Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Cardiac and vascular disease in HIV-infected patients

Melvin D Cheitlin, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD


Cardiac abnormalities were appreciated early in the epidemic of acquired immunodeficiency syndrome (AIDS), even before the etiologic agent, human immunodeficiency virus (HIV), was isolated and characterized. The etiology and pathogenesis of myocarditis and cardiomyopathy in association with HIV infection is still the subject of intense speculation [1,2]. In the era of potent antiretroviral therapy (ART), patients are living longer, and the disease has become a chronic infection, even in low- and middle-income countries [3]. Nevertheless, HIV infection confers a 61 percent increase in death compared to uninfected subjects [4], and a growing body of evidence implicates chronic inflammation that persists despite effective ART in the development of vascular dysfunction and accelerated atherosclerosis [5]. With this, atherosclerotic vascular disease, especially coronary artery disease, has become the most important cardiovascular complication of HIV infection and has had the most attention directed to its pathogenesis, prevention, and therapy [6,7]. In resource-limited settings where medical treatment is sparse, limited, or absent, HIV disease and its complications are similar to the disease in the pre–ART era.

This topic is devoted to the spectrum of cardiac and vascular diseases seen in HIV-infected patients. Discussions related specifically to coronary artery disease and its management in HIV-infected patients is discussed elsewhere. (See "Epidemiology of cardiovascular disease and risk factors in HIV-infected patients" and "Pathogenesis and biomarkers of cardiovascular disease in HIV-infected patients" and "Management of cardiovascular risk (including dyslipidemia) in the HIV-infected patient".)


Patients with HIV infection can have a variety of cardiac and vascular manifestations. However, certain cardiac disorders have been reported with greater frequency among HIV-infected patients compared with the general population; the specific type of cardiac disease varies by setting.

In resource-rich countries, with the widespread availability of potent antiretroviral therapy (ART), patients are living longer, and other comorbidities have surfaced, such as hypertension, metabolic abnormalities (hyperglycemia, hyperlipidemia, lipodystrophy), and accelerated atherosclerosis, including coronary artery disease [6,8-11]. Thus, cardiovascular disease has emerged as a major cause of morbidity and mortality in HIV-infected patients. As an example, in a study from the United States of death certificates that listed HIV infection, the proportion of deaths attributed to heart disease increased from 5 to 10 percent from 1996 to 2006 [12]. Although cardiovascular disease is accounting for a larger percentage of all those who died, the number of patients dying from cardiovascular disease has actually decreased. In a study of almost 50,000 HIV-infected patients, all-cause deaths decreased by 48 percent from 17.5 deaths per 1000 person-years in 1999 to 2000 to 9.1 deaths per 1000 person years in 2009 to 2011; cardiovascular deaths also decreased by 50 percent over this time period from 1.8 to 0.9 deaths per 1000 person-years [13]. The decrease in cardiovascular death could be explained by improved use of non-HIV specific preventive measures. (See "Epidemiology of cardiovascular disease and risk factors in HIV-infected patients", section on 'Cardiovascular disease associated with HIV infection'.)

In contrast, pericardial effusion and myocardial disease, such as myocarditis and cardiomyopathy, which were frequently reported among HIV-infected patients before the widespread use of ART, particularly in the setting of significant immunosuppression, are increasingly uncommon. However, in resource-limited settings, where many patients have limited access to ART, these syndromes remain the most common manifestations of HIV-associated cardiac disease [14,15]. In a study of 5328 patients presenting with a first diagnosis of heart disease to a large cardiology center in South Africa, 518 (10 percent) were HIV-infected, among whom cardiomyopathy was diagnosed in 38 percent and pericarditis in 13 percent [15]. Only 14 HIV-infected patients (2.7 percent) had a diagnosis of coronary artery disease.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Apr 29, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Lewis W. Cardiomyopathy in AIDS: a pathophysiological perspective. Prog Cardiovasc Dis 2000; 43:151.
  2. Sani MU. Myocardial disease in human immunodeficiency virus (HIV) infection: a review. Wien Klin Wochenschr 2008; 120:77.
