end of the year 2000. If 8–10% of patients develop symptomatic heart failure over a 2–5 year period, then three million cases of HIV related heart failure will have presented in that time period.2 Dilated cardiomyopathy, coronary artery disease, endocarditis, and pericardial effusion related to HIV infection will be reviewed here.