The cardiovascular system may be affected primarily by HIV, such as HIV-cardiomyopathy, or secondarily, such as the development of cor pulmonale following recurrent bouts of pneumonia or LIP, or hyperlipidemia as a consequence of antiretrovirals. In the pre-HAART era, subclinical cardiac abnormalities in HIV-infected children were common, persistent, and often progressive.22 Cardiac manifestations such as dilated cardiomyopathy and inappropriate left ventricular (LV) hypertrophy have been shown to limit survival in children not on HAART and depressed LV function correlates with the degree of baseline immune dysfunction. In HIV-infected children with cardiac involvement, carnitine, selenium, and multivitamin supplementation should be considered, especially in those with wasting or diarrhea syndromes.23 Monthly intravenous immunoglobulin (IVIG) infusions have been demonstrated to preserve LV parameters in HIV-infected children including ventricular recovery in some children with recalcitrant HIV-related cardiomyopathy. HAART, particularly the protease inhibitors (PI), maybe associated with the development of dyslipidemia and the metabolic syndrome necessitating monitoring of lipid profiles in all children on PI therapy. The pericardium may also be affected in HIV-infected children. Small asymptomatic effusions in end-stage children with AIDS are often nonspecific in nature, and maybe caused by the proinflammatory milieu found in advanced AIDS. In contrast, large or symptomatic effusions are often associated with infection or malignancy, and warrant thorough investigation and etiology-specific treatment.23