  3. Bloomfield GS, Alenezi F, Barasa FA, et al. Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries. JACC Heart Fail 2015; 3:579.
  4. Boccara F, Lang S, Meuleman C, et al. HIV and coronary heart disease: time for a better understanding. J Am Coll Cardiol 2013; 61:511.
  5. Hsue PY, Deeks SG, Hunt PW. Immunologic basis of cardiovascular disease in HIV-infected adults. J Infect Dis 2012; 205 Suppl 3:S375.
  6. Gopal M, Bhaskaran A, Khalife WI, Barbagelata A. Heart Disease in Patients with HIV/AIDS-An Emerging Clinical Problem. Curr Cardiol Rev 2009; 5:149.
  7. Luetkemeyer AF, Havlir DV, Currier JS. Complications of HIV disease and antiretroviral therapy. Top Antivir Med 2011; 19:58.
  8. DAD Study Group, Friis-Møller N, Reiss P, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 2007; 356:1723.
  9. Fisher SD, Lipshultz SE. Epidemiology of cardiovascular involvement in HIV disease and AIDS. Ann N Y Acad Sci 2001; 946:13.
  10. Lekakis J, Ikonomidis I. Cardiovascular complications of AIDS. Curr Opin Crit Care 2010; 16:408.
  11. Worm SW, Lundgren JD. The metabolic syndrome in HIV. Best Pract Res Clin Endocrinol Metab 2011; 25:479.
  12. Adih WK, Selik RM, Hu X. Trends in Diseases Reported on US Death Certificates That Mentioned HIV Infection, 1996-2006. J Int Assoc Physicians AIDS Care (Chic) 2011; 10:5.
  13. Smith CJ, Ryom L, Weber R, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet 2014; 384:241.
  14. Guha S, Pande A, Mookerjee S, et al. Echocardiographic profile of ART naïve human immunodeficiency virus (HIV) infected patients in a tertiary care hospital in Kolkata. Indian Heart J 2010; 62:330.
  15. Sliwa K, Carrington MJ, Becker A, et al. Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort. Eur Heart J 2012; 33:866.
  16. Lewis W. AIDS: cardiac findings from 115 autopsies. Prog Cardiovasc Dis 1989; 32:207.
  17. Anderson DW, Virmani R, Reilly JM, et al. Prevalent myocarditis at necropsy in the acquired immunodeficiency syndrome. J Am Coll Cardiol 1988; 11:792.
  18. Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G. Cardiac involvement in the acquired immunodeficiency syndrome: a multicenter clinical-pathological study. Gruppo Italiano per lo Studio Cardiologico dei pazienti affetti da AIDS Investigators. AIDS Res Hum Retroviruses 1998; 14:1071.
  19. Lanjewar DN, Katdare GA, Jain PP, Hira SK. Pathology of the heart in acquired immunodeficiency syndrome. Indian Heart J 1998; 50:321.
  20. Holloway CJ, Ntusi N, Suttie J, et al. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients. Circulation 2013; 128:814.
  21. Shaboodien G, Maske C, Wainwright H, et al. Prevalence of myocarditis and cardiotropic virus infection in Africans with HIV-associated cardiomyopathy, idiopathic dilated cardiomyopathy and heart transplant recipients: a pilot study: cardiovascular topic. Cardiovasc J Afr 2013; 24:218.
  22. Mondy KE, Gottdiener J, Overton ET, et al. High Prevalence of Echocardiographic Abnormalities among HIV-infected Persons in the Era of Highly Active Antiretroviral Therapy. Clin Infect Dis 2011; 52:378.
  23. Schuster I, Thöni GJ, Edérhy S, et al. Subclinical cardiac abnormalities in human immunodeficiency virus-infected men receiving antiretroviral therapy. Am J Cardiol 2008; 101:1213.
  24. Hsue PY, Hunt PW, Ho JE, et al. Impact of HIV infection on diastolic function and left ventricular mass. Circ Heart Fail 2010; 3:132.
  25. Reinsch N, Neuhaus K, Esser S, et al. Prevalence of cardiac diastolic dysfunction in HIV-infected patients: results of the HIV-HEART study. HIV Clin Trials 2010; 11:156.
