Infection with human immunodeficiency virus (HIV) has become a major pediatric health concern in the United States and around the world. Pediatric HIV infection is a multisystem illness that presents an ongoing challenge to practicing nurses. Most clinical cardiovascular diseases in children with HIV have been underreported, and often are clinically occult. The preclinical detection of cardiovascular abnormalities results in early therapeutic interventions and reduces cardiovascular morbidity and mortality. Cardiovascular involvement is important in the natural history and prognosis of HIV infection.