Cardiomyopathy and other symptomatic heart diseases associated with HIV infection

Approximately 14 million persons worldwide are estimated to be infected with HIV-1. As more effective therapies have produced longer survival times for HIV-infected patients, new complications of late-stage HIV infection including HIV-related heart disease have emerged. The most common and life-threatening cardiovascular complication of HIV infection is the development of primary heart muscle disease associated with severe global left ventricular dysfunction (also termed cardiomyopathy). Other less common forms of symptomatic heart disease in HIV-1-infected patients are pericardial effusion with cardiac tamponade, high-grade arrhythmia with sudden cardiac death, and systemic embolization caused by nonbacterial thrombotic endocarditis or infective endocarditis. The demographic and clinical characteristics of HIV-infected patients who develop cardiomyopathy as well as potential enhancing risk factors are as yet poorly characterized. This review briefly describes the various presentations and potential causes of symptomatic HIV-related heart disease and discusses the challenge facing clinicians who evaluate HIV-infected patients presenting with serious cardiac manifestations of their disease.