  26. Luo L, Zeng Y, Li T, et al. Prospective echocardiographic assessment of cardiac structure and function in Chinese persons living with HIV. Clin Infect Dis 2014; 58:1459.
  27. Cerrato E, D'Ascenzo F, Biondi-Zoccai G, et al. Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era. Eur Heart J 2013; 34:1432.
  28. Twagirumukiza M, Nkeramihigo E, Seminega B, et al. Prevalence of dilated cardiomyopathy in HIV-infected African patients not receiving HAART: a multicenter, observational, prospective, cohort study in Rwanda. Curr HIV Res 2007; 5:129.
  29. Aggarwal P, Sharma A, Bhardwaj R, Raina R. Myocardial dysfunction in human immunodeficiency virus infection: an echocardiographic study. J Assoc Physicians India 2009; 57:745.
  30. Luetkens JA, Doerner J, Schwarze-Zander C, et al. Cardiac Magnetic Resonance Reveals Signs of Subclinical Myocardial Inflammation in Asymptomatic HIV-Infected Patients. Circ Cardiovasc Imaging 2016; 9:e004091.
  31. Ntusi N, O'Dwyer E, Dorrell L, et al. HIV-1-Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema. Circ Cardiovasc Imaging 2016; 9:e004430.
  32. Currie PF, Jacob AJ, Foreman AR, et al. Heart muscle disease related to HIV infection: prognostic implications. BMJ 1994; 309:1605.
  33. Cardoso JS, Moura B, Martins L, et al. Left ventricular dysfunction in human immunodeficiency virus (HIV)-infected patients. Int J Cardiol 1998; 63:37.
  34. Herskowitz A, Vlahov D, Willoughby S, et al. Prevalence and incidence of left ventricular dysfunction in patients with human immunodeficiency virus infection. Am J Cardiol 1993; 71:955.
  35. Barbaro G, Di Lorenzo G, Grisorio B, Barbarini G. Incidence of dilated cardiomyopathy and detection of HIV in myocardial cells of HIV-positive patients. Gruppo Italiano per lo Studio Cardiologico dei Pazienti Affetti da AIDS. N Engl J Med 1998; 339:1093.
  36. Sudano I, Spieker LE, Noll G, et al. Cardiovascular disease in HIV infection. Am Heart J 2006; 151:1147.
  37. Lorgis L, Cottenet J, Molins G, et al. Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database. Circulation 2013; 127:1767.
  38. Hofman P, Drici MD, Gibelin P, et al. Prevalence of toxoplasma myocarditis in patients with the acquired immunodeficiency syndrome. Br Heart J 1993; 70:376.
  39. Rabaud C, May T, Amiel C, et al. Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey. Medicine (Baltimore) 1994; 73:306.
  40. Dittrich H, Chow L, Denaro F, Spector S. Human immunodeficiency virus, coxsackievirus, and cardiomyopathy. Ann Intern Med 1988; 108:308.
  41. Niedt GW, Schinella RA. Acquired immunodeficiency syndrome. Clinicopathologic study of 56 autopsies. Arch Pathol Lab Med 1985; 109:727.
  42. Ntsekhe M, Mayosi BM. Cardiac manifestations of HIV infection: an African perspective. Nat Clin Pract Cardiovasc Med 2009; 6:120.
  43. Goldblum N, Daefler S, Llana T, et al. Susceptibility to HIV-1 infection of a human B-lymphoblastoid cell line, DG75, transfected with subgenomic DNA fragments of Epstein-Barr virus. Dev Biol Stand 1990; 72:309.
  44. Cenacchi G, Re MC, Furlini G, et al. Human immunodeficiency virus type 1 antigen detection in endomyocardial biopsy: an immunomorphological study. Microbiologica 1990; 13:145.
  45. Wu AY, Forouhar F, Cartun RW, et al. Identification of human immunodeficiency virus in the heart of a patient with acquired immunodeficiency syndrome. Mod Pathol 1990; 3:625.
  46. Fiala M, Popik W, Qiao JH, et al. HIV-1 induces cardiomyopathyby cardiomyocyte invasion and gp120, Tat, and cytokine apoptotic signaling. Cardiovasc Toxicol 2004; 4:97.
