Invasion of the heart by HIV has become a clinical problem over the last decade. The objective of the present study was to systematically detect the excess HIV-related cardiac lesions in Kinshasa by performing echocardiography. The study population consisted of 166 HIV-infected patients and 166 HIV-seronegative patients with heart disease (control group). 69% of patients were at stage A of HIV infection and 31% were at stage AIDS C3 according to CDC 1993 criteria. A higher incidence of echocardiographic abnormalities was observed in HIV-seropositive subjects (28.3%) than in control subjects (13%) (p = 0.035). Systolic function was very severely impaired at the stage of AIDS (%R = 21,6 +/- 8.7) showing a highly significant difference (p < 0.01) compared to HIV-seropositive patients at stage A (% R = 29.2 +/- 11.9) and control subjects (%R = 28.9 +/- 5). One patient (0.6%) developed Salmonella enteritidis infectious endocarditis. Echocardiography, a noninvasive technique, contributes to the diagnosis of cardiac lesions associated with HIV infection. HIV has a predominant role in the severity of dilatation and alteration of the left ventricular systolic function in black Africans compared to Caucasian populations.