Background HIV is a well-known cause of dilated cardiomyopathy, with an annual incidence of 15.9 per 1000 asymptomatic HIV patients in the pre-HAART era. Despite reduced incidence with HAART, it remains an important cause of cardiac morbidity in people with HIV though its direct association to the virus is unclear.

Methods Retrospective case review.

Results Four patients with dilated cardiomyopathy were identified out of 4739 attending between 2002–2014. Mean age was 49 years (range 38–62), all were male. Two presented as admissions with cardiac failure; two were diagnosed on routine investigation for exertional dyspnoea. All clinically improved with medical management; the three cases under long term follow up (6–10 years) showed improvement in ejection fraction (EF), though one died 10 years post diagnosis of presumed sudden-cardiac death.

Discussion This small case series highlights the positive outcomes with medical management of dilated cardiomyopathy in HIV. The direct role of HIV remains unclear; these cases reinforce the importance of regular screening for recreational drug use and consideration of their potential cardiotoxicity, and awareness of other aetiological factors.