Aim: To assess left ventricular (LV) function in HIV patients by two-dimensional (2D) echocardiography to determine the pattern of myocardial dysfunction, and any correlation between cardiac dysfunction and severity of HIV infection. Background: Human immunodeficiency virus (HIV) infection may cause various cardiac dysfunctions in humans even in the asymptomatic state and its timely detection may have prognostic value. Materials and methods: One hundred treatment naı¨ve, asymptomatic HIV cases were subjected to trans- thoracic echocardiographic (2D, M-mode, pulse-wave, continuous-wave and colour Doppler) assess- ment by a single blinded cardiologist. Results: Twenty-nine (29%) of 100 patients (mean age: 36.8 years; male: 54%) had echocardiographic abnormalities. Grade 1 diastolic dysfunction was present in 20, reduced fractional shortening in 12, reduced ejection fraction (<50%) in two (2%), and dilated cardiomyopathy, pericardial effusion and regional wall motion abnormality in one patient each. Four had both systolic and diastolic dysfunction. In patients with diastolic dysfunction, 17 had CD4 count <200/ml (P < 0.001). Most cases with cardiac manifestation were in clinical stage III and IV. Cases having diastolic dysfunction had significantly different CD4 counts, haemoglobin level and erythrocyte sedimentation rate (ESR) values than the cases without cardiac dysfunction. CD4 counts were significantly negatively correlated with deceleration time (r = _0.2622, P < 0.05) and iso-volumetric relaxation time (IVRT) (r = _0.3681, P < 0.05) and significantly positively correlated with E/A ratio (r = +0.3291, P < 0.05). Conclusions: Twenty-nine (29%) HIV cases in relatively advanced clinical stage had cardiac dysfunction on echocardiography without overt cardiac manifestations. The CD4 cell counts significantly correlated with the presence of diastolic dysfunction.