  47. Grody WW, Cheng L, Lewis W. Infection of the heart by the human immunodeficiency virus. Am J Cardiol 1990; 66:203.
  48. Rodriguez ER, Nasim S, Hsia J, et al. Cardiac myocytes and dendritic cells harbor human immunodeficiency virus in infected patients with and without cardiac dysfunction: detection by multiplex, nested, polymerase chain reaction in individually microdissected cells from right ventricular endomyocardial biopsy tissue. Am J Cardiol 1991; 68:1511.
  49. Remick J, Georgiopoulou V, Marti C, et al. Heart failure in patients with human immunodeficiency virus infection: epidemiology, pathophysiology, treatment, and future research. Circulation 2014; 129:1781.
  50. Shannon, RP, Mathier, MA, Manleod, S, et al. Macrophages not cardiomyocytes are the reservoir for lentivirus in SIV cardiomyopathy. Circulation 1999; 100:1.
  51. Lähdevirta J, Maury CP, Teppo AM, Repo H. Elevated levels of circulating cachectin/tumor necrosis factor in patients with acquired immunodeficiency syndrome. Am J Med 1988; 85:289.
  52. Cohen MC, Huberman MS, Nesto RW. Recombinant alpha 2 interferon-related cardiomyopathy. Am J Med 1988; 85:549.
  53. Monsuez JJ, Escaut L, Teicher E, et al. Cytokines in HIV-associated cardiomyopathy. Int J Cardiol 2007; 120:150.
  54. Barbaro G, Di Lorenzo G, Soldini M, et al. Intensity of myocardial expression of inducible nitric oxide synthase influences the clinical course of human immunodeficiency virus-associated cardiomyopathy. Gruppo Italiano per lo Studio Cardiologico dei pazienti affetti da AIDS (GISCA). Circulation 1999; 100:933.
  55. Twu C, Liu NQ, Popik W, et al. Cardiomyocytes undergo apoptosis in human immunodeficiency virus cardiomyopathy through mitochondrion- and death receptor-controlled pathways. Proc Natl Acad Sci U S A 2002; 99:14386.
  56. Olinski R, Gackowski D, Foksinski M, et al. Oxidative DNA damage: assessment of the role in carcinogenesis, atherosclerosis, and acquired immunodeficiency syndrome. Free Radic Biol Med 2002; 33:192.
  57. Pozzan G, Pagliari C, Tuon FF, et al. Diffuse-regressive alterations and apoptosis of myocytes: possible causes of myocardial dysfunction in HIV-related cardiomyopathy. Int J Cardiol 2009; 132:90.
  58. Rogers JS, Zakaria S, Thom KA, et al. Immune reconstitution inflammatory syndrome and human immunodeficiency virus-associated myocarditis. Mayo Clin Proc 2008; 83:1275.
  59. Herskowitz A, Willoughby S, Wu TC, et al. Immunopathogenesis of HIV-1-associated cardiomyopathy. Clin Immunol Immunopathol 1993; 68:234.
  60. Zandman-Goddard G, Shoenfeld Y. HIV and autoimmunity. Autoimmun Rev 2002; 1:329.
  61. Sepúlveda RT, Jiang S, Beischel J, et al. Cocaine injection and coxsackievirus B3 infection increase heart disease during murine AIDS. J Acquir Immune Defic Syndr 2000; 25 Suppl 1:S19.
  62. Yu Q, Larson DF, Watson RR. Heart disease, methamphetamine and AIDS. Life Sci 2003; 73:129.
  63. Liang H, Wang X, Chen H, et al. Methamphetamine enhances HIV infection of macrophages. Am J Pathol 2008; 172:1617.
  64. Wharton JM, Demopulos PA, Goldschlager N. Torsade de pointes during administration of pentamidine isethionate. Am J Med 1987; 83:571.
  65. Herskowitz A, Willoughby SB, Baughman KL, et al. Cardiomyopathy associated with antiretroviral therapy in patients with HIV infection: a report of six cases. Ann Intern Med 1992; 116:311.
