The development of myocardial dysfunction in patients following HIV infection continues to be widely reported [1–6]. Compelling evidence of surprisingly frequent diastolic dysfunction followed by systolic dysfunction is observed in both the pediatric and adult populations [1–6]. Basic mechanisms proposed to explain these clinical observations include direct effects of HIV proteins, or indirect effects of cytokines, co-infection, autoimmunity and antiretroviral toxicity [1,7]. The advent of highly active antiretroviral therapies (HAART) has prolonged survival, but has been considered a potential source of cardiovascular complications of HIV infection [1]. Recent clinical studies in countries lacking universal access to HAART have provided some insights into the relative importance of HIV infection as opposed to its pharmacotherapy in HIV cardiomyopathy. These recent studies indicate that HIV cardiomyopathy is more prevalent among patients with HIV alone compared with those patients with HIV who also received HAART [1–6]. Thus, HIV infection appears to contribute more to HIV cardiomyopathy than does its treatment. Human autopsy data identifying gp120 in the hearts of HIV cardiomyopathy patients prior to HAART also support its potential pathogenic role in this condition [8]. The study by Kelly et al.[9] in this issue of AIDS provides an exciting and timely addition to the literature supporting a pathogenic role for HIV proteins in myocardial dysfunction following HIV infection. The authors use the most elegant and definitive hemodynamic and echocardiographic techniques to convincingly demonstrate the presence of diastolic dysfunction in their simian immunodeficiency virus (SIV) model. Their data are quite consistent with diastolic dysfunction in HIV patients that has been reported using echocardiographic methods. The authors found up-regulation of macrophage markers in the myocardium of SIV-infected animals that did not correlate with functional decline. On the contrary, SIV-induced diastolic dysfunction was strongly correlated with the extent of SIV replication in the myocardium. The authors concluded that their data support a pathogenic role for HIV virus or viral proteins in myocardial dysfunction. These clinical reports stimulated efforts to study the direct effects of recombinant HIV proteins in animal models to appreciate their potential pathogenic role in HIV cardiomyopathy [10–15]. The HIV coat protein, gp120, was reported to enhance IL-1beta-induced inducible nitric oxide synthase expression and nitric oxide production in neonatal rat cardiac myocytes in vitro[10]. A direct, negative inotropic effect of HIV gp120 on adult rat ventricular myocytes (ARVMs) was subsequently shown to be mediated through a novel CXCR4-iPLA2-p38 mitogen activated protein (MAP) kinase-troponin I signaling pathway [11–13]. Specifically relevant to Kelly et al. was a report that the injection of HIV gp120 resulted in a selective defect in the diastolic relaxation (lusitropic) response to adrenergic stimulation in vivo[14]. Defective adrenergic signaling is a common characteristic of both ischemic and nonischemic cardiomyopathies [16]. Previously described ‘classical’ mechanisms include decreased beta adrenergic receptor density, decreased adenylyl cyclase/protein kinase A activity, uncoupling the beta adrenergic receptor from stimulatory guanosine-5′-triphosphate (GTP)-binding protein, Gs, in conjunction with an increase in beta adrenergic receptor kinase (BARK) activity, as well as an increase in the content of the inhibitory GTP-binding protein, Gi [16]. Additional molecular insights into adrenergic signaling and diastolic function may provide an alternative mechanism for diastolic dysfunction in HIV [16]. Investigators using elegant experimental designs have provided compelling evidence for a role for p38 MAP kinase and troponin I as molecular components of signaling pathways participating in adrenergic-mediated enhancement of diastolic function. In particular, p38 MAP kinase has been reported to regulate pathways involved in the Ser 23/24 phosphorylation of troponin I [15,16]. Interestingly, a direct correlation was reported between the attenuation of the lusitropic effect of isoproterenol by the p38 MAP kinase inhibitor with blocking the phosphorylation of both p38 MAP kinase and troponin I [14]. These data are most consistent with a selective effect of HIV gp120 on p38 MAP kinase-troponin I signaling that results in attenuated adrenergic enhancement of diastolic relaxation. These clinical and experimental data are consistent with the hypothesis that HIV proteins may directly contribute to myocardial dysfunction. Kelly et al.[9] in this issue of AIDS now provide an excellent animal model with which to further explore potential molecular mechanisms contributing to myocardial dysfunction following HIV infection. Further studies into the signaling pathways stimulated by HIV proteins in the myocardium may provide novel insights and therapeutic targets relevant to HIV, as well, as other human cardiomyopathies. Acknowledgements The work was supported by NIH RO-1 #HL70565 and Department of Veterans Affairs MERIT Award. Conflicts of interest There are no conflicts of interest.