We report a case of successful urgent off-pump coronary artery bypass grafting (CABG) for unstable angina pectoris in a 54-year-old human with human immunodeficiency virus (HIV) infection. We studied the changes in CD4+ cells and HIV-RNA copy during the perioperative period. The results showed that off-pump CABG did not reduce the CD4+ cell count and did not affect the condition of HIV infection in this patient.