eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2019-09-06 7 11 297 300 10.12691/ajmcr-7-11-9 AJMCR20197119 article Pramod Theetha Kariyanna 1 Denis Yusupov 1 Benjamin Ramalanjaona 1 Apoorva Jayarangaia 2 Mohammed Al-Sadawi 2 Isabel. M. McFarlane Isabel.McFarlane@downstate.edu 2 Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203 Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, N.Y., U.S.A- 10461 Patients with human immunodeficiency virus (HIV) are at higher risk for coronary artery disease, due to accelerated atherosclerosis resulting from chronic inflammation, the prevalence of cardiovascular risk factors and the side effects of highly active antiretroviral therapy (HAART). The Wellens’ pattern is an electrocardiographic (ECG) finding that represents critical proximal left anterior descending (LAD) coronary artery stenosis that, that when is not promptly treated, can lead to extensive anterior wall myocardial infarction and death. Very few cases of Wellens’ syndrome in HIV positive patients have been reported. We present a case of Wellens’ syndrome in a 38-year-old male with HIV on HAART and hyperlipidemia, as his only traditional cardiovascular risk factor. Recognition of the characteristic biphasic T-waves in V2 and V3 on ECG in the setting of typical angina and elevated troponin levels directed the clinicians to proceed with an emergent cardiac catheterization and percutaneous coronary intervention with drug eluting stent placement in the proximal left anterior descending artery (LAD). Physicians should recognize Wellens’ syndrome as it indicates critical LAD stenosis requiring intervention. HIV positive patients can present with Wellens’ sign at a younger age, indicating premature coronary artery disease (CAD) in this population. http://pubs.sciepub.com/ajmcr/7/11/9/ajmcr-7-11-9.pdf human immunodeficiency virus HIV Wellens syndrome premature coronary artery disease biphasic T-waves chronic inflammation critical left anterior descending stenosis dyslipidemia