  66. Lewis W, Grupp IL, Grupp G, et al. Cardiac dysfunction occurs in the HIV-1 transgenic mouse treated with zidovudine. Lab Invest 2000; 80:187.
  67. Domanski MJ, Sloas MM, Follmann DA, et al. Effect of zidovudine and didanosine treatment on heart function in children infected with human immunodeficiency virus. J Pediatr 1995; 127:137.
  68. Lewis W. Mitochondrial DNA replication, nucleoside reverse-transcriptase inhibitors, and AIDS cardiomyopathy. Prog Cardiovasc Dis 2003; 45:305.
  69. Koehler A, Lewis W. Mitochondrial cardiomyopathy in HIV-1 patients treated with zidovudine. Lab Invest 1995; 72:33A.
  70. Kavanaugh-McHugh AL, Ruff A, Perlman E, et al. Selenium deficiency and cardiomyopathy in acquired immunodeficiency syndrome. JPEN J Parenter Enteral Nutr 1991; 15:347.
  71. Secemsky EA, Scherzer R, Nitta E, et al. Novel Biomarkers of Cardiac Stress, Cardiovascular Dysfunction, and Outcomes in HIV-Infected Individuals. JACC Heart Fail 2015; 3:591.
  72. Filsoufi F, Salzberg SP, Harbou KT, et al. Excellent outcomes of cardiac surgery in patients infected with HIV in the current era. Clin Infect Dis 2006; 43:532.
  73. Plebani A, Esposito S, Pinzani R, et al. Effect of highly active antiretroviral therapy on cardiovascular involvement in children with human immunodeficiency virus infection. Pediatr Infect Dis J 2004; 23:559.
  74. Lipshultz SE, Williams PL, Wilkinson JD, et al. Cardiac status of children infected with human immunodeficiency virus who are receiving long-term combination antiretroviral therapy: results from the Adolescent Master Protocol of the Multicenter Pediatric HIV/AIDS Cohort Study. JAMA Pediatr 2013; 167:520.
  75. Lind A, Reinsch N, Neuhaus K, et al. Pericardial effusion of HIV-infected patients ? Results of a prospective multicenter cohort study in the era of antiretroviral therapy. Eur J Med Res 2011; 16:480.
  76. Himelman RB, Chung WS, Chernoff DN, et al. Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study. J Am Coll Cardiol 1989; 13:1030.
  77. De Castro S, Migliau G, Silvestri A, et al. Heart involvement in AIDS: a prospective study during various stages of the disease. Eur Heart J 1992; 13:1452.
  78. Hsia J, Ross AM. Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection. Am J Cardiol 1994; 74:94.
  79. Heidenreich PA, Eisenberg MJ, Kee LL, et al. Pericardial effusion in AIDS. Incidence and survival. Circulation 1995; 92:3229.
  80. Estok L, Wallach F. Cardiac tamponade in a patient with AIDS: a review of pericardial disease in patients with HIV infection. Mt Sinai J Med 1998; 65:33.
  81. Thienemann F, Sliwa K, Rockstroh JK. HIV and the heart: the impact of antiretroviral therapy: a global perspective. Eur Heart J 2013; 34:3538.
  82. Syed FF, Sani MU. Recent advances in HIV-associated cardiovascular diseases in Africa. Heart 2013; 99:1146.
  83. Eisenberg MJ, Gordon AS, Schiller NB. HIV-associated pericardial effusions. Chest 1992; 102:956.
  84. Chen Y, Brennessel D, Walters J, et al. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J 1999; 137:516.
  85. Syed FF, Ntsekhe M, Gumedze F, et al. Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome. Heart 2014; 100:135.
  86. Flum DR, McGinn JT Jr, Tyras DH. The role of the 'pericardial window' in AIDS. Chest 1995; 107:1522.
  87. Gouny P, Lancelin C, Girard PM, et al. Pericardial effusion and AIDS: benefits of surgical drainage. Eur J Cardiothorac Surg 1998; 13:165.
  88. Maher D, Harries AD. Tuberculous pericardial effusion: a prospective clinical study in a low-resource setting--Blantyre, Malawi. Int J Tuberc Lung Dis 1997; 1:358.
