Cardiac involvement is commonly seen in AIDS patients, and the pericardium, myocardium, and/or endocardium may be involved in these patients. Pericardial effusion is one of the most common types of cardiac involvement in HIV patients, and its mechanism is unclear but it may be related to infections or neoplasms. Myocarditis, the cause of which is usually difficult to identify, may be responsible for myocardial dysfunction. Opportunistic infections have been reported to be a cause of myocarditis, including the HIV itself. Dilated cardiomyopathy is usually found in the late stage of HIV infection, and myocarditis may be the triggering causative factor. Nonbacterial thrombotic endocarditis and infective endocarditis have been described in AIDS patients, both of which can cause significant morbidity in these patients. Human immunodeficiency virus–related pulmonary hypertension is a diagnosis of exclusion, and symptoms and signs may mimic other pulmonary conditions in AIDS patients. Cardiac Kaposi sarcoma and cardiac lymphoma are the frequently encountered malignant neoplasms in AIDS patients, and the prognosis is grave in patients with these conditions. Coronary artery disease has previously been documented and may be related to highly active antiretroviral therapy. Many cardiovascular adverse effects from medications used in HIV patients have been described. As the survival of HIV patients has improved mainly because of aggressive antiretroviral therapy, it is anticipated that more late complications from this fatal viral infection, including cardiac involvement, will be encountered. Early recognition and prompt treatment are important to prevent significant morbidity from cardiac involvement. Whether this approach will prolong survival in AIDS patients remains to be seen.