Widespread use of effective antiretroviral therapy (ART) in people living with human immunodeficiency virus (PLHIV) infection has changed the prognosis of the disease from a fatal and debilitating one to a chronic manageable illness. ART leads to immune restoration, but immune functional levels seen in HIV-uninfected people are never achieved. The dynamics of immune suppression, chronic immune activation, and immune senescence predispose PLHIV to certain inflammatory and infectious conditions of the cardiovascular system.

Atherosclerotic cardiovascular disease is a chronic inflammatory condition that is a rising cause of mortality and morbidity among PLHIV. Certain risk factors prevalent among PLHIV, such as intravenous drug abuse, use of ART, and susceptibility, to tuberculous disease even at near-normal immune functional levels predispose them to inflammation and infections of the different components of the heart including the pericardium, epicardium, and endocardium. Molecular imaging using radionuclide techniques has been shown to have excellent clinical utility in the evaluation of inflammation and infection.

The strengths of molecular imaging techniques lie in their sensitivity for early disease detection before morphological changes occur and in therapy response assessment before significant reparative changes have occurred. Molecular imaging techniques are now becoming more widespread in clinical application with increasing availability and utilization in developing countries where the most significant burden of HIV infection is felt.

This review aimed to present an update on the evidence supporting the role of molecular imaging modalities with radionuclide techniques for imaging of cardiovascular inflammation and infection focusing on atherosclerotic cardiovascular disease, pericarditis, myocarditis, and endocarditis in PLHIV.