ABSTRACT
The human immunodeficiency virus (HIV) infects CD4 lymphocytes and macrophages, causing profound immunosuppression that eventually develops into acquired immunodeficiency symdrome (AIDS). An estimated 34.3 million people worldwide were living with HIV/AIDS at the end of 1999 (1,2). Since 1981, when AIDS was first identified, approximately 1 million Americans have become infected with HIV, with serious outcomes of morbidity and mortality (3). However, with the increased survival due to more effective antiviral therapy, new complications and manifestations of latestage HIV infection are being reported, including cardiovascular disease. Since the first reported case of fatal dilated cardiomyopathy in AIDS patients in 1986, numerous echocardiographic studies have reported a high incidence of symptomatic cardiovascular complications in HIV-infected individuals (4). These complications include pericardial effusion, myocarditis, dilated cardiomyopathy, endocarditis, malignant neoplasms, coronary artery disease, and drug-related cardiotoxicity. In 1991, the prevalence of cardiac manifestations in AIDS patients ranged from 28 to 73%. In 1996, HIV cardiomyopathy was reported to be the fourth leading cause of dilated cardiomyopathy in adults in the United States. Half of these patients died of this disease within 6 to 12 months. Similar cardiovascular complications have also been reported with substance abuse, in particular with cocaine abuse (see Chap. 21).
