A previously unreported complication, acute left main coronary artery occlusion with anterior myocardial infarction, in a patient at low coronary risk under HIV protease inhibitors, is described. Severe premature coronary artery disease has been reported in young men receiving HIV protease inhibitors, usually associated with hypertriglyceridemia, hypercholesterolemia, glucose intolerance and lipodystrophy syndrome. Percutaneous transluminal coronary angioplasty and stent implantation were successfully performed.