Longitudinal cardiovascular follow-up of HIV-infected children has shown that all components of the cardiovascular system might be affected during the course of the disease.

The most frequent feature observed in the pediatric population is left ventricular dysfunction [1-12]. In devel­oped countries, antiviral therapy has dra­matically improved morbidity and mortali­ty in HIV-infected children.

Consequently, the spectrum of HIV-related concerns has shifted from reduction of mortality towards longer-term complications of HIV infection and adverse effects associated with the use of antiretroviral therapy. With regards to the cardiovascular system, efforts have been made to describe the long-term out­come in children. In this chapter, we review the different cardiac diseases that occur in HIV-infected children. HIV-related cardiac complications are very similar to the spec­trum of disease described in adults, with a few exceptions. There have been descrip­tions of fetal and neonatal complications due to the common vertical transmission of the virus in most cases and the possible adverse intrauterine effects of maternal HIV infection with or without fetal HIV infection [12,13]. The pathogenesis of some cardiac manifestations remains uncertain. Although in some cases the myocardial [14], endocardial [15], or pericardial dis­ease [16,17] may be attributed to an oppor­tunistic infection, it is likely that HIV-relat­ed cardiac disease has a multifactorial ori­gin due to HIV, secondary infections, other concurrent disease states, side effects of therapy, nutritional deficiencies, or yet- unknown mechanisms. However, it is recom­mended that children with active HIV infection should be monitored for cardiac disease because symptoms of cardiac fail­ure are delayed and interventions might be required to reduce cardiac morbidity and mortality. Finally, the long-term “vascular” outcome might be impaired either by the HIV infection or by the metabolic effects of the antiretroviral therapy or their synergis­tic effect on endothelium. Early atheroscle­rosis may be a new emerging disease in HIV-infected children, and this raises con­cern on the prevention of vascular damage.

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