Myocardial Infarction in People Living with HIV (PLWH)

People living with HIV (PLWH) face a two-fold higher risk of myocardial infarction (MI) compared to HIV-negative individuals, often occurring at a younger age. We report the sudden death of a 37-year-old man with a 5-year history of HIV infection on antiretroviral therapy (ART), well controlled on a regimen of dolutegravir, lamivudine, and tenofovir disoproxil fumarate. He was a non-smoker and non-alcohol user with no traditional comorbidities (dyslipidaemia, hypertension, diabetes, smoking, and metabolic syndrome). At autopsy, the heart was enlarged and an erythematous patch was seen on the antero-lateral wall of the left ventricle. Histopathological examination confirmed myocardial infarction with neutrophilic infiltration and 50% occlusion of the lumen of left circumflex artery. This case emphasizes that cardiovascular risk in PLWH persists despite the use of newer, non-dyslipidaemic ART regimens and the absence of traditional risk factors. It stresses the need for aggressive cardiovascular risk assessment in the management of HIV-positive patients as part of their ART care and periodic follow-up.