Cardiovascular involvement associated with human immunodeficiency virus (HIV) includes cardiomyopathy, coronary artery disease, pericardial effusion, pulmonary hypertension and the adverse effects of highly active antiretroviral therapy (HAART).1,2 HIV-related cardiomyopathy may appear as myocarditis, dilated cardiomyopathy, or isolated left or right ventricular dysfunction.1,2 Although initially somewhat prevalent, the incidence of HIV-related cardiomyopathy has been clearly declining since introduction of HAART.1,3 We present a 41-year-old man admitted in the Intensive Care Unit, because of severe pneumonia and respiratory insufficiency. He was diagnosed with AIDS 10 years ago and was under HAART (zidovudine, lamivudine, efavirenz) for eight years. He had no opportunistic infections, and at the time of admission, he presented a CD4 cell count of 490, and non-detectable viral load. He had no previous known cardiovascular diseases or symptoms. In face of progressive hemodynamic instability, an echocardiogram was performed, demonstrating a manifestly dilated left ventricle (71 mm), with severe systolic dysfunction (only basal segments of