Cardiac complications of human immunodeficiency virus infection: diagnostic and therapeutic considerations.

Cardiac disease is being recognized as a complication of human immunodeficiency virus (HIV) infection, as more effective therapy is producing longer survival in patients with HIV infection and acquired immune deficiency syndrome (AIDS). Cardiac disease may occur coincidentally in a patient with AIDS, as a complication of AIDS, as a result of therapy for AIDS, or even as a direct result of HIV infection of the heart. Congestive heart failure (CHF) carries a poor prognosis and is best treated with traditional therapy. All patients with HIV/AIDS should get a baseline echocardiogram and electrocardiogram (ECG), because many patients are asymptomatic. Patients with low CD4 counts, those receiving zidovudine, and intravenous drug users must be further evaluated. Most patients with symptomatic effusions have a potentially treatable cause (neoplasm or infection), and a full workup must be initiated; however, small asymptomatic effusions often can be observed and followed by serial echocardiography. Physicians should be more alert to cardiac involvement in patients with HIV. Earlier surveillance is warranted and may lead to earlier treatment and supportive care.