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BioMed Research International
Volume 2016 (2016), Article ID 8196560, 9 pages
Review Article

The Causes of HIV-Associated Cardiomyopathy: A Tale of Two Worlds

1School of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
2Department of Medicine, Duke Clinical Research Institute and Duke Global Health Institute, Duke University Medical Center, Durham, NC 27705, USA

Received 6 November 2015; Accepted 15 December 2015

Academic Editor: Tomas Palecek

Copyright © 2016 Rebecca H. Lumsden and Gerald S. Bloomfield. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Antiretroviral therapy (ART) has transformed the clinical profile of human immunodeficiency virus (HIV) from an acute infection with a high mortality into a treatable, chronic disease. As a result, the clinical sequelae of HIV infection are changing as patients live longer. HIV-associated cardiomyopathy (HIVAC) is a stage IV, HIV-defining illness and remains a significant cause of morbidity and mortality among HIV-infected individuals despite ART. Causes and clinical manifestations of HIVAC depend on the degree of host immunosuppression. Myocarditis from direct HIV toxicity, opportunistic infections, and nutritional deficiencies are implicated in causing HIVAC when HIV viral replication is unchecked, whereas cardiac autoimmunity, chronic inflammation, and ART cardiotoxicity contribute to HIVAC in individuals with suppressed viral loads. The initiation of ART has dramatically changed the clinical manifestation of HIVAC in high income countries from one of severe, left ventricular systolic dysfunction to a pattern of subclinical cardiac dysfunction characterized by abnormal diastolic function and strain. In low and middle income countries, however, HIVAC is the most common HIV-associated cardiovascular disease. Clear diagnostic and treatment guidelines for HIVAC are currently lacking but should be prioritized given the global burden of HIVAC.