CD4 and dilated cardiomyopathy: The mechanisms by which these adverse effects on LV mass occur in HIV-positive patients are not fully understood, but are thought to be related to mitochondrial toxicity.36 Many studies have shown that HIV virions directly affect myocardial cells and are associated with local release of cytokines and other factors leading to inflammation, myocarditis and dilated cardiomyopathy.37 Also, increase or decrease in LV mass has been suggested to be associated with opportunistic infections andmalnutrition,35 therefore a lower nadir CD4 cell count has been associated with higher LV mass index.