Introduction: As HAART therapy continues to improve life expectancy of patients with human immunodeficiency virus, accelerated cardiovascular disease is emerging as a common cause of mortality. The etiology is multifactorial and includes: side effects of HAART therapy, increased risk of chronic disease burden like hypertension, and chronic inflammation of vessels. This case highlights a rare presentation of myocardial infarction in a patient with well-controlled HIV lacking the traditional cardiovascular risk factors. Notably, the infarction was due to critical left anterior descending stenosis initially suspected due to specific ECG findings consistent with Wellen’s syndrome. Case presentation: 62 year old non-obese male with PMHx of well-controlled HIV presented with 2 days of exertional chest pressure radiating to the left arm. Patient was given aspirin and sublingual nitroglycerin with relief. Patient denied history of hypertension, diabetes, hypercholesterolemia, cigarette use, other drug use or family history of early-onset cardiovascular disease. Troponin I was mildly elevated. EKG showed biphasic T-waves in V2 and V3 consistent with Wellen’s syndrome. Cardiac catheterization showed critical left anterior descending stenosis. Patient underwent successful percutaneous intervention with placement of two drug eluting stents. Discussion: The purpose of this case presentation is to highlight the importance of early recognition of Wellen’s syndrome through identification of specific ECG findings. Early diagnosis and treatment of this rare form of myocardial infarction is essential to prevent major anterior wall infarction. Due to absence of other traditional risk factors, this case also demonstrates how well-controlled HIV can be an independent risk factor for accelerated cardiovascular disease.