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