ISPUB.COM The Internet Journal of Cardiology Volume 9 Number 1 1 of 10 The Heart And HIV/ AIDS D Olusegun-Joseph, J Ajuluchukwu, C Okany, A Mbakwem, D Oke. Citation D Olusegun-Joseph, J Ajuluchukwu, C Okany, A Mbakwem, D Oke.. The Heart And HIV/ AIDS. The Internet Journal of Cardiology. 2009 Volume 9 Number 1. Abstract HIV/AIDS is one of the leading health problems in the world, especially in sub-saharan Africa, where it is the single greatest health challenge facing the continent. Cardiac involvement impacts on the natural history and prognosis of the disease, however, evidence of cardiac involvement may be clinically quiescent initially. With improved management of opportunistic infections, and the advent of Highly Active AntiRetroviral Therapy (HAART), more organ related manifestations of the disease including heart diseases are emerging. The extra cardiovascular burden will be enormous in view of the increasing prevalence of HIV infection globally.This demands an awareness by clinicians of its cardiovascular manifestations for a complete and rational diagnosis and management. This article presents a concise review of the clinical manifestations, pathophysiolgy/ pathogenesis and management of Cardiovascular complications in HIV/AIDS. INTRODUCTION HIV/AIDS is a multisystemic disease, affecting virtually every organ and system of the body, resulting in progressive dysfunction of affected areas 1 . The heart is not spared in the exploit of this rampaging entity. Cardiac manifestation was thought to be a rare feature of HIV presentation in the early periods of the disease, mainly because the presentation of the disease was largely dominated by opportunistic infections, malignancies, and manifestations of symptoms of other systems like the central nervous system (CNS), and respiratory system; however, currently there are evidences of increasing cardiac involvements in patients with the disease 2-5 . Infection with the HIV virus has become one of the leading cause of acquired heart disease and specifically of symptomatic heart failure 6 . Studies have suggested that HIV may exhibit a cardiac tropism, but the heart may also be affected by other opportunistic viruses, fungi, and protozoa. Cardiac disease associated with HIV may therefore be multifactorial, and can be caused by HIV infection itself, opportunistic infections by other viruses, neoplastic complications, drugs used in the treatment of the disease, or any of the established causes of cardiac disease in other patient populations 1,7 . The exact prevalence of cardiac involvement in HIV/AIDS is uncertain 8 . Estimates of prevalence vary widely from 28–73% depending on the screening methods selected, the population studied, and the definition of cardiac abnormality 9,10 . Other workers, however, puts the prevalence at a conservative estimate of 2-10% 2,11-13 . DISEASE SPECTRUM AND PATHOGENESIS A wide range of cardiovascular diseases has been identified in HIV/AIDS patients. The spectrum ranges from myocardial diseases to pericardial, endocardial disease, coronary artery disease, malignacies, vascular disease, cardiac arrhythmias and autonomic dysfunction 1,4,12-14 . MYOCARDIAL DISEASE Myocardial disease is common in HIV/AIDS. Studies have shown that serious clinical cardiac abnormalities are common in patients with AIDS and are associated with myocarditis 15-18 . Dilated cardiomyopathy occurs late in the course of HIV infection and is usually associated with a significantly reduced CD4 count 1,19 . Cohen et al described the first fatal case of dilated cardiomyopathy in three AIDS patients in 1986 20 . Post mortem examination in two of the patients revealed a globular heart with dilated cardiac chambers, and histological evidence of focal lymphocytic myocarditis. The pathogenesis of human immunodeficiency virus (HIV) associated cardiomyopathy include infection of myocardial