Unfortunately, Africa has the largest number of inhabitants with HIV/AIDS worldwide (∼23 of the 33 million people infected). Global efforts have yielded a 10-fold increase in availability of ART over 5 years; 43% of the African population now has access to HIV treatments.3 Still, pericardial and myocardial diseases associated with opportunistic infections prevail in 20% to 60% of the patients, according to pathologic and diagnostic methods and evaluation of the study population. Evidence of PAH in Africa is indirect because studies have been limited to echocardiographic measurements and anecdotes from African individuals. Echocardiographic abnormalities suggestive of PAH were found in 0.6% to 5% of the patients infected with HIV in Burkina Faso and Zimbabwe.19 Echocardiographic suspicions of PAH should be placed in the context of the relatively higher prevalence of pulmonary diseases (eg, TB, bronchiectasis, interstitial lung diseases), comorbidities (eg, sickle cell anemia, malnutrition, wasting syndrome, liver cirrhosis), and coinfections that are more prevalent in Africa. Cardiopulmonary pathologic conditions related to HIV infection are complicated by several additional infectious risk factors for PAH that are hyperendemic in regions like sub-Saharan Africa; these include schistosomiasis, filariasis, malaria, and chronic hepatitis B and C. In addition, human herpes virus 8, which is endemic in South America and sub-Saharan Africa, can be found in 62% of cells within and around the plexiform lesions in the lungs.20 Anecdotal data from centers in Africa indicate little difference between the clinical manifestations of the disease in Africa and the developed world.21 The fact that there are no established population studies focused on HRPAH in the African countries does not preclude judicious extrapolations from the developed world. Even if the percentage of people living with HIV who develop clinically defined HRPAH is relatively small, the disease burden in developing countries could be unbearable in the face of the high prevalence of HIV infection in these regions.