  89. Sá I, Môço R, Cabral S, et al. Constrictive pericarditis of tuberculous etiology in the HIV-positive patient: case report and review of the literature. Rev Port Cardiol 2006; 25:1029.
  90. Gowda RM, Khan IA, Mehta NJ, et al. Cardiac tamponade in patients with human immunodeficiency virus disease. Angiology 2003; 54:469.
  91. Boulanger E, Gérard L, Gabarre J, et al. Prognostic factors and outcome of human herpesvirus 8-associated primary effusion lymphoma in patients with AIDS. J Clin Oncol 2005; 23:4372.
  92. Cegielski JP, Lwakatare J, Dukes CS, et al. Tuberculous pericarditis in Tanzanian patients with and without HIV infection. Tuber Lung Dis 1994; 75:429.
  93. Blanchard DG, Hagenhoff C, Chow LC, et al. Reversibility of cardiac abnormalities in human immunodeficiency virus (HIV)-infected individuals: a serial echocardiographic study. J Am Coll Cardiol 1991; 17:1270.
  94. Small PM, Schecter GF, Goodman PC, et al. Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med 1991; 324:289.
  95. Syed FF, Mayosi BM. A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis 2007; 50:218.
  96. Maisch B, Seferović PM, Ristić AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 2004; 25:587.
  97. Cicalini S, Almodovar S, Grilli E, Flores S. Pulmonary hypertension and human immunodeficiency virus infection: epidemiology, pathogenesis, and clinical approach. Clin Microbiol Infect 2011; 17:25.
  98. Sitbon O, Lascoux-Combe C, Delfraissy JF, et al. Prevalence of HIV-related pulmonary arterial hypertension in the current antiretroviral therapy era. Am J Respir Crit Care Med 2008; 177:108.
  99. Dillmon MS, Saag MS, Hamza SH, et al. Unusual thromboses associated with protein S deficiency in patients with acquired immunodeficiency syndrome: case reports and review of the literature. AIDS Res Hum Retroviruses 2005; 21:753.
  100. Micieli E, Dentali F, Giola M, et al. Venous and arterial thrombosis in patients with HIV infection. Blood Coagul Fibrinolysis 2007; 18:259.
  101. Bibas M, Biava G, Antinori A. HIV-Associated Venous Thromboembolism. Mediterr J Hematol Infect Dis 2011; 3:e2011030.
  102. Kiser KL, Badowski ME. Risk factors for venous thromboembolism in patients with human immunodeficiency virus infection. Pharmacotherapy 2010; 30:1292.
  103. Sullivan PS, Dworkin MS, Jones JL, Hooper WC. Epidemiology of thrombosis in HIV-infected individuals. The Adult/Adolescent Spectrum of HIV Disease Project. AIDS 2000; 14:321.
  104. Saber AA, Aboolian A, LaRaja RD, et al. HIV/AIDS and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement. Am Surg 2001; 67:645.
  105. Saif MW, Bona R, Greenberg B. AIDS and thrombosis: retrospective study of 131 HIV-infected patients. AIDS Patient Care STDS 2001; 15:311.
  106. Lijfering WM, Sprenger HG, Georg RR, et al. Relationship between progression to AIDS and thrombophilic abnormalities in HIV infection. Clin Chem 2008; 54:1226.
  107. Baker JV, Duprez D. Biomarkers and HIV-associated cardiovascular disease. Curr Opin HIV AIDS 2010; 5:511.
  108. Ye Y, Zeng Y, Li X, et al. HIV infection: an independent risk factor of peripheral arterial disease. J Acquir Immune Defic Syndr 2010; 53:276.
  109. Bernal E, Masiá M, Padilla S, et al. Low prevalence of peripheral arterial disease in HIV-infected patients with multiple cardiovascular risk factors. J Acquir Immune Defic Syndr 2008; 47:126.
  110. Gupta N, Bajaj S, Shah P, et al. The Prevalence of Peripheral Arterial Disease in HIV Patients. J Vasc Surg 2013; 1:118.
  111. Periard D, Cavassini M, Taffé P, et al. High prevalence of peripheral arterial disease in HIV-infected persons. Clin Infect Dis 2008; 46:761.
