Cardiovascular illness is common in patients with human immunodeficiency virus (HIV) infection, particularly late in the disease course. As better therapy improves longevity for patients with HIV infection, symptomatic heart failure and related cardiovascular morbidity and mortality are becoming important global health concerns. The incidence of symptomatic heart failure among HIV-infected people followed for 2 to 5 years is 8% to 10%, suggesting that there may be about 3 million prevalent cases of symptomatic HIV-related heart failure. There are many different manifestations of cardiac disease in HIV-infected individuals, including left ventricular systolic dysfunction or cardiomyopathy, pericardial effusion, infective endocarditis, cardiovascular malignancy, vasculitis, atherosclerosis, and autonomic dysfunction. Cardiac disease may result from HIV itself, other infectious etiologies, or may be accelerated by the effects of the antiretroviral agents used to treat HIV infection. In this paper, we will examine the various cardiovascular manifestations of HIV disease and its treatment, review the prevalence, pathogenesis, and treatment options, and discuss preventive measures and monitoring to identify preclinical cardiac disease early on in its course...