B. Myocarditis and Left ventricular Systolic Dysfunction
Weakness of the muscle of the left ventricle with left ventricular systolic dysfunction is common and results in dilated cardiomyopathy and heart failure (see the chapter Cardiomyopathy). A five-year prospective clinical and echocardiographic study of asymptomatic HIV-positive patients with CD4 counts greater than 400 defined the incidence of dilated cardiomyopathy as 16 cases per thousand patients. The incidence rate is higher in those patients with CD4 counts less than 100 cells/ml4.
From 1998 to 2000, of the estimated 70 million people worldwide infected with HIV with an incidence of heart failure of 10% over 2 years, there would be approximately 7 million cases of heart failure during a 2-year interval due to AIDS. Left ventricular dysfunction occurs in about 6% of infected children.
The pathogenesis of myocarditis may be a result of primary infection with HIV or organisms such as CMV, Coxsackie virus, and a host of other microorganisms, or the reactivation of latent infections.
C. Other Complications
These include infective endocarditis that is more common in IV drug users with the infecting organisms S. aureus and salmonella. In the later stages of HIV malignancy occurs. This takes the form of Kaposi’s sarcoma which is linked with human herpesvirus 8 and mainly affects HIV homosexuals (~35%). Pulmonary hypertension and stroke may occur. Unexplained syncope or cardiac tampo¬nade in younger individuals should alert the search for HIV infection.

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