  112. Qaqa AY, DeBari VA, Isbitan A, et al. The role of postexercise measurements in the diagnosis of peripheral arterial disease in HIV-infected patients. Angiology 2011; 62:10.
  113. Ferraioli G, Tinelli C, Maggi P, et al. Arterial stiffness evaluation in HIV-positive patients: a multicenter matched control study. AJR Am J Roentgenol 2011; 197:1258.
  114. Voelker R. Stroke increase reported in HIV patients. JAMA 2011; 305:552.
  115. Ovbiagele B, Nath A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology 2011; 76:444.
  116. D'Ascenzo F, Quadri G, Cerrato E, et al. A meta-analysis investigating incidence and features of stroke in HIV-infected patients in the highly active antiretroviral therapy era. J Cardiovasc Med (Hagerstown) 2015; 16:839.
  117. Reinsch N, Esser S, Gelbrich G, et al. Valvular manifestations of human immunodeficiency virus infection--results from the prospective, multicenter HIV-HEART study. J Cardiovasc Med (Hagerstown) 2013; 14:733.
  118. Cicalini S, Forcina G, De Rosa FG. Infective endocarditis in patients with human immunodeficiency virus infection. J Infect 2001; 42:267.
  119. Gebo KA, Burkey MD, Lucas GM, et al. Incidence of, risk factors for, clinical presentation, and 1-year outcomes of infective endocarditis in an urban HIV cohort. J Acquir Immune Defic Syndr 2006; 43:426.
  120. Prendergast BD. HIV and cardiovascular medicine. Heart 2003; 89:793.
  121. Furuno JP, Johnson JK, Schweizer ML, et al. Community-associated methicillin-resistant Staphylococcus aureus bacteremia and endocarditis among HIV patients: a cohort study. BMC Infect Dis 2011; 11:298.
  122. Miró JM, del Río A, Mestres CA. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin North Am 2002; 16:273.
  123. Cecchi E, Imazio M, Tidu M, et al. Infective endocarditis in drug addicts: role of HIV infection and the diagnostic accuracy of Duke criteria. J Cardiovasc Med (Hagerstown) 2007; 8:169.
  124. Polanco A, Itagaki S, Chiang Y, Chikwe J. Changing prevalence, profile, and outcomes of patients with HIV undergoing cardiac surgery in the United States. Am Heart J 2014; 167:363.
  125. Qaqa AY, Shaaban H, DeBari VA, et al. Viral load and CD4+ cell count as risk factors for prolonged QT interval in HIV-infected subjects: a cohort-nested case-control study in an outpatient population. Cardiology 2010; 117:105.
  126. Kocheril AG, Bokhari SA, Batsford WP, Sinusas AJ. Long QTc and torsades de pointes in human immunodeficiency virus disease. Pacing Clin Electrophysiol 1997; 20:2810.
  127. Villa A, Foresti V, Confalonieri F. Autonomic neuropathy and prolongation of QT interval in human immunodeficiency virus infection. Clin Auton Res 1995; 5:48.
  128. Bai YL, Liu HB, Sun B, et al. HIV Tat protein inhibits hERG K+ channels: a potential mechanism of HIV infection induced LQTs. J Mol Cell Cardiol 2011; 51:876.
  129. Moreno T, Pérez I, Isasti G, et al. Prevalence and factors associated with a prolonged QTc interval in a cohort of asymptomatic HIV-infected patients. AIDS Res Hum Retroviruses 2013; 29:1195.
  130. Eisenhauer MD, Eliasson AH, Taylor AJ, et al. Incidence of cardiac arrhythmias during intravenous pentamidine therapy in HIV-infected patients. Chest 1994; 105:389.
  131. Singh M, Arora R, Jawad E. HIV protease inhibitors induced prolongation of the QT Interval: electrophysiology and clinical implications. Am J Ther 2010; 17:e193.
  132. Anson BD, Weaver JG, Ackerman MJ, et al. Blockade of HERG channels by HIV protease inhibitors. Lancet 2005; 365:682.
