ST-elevation myocardial infarction due to a spontaneous thrombus in the left anterior descending artery in a young HIV-infected patient

Abstract

With increasing life expectancy due to highly active antiretroviral therapy (HAART), the spectrum of human immunodeficiency virus (HIV)-associated morbidity and mortality has shifted from opportunistic infections toward associated chronic medical conditions. We report on a 26-year-old female patient receiving HAART for HIV infection, who developed spontaneous thrombosis of the proximal left anterior descending (LAD) artery, resulting in acute ST-elevation myocardial infarction. She had none of the conventional risk factors for the development of coronary artery disease. Following diagnostic coronary angiography that showed a large (16x3.4 mm) spontaneous thrombus in the proximal LAD artery, percutaneous coronary intervention was performed with prior aspiration of the occluding thrombus and implantation of a bare-metal stent. The patient was discharged with instruction of appropriate medical therapy. This case highlights the association between immunosuppression with HAART, particularly protease inhibitors, and the development of accelerated atherosclerosis in patients with HIV infection.