  133. Soliman EZ, Lundgren JD, Roediger MP, et al. Boosted protease inhibitors and the electrocardiographic measures of QT and PR durations. AIDS 2011; 25:367.
  134. Hunt K, Hughes CA, Hills-Nieminen C. Protease inhibitor-associated QT interval prolongation. Ann Pharmacother 2011; 45:1544.
  135. Ly T, Ruiz ME. Prolonged QT interval and torsades de pointes associated with atazanavir therapy. Clin Infect Dis 2007; 44:e67.
  136. Tseng ZH, Secemsky EA, Dowdy D, et al. Sudden cardiac death in patients with human immunodeficiency virus infection. J Am Coll Cardiol 2012; 59:1891.
  137. Hsu JC, Li Y, Marcus GM, et al. Atrial fibrillation and atrial flutter in human immunodeficiency virus-infected persons: incidence, risk factors, and association with markers of HIV disease severity. J Am Coll Cardiol 2013; 61:2288.
  138. Freeman R, Roberts MS, Friedman LS, Broadbridge C. Autonomic function and human immunodeficiency virus infection. Neurology 1990; 40:575.
  139. Benchimol-Barbosa PR. Circadian cardiac autonomic function in perinatally HIV-infected preschool children. Braz J Med Biol Res 2009; 42:722.
  140. Lebech AM, Kristoffersen US, Mehlsen J, et al. Autonomic dysfunction in HIV patients on antiretroviral therapy: studies of heart rate variability. Clin Physiol Funct Imaging 2007; 27:363.
  141. Chow DC, Wood R, Choi J, et al. Cardiovagal autonomic function in HIV-infected patients with unsuppressed HIV viremia. HIV Clin Trials 2011; 12:141.
  142. Chow D, Kocher M, Shikuma C, et al. Effects of antiretroviral therapy on autonomic function in early HIV infection: a preliminary report. Int J Med Sci 2012; 9:397.
  143. Robinson-Papp J, Sharma SK. Autonomic neuropathy in HIV is unrecognized and associated with medical morbidity. AIDS Patient Care STDS 2013; 27:539.
  144. Engels EA, Biggar RJ, Marshall VA, et al. Detection and quantification of Kaposi's sarcoma-associated herpesvirus to predict AIDS-associated Kaposi's sarcoma. AIDS 2003; 17:1847.
  145. Chyu KY, Birnbaum Y, Naqvi T, et al. Echocardiographic detection of Kaposi's sarcoma causing cardiac tamponade in a patient with acquired immunodeficiency syndrome. Clin Cardiol 1998; 21:131.
  146. Constantino A, West TE, Gupta M, Loghmanee F. Primary cardiac lymphoma in a patient with acquired immune deficiency syndrome. Cancer 1987; 60:2801.
  147. Armstrong EJ, Bhave P, Wong D, et al. Left ventricular rupture due to HIV-associated T-cell lymphoma. Tex Heart Inst J 2010; 37:457.
  148. Llitjos JF, Redheuil A, Puymirat E, et al. AIDS-related primary cardiac lymphoma with right-sided heart failure and high-grade AV block: insights from magnetic resonance imaging. Ann Cardiol Angeiol (Paris) 2014; 63:99.
  149. Vivekanandarajah A, Bhatt VR, Krishnarasa B, et al. Right upper quadrant pain and mass in a 41-year-old previously healthy man: a presenting feature of HIV-associated extranodal diffuse large B cell lymphoma with cardiac involvement. BMJ Case Rep 2012; 2012.
  150. Little RF, Gutierrez M, Jaffe ES, et al. HIV-associated non-Hodgkin lymphoma: incidence, presentation, and prognosis. JAMA 2001; 285:1880.
  151. Kelsey RC, Saker A, Morgan M. Cardiac lymphoma in a patient with AIDS. Ann Intern Med 1991; 115:370.
  152. Vishnu P, Aboulafia DM. AIDS-Related Non-Hodgkin's Lymphoma in the Era of Highly Active Antiretroviral Therapy. Adv Hematol 2012; 2012:485943.
  153. Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study group, Bohlius J, Schmidlin K, et al. Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy. AIDS 2009; 23:2029.